440 P.3d 916
Utah Ct. App.2019Background
- In Aug. 2012 David Fox, a Clean Harbors employee, suffered a high‑pressure water injury to his right hand at work and underwent multiple surgeries and therapies.
- Three treating physicians (Doctors 1–3) diagnosed Fox with Complex Regional Pain Syndrome (CRPS); a fourth (Doctor 4), retained by employer/insurer, concluded Fox did not have CRPS using the 2000 AMA Guides criteria.
- An ALJ referred medical causation and related issues to an impartial two‑doctor medical panel; the Panel diagnosed CRPS using the more recent Budapest Criteria and concluded the condition was caused by the workplace accident.
- Clean Harbors objected to the Panel report, arguing Utah Admin. Code R612‑300‑9(A) required use of the 2000 AMA Guides (via the 2006 Utah Guides) for CRPS diagnosis and thus the Panel’s report was inadmissible.
- The ALJ and the Utah Labor Commission rejected that argument, concluding the rule applies only to establishing impairment ratings (not general diagnosis) and that the Panel’s report was admissible and persuasive.
- The Court of Appeals affirmed, holding the Commission did not abuse its discretion in admitting and relying on the Panel report and in awarding permanent total disability benefits.
Issues
| Issue | Fox (Plaintiff) | Clean Harbors (Defendant) | Held |
|---|---|---|---|
| Whether the Labor Commission rule (R612‑300‑9) required exclusion of the medical panel report because the Panel did not apply the 2000 AMA Guides | Rule applies only to impairment ratings; current diagnostic standards (Budapest Criteria) govern diagnosis | Rule requires use of 2000 AMA Guides (via 2006 Utah Guides) for CRPS diagnosis so Panel’s report is improper | Rule applies only to impairment‑rating proceedings; Panel properly used current diagnostic criteria; report admissible |
| Whether the ALJ abused discretion by denying a hearing on Clean Harbors’ objection to the Panel report | Objection merits hearing because report used different diagnostic standard | Denial proper because objection rests on misapplication of the Rule | No abuse of discretion; objection was not well taken and hearing denial proper |
Key Cases Cited
- Bade‑Brown v. Labor Comm’n, 372 P.3d 44 (Utah Ct. App. 2016) (standards for admitting medical panel reports and reviewing ALJ discretion)
- Sierra Club v. Air Quality Bd., 226 P.3d 719 (Utah 2009) (interpretation of administrative rules like statutes)
- Olsen v. Samuel McIntyre Inv. Co., 956 P.2d 257 (Utah 1998) (workers’ compensation statutes construed liberally in favor of employee coverage)
- Foye v. Labor Comm’n, 428 P.3d 26 (Utah Ct. App. 2018) (ALJ discretion to adopt or reject medical panel findings)
- Hutchings v. Labor Comm’n, 378 P.3d 1273 (Utah Ct. App. 2016) (medical causation is a factual determination)