St. Joseph Healthcare System v. Travelers Companies

893 P.2d 1007, 119 N.M. 603
CourtNew Mexico Court of Appeals
DecidedFebruary 24, 1995
Docket15544, 15491
StatusPublished
Cited by11 cases

This text of 893 P.2d 1007 (St. Joseph Healthcare System v. Travelers Companies) 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
St. Joseph Healthcare System v. Travelers Companies, 893 P.2d 1007, 119 N.M. 603 (N.M. Ct. App. 1995).

Opinion

OPINION

ALARID, Judge.

St. Joseph Healthcare System (“St. Joseph”) appeals from an order dismissing claims against The Travelers Companies (“Travelers”) and the Ohio Casualty Group of Insurance Companies (“Ohio Casualty”). The issue presented is whether the insurers of third-party tortfeasors are obligated to protect a self-insured employer’s right to reimbursement of workers’ compensation benefits paid. We do not find that such a legal duty exists, and therefore affirm the trial court’s order of dismissal.

FACTS

Gordon Hoover (‘Worker”) was injured in the course and scope of his employment with St. Joseph in 1990. As a result of Worker’s claim, St. Joseph paid $28,485.77 in workers’ compensation benefits. Worker filed third-party claims against the Old Hospital Group, Ltd., insured by Travelers, and Sunrise Landscape Maintenance, insured by Ohio Casualty. When settling those third-party claims in 1992, Worker and his attorneys allegedly misrepresented to Travelers and Ohio Casualty that St. Joseph’s right to reimbursement (for its workers’ compensation payments) had been satisfied. As a result, Travelers and Ohio Casualty paid Worker directly without obtaining a separate release from St. Joseph. Thereafter, St. Joseph sued Travelers, Ohio Casualty, Worker and his attorneys. Ohio Casualty cross-claimed against Worker and his attorneys. The claims involving Worker and his attorneys, however, are not material to this appeal. On this Court’s own motion, we have consolidated St. Joseph’s appeal from the lower court’s dismissal of claims against Travelers and the interlocutory appeal from dismissal of Ohio Casualty.

St. Joseph claims that Travelers and Ohio Casualty knew of St. Joseph’s right of reimbursement, yet made payment to Worker in derogation of St. Joseph’s legal and equitable rights of subrogation. The right of subrogation is claimed under NMSA 1978, Section 52-5-17 (Repl.Pamp.1991) (effective January 1, 1991), in the Workers’ Compensation Act.

We initially note that St. Joseph’s claim is governed by the statute in effect at the time its claims accrued, rather than the statute in effect at the time of Worker’s injuries. See Herman v. Miners’ Hosp., 111 N.M. 550, 552 n. 1, 807 P.2d 734, 736 n. 1 (1991). Therefore, the relevant statute is Section 52-5-17 as amended and effective January 1, 1991. However, both versions of the statute are substantially identical. Indeed, all parties agree that the earlier versions relied upon in the case law discussed below are materially similar to the section we consider in this case.

DISCUSSION

Although the motions of Travelers and Ohio Casualty granted by the trial court were styled, in part, as “Motion[s] for Summary Judgment on the Complaint and/or, in the Alternative, Motion[s] to Dismiss,” the parties agree that the amended complaint as to both Travelers and Ohio Casualty were dismissed pursuant to SCRA 1986, 1-012(B)(6) (Repl.1992).

In reviewing an order for dismissal, this Court must accept as true all facts well pled and question only whether the plaintiff may prevail under any set of facts provable under the claim. Garcia v. Rodey, Dickason, Sloan, Akin & Robb, 106 N.M. 757, 760, 750 P.2d 118, 121 (1988). The plaintiff must affirmatively show it has a legal basis for recovery. Kisella v. Dunn, 58 N.M. 695, 700, 275 P.2d 181, 184 (1954). The trial judge ruled that this Court’s opinion in Transport Indemnity Co. v. Garcia, 89 N.M. 342, 552 P.2d 473 (Ct.App.), cert. denied, 90 N.M. 9, 558 P.2d 621 (1976), precluded St. Joseph from maintaining any cause of action against Travelers and Ohio Casualty. We agree.

A. RIGHT OF REIMBURSEMENT DOES NOT CONSTITUTE SUBROGATION

St. Joseph concedes that Section 52-5-17 “has not been interpreted in accordance with its apparent plain meaning as effecting a partial assignment of the worker’s cause of action against the third party tortfeasor. Instead, the statute has been interpreted by the Supreme Court as a ‘reimbursement statute.’ ” The pertinent portion of Section 52-5-17(B) reads:

[T]he receipt of compensation from the employer shall operate as an assignment to the employer or his insurer ... of any cause of action, to the extent of payment by the employer to or on behalf of the worker for compensation or any other benefits to which the worker was entitled under the Workers’ Compensation Act ... that the worker or his legal representative or others may have against any other party for the injury or disablement.

Though the language of the statute seems to allow an assignment or subrogation (in fact the title of the section is “Subrogation”), case law is clear in stating that the section “does not deal with the right of subrogation, but with the right of reimbursement.” Herrera v. Springer Corp., 85 N.M. 6, 8, 508 P.2d 1303, 1305 (Ct.App.), rev’d, on other grounds, 85 N.M. 201, 510 P.2d 1072 (1973), and overruled on other grounds by Sunwest Bank of Albuquerque v. Roderiguez, 108 N.M. 211, 214, 770 P.2d 533, 536 (1989). This proposition continues to be reaffirmed. See Fernandez v. Ford Motor Co., 118 N.M. 100, 106, 879 P.2d 101, 107 (Ct.App.), certs. denied, 118 N.M. 90, 879 P.2d 91 (1994) (“Although designated as a subrogation measure, in fact, the statute operates as a ‘reimbursement ’ provision for the employer or the employer’s workers’ compensation provider for compensation properly paid an employee.”); Seaboard Fire & Marine Ins. Co. v. Kurth, 96 N.M. 631, 633, 633 P.2d 1229, 1231 (Ct.App.1980) (statute creates no right of subrogation or assignment in the insurer, merely right of reimbursement); Transport Indem. Co., 89 N.M. at 345, 552 P.2d at 476 (statute does not create assignment of the cause of action; creates only a right of reimbursement).

Furthermore, the workers’ compensation carrier’s claim for reimbursement of proceeds paid is against the worker and not the third party. Transport Indem. Co., 89 N.M. at 345, 552 P.2d at 476. The “right to collect” through assignment of the original creditor’s rights constitutes subrogation. In contrast, reimbursement is from the “amounts received by the workman because the workman sues for the entire amount of damages suffered. Since the ‘right to collect’ is in the workman, the compensation insurer does not own the right to enforce liability and cannot release the third party from liability.” Herrera, 85 N.M. at 8, 508 P.2d at 1305 (citation omitted); see also American Gen. Fire & Casualty Co. v. J.T. Constr. Co., 106 N.M.

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Bluebook (online)
893 P.2d 1007, 119 N.M. 603, Counsel Stack Legal Research, https://law.counselstack.com/opinion/st-joseph-healthcare-system-v-travelers-companies-nmctapp-1995.