December 13, 2012 – Sherrie Fowler v. Vista Care and American Home Insurance Company, No. 31,438

31,438Nmctapp

Texte intégral

IN THE COURT OF APPEALS OF THE STATE OF NEW MEXICO
Opinion Number: __________
Filing Date: 	December 13, 2012
NO. 31,438
SHERRIE FOWLER,
Worker-Appellee,
v.
VISTA CARE and
AMERICAN HOME INSURANCE COMPANY,
Employer/Insurer-Appellants.
APPEAL FROM THE WORKERS’ COMPENSATION ADMINISTRATION
Victor S. Lopez, Workers’ Compensation Judge
Dunn Law Offices
Rod Dunn
Albuquerque, NM
for Appellee
Butt Thornton & Baehr PC
Emily A. Franke
David N. Whitham
Albuquerque, NM
for Appellants
OPINION
WECHSLER, Judge.
{1} 	Vista Care and American Home Insurance Co. (Vista Care) appeal from a
compensation order entered in the Workers’ Compensation Administration (WCA)
awarding Sherrie Fowler (Worker) temporary total disability benefits. We consider
various provisions of the Workers’ Compensation Act, NMSA 1978, §§ 52-1-1 to -70
(1929, as amended through 2007), in determining whether (1) temporary total
disability benefits are subject to a durational limit, (2) a previous determination that
a worker is at maximum medical improvement precludes a finding that the worker was
no longer at maximum medical improvement at a later date, and (3) Vista Care is
entitled to a credit against the temporary total disability benefits for previously paid
lump sum payments for future permanent partial disability benefits. We hold that (1)
temporary total disability benefits are subject to the 700-week durational limit found
in Section 52-1-47(A); (2) the Workers’ Compensation Judge (WCJ) did not err in
concluding that Worker was not at maximum medical improvement on March 14,
2007 despite a previous finding of maximum medical improvement; and (3) on
remand, the WCJ should consider how the 700-week limitation period affects the
application of any potential credit for lump sum advances of permanent partial
disability benefits. Accordingly, we reverse in part and affirm in part, and remand to
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the WCA for further proceedings consistent with this opinion.
BACKGROUND
{2} 	On April 7, 2003, Worker suffered a back injury arising out of, and occurring
in the course of, her employment with Vista Care. As a result of her injury, Worker
underwent a spinal fusion in October 2003. Thereafter, Worker continued to receive
medical care, including multiple spinal surgeries. On January 11, 2006, Dr. James
Thomas found that Worker had reached maximum medical improvement. As a result,
Worker filed a petition for a lump sum payment of permanent partial disability
benefits for payment of debt, pursuant to NMSA 1978, Section 52-5-12(C) (2009).
The WCJ granted the petition on April 27, 2006, finding that Worker had reached
maximum medical improvement prior to April 27, 2006.
{3} 	Worker continued to receive treatment on her injured back, and on February 7,
2007, Dr. Andrew Cash examined Worker. 	Dr. Cash’s evaluation revealed that
Worker suffered from an adjacent level breakdown and stenosis and recommended
that Worker undergo an extension of the previous fusion with decompression. Worker
saw Dr. Cash again on March 14, 2007, and Dr. Cash recommended an anterior-
posterior lumbar fusion of L3-4. After the parties disagreed whether the treatment
suggested by Dr. Cash related to the original injury, Dr. Jose Reyna provided an
independent medical evaluation on October 22, 2009, and concluded that the new
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injury related to the original injury and that Worker would benefit from the additional
treatment suggested by Dr. Cash. Worker underwent the surgery on July 13, 2010.
The parties have stipulated that Worker has yet to reach maximum medical
improvement following the July 13, 2010 surgery.
{4} 	In the compensation order entered on June 30, 2011 that is the subject of this
appeal, the WCJ concluded that Worker was no longer at maximum medical
improvement as of March 14, 2007. The WCJ awarded temporary total disability to
Worker beginning March 14, 2007, the date at which the WCJ determined that Worker
was no longer at maximum medical improvement, through the date Worker reaches
maximum medical improvement from the July 13, 2010 surgery. The WCJ further
concluded that the temporary total disability benefits were not subject to the 500- or
700-week durational limit found in Section 52-1-42(A), and, therefore, Worker could
be paid benefits for an indefinite period of time. 	Finally, the WCJ concluded that
Vista Care was not entitled to a credit for the lump sum advances of permanent partial
disability benefits to apply to the temporary total disability benefits it awarded.
{5} 	On appeal, Vista Care argues that the WCJ (1) erred in holding that temporary
total disability benefits are not subject to the 500- or 700-week limit in Section 52-1-
42(A) or the 700-week limit found in Section 52-1-47(A) and can potentially be
payable for Worker’s lifetime; (2) erred in concluding that Worker was no longer at
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maximum medical improvement as of March 14, 2007, despite finding that Worker
was at maximum medical improvement on January 11, 2006; and (3) abused his
discretion in holding that Vista Care is not entitled to a credit for the lump sum
advances of future payments for permanent partial disability benefits when applied to
the additional temporary total disability benefits.
STANDARD OF REVIEW
{6} 	“All workers’ compensation cases are reviewed under a whole record standard
of review.” Moya v. City of Albuquerque, 2008-NMSC-004, ¶ 6, 143 N.M. 258, 175
P.3d 926. When our review consists of reviewing a “WCJ’s interpretation of statutory
requirements, we apply a de novo standard of review.” DeWitt v. Rent-A-Center, Inc.,
2009-NMSC-032, ¶ 14, 146 N.M. 453, 212 P.3d 341. 	“We look first to the plain
meaning of the statute’s words, and we construe the provisions of the [Workers’
Compensation] Act together to produce a harmonious whole. After we determine the
meaning of the statutes, we review the whole record to determine whether the WCJ’s
findings and award are supported by substantial evidence.” 	Id. (internal quotation
marks and citation omitted). “When an agency that is governed by a particular statute
construes or applies that statute, the court will begin by according some deference to
the agency’s interpretation.” 	Morningstar Water Users Ass’n v. N.M. Pub. Util.
Comm’n, 120 N.M. 579, 583, 904 P.2d 28, 32 (1995). However, we are not bound by
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the agency’s interpretation and may substitute our “own independent judgment for
that of the agency because it is the function of the courts to interpret the law.” Id.
TEMPORARY TOTAL DISABILITY BENEFIT DURATION LIMITS
{7} 	As pertinent to this appeal, the Workers’ Compensation Act provides for
compensation benefits for permanent partial disability in Section 52-1-42 and for total
disability in Section 52-1-41. 	Both sections contain limits on the duration of the
benefits.
{8} 	In relevant part, Section 52-1-42(A) states that:
For permanent partial disability . . . [t]he duration of partial
disability benefits shall depend upon the extent and nature of the partial
disability, subject to the following:
(1) 	where the worker’s percentage of disability is equal
to or greater than eighty, the maximum period is seven hundred weeks;
(2) 	where the worker’s percentage of disability is less
than eighty, the maximum period is five hundred weeks[.]
Section 52-1-41(A) provides that, with exceptions that are not relevant to this appeal,
for total disability, a “worker shall receive compensation benefits for the remainder
of his life.”
{9} 	In addition to these limitation provisions stated together with specific types of
benefits, the Workers’ Compensation Act contains a general provision concerning the
limitation of compensation benefits. Section 52-1-47 provides in relevant part
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except for provision of lifetime benefits for total disability awarded
pursuant to Section 52-1-41 . . . :
A. 	compensation benefits for any combination of disabilities
or any combination of disabilities and death shall not be payable for a
period in excess of seven hundred weeks[.]
{10} 	The WCJ relied on Section 52-1-41(A) for the proposition that the temporary
total disability benefits are potentially subject to payment over Worker’s lifetime. The
WCJ determined that Section 52-1-41(A) clearly and unambiguously applies to both
permanent and temporary “total disability.” In the WCJ’s view, the “generic” term
“total disability” encompasses both “the temporary and permanent components of the
category.”
{11} 	In its entirety, Section 52-1-41(A) provides:
For total disability, the worker shall receive, during the period of
that disability, sixty-six and two-thirds percent of his average weekly
wage, and not to exceed a maximum compensation of eighty-five percent
of the average weekly wage in the state, a week, effective July 1, 1987
through December 31, 1999, and thereafter not to exceed a maximum
compensation of one hundred percent of the average weekly wage in the
state, a week; and to be not less than a minimum compensation of thirty-
six dollars ($36.00) a week. Except as provided in Subsections B and C
of this section, the worker shall receive compensation benefits for the
remainder of his life.
{12} 	The first sentence of Section 52-1-41(A) establishes the formula to set the
amount of compensation benefits that a worker may receive for total disability “during
the period of that disability.” (Emphasis added.) 	The formula is used to calculate
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temporary total disability as well as permanent total disability benefits. Cf. Breen v.
Carlsbad Mun. Sch., 2005-NMSC-028, ¶ 1, 138 N.M. 331, 120 P.3d 413 (reviewing
a case in which the worker received benefits under Section 52-1-41(A) for an injury
resulting in a temporary total disability). By the express language of the statute, it
applies only for benefits during the period of the disability. Section 52-1-41(A). The
second sentence, on the other hand, states that, with exceptions for mental impairment
and death, the worker is entitled to receive compensation benefits “for the remainder
of his life.” Section 52-1-41(A). Because this sentence is contained in Section 52-1-
41(A) that begins “[f]or total disability,” we presume that it relates to “total disability”
and means that a worker shall receive compensation benefits for total disability for the
remainder of the worker’s life. See Reule Sun Corp. v. Valles, 2010-NMSC-004, ¶ 30,
147 N.M. 512, 226 P.3d 611 (stating that the placement of language at the beginning
of a clause evinces legislative intent that the clause is meant to apply to the statute in
whole). Nothing in Section 52-1-41(A) explains the connection between a worker’s
entitlement to receive the compensation benefits calculated in the first sentence of
Section 52-1-41(A) for the period of the total disability and the worker’s entitlement
in the second sentence to receive compensation benefits for a total disability for the
remainder of the worker’s life. The language providing “benefits for the remainder
of his life” in the second sentence is inconsistent with temporary total disability,
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which by definition is temporary and contemplates a worker reaching maximum
medical improvement and returning to work. 	See § 52-1-25.1(A), (B); see also
Madrid v. St. Joseph Hosp., 1996-NMSC-064, ¶ 7, 122 N.M. 524, 928 P.2d 250
(“Eligibility for the various temporary benefits provided under the Act ends at the date
of [maximum medical improvement].”). 	Due to this ambiguity, we focus our
construction of Section 52-1-41(A) outside the plain meaning, focusing on the purpose
of the Workers’ Compensation Act. 	See T-N-T Taxi, Ltd. v. N.M. Pub. Regulation
Comm’n, 2006-NMSC-016, ¶ 5, 139 N.M. 550, 135 P.3d 814 (“[S]tatutes are given
effect as written without room for construction unless the language is doubtful,
ambiguous, or adherence to the literal use of the words would lead to injustice,
absurdity or contradiction, in which case the statute is to be construed according to its
obvious purpose.”).
{13} 	We interpret statutes to fulfill the intent of the Legislature. 	Vescio v. Wolf,
2009-NMCA-129, ¶ 13, 147 N.M. 374, 223 P.3d 371. 	By enacting the Workers’
Compensation Act, the Legislature intended “to protect injured workers from
becoming dependent on public welfare and to provide them with some financial
security.” 	Madrid, 1996-NMSC-064, ¶ 8. 	To achieve this purpose, the Workers’
Compensation Act sets forth grades of disability. Thus, a permanent total disability
is either (1) the permanent and total loss or loss of use of both hands, arms, feet, legs,
9
or eyes, or any two of them, or (2) a traumatic brain injury causing a certain degree
of permanent impairment. 	Section 52-1-25. 	A permanent partial disability is a
permanent impairment. Section 52-1-26(B). Further, workers with a compensable
permanent partial disability “should be provided with the opportunity to return to
gainful employment as soon as possible with minimal dependence on compensation
awards.” Section 52-1-26(A).
{14} 	The Workers’ Compensation Act therefore draws a sharp distinction between
permanent total disability and permanent partial disability. It does not contemplate
that workers suffering a compensable permanent total disability must return to work.
To this end, workers with a permanent total disability receive lifetime compensation
benefits. 	Section 52-1-41(A). 	A permanent partial disability, on the other hand,
justifies only the maximum of 500 or 700 weeks of compensation benefits in
accordance with the legislative purpose of minimal dependence on compensation
awards. Section 52-1-42(A)(1), (2).
{15} 	In addition, the Workers’ Compensation Act ties a worker’s entitlement to
permanent partial disability benefits and temporary total disability benefits to the
worker’s achieving maximum medical improvement. 	Section 52-1-24(A) defines
“impairment” as “an anatomical or functional abnormality existing after the date of
maximum medical improvement.” Further, temporary total disability is defined in
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relation to maximum medical improvement. It is “the inability of a worker, by reason
of accidental injury arising out of and in the course of the worker’s employment, to
perform the duties of that employment prior to the date of the worker’s maximum
medical improvement.” 	Section 52-1-25.1(A). 	A worker is entitled to receive
temporary total disability benefits if the worker is released to work prior to reaching
maximum medical improvement and returns to work at less than the worker’s pre-
injury wage. Section 52-1-25.1(C).
{16} 	This legislative scheme of the Workers’ Compensation Act resolves the issue
before us. 	See DeWitt, 2009-NMSC-032, ¶ 14. Although the Legislature used the
word “total” with respect to temporary total disability, it did not equate it with the
“total disability” that entitles a worker to benefits for the worker’s remaining life.
Because a designation of temporary total disability contemplates that the worker will
reach maximum medical improvement and return to work, it would be inconsistent for
the Legislature to have intended that workers receiving temporary total disability
benefits be paid for the remainder of the worker’s life. 	Such an interpretation is
inconsistent with the statutory scheme of being able to return to work “with minimal
dependence 	on 	compensation 	awards.” 	Section 	52-1-26(A). 	Indeed, 	this
inconsistency is underscored by the temporary nature of temporary total disability
benefits that are subject to a subsequent determination of maximum medical
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improvement. See Montoya v. Herrera, 2012-NMSC-011, ¶ 11, 276 P.3d 952 (“We
must take care to avoid adoption of a construction that would render the statute’s
application absurd or unreasonable or lead to injustice or contradiction.” (internal
quotation marks and citation omitted)). 	Although Section 52-1-41(A) does not
specifically make reference to permanent total disability in Section 52-1-25, when we
“construe the provisions of the [Workers’ Compensation] Act together to produce a
harmonious whole[,]” DeWitt, 2009-NMSC-032, ¶ 14, we understand Section 52-1-
41(A) to refer only to a permanent total disability under Section 52-1-25. 	In that
manner, Section 52-1-41(A) fulfills the purpose of the Workers’ Compensation Act
of providing permanent financial security to an injured worker who requires a
permanent source of income for the worker’s lifetime.
{17} 	The WCJ determined, and Worker argues, that the Legislature intended
temporary total disability benefits to “be limited only by the spigot of medical
judgment that a worker is, or is no longer, at [maximum medical improvement]
status.” Under this approach, we would have to read the language providing “benefits
for the remainder of his life” in Section 52-1-41(A) to mean that payment of total
disability benefits is periodic and indefinite in duration over the remainder of the
worker’s lifetime and is dependent solely on whether worker has reached maximum
medical improvement and is entitled to either permanent total disability or permanent
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temporary disability. 	Had the Legislature intended this approach, the Legislature
would have used clearer language and not provided benefits for the “remainder of [a
worker’s] life[,]” language that implies continuing benefits until death. See Colonias
Dev. Council v. Rhino Envtl. Servs., Inc., 2003-NMCA-141, ¶ 17, 134 N.M. 637, 81
P.3d 580 (stating that the Legislature would have provided a much “clearer indication”
if it had intended a statute to a more expansive meaning), rev’d on other grounds,
2005-NMSC-024, 138 N.M. 133, 117 P.3d 939; Webster’s Third New International
Dictionary 1919 (Unabridged 1993) (defining “remainder” as “ a remaining group,
part, or trace” and “remain” as “to continue unchanged in form, condition, status, or
quantity”). 	A more natural reading of Section 52-1-41(A) is that the Legislature
specifically used the phrase providing “benefits for the remainder of his life” for the
specific purpose of providing lifetime benefits exclusively for permanent total
disability.
{18} 	Moreover, at least one issue before the Court is whether to apply the durational
limit contained in Section 52-1-47(A) to temporary total disability benefits. Section
52-1-47 expressly provides an exception for lifetime benefits awarded under Section
52-1-41(A). By the plain language of Section 52-1-41(A), such lifetime benefits are
benefits that a worker receives for the remainder of the worker’s life. As we have
stated, temporary total disability benefits, by their temporary nature, do not continue
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for a worker’s lifetime.
{19} 	Because the exception of Section 52-1-41(A) does not apply for temporary total
disability benefits, we must determine the applicable durational limits for temporary
total disability benefits. We turn first to Section 52-1-42. Section 52-1-42(A)(1), (2)
provides a 500- or 700-week duration limit, but it applies only to permanent partial
disability, and temporary total disability is neither “permanent” nor “partial.” 	See
§ 52-1-25.1. However, Section 52-1-42(B) remains relevant. It states:
If an injured worker receives temporary total disability benefits
prior to an award of partial disability benefits, the maximum period for
partial disability benefits shall be reduced by the number of weeks the
worker actually receives temporary total disability benefits.
{20} 	Through Section 52-1-42(B), the Legislature has demonstrated its intent that
temporary total disability benefits are not excepted from the durational limits for
permanent partial benefits. Indeed, by its plain language, Section 52-1-42(B) requires
temporary total disability benefits to be included in the calculation of the durational
limits of subsequent permanent partial benefits. As we have discussed, the design of
the Workers’ Compensation Act is that an injured worker will receive temporary total
disability benefits until the worker has reached maximum medical improvement and
receives permanent partial disability benefits. Sections 52-1-25.1, -26.
{21} 	We acknowledge that there may be situations in which a worker receives
permanent partial disability benefits and subsequently aggravates the injury and
14
qualifies for temporary total disability only to not receive benefits because the worker
exhausted the durational limit for permanent partial disability. Although the Workers’
Compensation Act is intended to protect injured workers and provide financial
security, Madrid, 1996-NMSC-064, ¶ 8, this result is a legislative decision striking a
balance between the interests of the employer and the worker. See NMSA 1978, § 52-
5-1 (1990) (“It is the intent of the [L]egislature [that the Workers’ Compensation Act]
be interpreted to assure the quick and efficient delivery of indemnity and medical
benefits to injured and disabled workers at a reasonable cost to the employers . . .
based on a mutual renunciation of common law rights.”).
{22} 	We next turn to Section 52-1-47(A). Except for the lifetime benefits provision
set forth in Section 52-1-41(A), Section 52-1-47(A) provides a 700-week limit for
“compensation benefits for any combination of disabilities.” (Emphasis added.) The
plain language of Section 52-1-47(A) evinces a legislative intent to provide an
absolute limit of 700 weeks for “any” compensation benefits awarded under the
Worker’s Compensation Act, except for lifetime benefits set forth in Section 52-1-
41(A). We have determined that Section 52-1-41(A) does not apply to temporary total
disability. Thus, because temporary total disability does not fall within the Section
52-1-41(A) lifetime benefits exception, the 700-week durational limit of Section 52-1-
47(A) applies to temporary total disability benefits. 	Although Worker argues that
15
Section 52-1-47(A) contemplates a combination of compensation benefits that does
not include temporary total disability benefits, Section 52-1-47(A) limits to 700 weeks
“compensation benefits for any combination of disabilities” without any exception
other than for lifetime benefits.
{23} 	In sum, the WCJ erred in holding that the temporary total disability benefits
awarded to Worker were subject to payment over an indefinite duration pursuant to
Section 52-1-41(A). The temporary total disability benefits are subject to the 700-
week durational limit in Section 52-1-47(A). We therefore reverse the WCJ on this
issue.
CHANGED MAXIMUM MEDICAL IMPROVEMENT STATUS
{24} 	Vista Care next argues that the WCJ erred in concluding that Worker was no
longer at maximum medical improvement as of March 14, 2007, even though the WCJ
had previously determined that Worker was at maximum medical improvement prior
to April 27, 2006. Particularly, Vista Care argues that Worker’s prior admission that
she was at maximum medical improvement when applying for lump sum payments
precluded the WCJ from determining that Worker was no longer at maximum medical
improvement as of the date that Dr. Cash recommended that Worker undergo the
anterior-posterior lumbar fusion of L3-4.
{25} 	The date of maximum medical improvement is defined as “the date after which
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further recovery from or lasting improvement to an injury can no longer be reasonably
anticipated based upon reasonable medical probability as determined by a health care
provider.” 	Section 52-1-24.1. 	The Workers’ Compensation Act provides for the
modification of a compensation order. In relevant part, NMSA 1978, Section 52-5-9
(1989) provides that
A. 	Compensation 	orders 	are 	reviewable 	subject 	to 	the
conditions stated in this section upon application of any party in interest
in accordance with the procedures relating to hearings. The [WCJ], after
a hearing, may issue a compensation order to terminate, continue,
reinstate, increase, decrease or otherwise properly affect compensation
benefits provided by the Workers’ Compensation Act . . . .
B. 	A review may be obtained upon application of a party in
interest filed with the director at any time within two years after the date
of the last payment or the denial of benefits upon the following grounds:
(1) 	change in condition[.]
Further, Section 52-1-56 provides that
The [WCJ] may, upon the application of the employer, worker or
other person bound by the compensation order, fix a time and place for
hearing upon the issue of claimant’s recovery. . . . 	If it appears upon
such hearing that the disability of the worker has become more
aggravated or has increased without the fault of the worker, the [WCJ]
shall order an increase in the amount of compensation allowable as the
facts may warrant.
{26} 	Under these statutory provisions, the WCJ had the authority to modify the
maximum medical improvement determination upon a change of condition if
Worker’s injury became aggravated or worsened to an extent that Worker was no
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longer at maximum medical improvement. No statutory provision precludes such a
modification because Worker previously admitted to being at maximum medical
improvement and requested lump sum payment of benefits. 	Cf. Benny v. Moberg
Welding, 2007-NMCA-124, ¶¶ 6-12, 142 N.M. 501, 167 P.3d 949 (holding that
Section 52-5-9 and Section 52-1-56 provide authority for the WCJ to grant temporary
total disability benefits even after the worker received a lump sum settlement for
permanent partial disability benefits).
{27} 	Based on the evidence presented at trial, the WCJ concluded that “Worker’s
spinal condition slowly deteriorated and aggravated after her April 27, 2006
[maximum medical improvement] date.” Further, the WCJ concluded that “March 14,
2007 was the clear date on which Worker’s condition had changed sufficiently to
warrant a recommendation for scheduling of the surgical procedure” and therefore,
“Worker was no longer at [maximum medical improvement] status for her work
injuries on March 14, 2007.” 	Vista Care does not challenge the sufficiency of the
evidence to support these findings, and the findings are therefore binding on appeal.
Rendleman v. Heinley, 2007-NMCA-009, ¶ 10, 140 N.M. 912, 149 P.3d 1009 (“An
unchallenged finding is binding on appeal.”). The WCJ had the authority to modify
the designation that Worker was at maximum medical improvement and find that
Worker was no longer at maximum medical improvement as of March 14, 2007.
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{28} 	Vista Care cites Souter v. Ancae Heating & Air Conditioning, 2002-NMCA-
078, 132 N.M. 608, 52 P.3d 980, disproved in part by Benny, 2007-NMCA-124, for
the proposition that “the need for and receipt of additional medical treatment does not
alter the prior date and finding that worker has reached [maximum medical
improvement].” However, Souter dealt with an inapposite issue. In Souter, this Court
held that lump sum payments exhausting a worker’s awarded permanent partial
disability benefits did not preclude the worker from petitioning for a modification of
benefits for a change in condition as long as the worker sought the modification
during the statutory durational period beginning when the permanent partial disability
benefits were first awarded. 	Id. ¶¶ 18-22. 	Souter did not address a change of a
worker’s maximum medical improvement status or a worker’s maximum medical
improvement date and is not applicable to this case.
CREDIT FOR LUMP SUM ADVANCES
{29} 	Vista Care lastly argues that the WCJ erred in determining that Vista Care is not
entitled to a credit for its lump sum advances of future permanent partial disability
benefits applied to the awarded temporary total disability benefits. “New Mexico does
not provide a statutory section in the [Workers’] Compensation Act, which deals with
the question of overpayment of prejudgment compensation benefits.” Paternoster v.
La Cuesta Cabinets, Inc., 101 N.M. 773, 776, 689 P.2d 289, 292 (Ct. App. 1984)
19
(citation 	omitted). 	Accordingly, 	fundamental 	fairness, 	“which 	balances 	the
compensation goals of the [Workers’ Compensation] Act against the principle of
fundamental fairness toward the employer” guides courts in determining whether and
under what circumstances a credit for overpayment will be permitted. Id. at 779, 689
P.2d at 295. We will not disturb a WCJ’s determination concerning whether a credit
applies absent an abuse of discretion. See id. (“[T]he [district] court has discretion to
make an award of credit which balances the compensation goals of the [Workers’
Compensation] Act against the principle of fundamental fairness toward the
employer.”); West v. Home Care Res., 1999-NMCA-037, ¶ 13, 127 N.M. 78, 976 P.2d
1030 (Ct. App. 1999) (stating that review of the method for applying credit to a
WCJ’s determination is limited to whether the WCJ abused his or her discretion). “An
abuse of discretion occurs when a ruling is clearly contrary to the logical conclusions
demanded by the facts and circumstances of the case.” Sims v. Sims, 1996-NMSC-
078, ¶ 65, 122 N.M. 618, 930 P.2d 153. “A [district] court abuses its discretion when
it exercises its discretion based on a misunderstanding of the law.” 	Chavez v.
Lovelace Sandia Health Sys., Inc., 2008-NMCA-104, ¶ 25, 144 N.M. 578, 189 P.3d
711.
{30} 	Vista Care paid $78,428.38 in lump sum advances for debt to Worker for future
permanent 	partial 	disability 	benefits, 	and, 	at 	the 	time 	the 	WCJ 	issued 	the
20
compensation order, Worker had been overpaid $12,038.90. The WCJ determined
that, although Vista Care was entitled to a credit for any weekly permanent partial
disability or partial temporary total disability payment made after March 14, 2007,
Vista Care was not entitled to a credit for the lump sum permanent partial disability
advances as applied to the awarded temporary total disability benefits because the
advances were purely for permanent partial disability benefits. The WCJ reached this
conclusion that “credit issues are irrelevant to payment of [temporary total disability]
benefits because Worker may potentially receive such benefits beyond [the] 500[-] or
700[-]week limits established under Section 52-1-42.”
{31} 	Apparently, the WCJ concluded that the credit issues were irrelevant to the
payment of temporary total disability benefits because “it is customary to apportion
the credit for lump-sum payments by shortening the number of weeks that
compensation is paid; that is, by applying the credit at the back-end of the weekly
compensation award.” West, 1999-NMCA-037, ¶ 13. Because credits are typically
applied to the back-end of a compensation award, the WCJ apparently concluded that
a credit was not applicable in this case because of the indefinite duration of the
temporary total disability awarded. 	However, as we concluded, Worker may not
receive temporary total disability benefits beyond the 700-week limit established in
Section 52-1-47(A). 	On remand, the WCJ should consider how the 700-week
21
limitation period affects the application of any potential credit for lump sum advances
of permanent partial disability benefits.
CONCLUSION
{32} 	We hold that (1) temporary total disability benefits are subject to the 700-week
durational limitation found in Section 52-1-47(A); (2) the WCJ did not err in
concluding that Worker was not at maximum medical improvement on March 14,
2007 despite a previous finding of maximum medical improvement; and (3) on
remand, the WCJ should consider how the 700-week limitation period affects the
application of any potential credit for lump sum advances of permanent partial
disability benefits. Accordingly, we reverse in part and affirm in part, and we remand
to the WCA for further proceedings consistent with this opinion.
{33} 	IT IS SO ORDERED.
________________________________
JAMES J. WECHSLER, Judge
WE CONCUR:
_______________________________
LINDA M. VANZI, Judge
22
_______________________________
TIMOTHY L. GARCIA, Judge

1 printed pages contain little extracted OCR body text; searchable legal-body completeness has not been established for those pages.

OCR transcription for search; preserved printed pages are authoritative

IN THE COURT OF APPEALS OF THE STATE OF NEW MEXICO

Opinion Number:

Filing Date: _December 13, 2012

NO. 31,438

SHERRIE FOWLER,
Worker Appellee,
V.

VISTA CARE and
AMERICAN HOME INSURANCE COMPANY,

Employer/Insurer-A ppellants.

APPEAL FROM THE WORKERS’ COMPENSATION ADMINISTRATION
Victor S. Lopez, Workers’ Compensation J udge

Dunn Law Offices
Rod Dunn

Albuquerque, NM
for Appellee

Butt Thomton & Baehr PC
Emily A. Franke

David N. Whitham
Albuquerque, NM

for Appellants

OPINION
WECHSLER, Judge.
{1} 	Vista Care and American Home Insurance Co. (Vista Care) appeal from a
compensation order entered in the Workers’ Compensation Administration (WCA)
awarding Sherrie Fowler (Worker) temporary total disability benefits. We consider
various provisions of the Workers’ Compensation Act, NMSA 1978, §§ 52-1-1 to -70
(1929, as amended through 2007), in determining whether (1) temporary total
disability benefits are subject to a durational limit, (2) a previous determination that
a worker is at maximum medical improvement precludes a finding that the worker was
no longer at maximum medical improvement at a later date, and (3) Vista Care is
entitled to a credit against the temporary total disability benefits for previously paid
lump sum payments for future permanent partial disability benefits. We hold that (1)
temporary total disability benefits are subject to the 700-week durational limit found
in Section 52-1-47(A); (2) the Workers’ Compensation Judge (WCJ) did not err in
concluding that Worker was not at maximum medical improvement on March 14,
2007 despite a previous finding of maximum medical improvement; and (3) on
remand, the WCJ should consider how the 700-week limitation period affects the
application of any potential credit for lump sum advances of permanent partial
disability benefits. Accordingly, we reverse in part and affirm in part, and remand to

2
the WCA for further proceedings consistent with this opinion.
BACKGROUND
{2} 	On April 7, 2003, Worker suffered a back injury arising out of, and occurring
in the course of, her employment with Vista Care. As a result of her injury, Worker
underwent a spinal fusion in October 2003. Thereafter, Worker continued to receive
medical care, including multiple spinal surgeries. On January 11, 2006, Dr. James
Thomas found that Worker had reached maximum medical improvement. As a result,
Worker filed a petition for a lump sum payment of permanent partial disability
benefits for payment of debt, pursuant to NMSA 1978, Section 52-5-12(C) (2009).
The WCJ granted the petition on April 27, 2006, finding that Worker had reached
maximum medical improvement prior to April 27, 2006.
{3} 	Worker continued to receive treatment on her injured back, and on February 7,
2007, Dr. Andrew Cash examined Worker. 	Dr. Cash’s evaluation revealed that
Worker suffered from an adjacent level breakdown and stenosis and recommended
that Worker undergo an extension of the previous fusion with decompression. Worker
saw Dr. Cash again on March 14, 2007, and Dr. Cash recommended an anterior-
posterior lumbar fusion of L3-4. After the parties disagreed whether the treatment
suggested by Dr. Cash related to the original injury, Dr. Jose Reyna provided an
independent medical evaluation on October 22, 2009, and concluded that the new

3
injury related to the original injury and that Worker would benefit from the additional
treatment suggested by Dr. Cash. Worker underwent the surgery on July 13, 2010.
The parties have stipulated that Worker has yet to reach maximum medical
improvement following the July 13, 2010 surgery.
{4} 	In the compensation order entered on June 30, 2011 that is the subject of this
appeal, the WCJ concluded that Worker was no longer at maximum medical
improvement as of March 14, 2007. The WCJ awarded temporary total disability to
Worker beginning March 14, 2007, the date at which the WCJ determined that Worker
was no longer at maximum medical improvement, through the date Worker reaches
maximum medical improvement from the July 13, 2010 surgery. The WCJ further
concluded that the temporary total disability benefits were not subject to the 500- or
700-week durational limit found in Section 52-1-42(A), and, therefore, Worker could
be paid benefits for an indefinite period of time. 	Finally, the WCJ concluded that
Vista Care was not entitled to a credit for the lump sum advances of permanent partial
disability benefits to apply to the temporary total disability benefits it awarded.
{5} 	On appeal, Vista Care argues that the WCJ (1) erred in holding that temporary
total disability benefits are not subject to the 500- or 700-week limit in Section 52-1-
42(A) or the 700-week limit found in Section 52-1-47(A) and can potentially be
payable for Worker’s lifetime; (2) erred in concluding that Worker was no longer at

4
maximum medical improvement as of March 14, 2007, despite finding that Worker
was at maximum medical improvement on January 11, 2006; and (3) abused his
discretion in holding that Vista Care is not entitled to a credit for the lump sum
advances of future payments for permanent partial disability benefits when applied to
the additional temporary total disability benefits.
STANDARD OF REVIEW
{6} 	“All workers’ compensation cases are reviewed under a whole record standard
of review.” Moya v. City of Albuquerque, 2008-NMSC-004, ¶ 6, 143 N.M. 258, 175
P.3d 926. When our review consists of reviewing a “WCJ’s interpretation of statutory
requirements, we apply a de novo standard of review.” DeWitt v. Rent-A-Center, Inc.,
2009-NMSC-032, ¶ 14, 146 N.M. 453, 212 P.3d 341. 	“We look first to the plain
meaning of the statute’s words, and we construe the provisions of the [Workers’
Compensation] Act together to produce a harmonious whole. After we determine the
meaning of the statutes, we review the whole record to determine whether the WCJ’s
findings and award are supported by substantial evidence.” 	Id. (internal quotation
marks and citation omitted). “When an agency that is governed by a particular statute
construes or applies that statute, the court will begin by according some deference to
the agency’s interpretation.” 	Morningstar Water Users Ass’n v. N.M. Pub. Util.
Comm’n, 120 N.M. 579, 583, 904 P.2d 28, 32 (1995). However, we are not bound by

5
the agency’s interpretation and may substitute our “own independent judgment for
that of the agency because it is the function of the courts to interpret the law.” Id.
TEMPORARY TOTAL DISABILITY BENEFIT DURATION LIMITS
{7} 	As pertinent to this appeal, the Workers’ Compensation Act provides for
compensation benefits for permanent partial disability in Section 52-1-42 and for total
disability in Section 52-1-41. 	Both sections contain limits on the duration of the
benefits.
{8} 	In relevant part, Section 52-1-42(A) states that:
For permanent partial disability . . . [t]he duration of partial
disability benefits shall depend upon the extent and nature of the partial
disability, subject to the following:
(1) 	where the worker’s percentage of disability is equal
to or greater than eighty, the maximum period is seven hundred weeks;
(2) 	where the worker’s percentage of disability is less
than eighty, the maximum period is five hundred weeks[.]
Section 52-1-41(A) provides that, with exceptions that are not relevant to this appeal,
for total disability, a “worker shall receive compensation benefits for the remainder
of his life.”
{9} 	In addition to these limitation provisions stated together with specific types of
benefits, the Workers’ Compensation Act contains a general provision concerning the
limitation of compensation benefits. Section 52-1-47 provides in relevant part

6
except for provision of lifetime benefits for total disability awarded
pursuant to Section 52-1-41 . . . :
A. 	compensation benefits for any combination of disabilities
or any combination of disabilities and death shall not be payable for a
period in excess of seven hundred weeks[.]
{10} 	The WCJ relied on Section 52-1-41(A) for the proposition that the temporary
total disability benefits are potentially subject to payment over Worker’s lifetime. The
WCJ determined that Section 52-1-41(A) clearly and unambiguously applies to both
permanent and temporary “total disability.” In the WCJ’s view, the “generic” term
“total disability” encompasses both “the temporary and permanent components of the
category.”
{11} 	In its entirety, Section 52-1-41(A) provides:
For total disability, the worker shall receive, during the period of
that disability, sixty-six and two-thirds percent of his average weekly
wage, and not to exceed a maximum compensation of eighty-five percent
of the average weekly wage in the state, a week, effective July 1, 1987
through December 31, 1999, and thereafter not to exceed a maximum
compensation of one hundred percent of the average weekly wage in the
state, a week; and to be not less than a minimum compensation of thirty-
six dollars ($36.00) a week. Except as provided in Subsections B and C
of this section, the worker shall receive compensation benefits for the
remainder of his life.
{12} 	The first sentence of Section 52-1-41(A) establishes the formula to set the
amount of compensation benefits that a worker may receive for total disability “during
the period of that disability.” (Emphasis added.) 	The formula is used to calculate

7
temporary total disability as well as permanent total disability benefits. Cf. Breen v.
Carlsbad Mun. Sch., 2005-NMSC-028, ¶ 1, 138 N.M. 331, 120 P.3d 413 (reviewing
a case in which the worker received benefits under Section 52-1-41(A) for an injury
resulting in a temporary total disability). By the express language of the statute, it
applies only for benefits during the period of the disability. Section 52-1-41(A). The
second sentence, on the other hand, states that, with exceptions for mental impairment
and death, the worker is entitled to receive compensation benefits “for the remainder
of his life.” Section 52-1-41(A). Because this sentence is contained in Section 52-1-
41(A) that begins “[f]or total disability,” we presume that it relates to “total disability”
and means that a worker shall receive compensation benefits for total disability for the
remainder of the worker’s life. See Reule Sun Corp. v. Valles, 2010-NMSC-004, ¶ 30,
147 N.M. 512, 226 P.3d 611 (stating that the placement of language at the beginning
of a clause evinces legislative intent that the clause is meant to apply to the statute in
whole). Nothing in Section 52-1-41(A) explains the connection between a worker’s
entitlement to receive the compensation benefits calculated in the first sentence of
Section 52-1-41(A) for the period of the total disability and the worker’s entitlement
in the second sentence to receive compensation benefits for a total disability for the
remainder of the worker’s life. The language providing “benefits for the remainder
of his life” in the second sentence is inconsistent with temporary total disability,

8
which by definition is temporary and contemplates a worker reaching maximum
medical improvement and returning to work. 	See § 52-1-25.1(A), (B); see also
Madrid v. St. Joseph Hosp., 1996-NMSC-064, ¶ 7, 122 N.M. 524, 928 P.2d 250
(“Eligibility for the various temporary benefits provided under the Act ends at the date
of [maximum medical improvement].”). 	Due to this ambiguity, we focus our
construction of Section 52-1-41(A) outside the plain meaning, focusing on the purpose
of the Workers’ Compensation Act. 	See T-N-T Taxi, Ltd. v. N.M. Pub. Regulation
Comm’n, 2006-NMSC-016, ¶ 5, 139 N.M. 550, 135 P.3d 814 (“[S]tatutes are given
effect as written without room for construction unless the language is doubtful,
ambiguous, or adherence to the literal use of the words would lead to injustice,
absurdity or contradiction, in which case the statute is to be construed according to its
obvious purpose.”).
{13} 	We interpret statutes to fulfill the intent of the Legislature. 	Vescio v. Wolf,
2009-NMCA-129, ¶ 13, 147 N.M. 374, 223 P.3d 371. 	By enacting the Workers’
Compensation Act, the Legislature intended “to protect injured workers from
becoming dependent on public welfare and to provide them with some financial
security.” 	Madrid, 1996-NMSC-064, ¶ 8. 	To achieve this purpose, the Workers’
Compensation Act sets forth grades of disability. Thus, a permanent total disability
is either (1) the permanent and total loss or loss of use of both hands, arms, feet, legs,

9
or eyes, or any two of them, or (2) a traumatic brain injury causing a certain degree
of permanent impairment. 	Section 52-1-25. 	A permanent partial disability is a
permanent impairment. Section 52-1-26(B). Further, workers with a compensable
permanent partial disability “should be provided with the opportunity to return to
gainful employment as soon as possible with minimal dependence on compensation
awards.” Section 52-1-26(A).
{14} 	The Workers’ Compensation Act therefore draws a sharp distinction between
permanent total disability and permanent partial disability. It does not contemplate
that workers suffering a compensable permanent total disability must return to work.
To this end, workers with a permanent total disability receive lifetime compensation
benefits. 	Section 52-1-41(A). 	A permanent partial disability, on the other hand,
justifies only the maximum of 500 or 700 weeks of compensation benefits in
accordance with the legislative purpose of minimal dependence on compensation
awards. Section 52-1-42(A)(1), (2).
{15} 	In addition, the Workers’ Compensation Act ties a worker’s entitlement to
permanent partial disability benefits and temporary total disability benefits to the
worker’s achieving maximum medical improvement. 	Section 52-1-24(A) defines
“impairment” as “an anatomical or functional abnormality existing after the date of
maximum medical improvement.” Further, temporary total disability is defined in

10
relation to maximum medical improvement. It is “the inability of a worker, by reason
of accidental injury arising out of and in the course of the worker’s employment, to
perform the duties of that employment prior to the date of the worker’s maximum
medical improvement.” 	Section 52-1-25.1(A). 	A worker is entitled to receive
temporary total disability benefits if the worker is released to work prior to reaching
maximum medical improvement and returns to work at less than the worker’s pre-
injury wage. Section 52-1-25.1(C).
{16} 	This legislative scheme of the Workers’ Compensation Act resolves the issue
before us. 	See DeWitt, 2009-NMSC-032, ¶ 14. Although the Legislature used the
word “total” with respect to temporary total disability, it did not equate it with the
“total disability” that entitles a worker to benefits for the worker’s remaining life.
Because a designation of temporary total disability contemplates that the worker will
reach maximum medical improvement and return to work, it would be inconsistent for
the Legislature to have intended that workers receiving temporary total disability
benefits be paid for the remainder of the worker’s life. 	Such an interpretation is
inconsistent with the statutory scheme of being able to return to work “with minimal
dependence 	on 	compensation 	awards.” 	Section 	52-1-26(A). 	Indeed, 	this
inconsistency is underscored by the temporary nature of temporary total disability
benefits that are subject to a subsequent determination of maximum medical

11
improvement. See Montoya v. Herrera, 2012-NMSC-011, ¶ 11, 276 P.3d 952 (“We
must take care to avoid adoption of a construction that would render the statute’s
application absurd or unreasonable or lead to injustice or contradiction.” (internal
quotation marks and citation omitted)). 	Although Section 52-1-41(A) does not
specifically make reference to permanent total disability in Section 52-1-25, when we
“construe the provisions of the [Workers’ Compensation] Act together to produce a
harmonious whole[,]” DeWitt, 2009-NMSC-032, ¶ 14, we understand Section 52-1-
41(A) to refer only to a permanent total disability under Section 52-1-25. 	In that
manner, Section 52-1-41(A) fulfills the purpose of the Workers’ Compensation Act
of providing permanent financial security to an injured worker who requires a
permanent source of income for the worker’s lifetime.
{17} 	The WCJ determined, and Worker argues, that the Legislature intended
temporary total disability benefits to “be limited only by the spigot of medical
judgment that a worker is, or is no longer, at [maximum medical improvement]
status.” Under this approach, we would have to read the language providing “benefits
for the remainder of his life” in Section 52-1-41(A) to mean that payment of total
disability benefits is periodic and indefinite in duration over the remainder of the
worker’s lifetime and is dependent solely on whether worker has reached maximum
medical improvement and is entitled to either permanent total disability or permanent

12
temporary disability. 	Had the Legislature intended this approach, the Legislature
would have used clearer language and not provided benefits for the “remainder of [a
worker’s] life[,]” language that implies continuing benefits until death. See Colonias
Dev. Council v. Rhino Envtl. Servs., Inc., 2003-NMCA-141, ¶ 17, 134 N.M. 637, 81
P.3d 580 (stating that the Legislature would have provided a much “clearer indication”
if it had intended a statute to a more expansive meaning), rev’d on other grounds,
2005-NMSC-024, 138 N.M. 133, 117 P.3d 939; Webster’s Third New International
Dictionary 1919 (Unabridged 1993) (defining “remainder” as “ a remaining group,
part, or trace” and “remain” as “to continue unchanged in form, condition, status, or
quantity”). 	A more natural reading of Section 52-1-41(A) is that the Legislature
specifically used the phrase providing “benefits for the remainder of his life” for the
specific purpose of providing lifetime benefits exclusively for permanent total
disability.
{18} 	Moreover, at least one issue before the Court is whether to apply the durational
limit contained in Section 52-1-47(A) to temporary total disability benefits. Section
52-1-47 expressly provides an exception for lifetime benefits awarded under Section
52-1-41(A). By the plain language of Section 52-1-41(A), such lifetime benefits are
benefits that a worker receives for the remainder of the worker’s life. As we have
stated, temporary total disability benefits, by their temporary nature, do not continue

13
for a worker’s lifetime.
{19} 	Because the exception of Section 52-1-41(A) does not apply for temporary total
disability benefits, we must determine the applicable durational limits for temporary
total disability benefits. We turn first to Section 52-1-42. Section 52-1-42(A)(1), (2)
provides a 500- or 700-week duration limit, but it applies only to permanent partial
disability, and temporary total disability is neither “permanent” nor “partial.” 	See
§ 52-1-25.1. However, Section 52-1-42(B) remains relevant. It states:
If an injured worker receives temporary total disability benefits
prior to an award of partial disability benefits, the maximum period for
partial disability benefits shall be reduced by the number of weeks the
worker actually receives temporary total disability benefits.
{20} 	Through Section 52-1-42(B), the Legislature has demonstrated its intent that
temporary total disability benefits are not excepted from the durational limits for
permanent partial benefits. Indeed, by its plain language, Section 52-1-42(B) requires
temporary total disability benefits to be included in the calculation of the durational
limits of subsequent permanent partial benefits. As we have discussed, the design of
the Workers’ Compensation Act is that an injured worker will receive temporary total
disability benefits until the worker has reached maximum medical improvement and
receives permanent partial disability benefits. Sections 52-1-25.1, -26.
{21} 	We acknowledge that there may be situations in which a worker receives
permanent partial disability benefits and subsequently aggravates the injury and

14
qualifies for temporary total disability only to not receive benefits because the worker
exhausted the durational limit for permanent partial disability. Although the Workers’
Compensation Act is intended to protect injured workers and provide financial
security, Madrid, 1996-NMSC-064, ¶ 8, this result is a legislative decision striking a
balance between the interests of the employer and the worker. See NMSA 1978, § 52-
5-1 (1990) (“It is the intent of the [L]egislature [that the Workers’ Compensation Act]
be interpreted to assure the quick and efficient delivery of indemnity and medical
benefits to injured and disabled workers at a reasonable cost to the employers . . .
based on a mutual renunciation of common law rights.”).
{22} 	We next turn to Section 52-1-47(A). Except for the lifetime benefits provision
set forth in Section 52-1-41(A), Section 52-1-47(A) provides a 700-week limit for
“compensation benefits for any combination of disabilities.” (Emphasis added.) The
plain language of Section 52-1-47(A) evinces a legislative intent to provide an
absolute limit of 700 weeks for “any” compensation benefits awarded under the
Worker’s Compensation Act, except for lifetime benefits set forth in Section 52-1-
41(A). We have determined that Section 52-1-41(A) does not apply to temporary total
disability. Thus, because temporary total disability does not fall within the Section
52-1-41(A) lifetime benefits exception, the 700-week durational limit of Section 52-1-
47(A) applies to temporary total disability benefits. 	Although Worker argues that

15
Section 52-1-47(A) contemplates a combination of compensation benefits that does
not include temporary total disability benefits, Section 52-1-47(A) limits to 700 weeks
“compensation benefits for any combination of disabilities” without any exception
other than for lifetime benefits.
{23} 	In sum, the WCJ erred in holding that the temporary total disability benefits
awarded to Worker were subject to payment over an indefinite duration pursuant to
Section 52-1-41(A). The temporary total disability benefits are subject to the 700-
week durational limit in Section 52-1-47(A). We therefore reverse the WCJ on this
issue.
CHANGED MAXIMUM MEDICAL IMPROVEMENT STATUS
{24} 	Vista Care next argues that the WCJ erred in concluding that Worker was no
longer at maximum medical improvement as of March 14, 2007, even though the WCJ
had previously determined that Worker was at maximum medical improvement prior
to April 27, 2006. Particularly, Vista Care argues that Worker’s prior admission that
she was at maximum medical improvement when applying for lump sum payments
precluded the WCJ from determining that Worker was no longer at maximum medical
improvement as of the date that Dr. Cash recommended that Worker undergo the
anterior-posterior lumbar fusion of L3-4.
{25} 	The date of maximum medical improvement is defined as “the date after which

16
further recovery from or lasting improvement to an injury can no longer be reasonably
anticipated based upon reasonable medical probability as determined by a health care
provider.” 	Section 52-1-24.1. 	The Workers’ Compensation Act provides for the
modification of a compensation order. In relevant part, NMSA 1978, Section 52-5-9
(1989) provides that
A. 	Compensation 	orders 	are 	reviewable 	subject 	to 	the
conditions stated in this section upon application of any party in interest
in accordance with the procedures relating to hearings. The [WCJ], after
a hearing, may issue a compensation order to terminate, continue,
reinstate, increase, decrease or otherwise properly affect compensation
benefits provided by the Workers’ Compensation Act . . . .
B. 	A review may be obtained upon application of a party in
interest filed with the director at any time within two years after the date
of the last payment or the denial of benefits upon the following grounds:
(1) 	change in condition[.]
Further, Section 52-1-56 provides that
The [WCJ] may, upon the application of the employer, worker or
other person bound by the compensation order, fix a time and place for
hearing upon the issue of claimant’s recovery. . . . 	If it appears upon
such hearing that the disability of the worker has become more
aggravated or has increased without the fault of the worker, the [WCJ]
shall order an increase in the amount of compensation allowable as the
facts may warrant.
{26} 	Under these statutory provisions, the WCJ had the authority to modify the
maximum medical improvement determination upon a change of condition if
Worker’s injury became aggravated or worsened to an extent that Worker was no

17
longer at maximum medical improvement. No statutory provision precludes such a
modification because Worker previously admitted to being at maximum medical
improvement and requested lump sum payment of benefits. 	Cf. Benny v. Moberg
Welding, 2007-NMCA-124, ¶¶ 6-12, 142 N.M. 501, 167 P.3d 949 (holding that
Section 52-5-9 and Section 52-1-56 provide authority for the WCJ to grant temporary
total disability benefits even after the worker received a lump sum settlement for
permanent partial disability benefits).
{27} 	Based on the evidence presented at trial, the WCJ concluded that “Worker’s
spinal condition slowly deteriorated and aggravated after her April 27, 2006
[maximum medical improvement] date.” Further, the WCJ concluded that “March 14,
2007 was the clear date on which Worker’s condition had changed sufficiently to
warrant a recommendation for scheduling of the surgical procedure” and therefore,
“Worker was no longer at [maximum medical improvement] status for her work
injuries on March 14, 2007.” 	Vista Care does not challenge the sufficiency of the
evidence to support these findings, and the findings are therefore binding on appeal.
Rendleman v. Heinley, 2007-NMCA-009, ¶ 10, 140 N.M. 912, 149 P.3d 1009 (“An
unchallenged finding is binding on appeal.”). The WCJ had the authority to modify
the designation that Worker was at maximum medical improvement and find that
Worker was no longer at maximum medical improvement as of March 14, 2007.

18
{28} 	Vista Care cites Souter v. Ancae Heating & Air Conditioning, 2002-NMCA-
078, 132 N.M. 608, 52 P.3d 980, disproved in part by Benny, 2007-NMCA-124, for
the proposition that “the need for and receipt of additional medical treatment does not
alter the prior date and finding that worker has reached [maximum medical
improvement].” However, Souter dealt with an inapposite issue. In Souter, this Court
held that lump sum payments exhausting a worker’s awarded permanent partial
disability benefits did not preclude the worker from petitioning for a modification of
benefits for a change in condition as long as the worker sought the modification
during the statutory durational period beginning when the permanent partial disability
benefits were first awarded. 	Id. ¶¶ 18-22. 	Souter did not address a change of a
worker’s maximum medical improvement status or a worker’s maximum medical
improvement date and is not applicable to this case.
CREDIT FOR LUMP SUM ADVANCES
{29} 	Vista Care lastly argues that the WCJ erred in determining that Vista Care is not
entitled to a credit for its lump sum advances of future permanent partial disability
benefits applied to the awarded temporary total disability benefits. “New Mexico does
not provide a statutory section in the [Workers’] Compensation Act, which deals with
the question of overpayment of prejudgment compensation benefits.” Paternoster v.
La Cuesta Cabinets, Inc., 101 N.M. 773, 776, 689 P.2d 289, 292 (Ct. App. 1984)

19
(citation 	omitted). 	Accordingly, 	fundamental 	fairness, 	“which 	balances 	the
compensation goals of the [Workers’ Compensation] Act against the principle of
fundamental fairness toward the employer” guides courts in determining whether and
under what circumstances a credit for overpayment will be permitted. Id. at 779, 689
P.2d at 295. We will not disturb a WCJ’s determination concerning whether a credit
applies absent an abuse of discretion. See id. (“[T]he [district] court has discretion to
make an award of credit which balances the compensation goals of the [Workers’
Compensation] Act against the principle of fundamental fairness toward the
employer.”); West v. Home Care Res., 1999-NMCA-037, ¶ 13, 127 N.M. 78, 976 P.2d
1030 (Ct. App. 1999) (stating that review of the method for applying credit to a
WCJ’s determination is limited to whether the WCJ abused his or her discretion). “An
abuse of discretion occurs when a ruling is clearly contrary to the logical conclusions
demanded by the facts and circumstances of the case.” Sims v. Sims, 1996-NMSC-
078, ¶ 65, 122 N.M. 618, 930 P.2d 153. “A [district] court abuses its discretion when
it exercises its discretion based on a misunderstanding of the law.” 	Chavez v.
Lovelace Sandia Health Sys., Inc., 2008-NMCA-104, ¶ 25, 144 N.M. 578, 189 P.3d
711.
{30} 	Vista Care paid $78,428.38 in lump sum advances for debt to Worker for future
permanent 	partial 	disability 	benefits, 	and, 	at 	the 	time 	the 	WCJ 	issued 	the

20
compensation order, Worker had been overpaid $12,038.90. The WCJ determined
that, although Vista Care was entitled to a credit for any weekly permanent partial
disability or partial temporary total disability payment made after March 14, 2007,
Vista Care was not entitled to a credit for the lump sum permanent partial disability
advances as applied to the awarded temporary total disability benefits because the
advances were purely for permanent partial disability benefits. The WCJ reached this
conclusion that “credit issues are irrelevant to payment of [temporary total disability]
benefits because Worker may potentially receive such benefits beyond [the] 500[-] or
700[-]week limits established under Section 52-1-42.”
{31} 	Apparently, the WCJ concluded that the credit issues were irrelevant to the
payment of temporary total disability benefits because “it is customary to apportion
the credit for lump-sum payments by shortening the number of weeks that
compensation is paid; that is, by applying the credit at the back-end of the weekly
compensation award.” West, 1999-NMCA-037, ¶ 13. Because credits are typically
applied to the back-end of a compensation award, the WCJ apparently concluded that
a credit was not applicable in this case because of the indefinite duration of the
temporary total disability awarded. 	However, as we concluded, Worker may not
receive temporary total disability benefits beyond the 700-week limit established in
Section 52-1-47(A). 	On remand, the WCJ should consider how the 700-week

21
limitation period affects the application of any potential credit for lump sum advances
of permanent partial disability benefits.
CONCLUSION
{32} 	We hold that (1) temporary total disability benefits are subject to the 700-week
durational limitation found in Section 52-1-47(A); (2) the WCJ did not err in
concluding that Worker was not at maximum medical improvement on March 14,
2007 despite a previous finding of maximum medical improvement; and (3) on
remand, the WCJ should consider how the 700-week limitation period affects the
application of any potential credit for lump sum advances of permanent partial
disability benefits. Accordingly, we reverse in part and affirm in part, and we remand
to the WCA for further proceedings consistent with this opinion.
{33} 	IT IS SO ORDERED.
________________________________
JAMES J. WECHSLER, Judge
WE CONCUR:
_______________________________
LINDA M. VANZI, Judge

TIMOTHY L. GARCIA, Judge
22

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