Opinion
Case No. 20090534-CA.
Filed September 17, 2009. Not For Official Publication
Original Proceeding in this Court.
Suzanne A. Gallegos, Salt Lake City, Petitioner Pro Se.
Hans M. Scheffler, Salt Lake City, for Respondents Department of Alcoholic Beverage Control and Workers' Compensation Fund.
Before Judges Bench, Davis, and McHugh.
MEMORANDUM DECISION
Suzanne A. Gallegos seeks judicial review of the decision of the Labor Commission denying additional workers' compensation benefits from a 2002 incident. This case is before the court on a sua sponte motion for summary disposition for insubstantial question.
Gallegos injured her lower back on April 29, 2002, after lifting cases of beer during her employment by the Utah Department of Alcoholic Beverage Control (UDABC). The Workers' Compensation Fund, as insurer for UDABC, paid temporary total disability from April 30 to December 2, 2002; paid permanent partial disability; and paid medical expenses. On December 2, 2002, Respondents' medical reviewer conducted an independent medical examination (IME) and reported that degenerative changes in the lumbar spine existed before the industrial injury. The IME opined that Gallegos had achieved maximum medical improvement from the April 2002 injury as of December 2, 2002.
In October 2007, Gallegos had back surgery and claimed additional benefits as a result of the April 29, 2002 industrial accident. The Administrative Law Judge (ALJ) issued a Stipulation and Order for Direct Referral to Medical Panel in which the parties waived their right to a hearing and agreed that the matter should be referred directly to a medical panel. The medical panel was instructed that "[a] medical controversy exists as to whether or not the petitioner's back condition after December 2002, and her subsequent surgery, is medically causally related to the April 29, 2002 accident and when she became medically stable as a result."
The medical panel issued its report after reviewing the medical history with Gallegos, examining her, reviewing imaging studies, and reviewing medical records generated by nineteen providers and medical facilities. The report concluded that there was no medically demonstrable causal connection between Gallegos's condition after December 2002 and the April 29, 2002 accident. The panel concluded that the progressive lumbar degenerative disk and joint changes would have occurred at the same rate with or without the April 29, 2002 industrial accident. The panel further concluded that medical stability from the accident had occurred by the time of the December 2, 2002 IME; that medical care since December 2002 was the result of the ongoing progressive degenerative lumbar disk disease and not the work injury of April 29, 2002; and that the 2007 surgery was due to a progression of degenerative changes and not the 2002 injury.
The ALJ concluded that Gallegos failed to meet her burden of proving that a medical causal connection existed between her low back condition after December 2002 and the April 29, 2002 industrial accident. A Labor Commissioner affirmed the ALJ's decision, accepting "the impartial medical panel's findings that these continuing problems are caused by Ms. Gallegos's degenerative spinal condition, rather than the work accident of April 29, 2002." The Labor Commission denied a request for reconsideration.
Gallegos contends that she was denied an opportunity to present her case, claiming the ALJ forced her to retain counsel who agreed to allow the independent medical panel to consider the medical evidence. With respect to Petitioner's assertion that she was denied her "day in court," she waived her right to a hearing by signing the stipulation in July 2008. She contends that the insurance adjuster and the physician who performed the IME conspired to perpetrate a "lie" that she had reached maximum medical stability following the April 29, 2002 accident. Gallegos denies that her back problems were caused by anything other than the April 29, 2002 accident. She claims that only the opinions of her two treating physicians should have been considered. Her claim is properly characterized as a challenge to the relative weight that the ALJ and Labor Commission gave to the competing medical expert opinions regarding medical causation.
"To award compensation, the [Labor] Commission must determine that an accident has occurred and that there is a causal connection between the accident and the injury claimed." Speirs v. Southern Utah Univ., 2002 UT App 389, ¶ 9, 60 P.3d 42. An ALJ may refer the medical aspects of a case to a medical panel. See Utah Code Ann. § 34A-2-601(1)(a) (2005); see also Utah Admin. Code R602-2-1 and-2 (describing the role of independent medical panels). "However, even when a medical panel is convened, the ALJ/Commission is always the ultimate fact finder."Speirs, 2002 UT App 389, ¶ 10. "The Legislature has granted the Commission discretion to determine the facts and apply the law to the facts." Id. ¶ 7. We uphold the Commission's determination unless the determination exceeds the bounds of reasonableness and rationality. See id. "It is not the role of this court to reweigh the evidence and substitute our conclusion for that of the Commission." Id. ¶ 13. Therefore, "when reasonably conflicting views arise, it is the Commission's province to draw inferences and resolve these conflicts." Id.
The independent medical panel reviewed the entire medical record, which included the records from Gallegos's treating physicians. Gallegos claims that this court should accept the opinions of her treating physicians over the opinions expressed by the independent medical panel and other medical experts. However, it is not the role of this court to reweigh the evidence and assign what weight should be given to medical expert evidence. The ALJ reviewed the opinions of the parties' medical experts, as well as the independent medical panel's report. The ALJ found that Gallegos suffered from significant degenerative disk disease prior to the accident and failed to meet her burden of proving a medical causal connection between her low back condition after December 2002 and the April 29, 2002 industrial accident. The Labor Commission affirmed the ALJ's decision. The Commission's decision is within the bounds of reasonableness and rationality. Accordingly, we affirm.
Russell W. Bench, Judge, James Z. Davis, Judge, Carolyn B. McHugh, Judge.