Buckingham v. Health South Rehabilitation Hospital

1997 NMCA 127, 952 P.2d 20, 124 N.M. 419
CourtNew Mexico Court of Appeals
DecidedNovember 18, 1997
Docket17305
StatusPublished
Cited by5 cases

This text of 1997 NMCA 127 (Buckingham v. Health South Rehabilitation Hospital) is published on Counsel Stack Legal Research, covering New Mexico Court of Appeals primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Buckingham v. Health South Rehabilitation Hospital, 1997 NMCA 127, 952 P.2d 20, 124 N.M. 419 (N.M. Ct. App. 1997).

Opinions

OPINION

HARTZ, Chief Judge.

(1) Appellants Health South Rehabilitation Hospital (Employer) and CIGNA Insurance Company (Insurer) appeal a decision of the Workers’ Compensation Judge (WCJ) awarding attorney’s fees to Worker. They contend that the Workers’ Compensation Act bars the award even if the efforts of Worker’s attorney benefitted Worker. Because we agree that the WCJ based the award on improper considerations, we reverse the award. An attorney’s fee award may, however, be appropriate. Therefore, we remand for further proceedings. With respect to the attorney’s efforts to obtain medical benefits, the panel is divided on the standard for awarding a fee. On that matter this opinion represents a dissenting view.

I. BACKGROUND

(2) Worker suffered an occupational injury to her knee on September 9, 1992. She became unable to perform her job duties on December 12, 1994,' following two surgeries on her knee. By the time she filed her complaint with the Workers’ Compensation Administration (WCA) on June 14, 1995, her knee had been operated on four times. Her complaint contended that she needed a total knee replacement but that Appellants had refused to pay for reasonable and necessary surgery. According to the complaint, such surgery was “one of two alternatives at this point in time, and the alternative of choice for myself.”

(3) Appellants’ response to the claim, filed on July 21,1995, stated:

[1.] The Employer has provided adequate medical care.
[2.] There would appear to be a pending issue of what constitutes reasonable and necessary care.
[3.] Employer / Insurer have not been contacted by the authorized treating physicians for the purpose of securing authorization for the surgical procedure which Worker desires.
[4.] There is a dispute between Worker and her authorized treating physician and his referrals regarding the type of surgical proceedure [sic] which should be performed and it is likely that the physicians should be allowed to address this in detail through depositions. The physicians believe that a knee arthrodesis (fusion) should be performed. Worker wants a knee arthroplasty (replacement joint).
[5.] A psychological profile has determined that worker is not a good surgical candidate.
[6.] Worker has had a difficult time recovering from surgery previously performed in the course of treatment of the injured knee and this may impact future surgeries.

(4) After a mediation conference on July 27 the mediator recommended:

Dr. [Samuel] Tabet shall be contacted jointly by the parties to discuss the feasibility of knee replacement for Worker. If Dr. Tabet agrees that the knee replacement is reasonable and necessary under tbe circumstances, and agrees to perform the Employer/Insurer shall pay for the surgery[.]

Dr. Tabet was deposed by the parties on August 29. Early in his deposition he announced that, contrary to his previous position, total knee replacement for Worker would be appropriate. He explained that he changed his mind after deciding that her knee was not infected and conferring with his colleagues. Both parties accepted the recommended resolution and on December 1 the clerk of the WCA filed a Notice of Completion, stating that the issues had been resolved by the parties.

(5) On February 5, 1996 Worker’s attorney petitioned the WCA for an attorney’s fee. The petition requested a fee of $4000, plus tax and costs. The affidavit in support of the petition contained a statement listing services for 23.9 hours. The affidavit stated that the attorney’s work related to two matters. One was the knee surgery. The other was Appellants’ failure to pay disability benefits in the amount of $3963.04 until the attorney made four demands. Worker never filed a complaint with the WCA regarding nonpayment of disability bénefits, and there had been no proceedings before the WCA with respect to that matter.

(6) The WCJ awarded attorney’s fees of $4000 plus tax and costs, with Worker to pay half the fee and Appellants the other half. The Wed’s findings noted that Appellants had made no offer of settlement more than four days before the mediation conference and:

6. The fundamental dispute was whether Worker should receive a knee arthroplasty as a reasonable and necessary medical procedure.
7. The present value of Counsel’s recovery in the Worker’s favor is $28,963.00. This is calculated based on the following figures:
Medicals for the arthro- $25,000.00 plasty
Past weekly benefits $ 3,963.04
8. Judicial notice is taken of the chilling effect of miserly attorney fees on representation.
9. Worker’s Counsel reasonably and necessarily expended 23.9 hours of effort in this case.
10. Worker’s Counsel’s regular hourly billing rate is $140.00 per hour.
11. The issues in this cause were contested to an average degree.
12. The issues in this cause were of average complexity.
13. The issues in this cause were of average novelty.
14. Worker’s Counsel has been in practice in New Mexico for 15 years.
15. Counsel’s ability, skill[,] experience, and reputation are excellent.
16. Worker was relatively successful in this cause.

Although the WCJ made no finding on the point, it is undisputed that the knee replacement surgery had not been performed prior to the date of the court’s order.

II. THE ATTORNEY’S FEE AWARD IN THIS CASE.

A. Past-Due Disability Benefits.

(7) We now turn to the award of attorney’s fees in this case. First, we consider the propriety of awarding attorney’s fees for obtaining past-due disability benefits for Worker.

(8) NMSA 1978, Section 52-1-54(E) (Repl.Pamp.1991) (effective Jan. 1, 1991), states:

In all cases where compensation to which any person is entitled under the provisions of the Workers’ Compensation Act is refused and the claimant thereafter collects compensation through proceedings before the workers’ compensation administration or courts in an amount in excess of the amount offered in writing by an employer five business days or more prior to the informal hearing before the administration, then the compensation to be paid the attorney for the claimant shall be fixed by the workers’ compensation judge hearing the claim[.]

(Emphasis added.) An award under this subsection is authorized only when the worker obtains benefits through proceedings before the WCA or a court.

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Garcia v. General Electric
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Buckingham v. Health South Rehabilitation Hospital
1997 NMCA 127 (New Mexico Court of Appeals, 1997)

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Bluebook (online)
1997 NMCA 127, 952 P.2d 20, 124 N.M. 419, Counsel Stack Legal Research, https://law.counselstack.com/opinion/buckingham-v-health-south-rehabilitation-hospital-nmctapp-1997.