NCCI Court Case Update, New Mexico – October 2022

Barrozo v. Albertson’s, Inc.

On October 11, 2022, the Court of Appeals of New Mexico, in Barrozo v. Albertson’s, Inc., ruled that an employer was not required to reimburse an injured employee the full amount the employee spent on medical marijuana that was used as a workers compensation (WC) treatment, but was only required to reimburse up to the maximum allowable payment provided in the fee schedule.

In this case, an injured employee—whose medical marijuana treatment was deemed reasonable and necessary under New Mexico WC laws—sought reimbursement from the employer/WC carrier for the full amount spent on medical marijuana. The Workers’ Compensation Administration found that the employer was only required to reimburse up to the maximum allowable payment provided in the fee schedule. On appeal, the employee argued that the employer was required to cover the full cost of the medical marijuana in accordance with New Mexico statute 52-1-49(A), which requires employers to provide workers reasonable and necessary healthcare services.

The Court of Appeals affirmed the Workers’ Compensation Administration determination that the employer was not required to reimburse the full amount. The court acknowledged that while its prior decision in Vialpando v. Ben’s Auto. Servs., allowed employees to be reimbursed by employers for their medical marijuana costs, it did not address whether such reimbursements are subject to cost limits.

The court went on to note that the statute relied on by the employee does not explicitly require the employer to pay the full cost for healthcare services and that the employee’s argument is contrary to legislative intent that WC laws should be interpreted to assure the quick and efficient delivery of benefits to injured workers at a reasonable cost to the employers.

The court also found that other statutory requirements—such as those set forth in 52-4-5, providing that the fee for services rendered may not exceed the maximum allowed by administrative rule—directly contradicted the employee’s argument. The court concluded that when read together, statutes 52-1-49(A) and 52-4-5 address the employer’s obligation to provide reasonable and necessary healthcare services by covering the cost of those services, but only up to the maximum allowable payment as provided in the fee schedule.

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

For more information on other cases monitored by NCCI’s Legal Division, visit previous Court Case Updates and Court Case Insights, under the Legal section of INSIGHTS on ncci.com.

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