State News : Utah

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Utah

SCALLEY READING BATES HANSEN & RASMUSSEN, P.C.

  801-531-7968

Challenge to Qualification of Medical Panel Rejected

 Frank Horning v. Labor Commission, Aeroscape and American Liberty Insurance.  2023 Ut. App 30 (April 6, 2023). Mr. Horning lost consciousness at work when a weed trimmer fell off a shelf striking him in the head. He complained of continuing psychological issues long after the accident. When his carrier cut off benefits, he requested a hearing. The ALJ relying on a medical panel report denied ongoing benefits. Mr. Horning challenged the qualifications of the medical panel. The ALJ and the Labor Commission also denied benefits. Horning appealed and on Appeal, the Utah Court of Appeals rejected Horning’s claim that the panel was not qualified based on the record which clearly indicated that both panel members specialized in the treatment of the disease or condition involved in the claim.

Apportioning Benefits Requires Proof of Aggravation

 Dirk W. Barker v. Labor Commission, Burrell Mining Products, and Zurich American Insurance Company of Illinois, 2023 Ut.App.31 (April 6, 2023). Mr. Barker, a longtime cigarette smoker, was exposed to welding fumes, fly ash, cement and foam concentrate at work for approximately 25 years. He was diagnosed with a chronic breathing disorder which prevented him from working. The ALJ required him to undergo an insurer’s exam without recording. The ALJ approved his application seeking permanent total disability benefits but reduced those benefits by 75% based on its finding that disorder was 75% attributable to non-industrial causes (ie smoking.) The Utah Appeals Board upheld those determinations and Barker appealed to the Utah Court of Appeals. The Court of Appeals held that under Utah R.Civ.P.35(a) the ALJ erred in ordering Barker to undergo an insurer’s exam without a recording. The Court of Appeals also held the Board erred in apportioning benefits among causes of his disease rather than causes of his disability. The Court explained its decision by pointing out that Barker’s disability was caused by only one disease: COPD with emphysema and where there was no evidence that his disease was aggravated by any other disease or that any other disease contributed to Barker’s disability, apportionment was not appropriate under Utah Code Ann. §34A-3-110 (3) or (4) of Utah’s apportionment statute.

Need for Cognitive Behavioral Therapy Affirmed

 Suzi Poyfair v. CR England, Indemnity Insurance Company of North America. 2023 Ut.App.40 (April 20, 2023). Suzi Poyfair suffered a work-related injury. The administrative law judge referred the case to a medical panel. The Panel opined that she was limited in her ability to remain at work, had decreased degree of flexibility, strength, and endurance. The panel recommended treatment options including cognitive behavioral therapy which it stated, “may be beneficial.” The Appeal Board rejected the Employer’s objections to use of the word “may”, indicating its recommendation was not made based on the standard of medical probability. The Court of Appeals affirmed the Appeals Board finding that when the report is reviewed “as a whole”, it supports the recommendation of cognitive behavioral therapy to a reasonable medical probability.

 

 

© Copyright 2023 by Ford G. Scalley, Scalley Reading Bates Hansen & Rasmussen, P.C.

TRENDS

1.   Frank Horning v. Labor Commission. Aeroscape and American Liberty Insurance. 2023 Ut.App 30 (April 6,2023). Mr. Horning lost consciousness at work when a weed trimmer fell off a shelf striking him in the head. He complained of continuing psychological issues long after the accident. He received workers compensation benefits for some time. When his employer cut off benefits, He requested a hearing. The AU relying on a medical panel report denied ongoing benefits. Mr. Horning challenged the qualifications of the medical panel, but the AU overruled the objection. Horning sought review before the Labor Commission, which also denied ongoing benefits. Horning appealed to the Utah Court of Appeals . On Appeal, The Utah Court of Appeals rejected Homing's claim that the panel was not qualified based on the record which clearly indicated that both panel members specialized in the treatment of the disease or condition involved in the claim. In declining to disturb the Commission's decision, the Court of Appeals also rejected the argument that the Commission abused its discretion in relying soley on the medical panel's report, and held that the Commission's findings were supported by the entirety of the medical record including the corroborating opinions of other doctors.

 

2.  Dirk W. Barker v. Labor Commission. Burrell Mining Products. and Zurich American Insurance Company Of Illinois, 2023 Ut.App.31 (April 6,2023). Dirk W. Barker, a longtime cigarette smoker, was also exposed to welding fumes, fly ash, cement and foam concentrate at work for approximately 25 years . He was diagnosed with a chronic breathing disorder which prevented him from working. The AU required him to undergo an insurer's exam without recording. The AU also approved his application seeking permanent total disability benefits, but reduced those benefits by 75% based on its finding that his disorder was 75% attributable to non-industrial causes-ie., his smoking. The Utah Appeals Board upheld those determinations. Barker appealed to the Utah Court of Appeals to determine (1) whether he should have been permitted to make a video recording of the insurer's exam and (2) whether the Board correctly apportioned his award. In response to the first question the Court of appeals held that under Utah R.Civ.P.35(a) the AU erred in ordering Barker to undergo an insurer's exam without a recording. The Court of Appeals also held the Board erred in apportioning benefits among causes of his disease rather than causes of his disability. The Court of Appeals went on to explain its decision by pointing out that where Barker's disability was caused by only one disease: COPD with emphysema and where there is no evidence that this disease was aggravated by any other disease or that any other disease contributed to Barker's disability, apportionment was not appropriate under Utah Code Ann. §34A-3-110 (3) or (4) of Utah's apportionment statute.

 

 

 

© Copyright 2023 by Ford g. Scalley, Scalley Reading Bates Hansen & Rasmussen,P.C.