Giron v. Labor Comm'n

539 P.3d 822

Theresa R. GIRON, Petitioner,

v.LABOR COMMISSION, Black Diamond Equipment, and Workers’ Compensation Fund, Respondents.

No. 20220342-CA

Court of Appeals of Utah.

Filed November 2, 2023

Loren M. Lambert, Midvale, Attorney for Petitioner

Hans M. Scheffler, Attorney for Respondents Black Diamond Equipment and Workers’ Compensation Fund

Judge Amy J. Oliver authored this Opinion, in which Judges Gregory K. Orme and Michele M. Christiansen Forster concurred.

Opinion

OLIVER, Judge:

¶1 In April 2017, Theresa R. Giron injured her back at work. A few months later, Giron was diagnosed with a degenerative disc disorder that had been aggravated by the workplace accident. Initially, Giron's medical bills for the injury were paid by her employer, Black Diamond Equipment (Black Diamond), and its insurance carrier at the time of the accident, Workers’ Compensation Fund (WCF; collectively, Respondents). Respondents stopped paying on Giron's claim several months later, and nearly two years after that, Giron initiated a formal adjudicative proceeding against Respondents through the Utah Labor Commission (the Commission) for medical expenses and lost wages. The administrative law judge (the ALJ) dismissed the case after a medical panel opined that Giron had reached maximum medical improvement (MMI) by the end of 2017. On review, the Appeals Board of the Commission (the Board) set aside the ALJ's order and issued an order of remand. On remand, the ALJ awarded Giron medical and compensation benefits, and Respondents sought review. After referring the matter back to the medical panel, the ALJ awarded Giron past medical expenses but denied recommended medical care, and the Board affirmed. Giron now seeks judicial review of the Commission's decision. We conclude that the Board had substantial evidence to support its conclusion, Giron's claim of the medical panel's impartiality is procedurally barred, and the ALJ's evidentiary rulings were not an abuse of discretion. Accordingly, we decline to disturb the Commission's decision.

BACKGROUND¹

Work Injury and Initial Treatment

¶2 Giron's job at Black Diamond entailed fulfilling customer orders by pulling items—ranging from skis to gloves—off the shelves at a warehouse and scanning them. During a shift in April 2017, Giron was pulling an "old" and "worn" cardboard box weighing approximately fifty pounds with six pairs of skis in it from a middle shelf at waist level. Giron had to twist her body to pull the long box free from the shelf. She then let it fall to the ground because it was too heavy for her to carry. When Giron bent over to pick up one end of the box and drag it to a cart, she felt pain in her back that radiated down the right side of her leg. The next day, Giron reported a complaint of lower back pain to Intermountain WorkMed (WorkMed). The WorkMed doctor diagnosed Giron with a lumbar strain, prescribed a muscle relaxant, and placed Giron on the following work restrictions: "no lifting more than 10 pounds, minimal bending at the waist, and change positions as necessary."

¶3 Over the next several months, the WorkMed doctor reduced Giron's work restrictions and recommended Giron continue to do her home exercises and use ice and heat. In early June, WorkMed requested an MRI, and in August, Giron was seen by the doctor recommended by WorkMed, Richard Hurst, MD who used the MRI to diagnose Giron with a degenerative back condition. Dr. Hurst discussed surgical options and recommended injections; Giron elected not to get the injections at that time.

¶4 In November, Giron's claim was "denied as noncompensable" and Respondents stopped paying Giron's medical expenses related to the workplace injury.

Formal Adjudicative Proceedings

¶5 In June 2019, almost two years after the ALJ denied Giron's claim, Giron initiated a formal adjudicative proceeding against Respondents, seeking medical expenses related to her workplace injury and lost wages.² Giron and WCF submitted reports by their respective experts to the ALJ. Giron's expert, Jeffrey F. Clayton, DC, opined that Giron's "mechanism of injury is related to her current medical conditions ... which play a role in her current condition." Zoran Maric, MD, submitted a medical report opining that "Giron has subjective pain complaints and no objective findings to substantiate those complaints." Dr. Clayton opined Giron was at MMI in July 2018 and Dr. Maric placed Giron's MMI in May 2017.

¶6 Before the evidentiary hearing was held, Respondents filed a motion in limine to prevent Dr. Clayton from testifying. The ALJ granted the motion, reasoning that Giron had "not provided sufficient justification as to why the [c]ourt would need to hear" the expert's "testimony, rather than rely on his opinion in the [medical records exhibit]" as is the custom in such proceedings.

¶7 At the December 2019 evidentiary hearing, Giron asked the ALJ to strike the following statement in Dr. Maric's report: "Giron does not appear to be happy with her employer. She expressed significant dissatisfaction that she was not provided help to lift these large ski boxes. Medical studies have shown that dissatisfied employees file workers’ compensation claims much more often than satisfied employees." Giron argued this statement cast doubt on her credibility and should be stricken for being prejudicial and unreliable. The expert's full, unredacted report was admitted into the record.

¶8 In January 2020, the ALJ referred the disputed medical issues to a medical panel, appointing Jeremy Biggs, MD as its chair and directing him to "select the specialists" to assist in his evaluation.³ See Utah Admin. Code R602-2-2 ; Utah Code § 34A-2-601. In February, Giron sent a letter to the ALJ, requesting that none of the medical panel members have association with "NIOSH, Rocky Mountain Center for Occupational and Environmental Health, PEHP, any workers’ compensation or disability insurance provider or any provider who performs defense medical evaluations."⁴ Giron did not include any supporting exhibits or evidence in the single-page letter. The ALJ denied Giron's unsupported request, concluding that it had "no basis in fact or law" and was merely "speculative."

First Medical Report

¶9 In its initial report, the medical panel opined that Giron "suffered an acute exacerbation of her chronic underlying lumbar degenerative disease due to lifting and twisting of heavy objects on the day of the industrial accident." The panel agreed with Dr. Hurst's diagnosis that Giron had "severe facet joint arthritis" that caused " ‘severe’ degenerative disc disease" and opined that these conditions existed before the "lifting injury ... but having them present contributed to the pain" Giron was experiencing. The panel also agreed with Dr. Hurst's recommended injections. The report went on to agree that the doctor visits, MRI, physical therapy, and medications Giron received until the end of December 2017 were necessary and "reasonably related to the injury."

¶10 The medical panel filed its report with the ALJ in July 2020 without objection. The ALJ issued findings of fact and conclusions of law, finding legal causation for Giron's repetitive trauma claim from 2014 to 2017 but not for her workplace injury. The ALJ found no medical causation, however, concluding that Giron "has failed to show by a preponderance of the evidence that her repetitive work activities medically caused her industrial injury," and dismissed the case with prejudice.

¶11 Giron filed a motion for review. The Board conducted a "totality of the circumstances" analysis of Giron's "employment activity" as required by the Utah Supreme Court, see Murray v. Utah Labor Comm'n , 2013 UT 38, ¶¶ 47–48, 308 P.3d 461, and concluded that Giron meets "the more stringent standard of legal causation given the unusual or extraordinary exertion involved in the work activity that precipitated her work injury." Having established legal causation for her workplace injury, the Board remanded the matter for further proceedings.

¶12 The ALJ then issued findings of fact, conclusions of law, and an order on remand, in which the ALJ found legal but not medical causation for the repetitive trauma claim, dismissing that claim with prejudice. The ALJ awarded medical expenses for the care Giron received to treat her workplace injury, including the "MRI in July 2017" and "doctor visits, physical therapy and medications until the end of December 2017." The ALJ then awarded the "recommended medical care" of injections and "ongoing temporary total disability compensation until medical stability is reached."

¶13 WCF then filed a motion for review. The Board concluded there was both legal and medical causation, affirmed the total disability award, and remanded for clarification about whether the medical care awarded by the ALJ was for Giron's work injury or her underlying condition. The ALJ, in turn, referred the matter back to the medical panel for clarification on whether and when Giron's injuries had "become medically stable" and "regarding its statements on necessary medical care."

Second Medical Report

¶14 The medical panel provided an addendum to its initial report that stated, "It is our medical opinion that the acute exacerbation that occurred on 4-13-2017 in relation to [Giron's] work injury [was] medically stable by 12-31-2017. The recommended injections we discussed were for treatment of her underlying spine disease and not her original injury." The report also opined that no future medical care is "reasonably necessary to treat [Giron's] industrial conditions, including medications." Giron filed an objection to this report.

¶15 The ALJ again issued findings of fact, conclusions of law, and an order on remand. The ALJ dismissed Giron's claims for temporary total disability and for recommended medical care with prejudice, but granted Giron's medical expenses claim. Respondents were ordered to pay Giron her "compensable historical medical expenses" including "doctor visits,...