Grine ex rel. Grine v. Peabody Natural Resources

2005 NMCA 075, 114 P.3d 329, 137 N.M. 649
CourtNew Mexico Court of Appeals
DecidedApril 8, 2005
DocketNo. 24,354
StatusPublished
Cited by5 cases

This text of 2005 NMCA 075 (Grine ex rel. Grine v. Peabody Natural Resources) 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
Grine ex rel. Grine v. Peabody Natural Resources, 2005 NMCA 075, 114 P.3d 329, 137 N.M. 649 (N.M. Ct. App. 2005).

Opinion

OPINION

CASTILLO, J.

{1} In this workers’ compensation case, we review the dismissal of Worker Gary Grine’s claim, based on the determination that the heart attack he suffered on the job did not arise out of or occur in the course and scope of his employment. We must first decide the threshold issue of an employer’s right to choose a health care provider for a worker when the employer has denied the worker’s claim. Because we hold that NMSA 1978, § 52-1-49 (1990), authorized the employer in this ease to select a health care provider for Worker, notwithstanding employer’s denial of Worker’s claim, and because the testimony of the provider furnished the requisite evidence that work-related stress factors did not contribute to or trigger the heart attack, we affirm the dismissal of Worker’s complaint with prejudice.

I. WORKER’S ISSUES ON APPEAL

{2} Worker suffered his heart attack on October 2, 2000, filed his claim for benefits on July 16, 2001, and died a little more than a year later, on June 21, 2002. Margie Grine (Margie), Worker’s surviving spouse, was substituted as Claimant to continue to assert Worker’s claims and to assert her own claims to death benefits. Margie is the appellant in the case; however, for purposes of this appeal, we will refer to her as Worker.

{3} Worker appeals from the Workers’ Compensation Administration (WCA) to this Court for review of the compensation order that dismissed Worker’s complaint with prejudice. This appeal is taken against Worker’s employer, Peabody Natural Resources, dba Lee Ranch Coal Company, and its insurer, Old Republic Insurance Company (together referred to as Appellees). On appeal, Worker argues (1) that there was ample evidence that work-related stress triggered Worker’s heart attack and that the Workers’ Compensation Judge (WCJ) erred as a matter of law in requiring a higher standard of proof; (2) that under whole record review, the evidence supports the conclusion that numerous work-related stress factors contributed to or triggered Worker’s heart attack and that the WCJ’s decision to the contrary was clearly against logic and reason; (3) that pursuant to Section 52-1-49 of the Workers’ Compensation Act (Act), NMSA 1978, §§ 52-1-1 to -70 (1929, as amended through 2004), the WCJ erred by permitting Appellees to switch Worker’s treating physician; (4) that the WCJ erred by allowing Appellees’ treating physician to testify, in violation of Section 52-l-51(C) of the Act; and (5) that Worker’s rights to due process, equal protection, and a fair trial were violated by the wrongful actions of the current WCA director. We organize Worker’s issues into three: health care providers, causal link between the heart attack and employment, and violation of constitutional rights. The facts related to each issue are contained in the appropriate section.

II. DISCUSSION

A. Appellees’ Referral to Dr. Shadoff and the Admission of His Report and Deposition

{4} We first address the issue related to health care providers. We begin with the pertinent facts. Although Worker was not aware of it, his heart attack occurred during his shift on October 1-2, 2000. After obtaining permission to leave work because he was feeling bad, Worker left work shortly after 1:30 a.m. on October 2, drove himself home, and went to sleep. On the morning of October 2, Worker saw Margie’s doctor, Dr. Cubine, because Worker thought he was still experiencing heartburn. Dr. Cubine did not diagnose Worker’s heart attack. Rather, she felt that Worker had stomach problems, ordered an upper GI to be performed in ten days, and gave Worker some medicine to drink. He still did not feel well, and on the evening of October 3, 2000, he went to the emergency room at Cibola Hospital in Grants, and it was determined that he had suffered a heart attack. Worker was then airlifted to the Heart Hospital of New Mexico in Albuquerque. He was treated for coronary artery disease the following morning, and an angioplasty was performed. Initially, Worker sought treatment from the Heart Hospital of New Mexico, the New Mexico Heart Institute, and his own physician, Dr. Orchard. On July 16, 2001, more than nine months after the heart attack, Worker filed a workers’ compensation complaint. Up to the time of the filing of the complaint, Appellees had not directed any of Worker’s health care.

{5} Appellees denied liability. In its October 17, 2001, answer to Worker’s complaint, Appellees set forth a number of affirmative defenses — denying that Worker was hurt on the job, that there was any causal link between disability and accident, and that Worker’s heart condition was work related or aggravated at work. Appellees requested that Worker’s complaint be dismissed in whole. The WCA assigned Judge Joan O’Connell as the WCJ to hear Worker’s case.

{6} Appellees raised the issue of health care providers by filing a motion in limine to exclude all medical records of the Heart Hospital of New Mexico, the New Mexico Heart Institute, and Dr. Orchard or, in the alternative, to allow a second opinion or an independent medical examination. After a hearing on December 10, 2001, the WCJ denied Appellees’ request for an independent medical evaluation, a second opinion, or appointment of an expert witness but did allow Appellees to select a health care provider to treat Worker. In its order, the WCJ concluded that under Section 52-l-49(B), Appellees did not initially select a health care provider for Worker because it had denied liability for Worker’s injuries. The WCJ further concluded that Worker had selected his own health care provider for the alleged injury of October 2, 2000: Dr. Orchard and physicians at the Heart Hospital of New Mexico and the New Mexico Heart Institute. The WCJ also concluded that no conflict existed between authorized medical providers and that an independent medical examination was therefore not authorized. Appellees’ right to select a health care provider to treat Worker was based on a “reservation of rights,” allowing Appellees to select a health care provider without admitting the compensability of the claim under the Act. In addition, the WCJ concluded that Appellees must pay for any medical care offered to Worker under Section 52-1-49 and that the records of such care would be admissible under Section 52-1 — 51(C). In reaching this conclusion, the WCJ observed that two of the purposes behind Section 52-1^49 are (1) to ensure that each party may select a doctor to provide medical care and inform the WCJ about relevant medical issues and (2) to limit the number of medical providers who may treat Worker, in order to prevent expensive and time-consuming litigation.

{7} Understanding the order to have allowed Worker to have already made the choice of first health care provider, Appellees issued a notice of change of health care provider to Worker on January 16, 2002. Appellees wanted Worker to be treated by Dr. Shadoff. Worker objected to this notice and asserted that Appellees made the initial selection of physicians or waived its right to do so under Section 52-1-49 and 11.4.4.11 NMAC (2005). Additionally, Worker stated that by denying his claim to benefits, Appellees had no right to change treating physicians under Section 52-1^49. Thus, Worker requested that Appellees’ attempt to change treating physicians be denied.

{8} Based on the WCJ’s conclusion that Appellees’ initial selection of a health care provider was Dr.

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Cite This Page — Counsel Stack

Bluebook (online)
2005 NMCA 075, 114 P.3d 329, 137 N.M. 649, Counsel Stack Legal Research, https://law.counselstack.com/opinion/grine-ex-rel-grine-v-peabody-natural-resources-nmctapp-2005.