Ramirez v. IBP Prepared Foods

2001 NMCA 036, 28 P.3d 1100, 130 N.M. 559
CourtNew Mexico Court of Appeals
DecidedMarch 20, 2001
Docket21,139, 21,734
StatusPublished
Cited by21 cases

This text of 2001 NMCA 036 (Ramirez v. IBP Prepared Foods) 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
Ramirez v. IBP Prepared Foods, 2001 NMCA 036, 28 P.3d 1100, 130 N.M. 559 (N.M. Ct. App. 2001).

Opinion

OPINION

BOSSON, Chief Judge.

{1} Concepcion Ramirez (Worker) appeals a compensation order denying her coverage for knee replacement surgery. She also appeals an order on a request for discovery that was entered after the compensation order. The two appeals are hereby consolidated. We address only the merits of the first appeal, as the second is made moot by our decision. In her first appeal, Worker raises several issues: (1) whether the Workers’ Compensation Judge (WCJ) erred in granting the motion for an independent medical examination (IME); (2) if the IME was improperly ordered, should the doctor’s report and testimony have been admitted at trial; (3) if the doctor’s report and testimony are stricken, whether there is sufficient evidence to support the decision of the WCJ; and (4) finally, even considering the doctor’s report and testimony, whether there is sufficient evidence to support the decision?

BACKGROUND

{2} Worker began working for IBP Prepared Foods (Employer) as a meat packer in August of 1995. Before she started work, she completed a pre-employment physical examination. That examination did not reveal any problems with her knees. On January 3, 1997, Worker fell down two or three steps at work. She landed on her right shoulder and right knee. Employer provided medical care at the time of the accident. A day later, Worker went to Santa Teresa Immediate Care Clinic (Clinic), where apparently all Employer’s workers are treated. The Clinic documented a right shoulder strain and fitted Worker with a sling. The Clinic also documented that the right knee had a contusion and was swollen and strained. X-rays revealed chronic advanced arthritis of the knee for which there had been no prior treatment. The prognosis was “mediocre to poor due to pre-existing disease.” The Clinic referred Worker to the El Paso Orthopaedic Surgery Group, where Dr. Boone examined her. Dr. Boone treated Worker’s shoulder and then referred her to a colleague, Dr. Alicea, for treatment of her knee.

{3} After his initial examination, Dr. Alicea wrote that “there [was] a good chance [that] she may end up needing a knee replacement in the future. Since I have no documentation of her having any pain in her knees prior to the fall you would have to consider this to be an exacerbation of a preexisting condition.” Worker remained off work for about a month after the injury and was on light duty for another three months, after which she returned to her full job duties. During that time, she was treated with a steroid injection and anti-inflammatory medication. By April of 1997, Worker noted that her pain was much better. Dr. Alicea told her to come back if she had any problems.

{4} A year later, in April of 1998, Worker returned to Dr. AJicea because the pain in her right knee had gotten worse. There was no indication that the increased pain was precipitated by any particular event. Dr. Alicea gave Worker another steroid injection, but noted once again that she would probably need a knee replacement.

{5} In May 1998, Worker returned to Dr. Alicea for a follow-up visit. The steroid injection had given Worker relief for only a month and Dr. Alicea was thereby prompted to recommend a total knee replacement. Employer refused the treatment. As a result, Worker filed a complaint for benefits. Employer denied liability. It maintained that the need for the knee replacement was not caused by a work-related injury.

{6} Employer then filed a motion for an IME. In its motion, Employer stated that a dispute had arisen over whether or not Worker had suffered an impairment by reason of the injury arising out of and in the course of employment, and whether the disability was a natural and direct result of the accident. Worker objected to the motion on the basis that there was no medical dispute between authorized health care providers regarding these issues. At the hearing on the motion, Employer argued that an IME could be ordered if there was a medical dispute between the parties, and not just a dispute between two medical providers. The WCJ stated that he had authority to order the IME on his own motion. The WCJ opined that there was confusion regarding whether the need for surgery arose out of the preexisting condition or an aggravating injury. Therefore, to assist him in determining the issues in the case, the WCJ ordered an IME and selected Dr. Stern to conduct the examination.

{7} Dr. Stern’s examination showed degenerative arthritis in Worker’s knees. Her condition was asymptomatic before the fall, but her right knee became symptomatic after the fall. He acknowledged that the right knee was clearly injured in January of 1997. Dr. Stern recommended that Worker not undergo knee replacement because she was too young. Dr. Stem opined that the pain complained of in 1998 was likely unrelated to the fall. He contended that she was in pain now because her knees were worn out. Dr. Stem concluded that as a reasonable medical probability, he did not think that Worker had any permanent consequence from the fall on the stairs in January of 1997 and that Worker’s need for knee replacement had very little to do with the fall.

{8} Dr. Alicea had a different opinion. He opined that the inflammation, increased pain, and the need for replacement surgery was caused by the fall, which aggravated Worker’s pre-existing condition. The WCJ considered the testimony of both doctors. The WCJ concluded that Worker had failed to prove that her right knee condition was a natural and direct result of the accidental injury and denied her benefits for a knee replacement. Worker’s first appeal followed.

{9} Having been denied workers’ compensation benefits to pay for a knee replacement, Worker asked her health insurance carrier to authorize and pay for the knee replacement. Worker’s health insurance, a self-funded plan created by Employer, informed Worker that the plan would not cover her knee injury. According to a letter Employer sent to the health insurance carrier, the injury was work-related, a position directly contrary to what the Employer argued before the WCJ. Worker requested a copy of the letter, which both Employer and the health insurance administrator refused. Worker filed a motion to compel discovery. Employer opposed the motion. After a hearing on the motion, the WCJ denied the motion on the basis that the first appeal had divested it of jurisdiction and the time period for disclosure had been closed. Worker’s second appeal resulted from that decision.

DISCUSSION

Independent Medical Examination

{10} The authority of the WCJ to order an IME can be found in NMSA 1978, Section 52-l-51(A) (1990). That statute states, “[i]n the event of a dispute concerning any medical issue, if the parties cannot agree upon the use of a specific independent medical examiner, either party may petition a workers’ compensation judge for permission to have the worker undergo an independent medical examination.” In this case, we are asked to determine the meaning of the statute with respect to “a dispute concerning any medical issue.” Id. Interpretation of statutory language is a question of law that this Court reviews de novo. See Bajart v. Univ. of N.M., 1999-NMCA-064, ¶ 7, 127 N.M. 311, 980 P.2d 94. In interpreting the meaning of a statute, we endeavor to give effect to the legislature’s intent. Gutierrez v.

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Cite This Page — Counsel Stack

Bluebook (online)
2001 NMCA 036, 28 P.3d 1100, 130 N.M. 559, Counsel Stack Legal Research, https://law.counselstack.com/opinion/ramirez-v-ibp-prepared-foods-nmctapp-2001.