Danny's Drywall v. Labor Commission
2014 UT App 277
Utah Ct. App.2014Background
- Claimant (Rafael Suastegui Bernal) fell ~14 feet at work in 2009, sustaining facial and hand fractures, right shoulder tears, headaches, chronic jaw/neck/back pain, and torn/bulging discs; he sought permanent total disability benefits.
- Conflicting medical opinions prompted the ALJ to convene a statutorily authorized medical panel (pain management and psychiatry specialists) to determine Claimant’s "permanent physical restrictions as a result of" the industrial accident.
- The panel reviewed records, interviewed/examined Claimant (family members assisted), diagnosed traumatic brain injury and chronic pain attributable to the accident, and concluded Claimant could not be a productive worker for more than ~4 hours/day with additional absences likely.
- Employer retained a physiatrist (Dr. Chung) who critiqued the panel report without examining Claimant or records; Employer objected to the panel report on scope, probability, and conflicting-evidence grounds.
- The ALJ admitted the panel report, adopted its functional-capacity findings, and awarded permanent total disability; the Labor Commission affirmed on review, and Employer petitioned for judicial review.
Issues
| Issue | Employer's Argument | Claimant/Labor Commission's Argument | Held |
|---|---|---|---|
| Whether the medical panel exceeded its charging order by addressing causation, diagnosis, and care | ALP’s charge limited panel to "permanent physical restrictions"; panel impermissibly reached diagnosis/causation | ALJ’s charge necessarily encompassed identifying conditions and whether they were work-related to assess restrictions; panel authorized to examine and report | Court: No abuse of discretion; causation/diagnosis were properly before the panel |
| Whether the panel’s opinions were only speculative (medical possibility vs. reasonable medical probability) | Panel’s use of terms like "may"/"possible" renders report speculative | Panel expressly stated Claimant "has the following medical conditions" from the accident; read as whole it reflects medical probability | Court: Affirmed Commission; report supports reasonable medical probability |
| Whether panel improperly relied on extra-record statements (family observations) without Employer’s cross-examination rights, violating UAPA and due process | Employer: Family statements were outside the record; Employer was denied right to cross-examine, violating UAPA §63G-4-206 and due process | Medical panels may conduct examinations and obtain history; family statements were noted and consistent with ALJ instructions; Employer did not preserve constitutional argument | Court: Panel’s examination lawful; cross-examination argument unpreserved and rejected on merits insofar as statutory right asserted |
| Whether substantial conflicting evidence (Dr. Chung, other records) required exclusion or reversal of the panel report | Employer: Other substantial evidence supports contrary findings; ALJ/Commission should not rely on panel | Conflicting evidence does not bar adoption of a panel report; factfinder may weigh evidence; medical panels are used because opinions conflict | Court: Commission’s findings supported by substantial evidence; no reweighing by appellate court |
Key Cases Cited
- Jex v. Labor Comm’n, 306 P.3d 799 (Utah 2013) (standards for reviewing mixed questions of law and fact)
- Murray v. Labor Comm’n, 308 P.3d 461 (Utah 2013) (deference framework for mixed questions and fact-finding)
- Blair v. Labor Comm’n, 262 P.3d 456 (Utah Ct. App. 2011) (role and effect of medical panel reports on ALJ/Commission findings)
- Intermountain Health Care, Inc. v. Board of Review of the Indus. Comm’n, 839 P.2d 841 (Utah Ct. App. 1992) (medical panel’s proper role limited to examination/diagnosis as evidence for the commission)
- Greyhound Lines, Inc. v. Wallace, 728 P.2d 1021 (Utah 1986) (accepting one physician’s statements over conflicting medical panel findings is within commission discretion)