Jones v. Holiday Inn Express & Aig Claims Serv.

331 P.3d 992

Sandy Allen JONES, Worker,

v.HOLIDAY INN EXPRESS and AIG Claims Service n/k/a Chartis Insurance Company, Employer/Insurer/Third–Party Plaintiffs–Appellees/Cross–Appellants,

v.Alea North American Insurance Company and Chubb Services Corporation, Third–Party Defendants–Appellants/Cross–Appellees.

No. 32,698.

Court of Appeals of New Mexico.

May 27, 2014.

Mason & Isaacson, P.A., Thomas Lynn Isaacson, Gallup, NM, for Appellees.

Civerolo, Gralow, Hill & Curtis, Lawrence H. Hill, David M. Wesner, Albuquerque, NM, for Appellants.

OPINION

VIGIL, Judge.

{1} This case presents an issue of first impression: whether the Workers' Compensation Administration (WCA) has jurisdiction over a controversy between workers' compensation insurers, which has no effect on the rights of the worker. The workers' compensation judge (WCJ) found that it had jurisdiction to resolve matters that were ancillary to the purpose of the Workers' Compensation Act (the Compensation Act). We disagree and reverse.

BACKGROUND

{2} Worker injured his back while working for Employer. Thirteen days before the accident, Employer changed its workers' compensation carrier from AIG Claims Services (AIG) to ALEA North American Insurance Company (ALEA). Unaware of the policy change, Employer's assistant manager gave notice to AIG of Worker's claim for benefits. Without researching whether Employer was insured through AIG at that time, an AIG claims specialist accepted the claim and began paying indemnity and medical benefits to Worker. The claims specialist also erred by miscalculating the amount of benefits to which Worker was entitled, a mistake that provided Worker with 700 weeks of benefits instead of 500 weeks. Worker and AIG subsequently entered into a stipulated order awarding Worker a lump-sum payment and benefits at the full amount for the remainder of 700 weeks.

{3} Approximately four years later, AIG discovered it was not Employer's insurer at the time of Worker's accident and that ALEA was the insurer. After demanding that ALEA assume responsibility for making future payments to Worker and reimburse AIG for all benefits it had paid, AIG filed a complaint in the WCA. It asked the WCJ to order ALEA to assume the obligation to pay all future benefits payments to Worker and to reimburse the payments AIG had paid, including the overpayments made due to its calculation error.

{4} For reasons unknown, two WCJs were involved in adjudicating this case. The first WCJ, Judge Martinez, concluded that the WCA lacked jurisdiction to determine whether ALEA must reimburse AIG for benefits it paid Worker because the claim of one insurer against another was outside a WCA's jurisdiction. However, the WCJ retained jurisdiction over the issue of which company should continue paying Worker's benefits.

{5} The second WCJ, Judge Riley, decided the merits of the case. In response to AIG's continued pursuit of reimbursement for indemnity benefits it paid Worker, Judge Riley concluded that Judge Martinez's order regarding the WCA's lack of jurisdiction on that issue was the law of the case. However, Judge Riley determined that it was no longer equitable for the lump-sum order to have prospective effect and ruled that ALEA would be responsible for paying Worker's future indemnity benefits at an amount agreed to by the parties.

{6} Regarding Worker's medical benefits, Judge Riley concluded that because neither the lump-sum settlement nor Judge Martinez's order addressed them, she had jurisdiction to determine which carrier should be paying them. Judge Riley ordered ALEA to assume responsibility for Worker's future medical expenses and to reimburse AIG for the medical payments it had made on behalf of Worker because it was Employer's carrier at the time of Worker's accident.

{7} ALEA appeals the WCJ's determination that the WCA had jurisdiction to hear any of AIG's claims against ALEA. AIG cross-appeals the WCJ's determination that the WCA lacked jurisdiction over AIG's claim for reimbursement of indemnity payments. Because we conclude the WCA lacked jurisdiction over this controversy, our decision disposes of AIG's cross-appeal and makes it unnecessary to address ALEA's additional arguments that the WCJ erred on the merits.

DISCUSSION

{8} This is a controversy between insurers that arose long after Worker's benefits claim had been decided. The parties do not dispute that Worker will be entitled to his past, present, and future benefits regardless of the outcome of this controversy. Thus, the only issue is whether the WCA has jurisdiction over a dispute that does not involve Worker and only involves legal issues between the insurers.

The WCA's Jurisdiction

{9} It is well-settled that an agency only has jurisdiction to decide matters that the Legislature has granted it by statute. See Morningstar Water Users Ass'n v. N.M. Pub. Util. Comm'n, 1995–NMSC–062, ¶ 13, 120 N.M. 579, 904 P.2d 28 (“As an administrative body created by statute, the agency's authority and jurisdiction are defined by statute.”); Eldridge v. Circle K Corp., 1997–NMCA–022, ¶ 7, 123 N.M. 145, 934 P.2d 1074 (“Agency jurisdiction is defined by statute and the determination of whether agency jurisdiction exists in a case is a question of law.”); 100 C.J.S. Workers' Compensation § 916 (2014) (“Workers' compensation courts are tribunals of limited and special jurisdiction and have only such authority as has been conferred on them by statute.”). The statute governing the agency must confer jurisdiction over a matter “either expressly or by necessary implication.” N.M. Elec. Serv. Co. v. N.M. Pub. Serv. Comm'n, 1970–NMSC–097, ¶ 4, 81 N.M. 683, 472 P.2d 648. Thus, the WCA, as a statutorily created agency, is an administrative agency with limited jurisdiction.

{10} Because the scope of the WCA's jurisdiction is statutorily defined, we examine the Workers' Compensation Administration Act (the Administration Act), NMSA 1978, §§ 52–5–1 to –22 (1987, as amended through 2013), as well as the Compensation Act, NMSA 1978, §§ 52–1–1 to –70 (1929, as amended through 2013) (collectively, the workers' compensation acts) to determine the scope of the WCA's jurisdiction in this case. We apply de novo review to interpret the meaning of a statute. Hall v. Carlsbad Supermarket/IGA, 2008–NMCA–026, ¶ 7, 143 N.M. 479, 177 P.3d 530; see also Eldridge, 1997–NMCA–022, ¶ 7, 123 N.M. 145, 934 P.2d 1074 (explaining that, although we “may accord deference to an agency's determination on factual matters involving agency expertise, [we are] not bound by the agency's interpretation of its jurisdiction”). In construing a statute, we first examine the plain meaning of the statute's words. Grine v. Peabody Natural Res., 2006–NMSC–031, ¶ 17, 140 N.M. 30, 139 P.3d 190. We also “construe the provisions of [an act] together to produce a harmonious whole.” Id. When engaging in statutory construction, our primary concern “is to determine and give effect to legislative intent.” Eldridge, 1997–NMCA–022, ¶ 10, 123 N.M. 145, 934 P.2d 1074.

{11} With its creation of the WCA, the Legislature gave the WCA exclusive jurisdiction over workers' compensation cases, removing these cases from the district court's jurisdiction. Wylie Corp. v. Mowrer, 1986–NMSC–075, ¶¶ 1, 8, 104 N.M. 751, 726 P.2d 1381 (explaining changes in the CompensationAct to include the creation of the WCA, which divested the district court of jurisdiction over workers' compensation cases); see also Tracy E. McGee, Workers' Compensation Law, 18 N.M. L.Rev. 579, 579 n. 1 (1988) (same). In creating the WCA, the Legislature declared that the purpose of the WCA is “to assure the quick and efficient delivery of indemnity and medical benefits to injured and disabled workers at a reasonable cost to the employers.” Section 52–5–1; see Eldridge, 1997–NMCA–022, ¶ 23, 123 N.M. 145, 934 P.2d 1074 (citing to Section 52–5–1 to declare that the WCA was created in order “to manage benefit payments to workers injured in work-related accidents by the use of specialized tribunals that could quickly and efficiently process a large volume of cases by the use of informal and expedited procedures”).

{12} Most states that have held that a workers' compensation agency does have jurisdiction over disputes between insurers concluded that statutes expressly conferred jurisdiction to the agency over such disputes. See, e.g., Midwest PMS v. Olsen, 279 Neb. 492, 778 N.W.2d 727, 729–33 (2010) (noting that the Nebraska workers' compensation act gave the workers' compensation court jurisdiction to resolve “any issue ancillary” to the employee's right to benefits, in addition to deciding disputed claims for workers' compensation and concluding that a dispute between insurers fell under the court's jurisdiction to resolve “ancillary” matters (internal quotation marks and citation omitted)); see also Larkin v. Regis Hair Stylists, 2002–127 (La.App. 3 Cir. 5/15/02); 817 So.2d 1266, 1267–68 (noting that the Louisiana legislature amended its workers' compensation act in 1997, vesting the workers' compensation judge with exclusive jurisdiction over certain claims, including “cross-claims between employers or workers' compensation insurers for indemnification or contribution” (emphasis omitted)); In re Comp. of Reynolds, 55 Or.App. 487, 638 P.2d 495, 496–97 (1982) (noting that the Oregon workers' compensation board formerly had jurisdiction to resolve disputes over liability between insurance carriers until the legislature amended the statute to transfer that jurisdiction to the director of the board).

{13} In New Mexico, our workers' compensation acts do not have any such express provision granting the WCA jurisdiction over this type of dispute between insurers. The express terms of the Administration Act limit the WCA to resolving disputes that arise under the Compensation Act. Specifically, Section 52–5–5(A) provides that a party may file a claim in the WCA for a dispute that “arises under the ... ...