Opinion ID: 2570294
Heading Depth: 3
Heading Rank: 5

Heading: Apportionment Under Section 52-1-47(D)

Text: {42} The Workers' Compensation Act does not provide for contribution by different employers or insurers for disability or medical benefits. However, the Act does contain a provision regarding the reduction of benefits that would duplicate previous benefits. Section 52-1-47(D) provides that the compensation benefits payable by reason of disability caused by accidental injury shall be reduced by the compensation benefits paid or payable on account of any prior injury suffered by the worker if compensation benefits in both instances are for injury to the same member or function or different parts of the same member or function or for disfigurement and if the compensation benefits payable on account of the subsequent injury would, in whole or in part, duplicate the benefits paid or payable on account of such prior injury. Section 52-1-47(D) `is not merely a device for preventing a double recovery. It is an affirmative allocation of the burden in a successive injuries situation.' Garcia, 112 N.M. at 603, 817 P.2d at 1245 (quoted authority omitted). {43} We note that this section does not limit its application in terms of employers; thus, it is presumably applicable to a single employer or insurer, as well as subsequent employers and subsequent insurers. Stated another way, an employer could reduce compensation payments for a current disability if that employer previously paid disability to the employee for injury to the same member if the compensation would otherwise duplicate the benefits the employer paid on account of the prior injury. Section 52-1-47(D) authorizes a reduction in benefits paid by the current employer or insurer only when previous compensation benefits paid or payable on account of any prior injury would, in whole or in part, duplicate the benefits paid or payable on account of such prior injury. As discussed below, based on Section 52-1-47(D) as well as New Mexico precedent, a reduction of payments for the current employer, initially responsible for all disability compensation to a worker disabled by a work-related injury in compliance with requirements of the Act, is authorized only where the worker has suffered a prior work-related accident for which the initial employer or insurer paid or must pay on account of the prior injury. Thus, Section 52-1-47(D) is operative where an employer or insurer has paid or must pay a worker for medical benefits or disability compensation for a prior accidental injury when the worker has suffered an aggravation or later injury to the same member or function and the compensation benefits payable on account of the subsequent injury would, in whole or in part, duplicate the benefits paid or payable on account of such prior injury. We believe that this interpretation of Section 52-1-47(D) is consistent with the plain language of the statute, legislative intent, and our precedent. {44} In Stanke-Brown, the Court of Appeals discussed a hypothetical situation in which a worker suffers an accidental injury resulting in a 50 percent partial disability and compensation benefits are paid on the basis of that disability and then the worker suffers [a] subsequent accidental injury [that] results in a 100 percent disability where [t]he subsequent accidental injury aggravated the pre-existing condition and caused disability. 98 N.M. at 386, 648 P.2d at 1199. The Court noted that, under Reynolds, the employer and compensation carrier for the subsequent accident are liable for the 100 percent disability, but that because it was not an issue in Reynolds, that case did not address what happened to the liability of the employer and compensation carrier for the pre-existing 50 percent disability. Id. The Court of Appeals then discussed the applicability of Section 52-1-47(D) and concluded that [t]he employer and compensation carrier at the time of the first accidental injury remain liable for compensation benefits payable for disability resulting therefrom. The employer and compensation carrier at the time of the second accidental injury are initially liable for disability resulting from the second accidental injury, to the full extent of the disability. Liability for disability resulting from the second accidental injury is reduced to the extent of benefits paid or payable for disability resulting from the first accidental injury if the requirements of [Section] 52-1-47(D) are met. Id. `[B]enefits for the subsequent injury may not duplicate benefits paid or payable for the prior injury. It is the overlap in benefits to which the reduction applies.' Id. at 387, 648 P.2d at 1200 (quoted authority omitted, alteration in original). Thus, Stanke-Brown's analysis applies when there is disability and compensation paid or payable for that disability for an initial injury. {45} Although involving the later repealed Subsequent Injury Act, the Court of Appeals instructively discussed Stanke-Brown and Section 52-1-47(D) in Lea County Good Samaritan Village v. Wojcik, 108 N.M. 76, 766 P.2d 920 (Ct.App.1988). Based on Stanke-Brown and Section 52-1-47(D), if an employee has previously sustained a compensable injury under the Workers' Compensation Act and has been awarded benefits and thereafter suffers a subsequent injury involving the same members or functions,... the employer at the time of the second accident ... [is not] liable for any impairment for which the worker has already been compensated.  Wojcik, 108 N.M. at 81, 766 P.2d at 925 (emphasis added). Thus, Section 52-1-47(D) operates only where the worker received benefits for the initial injury and subsequently suffers a work-related injury to the same member or function and benefits for the subsequent injury would duplicate benefits paid or payable for the initial injury. {46} Under Stanke-Brown, the employer at the time of the second or subsequent accidental injury is initially liable for the full extent of the disability, and then the current employer's liability is reduced to the extent of benefits paid or payable for disability resulting from the first accidental injury. 98 N.M. at 386, 648 P.2d at 1199. Applying Section 52-1-47(D) and the analysis of Stanke-Brown to the present matter, Big Dog and its insurer, as the employer and compensation carrier at the time of the subsequent accidental injury resulting in disability, are initially potentially liable for disability resulting from the subsequent accidental injury, to the full extent of the disability. Big Dog's potential liability for Jouett's disability can be reduced under Section 52-1-47(D) only to the extent of disability benefits paid or payable by Growney Equipment or Patterson Drilling resulting from the first or prior accidental injuries. {47} In order for Growney Equipment or Patterson Drilling to be liable for any portion of disability compensation or medical benefits under Section 52-1-47(D), in addition to any other requirements with the Workers' Compensation Act, these employers must be responsible for compensation benefits paid or payable on account of any prior injury suffered by the worker. Jouett must have previously complied with all requirements of the Act and received medical or disability benefits paid or payable by Growney Equipment or Patterson Drilling for his prior injury for which current benefits would be duplicative. {48} Patterson Drilling argues that it is not responsible for either medical benefits or disability compensation by operation of the notice statute as well as the statute of limitations. Patterson Drilling recognizes that Stanke-Brown held that the worker's employer at the time the injury becomes disabling is responsible for compensation benefits related to the disability, and notes that the employer can then seek apportionment under Section 52-1-47 to reduce benefits proportionally to the extent of any benefits payable from a prior disability or preexisting injury. Patterson Drilling asserts that under New Mexico case law and the undisputed facts of the present case, Big Dog is solely responsible for payment of disability benefits to Jouett because Jouett continued to work after his initial January 1999 accident with Growney Equipment and the injury did not become disabling until December of 2001. We agree that Patterson Drilling is not liable for disability or medical benefits. Because Jouett did not make any claim for disability or medical benefits while working at Patterson Drilling, there is no injury for which Patterson Drilling is responsible for benefits paid or payable that would duplicate the medical or disability payments potentially owed by Big Dog. Had Jouett given proper notice and filed a successful claim against Patterson Drilling within the statute of limitations for medical or disability benefits suffered while he was an employee, Big Dog could reduce its liability by any duplicative benefits. Because Jouett did not give notice or file a claim while working for Patterson Drilling for any work-related accidental injury or disability for his two weeks of employment, Patterson Drilling was not liable to Jouett while he was an employee for any compensation benefits paid or payable on account of any prior injury which would be duplicative of disability benefits theoretically owed by Big Dog for Jouett's 2001 disability. Thus, Big Dog would not be able to reduce its compensation payments to Jouett for his 2001 disability in relation to Patterson Drilling. {49} Similarly, because Jouett's 1999 accidental injury did not result in disability, Growney Equipment was not liable to Jouett for disability compensation benefits that would be duplicative of disability benefits theoretically owed by Big Dog. Again, Section 52-1-47(D) would not provide for Big Dog to reduce its compensation payments to Jouett for his 2001 disability in relation to Growney Equipment. {50} Consistent with our interpretation of Section 52-1-47(D), our precedent supports the conclusion that prior employers and their insurers are not responsible for any portion of disability resulting from an aggravation of a prior injury or a subsequent injury to the same member or function if the initial accidental injury did not result in disability. The employer and its insurer at the time of the disability under such circumstances is wholly responsible. To illustrate this point, we compare those cases which apportioned disability compensation due to a prior injury resulting in disability with a case, similar to the present matter, where the initial injury did not result in disability. Although Stanke-Brown concluded that the employer and compensation carrier at the time of the first accidental injury remain liable for compensation benefits payable for disability resulting from the initial injury, 98 N.M. at 382, 648 P.2d at 1195, the initial injury in Stanke-Brown resulted in a permanent partial disability that existed prior to the successive injury and resulting disability, id. at 381, 648 P.2d at 1194. However, unlike Stanke-Brown, Jouett suffered an accidental injury in 1999 with no resulting disability. In Garcia, the worker received disability benefits and medical expenses for an initial accidental injury that resulted in disability prior to the second injury and resulting disability. 112 N.M. at 598, 817 P.2d at 1240. Urioste applied Stanke-Brown's holding that the employer at the time of the initial accidental injury remains liable to the worker for compensation benefits payable to the extent of any disability resulting from the initial injury, 107 N.M. at 738, 764 P.2d at 509, but also addressed a situation in which the worker was temporarily totally disabled at the time of the initial accident. Id. at 736, 764 P.2d at 507. Again, in McMains, the Court of Appeals affirmed apportioning liability for disability compensation where the worker received disability benefits from the initial accidental injury. 119 N.M. at 23, 888 P.2d at 469. Unlike Stanke-Brown, Garcia, Urioste, and McMains, however, Salinas-Kendrick is factually identical to the present matter on this point. {51} In Salinas-Kendrick, the worker suffered an accidental injury in 1990 that was not disabling; more than a year later, she became disabled because her initial injury was aggravated by continued work. 118 N.M. at 165, 879 P.2d at 797. The employer at the time of the disability is responsible for disability benefits where the evidence indicates that the worker's continued work-related activities contributed to his or her disability. Id. We conclude that Growney Equipment is not liable for Jouett's 2001 disability compensation because Jouett was not disabled as a result of his initial accidental injury; Jouett's continued work-related activities at his subsequent employers contributed to his disability, and Gowney Equipment was not the employer at the time Jouett became disabled. The date of an accident that does not result in disability ... is irrelevant. In this case, the date that the injury became compensable due to further work-related causes is the determinative factor. Id. at 166, 879 P.2d at 798. We see no way to meaningfully distinguish Jouett's case from Salinas-Kendrick. We note that Salinas-Kendrick did not discuss application of Section 52-1-47(D) despite the fact that the insurer at the time the disability arose argued that the injury was sustained while the worker was employed under an initial insurer. It is consistent to conclude that Section 52-1-47(D) would not apply in Salinas-Kendrick because the insurer at the time of the initial injury was not responsible for any disability payments to the worker at that time because her disability arose subsequently. Similarly, with regard to the present case, Section 52-1-47(D) does not apply to Growney Equipment for Jouett's disability benefits because he was not disabled by his 1999 injury and his disability arose later. {52} Regarding medical benefits, we begin by noting that NMSA 1978, § 52-1-49(A) (1991) provides that employers must provide necessary health care services as long as medical or related treatment is reasonably necessary. See Wojcik, 108 N.M. at 82, 766 P.2d at 926 (A party seeking recovery of medical expenses in a worker's compensation proceeding has the burden of proving that the expenses were reasonably necessary and directly related to the worker's disability. Similarly, a party seeking payment or reimbursement of medical expenses carries the burden of proof on this issue.) (citation omitted). Growney Equipment was responsible for and paid medical benefits for Jouett's prior 1999 shoulder injury. Our precedent has held that Section 52-1-47(D) applies to medical benefits as well as disability compensation. Brewster v. Cooley & Assocs., 116 N.M. 681, 686, 866 P.2d 409, 414 (Ct.App.1993) (concluding that, despite the plain language of Section 52-1-47(D) applying to compensation benefits payable by reason of disability, the Section applies to medical benefits); McMains, 119 N.M. at 24, 888 P.2d at 470 (concluding that the subsequent employer had primary responsibility for payment of future medical benefits and that the subsequent employer could reduce its liability based on Section 52-1-47(D)). Thus, Section 52-1-47(D) would authorize Big Dog, theoretically, to reduce medical benefits paid or payable on account of Jouett's prior 1999 shoulder injury by Growney Equipment if such benefits would, in part, duplicate the benefits paid by Growney Equipment. Although any current medical payments for Jouett's 2001 injury would not presumably duplicate the benefits paid by Growney Equipment in 1999, Growney Equipment may be responsible for some portion of Jouett's current medical benefits that would duplicate Big Dog's liability for Jouett's current medical benefits if causally connected to Jouett's 1999 injury. See McMains, 119 N.M. at 25, 888 P.2d at 471 (If [the worker] incurred medical expenses relating to a work-related injury in the future, he [or she] would still have to prove them in order to recover.) (quoted authority omitted); cf. Stanke-Brown, 98 N.M. at 382, 648 P.2d at 1195 (This causation requirement applies to any claim for worker's compensation; it makes no difference whether the claim is for a first, second or successive accidental injury.). On remand, the WCJ should consider whether, if it determines that Big Dog is liable for disability and medical benefits, Big Dog is entitled to reduce some portion of the medical expenses duplicative of medical expenses paid or payable by Growney Equipment.