Opinion ID: 2638912
Heading Depth: 2
Heading Rank: 2

Heading: Application of Intermediate Scrutiny to Sections 52-1-41 and -42

Text: {33} Respondents argue that the governmental interest in treating mentally impaired workers differently is to protect the financial viability of Workers' Compensation. This has previously been recognized as a proper goal for legislation and it is surely an important interest. See Candelaria v. Gen. Elec. Co., 105 N.M. 167, 174, 730 P.2d 470, 477 (Ct.App.1986), superceded by statute as stated in Jensen v. N.M. State Police, 109 N.M. 626, 628, 788 P.2d 382, 384 (Ct.App. 1990). They argue that limiting mental disability compensation to 100 weeks, while allowing lifetime compensation for physical disability, will prevent fraudulent claims of mental disability. Additionally, they argue that claims involving mental disabilities are harder to diagnose and are more susceptible to fraudulent claims. {34} It is certainly important to keep Workers' Compensation financially sound. However, a determination that the classification is aimed at furthering an important governmental interest does not necessarily imply that the classification is `substantially related' to the interest so identified. Trujillo I, 110 N.M. at 628, 798 P.2d at 578. {35} Because there is an important governmental interest at stake in this case, the only determination we need to make is whether the challenged classification is substantially related to that important interest. See Corn, 119 N.M. at 211, 889 P.2d at 246 (Apodaca, J., Specially Concurring). Again, to make this determination we will look to the purposes of the Act to determine the burdens imposed on Petitioners and analyze whether there are other less restrictive means of accomplishing the governmental interest. {36} The Act is intended to provide a humanitarian and economical system of compensation for injured workmen. Graham v. Wheeler, 77 N.M. 455, 457, 423 P.2d 980, 981 (1967), abrogated on other grounds by NMSA 1978, § 52-5-1 (1990). Our Court of Appeals has stated that the Act is the result of a legislative balancing involving the subjection of employers to liability without fault for work-related injuries suffered by workers, with a limitation restricting other actions against employers under the exclusivity provisions contained therein. Mieras, 1996-NMCA-095, ¶ 30. The Act is designed to provide quick and reliable recovery for injured workers while at the same time protecting society by shifting the burden of caring for injured workers away from society and toward industry. Id. In this way, the Act is intended to prevent the worker from becoming a public charge and to assist the worker in returning to work with minimal dependence on compensation awards. Madrid, 1996-NMSC-064, ¶ 12. {37} Compensation for a disability under the Act is for the impairment in capacity to perform work suffered by the worker, or lost earning capacity. It is not simply an award for an injury. See Shores v. Charter Servs., Inc., 112 N.M. 431, 432, 816 P.2d 500, 501 (1991); see also Medina v. Zia Co., 88 N.M. 615, 544 P.2d 1180 (Ct.App.1975). NMSA 1978, Section 52-1-20 (1990) orders compensation to be determined by the worker's average weekly wage and how much it has been reduced by the injury. The main goal is not to punish or allocate blame for the injury, but to compensate a worker for lost earning capacity without burdening the social welfare system. How the disability was caused ceases to be important once a worker has been determined to have suffered a compensable disability. {38} The Act is also Petitioners' only available remedy. The Act is designed to be the exclusive remedy for participating workplace accidents. See NMSA 1978, § 52-1-9 (1973); see, e.g., Morales v. Reynolds, 2004-NMCA-098, ¶ 6, 136 N.M. 280, 97 P.3d 612 (the benefits and remedies provided [in the Act] are the exclusive remedy for that employer's workers who are injured or killed in accidents `arising out of and in the course of' their employment.); cf. Delgado v. Phelps Dodge Chino, Inc., 2001-NMSC-034, ¶ 24, 131 N.M. 272, 34 P.3d 1148 ([W]hen an employer intentionally inflicts or willfully causes a worker to suffer an injury that would otherwise be exclusively compensable under the Act, that employer may not enjoy the benefits of exclusivity, and the injured worker may sue in tort.). This exclusivity provision is the keystone of the compromise in the workers compensation system: an injured worker gives up his or her right to sue the employer for damages in return for an expedient settlement covering medical expenses and wage benefits, while the employer gives up its defenses in return for immunity from a tort claim. Morales, 2004-NMCA-098, ¶ 6. {39} Sections 52-1-41 and -42 limit the basic benefits of the Act for persons with mental disabilities. The limitation on compensation contained in those sections hamstrings Petitioners' ability to receive adequate compensation and return to work in a different capacity. Petitioners can only receive 100 weeks of compensation, while a worker who suffers a non-scheduled physical injury receives 500 to 700 weeks of compensation if the injury is partial and permanent or lifetime compensation if the injury is total and permanent. See §§ 52-1-41 and -42. Thus, at best, a mentally disabled worker can only receive one-fifth the compensation of a physically disabled worker. Additionally, any temporary total compensation a worker receives prior to Maximum Medical Improvement (MMI) will be deducted from his or her permanent partial compensation. § 52-1-42(B). If the worker is totally disabled for over 100 weeks with a primary mental impairment, he or she will receive no permanent partial compensation at all. Therefore, mentally disabled workers are burdened with severely less time to transition into a job that is not compromised by their disability. {40} Because Respondents point to the potential for fraud as a rationale for the disparity in benefits, we next analyze whether there are alternative ways to address possible fraudulent claims while posing less of a burden to Petitioners and other workers with compensable mental disabilities. The Act already contains several mechanisms to prevent fraudulent claims. The most obvious is the narrow definition of primary mental impairment, as contained in See Section 52-1-24(B): a mental illness arising from an accidental injury arising out of and in the course of employment when the accidental injury involves no physical injury and consists of a psychologically traumatic event that is generally outside of a worker's usual experience and would evoke significant symptoms of distress in a worker in similar circumstances, but is not an event in connection with disciplinary, corrective or job evaluation action or cessation of the worker's employment. This definition is purposefully narrow in scope so that it covers only mental illnesses that arise from a specific and definite occurrence, and not mental illnesses that develop gradually over time and are more difficult to determine if they are related to employment. See Jensen v. N.M. State Police, 109 N.M. 626, 629, 788 P.2d 382, 385 (Ct.App.1990). This amounts to a permissible proof requirement. See Holford v. Regents of Univ. of Cal., 110 N.M. 366, 368, 796 P.2d 259, 261 (Ct.App.1990). These proof requirements are a valid way to prevent fraudulent claims from being compensated in the first place. {41} Beyond the narrow definition of a primary mental impairment, the Legislature has provided additional means of preventing fraud in awarding compensation benefits under the Act. The New Mexico Workers' Compensation Administration is authorized to dismiss a claim or otherwise punish a worker if it determines a claim was fraudulent. See NMSA 1978, § 52-1-28.1 (1990) (addressing unfair claims practices and bad faith); see also NMSA 1978, § 52-1-28.3 (1990) (addressing false statements or representations with regard to physical condition); NMSA 1978, § 52-1-51(I) (1990) (addressing in part unsanitary or injurious practices); 11 NMAC 4.1.7.C (defining bad faith); 11 NMAC 4.5.1-.18 (addressing the enforcement power of the Administration to penalize fraudulent claims); Varbel v. Sandia Auto Elec., 1999-NMCA-112, 128 N.M. 7, 988 P.2d 317. These procedures are used within an adversarial process so that each party has an interest in exposing the other's possible fraud. {42} The Act provides that both the employer and employee may choose a health care provider to evaluate and treat the employee claiming a disability. See NMSA 1978, § 52-1-49 (1990). These health care providers may then offer testimony when a mental disability is claimed. The chances of fraud are diminished when multiple doctors examine the employee, offer their opinions about the disability and are cross-examined. {43} Finally, WCJs are trained to handle cases of mental impairment or disability. Along with the procedures described above, the WCJ is in a position to weigh all the evidence presented by both sides and come to an accurate determination of the case. A good example of how the system works is presented in this case, as Petitioners' mental disabilities did arise from a specific event and were held to be properly compensable under Section 52-1-24(B) by both the WCJ and the Court of Appeals. See Carrasco, No. 20,833/20,832 (N.M.Ct.App. May 29, 2001) (consolidated). Indeed, Respondents do not contest that Petitioners suffered a valid and compensable disability under the Act on this appeal. {44} All of these valid mechanisms are less restrictive means to prevent fraud than arbitrarily limiting the amount of compensation for persons with mental impairments. In fact, the rest of the Act shows that the Legislature knows how to prevent fraudulent claims without arbitrarily restricting one group's access to benefits it otherwise deserves under the Act. Respondents have not demonstrated why these less restrictive means are ineffective or inadequate to control fraudulent claims without also imposing an arbitrary limit of 100 weeks. {45} Respondents also argue that mental disability claims are inherently more difficult to diagnose than physical injuries. They argue that caps are needed on recovery for mental disabilities to compensate for the uncertainty in diagnosis. While there is perhaps more uncertainty in diagnosing a mental disability than a physical disability, we are not convinced this is a sufficiently substantial concern to justify the disparate treatment at issue here. First, the provisions of the Act discussed above aimed at preventing fraud also help the WCJ consider the claim and correctly determine if compensation is appropriate. Second, in Smith v. Cutler Repaving, 1999-NMCA-030, ¶ 13, 126 N.M. 725, 974 P.2d 1182, our Court of Appeals reversed a WCJ's determination that a worker had reached MMI on his secondary mental impairment, even though it affirmed the WCJ's determination that the worker reached MMI on his physical impairment. The court first noted that MMI turns on a determination of reasonable medical probability of future recovery and lasting improvement. Id. ¶ 12. Then the court analyzed the medical testimony regarding the chances for improvement of the worker's mental disability. The court held that the testimony did not indicate a reasonable probability that the worker had recovered from his mental disability. Thus, it is possible for a WCJ to determine when and if a worker has reached MMI due to a mental impairment and also for an appellate court to review that determination. {46} We also note that the definition of total disability includes a brain injury that results in a permanent impairment of thirty percent or more. See § 52-1-25(A)(2). As Amicus New Mexico Trial Lawyers Association pointed out, brain injuries, or closed head injuries, share similar symptoms and diagnosis concerns as mental disabilities. Thus, the Legislature has shown a willingness to give compensation to brain injuries that are subject to similar criticism as mental disabilities. {47} Respondents also argue that allowing mental disability claims to be equalized with physical disabilities will possibly harm the financial viability of the Act. Basically, they argue that the cap is necessary to hold down costs. Again, we agree that preserving the financial viability of workers' compensation is important. However, we agree with Petitioners that the 100 week cap only limits fraudulent recovery to 100 weeks. Limiting fraudulent claims in this manner must be balanced against the severe burden it places on workers with legitimate mental disabilities. {48} We agree with Petitioner that the disparity between the compensation granted to workers who suffer physical injuries and those who suffer mental injuries is not substantially related to the important government interests alleged. The Act is designed to compensate a worker's diminished capacity to earn because of an accidental injury on the job. This protects New Mexico's social welfare system and rightly shifts the burden of protecting workers onto industry. With all of the procedural safeguards against fraud built into the system, severely limiting compensation for mental injuries does not substantially further these goals. The limits impinge on a mentally disabled worker's ability to take advantage of the rights afforded to him or her under the Act. See Plyer, 457 U.S. at 221-22, 102 S.Ct. 2382 (noting that one of the goals of the Equal Protection Clause . . . [is] the abolition of governmental barriers presenting unreasonable obstacles to advancement on the basis of individual merit.). {49} As Petitioner argues, Section 52-1-25.1 defines all total temporary disabled workers as those who cannot perform their duties until they have reached MMI. The idea that mentally disabled workers are less entitled to recover compensation than physically disabled workers does not fit with the purpose of the Act. Under the Act, both mentally disabled workers and physically disabled workers are impaired in their capacity to perform work because of their disabilities. A mental disability, compensable under the Act, affects workers in the same way as a physical disability does: it prevents them from earning a wage because of an on-the-job accident.