Court Cases Update, New Mexico

0

On October 11, 2022, the New Mexico Court of Appeals, in Barrozo vs. Albertson’s, Inc.ruled that an employer was not required to reimburse an injured employee for the full amount the employee spent on medical marijuana used as workers’ compensation treatment, but was only obligated to repay up to the maximum authorized payment set out in the program fee.

In this case, an injured employee – whose treatment with medical marijuana was deemed reasonable and necessary under New Mexico WC laws – sought reimbursement from the WC employer/carrier of the total amount spent on medical marijuana. The Workers’ Compensation Administration concluded that the employer was only liable to reimburse the maximum allowable payment set out in the fee schedule. On appeal, the employee argued that the employer was required to cover the full cost of the medical marijuana pursuant to New Mexico law 52-1-49(A), which requires employers to provide workers with reasonable and necessary health care services.

The Court of Appeal upheld the decision of the Workmen’s Compensation Administration that the employer was not liable to reimburse the full amount. The court acknowledged that although its earlier decision in Vialpando versus Ben’s Auto. Serves.allowed employees to be reimbursed by employers for medical marijuana expenses, it did not specify whether such reimbursements are subject to cost limits.

The court went on to note that the statute relied upon by the employee does not explicitly require the employer to pay the full cost of health care services and that the employee’s argument is contrary to legislative intent. that WC laws should be interpreted in such a way as to ensure prompt and effective provision of benefits to injured workers at a reasonable cost to employers.

The court also found that other legal requirements, such as those set out in 52-4-5, that fees for services rendered cannot exceed the maximum allowed by the administrative rule, directly contradicted the argument of the employee. The court found that, read together, Acts 52-1-49(A) and 52-4-5 address the employer’s obligation to provide reasonable and necessary health care services by covering the cost of these services, but only up to the maximum authorized payment as provided for in the fee schedule.

This case could be appealed. The NCCI will monitor further developments.

For information on other cases being monitored by the NCCI Legal Division, see previous court case updates and
Overview of court casesin the legal section of
KNOWLEDGE on
ncci.com.


This article is provided solely as a reference tool to be used for informational purposes only. The information in this article should not be construed or construed as providing legal or other advice. Use of this article for purposes other than those stated herein is strictly prohibited.

Share.

Comments are closed.