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Sheena Harrison

Total disability payments available 'for life': New Mexico high court

June 9, 2014 - 12:43pm

New Mexico Disability Payments Ruling


The New Mexico Supreme Court has ruled that workers compensation temporary total disability benefits are payable “for the remainder of a worker's life” and aren't subject to time limits that the state places on permanent disability benefits.

In Sherrie Fowler v. Vista Care and American Home Insurance Co., Ms. Fowler hurt her back while working for Vista Care in April 2003, court records show. She underwent back surgery later that year.

Ms. Fowler's TTD benefits were terminated after a doctor said she had reached maximum medical improvement in January 2006, records show. She received a lump-sum payment for permanent partial disability benefits later that year.

Ms. Fowler continued being treated for her back injury, but her doctor determined in March 2007 that her condition had deteriorated, court documents show. The doctor recommended that Ms. Fowler undergo another back surgery, which she did not receive until July 2010.

Based on the worsening of her condition, Ms. Fowler filed a complaint with the New Mexico Workers' Compensation Administration seeking additional TTD benefits. Vista Care began paying TTD benefits to Ms. Fowler from the date of her surgery, but disputed whether the procedure was related to Ms. Fowler's April 2003 work injury.

A judge with the workers comp administration ruled that Ms. Fowler was due TTD benefits as of March 2007, when a doctor deemed that she was no longer at maximum medical improvement, records show. The judge also found that TTD benefits aren't subject to week time limits that PPD benefits are limited to under New Mexico law, and therefore Ms. Fowler could receive TTD benefits indefinitely.

The New Mexico Court of Appeals affirmed the reinstatement of Ms. Fowler's TTD benefits as of 2007, but found that New Mexico workers comp law limits TTD benefits up to 700 weeks, records show.

Benefits eligibility doesn't mean benefits in perpetuity: High court

In a unanimous decision Thursday, the New Mexico Supreme Court reversed the appellate court's ruling on TTD duration limits and upheld Ms. Fowler's TTD benefit determination.

In its opinion, the high court noted that New Mexico law allows workers to receive TTD benefits until they reach maximum medical improvement or return to work at their preinjury wage.

“This scheme acknowledges the realistic possibility that some workers may become totally disabled for a period of time, reach (maximum medical improvement) or be released for work by their physicians before (maximum medical improvement) and return to work, and later face subsequent work-related injuries or find their existing injuries exacerbated, rendering them totally disabled yet again,” the opinion reads.

The high court found New Mexico workers comp law allows lifetime benefits for total disability — whether temporary or permanent — and that the state's workers comp benefit time limits only apply to partial disability determinations, also whether temporary or permanent.

“The fact that Fowler remains eligible for total disability benefits for the duration of her life does not mean that she will necessarily receive TTD benefits in perpetuity or that the distinction between 'permanent' and 'temporary' is undermined; a worker like Fowler can come in and out of TTD based on medical determinations of (maximum medical improvement) for the remainder of her life.”

 



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