Opinion ID: 891587
Heading Depth: 3
Heading Rank: 1

Heading: Whether Employer Failed to Provide Continuing Treatment and Justified Worker's Unilaterally Selecting HCPs Outside the Act

Text: {20} We first address Worker's argument that Employer failed to fulfill its statutory duty to provide health care services after Worker requested additional treatment on July 16, 2004, and that she was thereby entitled to select her own HCPs without complying with the advance notice and dispute resolution provisions of Section 52-1-49 of the Act. {21} An employer is required to provide a worker with reasonable and necessary health care services in a timely manner after sustaining a work-related injury. See § 52-1-49(A); Grine, 2006-NMSC-031, ¶ 24, 140 N.M. 30, 139 P.3d 190 (If Employer had notice of the accident, it was required to `provide the worker in a timely manner reasonable and necessary health care services from a health care provider.' (quoting § 52-1-49(A))). Worker asserts, however, that Employer failed in its duty to provide medical care when Employer improperly advised her that her case was closed and suggested she should seek treatment by other means. As a result of this abandonment, Worker argues, she was entitled to choose her own HCPs because she was not provided care and was advised to seek other treatment. {22} The WCJ considered and rejected Worker's claims of abandonment in detailed findings of fact. We review the WCJ's findings by determining whether substantial evidence supports them. Because weighing evidence and making credibility determinations are uniquely within the province of the trier of fact, we will not reweigh the evidence nor substitute our judgment for that of the WCJ, unless substantial evidence does not support the findings. See Gallegos v. City of Albuquerque, 115 N.M. 461, 464, 853 P.2d 163, 166 (Ct.App.1993) (observing that it is for the WCJ, not the appellate court, to weigh the evidence and make findings of fact); Marez v. Kerr-McGee Nuclear Corp., 93 N.M. 9, 11, 595 P.2d 1204, 1206 (Ct.App.1978) (stating that in workers' compensation cases [w]e will not weigh the evidence or determine the credibility of witnesses. The trier of facts is the sole judge of the credibility of witnesses and the weight to be given their testimony. (citation omitted)). We will not disturb the decision if a reasonable mind would accept the evidence as adequate to support the decision. See Herman, 111 N.M. at 552, 807 P.2d at 736. {23} The evidence supports the WCJ's resolution of factual issues in a textbook case of weighing witness credibility and drawing reasonable factual inferences. Worker testified that her store manager told her to call Concentra, Employer's HCP, on July 16, 2004, after she claimed to be experiencing a recurrence of back pain that she felt was related to the February 25 accident. According to Worker, she called Concentra and was told she could not receive treatment. She testified that she was then directed to call Employer's risk management office at a 1-800 number that was posted on the wall. Although she could not remember what number she called nor to whom she spoke, she was reportedly told by someone she would need to seek medical treatment by other means because she had been released by her doctor and her case had been closed. {24} Employer presented contrary evidence that there was no such risk management number posted on the wall. Additionally, Employer's insurance claims adjuster, Sherri Stoner, testified that she spoke with Worker on more than one occasion and sent correspondence to her that contained her contact information and also included a description of the workers' compensation process. Stoner further testified that the information she sent encouraged Worker to call her if she had any questions regarding her claim. Worker denied receiving Stoner's correspondence, although it was mailed to the same address given by Worker in her deposition. The WCJ specifically found from the testimony that Worker had her local adjuster's contact information and had previously contacted her both by letter and phone. {25} While the evidence presented might have supported contrary findings in this factual controversy, the record contains sufficient evidence to sustain the WCJ's decision. See Easterling v. Woodward Lumber Co., 112 N.M. 32, 37, 810 P.2d 1252, 1257 (Ct.App 1991) (In making a whole record review, it is not a function of this court to reweigh the evidence. The judge could give such weight as he deemed appropriate to the testimony of worker and his witnesses.). The WCJ entered detailed findings of fact and conclusions of law, and while there was contrary evidence in the record, the evidence reasonably supports the WCJ's credibility determinations and holding. See Tom Growney Equip. Co. v. Jouett, 2005-NMSC-015, ¶ 13, 137 N.M. 497, 113 P.3d 320 (`Where the testimony is conflicting, the issue on appeal is not whether there is evidence to support a contrary result, but rather whether the evidence supports the findings of the trier of fact.' (citation omitted)). We hold there is substantial evidence to support the WCJ's finding that Worker had the requisite information to contact her claims adjuster, but did not, and that Employer therefore did not fail to provide Worker with reasonable and necessary health care services. We affirm the WCJ's conclusion that Drs. Whalen and Gelinas did not become authorized HCPs until July 18, 2005, after Worker finally complied with the notice provisions of Section 52-1-49. We therefore do not need to determine the effect of an employer's failure to provide health care on a worker's obligations to comply with the HCP selection provisions of the Act.