State News : Utah

LEGISLATIVE AND CASE LAW UPDATE

Senate Bill 190 is a workers compensation bill passed this 2025 session. It allows the Utah Labor Cimmission to establish a fee schedule for hospitals which may charge for services based on Medicare reimbursement rates if the commission so determines. This bill also prohibits balance billing by Hospitals.

House Bill 301 is another workers compensation bill that passed. It provides for a maximum base rate at which ground ambulances can charge workers compensation and health insurers for ambulance services and provides that mileage rates will be set by rule. This bill also prohibits balance billing.

Darden Restaurant v. Chinyu James Sun v. Labor Commission, 2024 UT App 153 (Issued Oct. 24, 2024)

                Chinyu James Sun suffered injuries in July of 2020 to his neck and right shoulder when he slipped and fell while carrying a tub of ice, causing him to hit his head on a wall and right shoulder on an ice machine. Although his whole upper body was hurting, his right shoulder injury was the worst. Sun did not file a formal accident report but alleged that he informed the Darden Restaurant management in a voicemail the day of the accident. Following an evidentiary hearing in which the Darden director denied getting a voicemail about the accident, the Utah Labor Commission Administrative Law Judge determined that Sun failed to give timely notice within 180 days of his injury as required under Utah Code. Ann. §34A-2-407. On Motion for Review, the Labor Commission Appeals Board concluded that because Sun was not aware his cervical injury was likely caused by the accident until February 2021, there was no prejudice to Darden, and the neck claim was not time barred. However, the Board affirmed the ALJ decision as to the right shoulder claim. Darden appealed the determination that the neck claim was not time barred. Sun filed a cross-petition arguing that the shoulder claim should not have been dismissed because of untimely notice. The Utah Court of Appeals affirmed the Board’s decision to dismiss the shoulder claim but set aside the Board’s decision to allow the neck claim. The Court reasoned that, under rules of statutory construction of the provision of the reporting statute, that a claim is barred if the injured worker fails to notify the employee within 180 days of the day on which the injury occurs. Sun’s reliance upon earlier case law interpreting an earlier statute was rejected because the legislature had removed the language allowing full benefits if there was no prejudice to the employer.

C.R. England Inc. v. Labor Commission, 2024 UT App 170 (Issued Nov. 15, 2024)

                Jeziah Johnson (Johnson) was resting in a sleeper berth traveling down the road when his co-driver had to swerve to miss another vehicle. The rollover caused Johnson to sustain both low back pain and an unspecified head injury. Respondents medical evaluation concluded that Johnson sustained only a concussion, an eyebrow laceration, and a low back strain/sprain as a result of the accident. Johson’s neurologist concluded that, in addition to injuries noted above, Johnson suffered headaches, anxiety and depression because of the accident. 

                The Utah Labor Commission’s Administrative Law Judge referred the issues of causation to a medical panel. The medical panel concluded the accident caused headaches and permanently aggravated psychological injuries. The panel also mentioned that Johnson smoked cannabis which also could be contributing to his conditions. The Respondents objected to the report which suggested two reasons for the psychological injuries: namely, both the accident and the cannabis use. The ALJ agreed and requested that the medical panel clarify the report. The medical panel agreed that the cannabis use did indeed worsen Johson’s conditions but that it only worsened those conditions already caused by the accident. The ALJ ultimately awarded benefits, and, on Motion for Review, the Labor Commission affirmed. On appeal, the Utah Court of Appeals held that there was substantial evidence supporting the decisions of the Labor Commission and that Johnson could prevail on the issue of causation simply by showing that the accident was a cause, and not necessarily the only cause, of Johnson’s injuries.

Waxies Enterprises inc. v. Thomas Halladay, 2025 UT App 7 (Issued Jan. 16, 2025)

                Thomas Halladay and Waxies Enterprises entered into a settlement agreement that included a Medicare Set Aside Allocation (MSA). After the settlement agreement was approved by the Administrative Law Judge (ALJ), Waxies asked Halladay to sign two additional documents that would allow Waxies to assign its ongoing obligations under the MSA to a third party and to provide payments that would last 14 years, but only if Halladay was still living. Halladay refused to sign these documents. Halliday’s view was that the settlement agreement specifically provided for payments to be made so long as he lived which could be longer than 14 years. Waxies asked the Utah Labor Commission (Commission) to either compel Halladay to sign the additional documents or, in the alternative to set aside the settlement agreement entirely and for Halladay to reimburse the funds already paid under the settlement agreement. The ALJ assigned to the case rejected these options. On a Motion for Review the Commission’s Appeals Board affirmed the ALJ’s decision. On judicial review, the Utah Court of Appeals concluded that because there was not a meeting of the minds on how long the yearly benefits were to be paid under the MSA, the Commission had authority under its continuing jurisdiction to set aside the settlement agreement due to a lack of a meeting of the minds on a material provision. The Court also instructed the Commission to “revisit” the issue of whether there was a meeting of the minds.

© Copyright 2025 by Ford G. Scalley, Scalley Reading Bates Hansen & Rasmussen, P.C.

UTAH

TRENDS

UTAH COURT OF APPELAS DECISION RE: LABOR COMMISSION AUTHORITY TO RESCIND PRIOR APPROVAL OF SETTLEMENT AGREEMENT

Waxies Enterprises, Inc. v. Halladay, 2025 UT App 7 (January 16, 2025)

After reaching a settlement of a claim made for injuries suffered while on the job, which the Labor Commission approved, the parties discovered they had different ideas about how to interpret one of the agreement’s material terms. The employer moved to have the Labor Commission either compel the employee to sign additional documents to implement its understanding of the agreement or set aside the prior approval of the agreement. The Labor Commission denied both requests. On appeal, the Utah Court of Appeals affirmed the denial of the motion to compel but reversed the denial of the motion to set aside. With respect to the latter, the court reiterated prior precedent that the Labor Commission has continuing jurisdiction that encompasses the authority district courts have under Rule 60 of the Utah Rules of Civil Procedure. The court went on to hold the Labor Commission had the authority to rescind its prior approval of the settlement agreement once it was presented with a substantial question as to whether there had been a meeting of the minds on the material term at issue.  Because the appeals Board ruled that it lacked such authority, Utah Court of Appeals set aside that decision and instructed the labor Commission to revisit the issue.

© Copyright 2025 by Ford G. Scalley, Scalley Reading Bates Hansen & Rasmussen, P.C.

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.