Borja v. Labor Commission
2014 UT App 123
| Utah Ct. App. | 2014Background
- On March 7, 2010 Borja injured his low back at work; conservative treatment and epidural steroid injections failed and MRI showed multilevel degenerative changes.
- treating surgeon (Dr. Major) recommended lumbar decompression and fusion; employer’s medical reviewer (Dr. Knoebel) and a statutorily convened medical panel found no objective indications for surgery and observed Waddell signs / pain-amplification behavior.
- The medical panel concluded surgery was not medically justified and recommended non-narcotic medication, exercise, and activity increase.
- Borja objected, arguing Waddell signs are unreliable and that the panel lacked a proper basis; he sought a hearing under Utah Code § 34A-2-601(2)(f)(i). He submitted studies critical of Waddell signs to the Board (some after the panel report).
- The ALJ declined to hold a hearing; the Board affirmed, finding the panel relied on other objective factors (e.g., failure to respond to injections, lack of objective surgical findings) and that Borja’s proffered studies would not have altered the panel’s analysis.
- On judicial review, the court applied abuse-of-discretion review to the ALJ’s refusal to hold a hearing and declined to disturb the Board’s decision.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether ALJ abused discretion by denying a hearing on Borja’s objection to the medical panel report | Borja argued he proffered new, relevant studies undermining Waddell signs and thus warranted a hearing | The ALJ/Board argued the statute gives discretion to deny a hearing and the panel relied on multiple factors beyond Waddell signs, so the studies would not change the outcome | Denied — no abuse of discretion: studies would not have altered panel’s conclusions and ALJ reasonably declined a hearing |
| Whether the medical panel report lacked adequate foundation because it relied on nonmedical/behavioral indicators (Waddell signs) | Borja contended reliance on Waddell signs (unreliable) and behavioral observations exceeded the panel’s expertise and corrupted the report’s foundation | The Board/ALJ noted the panel relied on objective medical findings (failed injections, lack of objective surgical indications) in addition to observed behaviors; record permitted consideration of the report without additional foundational testimony | Held: report admissible without extra foundational testimony; denial of hearing made further foundation unnecessary |
Key Cases Cited
- Johnston v. Labor Comm'n, 307 P.3d 615 (Utah Ct. App. 2013) (agency decision to deny hearing on medical-panel objection reviewed for abuse of discretion; Board is factfinder reviewing all evidence)
- Murray v. Labor Comm'n, 308 P.3d 461 (Utah 2013) (standard of review for agency discretionary decisions is abuse of discretion)
- Certified Bldg. Maint. v. Labor Comm'n, 285 P.3d 831 (Utah Ct. App. 2012) (new evidence must be likely to alter panel analysis to justify a hearing)