AI Generated Opinion Summaries

This summary was computer-generated without any editorial revision. It is not official, has not been checked for accuracy, and is NOT citable.

Facts

• While working as a prop builder on the set of the television show Longmire on April 16, 2016, the Worker suffered a work-related injury to his right shoulder. He notified his employer of the injury on the same day and received treatment from Dr. Carl Gilmore. The employer's insurer later sent a letter allowing the Worker to select the initial healthcare provider (HCP), but this was done eighty-one days after the injury. The Worker continued treatment with Dr. Gilmore, who performed surgery on the Worker's shoulder. Subsequently, the employer/insurer changed the Worker's HCP, leading to a dispute over the right to select the HCP and the impact on the Worker's ability to obtain an impairment rating (paras 2-3).

Procedural History

• [Not applicable or not found]

Parties' Submissions

• Worker-Appellant: Argued that the employer did not timely communicate its decision regarding the initial selection of HCP, which led to the employer improperly selecting the second HCP and prevented the Worker from obtaining an impairment rating from his choice of HCP before the formal hearing (para 1).
• Employer/Insurer-Appellees: Initially argued that the Worker failed to preserve his objection to the HCP issue because he did not contest the matter at the formal hearing. They also contended that the delay in sending the HCP notice was due to the case being reassigned to a new adjuster (paras 5, 7).

Legal Issues

• Whether the employer/insurer failed to provide written notice of its decision regarding the initial HCP selection within a reasonable period of time as required by Section 52-1-49(B).
• Whether the Worker properly preserved his objection to the HCP issue for appeal.
• Whether the initial selection of HCP by the employer/insurer was valid given the delay in notification.

Disposition

• The court reversed the Worker’s Compensation Judge’s (WCJ) order finding that the Worker selected the initial HCP and the final workers’ compensation order adjudicating his claims for benefits. The case was remanded for further proceedings consistent with the opinion (para 11).

Reasons

• The Court of Appeals, with Judge Megan P. Duffy writing the opinion and Judges Jennifer L. Attrep and Briana H. Zamora concurring, found that the employer/insurer did not comply with the notice requirements of Section 52-1-49(B) and 11.4.4.12(B)(2)(a) NMAC, as they did not provide timely notice of their decision regarding the initial HCP selection. This failure led to the conclusion that Dr. Gilmore, the first non-emergency HCP treating the Worker, was the employer/insurer’s initial selection of HCP. As a result, the Worker retained the right of second selection of HCP, and the WCJ erred in upholding the employer/insurer’s notice of change of HCP. The appellate court also addressed the issue of preservation for appeal, finding that the Worker had indeed preserved his objection to the HCP issue by filing a written objection to the employer/insurer’s notice of change of HCP. The court did not address the Worker’s remaining argument regarding the WCJ’s findings on the Worker’s residual physical capacity modifier due to the decision to remand for redisposition (paras 4-10).