2021 UT App 131

THE UTAH COURT OF APPEALS

ILENE MORRIS,

Petitioner,

v.

LABOR COMMISSION, HERITAGE PARK CARE CENTER, AND SAFETY 

NATIONAL CASUALTY CORP. CO.,

Respondents.

Opinion

No. 20200440-CA

Filed November 26, 2021

Original Proceeding in this Court

Jared L. Mortenson, Attorney for Petitioner

Christin Bechmann and Jeffrey A. Callister,

Attorneys for Respondents Heritage Park Care 

Center and Safety National Casualty Corp. Co.

JUDGE DIANA HAGEN authored this Opinion, in which JUDGES

GREGORY K. ORME and JILL M. POHLMAN concurred.

HAGEN, Judge:

¶1 Ilene Morris applied for workers’ compensation benefits 

after injuring her back at work. The Utah Labor Commission 

found that Morris had a preexisting back condition and that her 

accident had temporarily aggravated her condition for a period 

of three months. Although Morris complained of health issues 

beyond that time, the Commission found that those issues were 

not medically caused by the accident. Accordingly, it awarded

her three months’ worth of temporary benefits. Morris now 

seeks judicial review. We decline to disturb the Commission’s 

decision.
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BACKGROUND1

¶2 At the time of her accident, Morris worked as a 

respiratory therapist for Heritage Park Care Center. On August 

19, 2017, Morris entered a patient’s room and found her standing 

over the bedside commode, swaying as if she were about to fall.

Morris caught the patient and immediately felt a sharp, pinching 

pain in her back. Although the pain eventually dulled, it 

returned later that day after Morris tried to lift a different patient 

with the help of a coworker. Morris was ultimately referred to an 

occupational health services provider and diagnosed with a 

muscle and tendon sprain of the lower back.

¶3 Morris’s recovery fluctuated over the next several 

months. On September 21, 2017, Morris told one of her treating 

physicians that she was “definitely doing better” and rated her 

pain as a one on a ten-point scale. By the following month,

however, Morris began experiencing flare-ups of pain in her 

lower back, along with other health issues. Two of these flareups coincided with severe coughing episodes that Morris 

suffered on October 24 and November 1, 2017.

¶4 Morris requested workers’ compensation in the form of 

permanent partial disability benefits.2 After Heritage opposed 

 

1. “In reviewing an order from the Commission, we view the 

facts in the light most favorable to the Commission’s findings 

and recite them accordingly.” JBS USA v. Labor Comm’n, 2020 UT 

App 86, n.1, 467 P.3d 905 (cleaned up).

2. Morris also requested temporary total and temporary partial 

disability compensation for various periods of her recovery, as 

well as compensation for past medical expenses, recommended 

medical care, travel expenses, and unpaid interest. Morris does 

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the request, the administrative law judge (ALJ) referred the 

medical aspects of Morris’s claim to a panel of experts. The 

medical panel then reviewed 1,072 pages of Morris’s medical 

records and physically examined Morris before submitting a 

written report to the ALJ. The panel concluded that Morris had 

preexisting degenerative disc disease and that her accident had 

caused “an acute exacerbation” of that condition. It opined that 

Morris’s workplace injury had “most likely reached medical 

stability on September 21, 2017.” Neither party objected to the 

panel’s report, and the ALJ entered the report into evidence.

¶5 Based on the medical panel report, the ALJ awarded 

Morris temporary partial disability benefits from the date of the 

accident through September 21, 2017. Morris sought review from

the Commission, arguing that the ALJ should not have adopted

the medical panel’s conclusions because the report failed to 

account for her ongoing health issues. The Commission found

that the report was thorough, well-reasoned, and impartial, and 

that it supported the ALJ’s determination that “Morris’s workrelated low-back injury was temporary in nature.” But “in light 

of the evidence that [Morris’s] symptoms appeared to continue 

beyond September 21, 2017,” the Commission remanded for 

clarification from the medical panel as to the date Morris’s 

workplace injury had resolved.

¶6 In a supplemental report, the panel expanded on several 

of its prior conclusions. Regarding Morris’s preexisting 

condition, the panel explained that “[o]ften, . . . degenerative 

disc disease is asymptomatic,” but that when symptoms occur, 

they “can range from having no pain to having significant low 

back pain . . . . Pain often occurs without a known injury or 

 

(...continued)

not challenge the Commission’s rulings as to these other 

benefits.
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change in daily activity.” The panel added that “[a]cute episodes 

of back pain are expected and considered to be a normal 

manifestation of the chronic disease process” and that “[ninety 

percent] of people with an acute episode of low back pain will 

recover” within three months.

¶7 The panel next discussed the relationship between 

Morris’s coughing episodes and her preexisting condition: “With 

degenerative disc disease, an increase in pressure near the disc 

can cause pain. An increase in pressure can occur with lifting or 

with coughing or sneezing.” In the panel’s view, it was 

“medically more likely than not” that this increase in pressure 

explained Morris’s flare-ups following each of her coughing 

episodes.

¶8 Finally, the panel clarified its opinion regarding the date 

Morris’s workplace injury had resolved. For the period before 

November 19, 2017 (three months after Morris’s accident), the 

panel concluded that it was “medically more likely than not 

that” Morris’s health issues “were a result of her industrial 

accident, her degenerative disc disease[,] and the reported 

coughing episode[s].” After November 19, 2017, however, the 

panel said Morris’s symptoms were no longer “a clinically 

significant result of her lifting injury at work.”

¶9 Over Morris’s objection, the ALJ entered the 

supplemental report into evidence. And based on the panel’s 

clarified opinions, the ALJ found that Morris’s workplace 

“accident caused an acute lumbar strain, which would be 

considered a temporary exacerbation of her preexisting 

[condition].” The ALJ also found that Morris’s workplace injury 

“would have been expected to reach medical stability within 

three months of the injury date,” but that her first coughing 

episode was an intervening injury that “sever[ed] medical 

causation.” The ALJ then awarded Morris benefits from the date
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of her accident up to October 23, 2017, the day before Morris’s 

first coughing episode.

¶10 On review, the Commission adopted the ALJ’s findings of 

fact but modified the temporary benefits award. The 

Commission reasoned that, according to the supplemental 

medical panel report, Morris’s workplace accident affected her 

until November 19, 2017, after which the accident was no longer 

a clinically significant cause of her health issues. Therefore,

Morris was entitled to benefits from the date of her accident until 

November 19, 2017. As the Commission explained, “Whether 

such problems after that date resulted from the coughing 

episodes or progression of [Morris’s] underlying lumbar-spine 

degeneration, the medical causal connection between . . . 

Morris’s low-back condition and her work activities was 

severed.”

¶11 Morris now seeks judicial review of the Commission’s 

decision.

ISSUE AND STANDARD OF REVIEW

¶12 Morris challenges the Commission’s determination of 

medical causation. “[W]hether the Commission properly found 

that medical causation exists is a question of fact we review for 

substantial evidence.” YESCO v. Labor Comm’n, 2021 UT App 96, 

¶ 13. “Substantial evidence is more than a mere scintilla of 

evidence though something less than the weight of the evidence, 

and the substantial evidence test is met when a reasonable mind 

might accept as adequate the evidence supporting the decision.” 

Hutchings v. Labor Comm’n, 2016 UT App 160, ¶ 30, 378 P.3d 1273

(cleaned up).
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ANALYSIS

¶13 Morris argues that the Commission erred in finding that 

her workplace accident was not the medical cause of her health 

issues after November 19, 2017. We conclude that there is 

substantial evidence supporting that determination and, 

therefore, decline to disturb the Commission’s decision.

¶14 Under Utah’s Workers’ Compensation Act (the Act), an 

employer must compensate an employee “who is injured . . . by 

accident arising out of and in the course of [her] employment.” 

Utah Code Ann. § 34A-2-401(1) (LexisNexis 2019). “Thus, in 

addition to proving that an injury was accidental, an employee 

must establish that there is a causal connection between the 

injury and the employment.” Wright v. Labor Comm’n, 2021 UT 

App 43, ¶ 28, 489 P.3d 211 (cleaned up), cert. granted, 496 P.3d 

711 (Utah 2021). To establish a causal connection, the employee 

must show that the “accident was both the legal cause and the 

medical cause of the injury.” Cox v. Labor Comm’n, 2017 UT App 

175, ¶ 14, 405 P.3d 863 (citing Allen v. Industrial Comm’n, 729 P.2d 

15, 25 (Utah 1986)). In this case, Morris challenges the 

Commission’s finding only as to medical causation.

¶15 “To prove medical causation, an injured employee must 

establish by evidence, opinion, or otherwise that the stress, 

strain, or exertion required by his or her occupation led to the 

resulting injury or disability.” Wright, 2021 UT App 43, ¶ 29 

(cleaned up). A workplace accident leads to an injury even if it is 

merely “a cause—as opposed to the cause—of the condition 

requiring treatment.” Cox, 2017 UT App 175, ¶ 18. For this 

reason, “the aggravation or lighting up of a pre-existing disease 

by an industrial accident is compensable” under the Act. Id.

(cleaned up).

¶16 Like any workplace injury, the aggravation of a 

preexisting condition is compensable only to the extent there is 
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“a nexus between the accident and the injury for which 

treatment is sought.” See Petersen v. Labor Comm’n, 2016 UT App 

222, ¶ 18, 385 P.3d 759. This means that even though

a claimant may be compensated for the 

aggravation of preexisting conditions caused by an 

industrial accident . . . , that entitlement ends when 

the aggravation stops being attributable to the 

industrial accident. In other words, if a preexisting 

condition is only temporarily aggravated by an 

industrial accident, a claimant may only recover for 

the temporary aggravation, and not for unrelated 

symptoms or complications [s]he may experience 

down the road.

Valdez v. Labor Comm’n, 2017 UT App 64, ¶ 14, 397 P.3d 753

(cleaned up). This principle “prevents an employer from 

becoming a general insurer of [its] employees and discourages 

fraudulent claims.” See Petersen, 2016 UT App 222, ¶ 18 (cleaned 

up).

¶17 With that understanding, we conclude that there is 

substantial evidence to support the Commission’s decision in 

this case. As a preliminary matter, we note that a “medical 

panel’s report alone can be enough to conclude that [the]

Commission’s determination was supported by substantial 

evidence.” Valdez, 2017 UT App 64, ¶ 22. After all, the Act 

expressly permits the Commission to base its findings on a 

medical panel’s report, see Utah Code Ann. § 34A-2-601(2)(e)(i)

(LexisNexis 2019), and we will not question the Commission’s 

decision to do so where, as here, the reports are thorough and 

prepared by neutral medical experts,3 see, e.g., Hutchings v. Labor 

 

3. Morris argues that one of the panelists was biased against her, 

but she does not direct us to where this argument was raised 

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Comm’n, 2016 UT App 160, ¶¶32–38, 378 P.3d 1273; Cook v. Labor 

Comm’n, 2013 UT App 286, ¶ 18, 317 P.3d 464. Accordingly, if the 

Commission’s decision is supported by the medical panel 

reports, the substantial evidence standard is satisfied.

¶18 In this case, the medical panel reports fully support the 

Commission’s medical cause determination. In its initial report, 

the panel concluded that Morris suffered from preexisting 

degenerative disc disease and that her accident caused an “acute 

exacerbation of that condition.” Then, on remand, the panel 

indicated that the effects of the exacerbation were no longer 

“clinically significant” by November 19, 2017. The panel further 

explained that intermittent symptoms were “a normal 

manifestation” of Morris’s preexisting condition and that it was 

more likely than not that her condition was aggravated by the 

subsequent coughing episodes. Accordingly, though Morris still 

had ongoing health issues, the panel attributed those symptoms 

to “her degenerative disc disease and the reported coughing 

episode[s].” These conclusions support the Commission’s 

finding that Morris’s accident caused a temporary aggravation of 

her preexisting condition and that the aggravation resolved by 

November 19, 2017.4

 

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before the ALJ or the Commission. “Our rules require petitioners 

to demonstrate, by citation to the record, that all issues raised for 

judicial review were presented before the Commission.” Par Elec. 

v. Labor Comm’n, 2017 UT App 169, ¶ 17, 405 P.3d 842. Because 

the issue is unpreserved, we will not address it for the first time 

on review. See id. ¶¶ 19–20.

4. Morris also challenges the Commission’s adoption of these 

key conclusions in its factual findings. To the extent Morris 

believes the medical panel reports themselves are unsupported 

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¶19 Notwithstanding that evidence, Morris contends that she 

is entitled to ongoing benefits based on the two-part test we 

articulated in Cox v. Labor Commission, 2017 UT App 175, 405 

P.3d 863. There, we said,

[T]o recover for a medical condition, a claimant 

must show that (1) the industrial accident 

contributed in any degree to the claimant’s 

condition, such as by aggravating a preexisting 

condition, and (2) the aggravation is permanent, 

i.e., the claimant’s medical condition never 

returned to baseline, meaning the claimant’s 

condition immediately before the accident.

Id. ¶ 20. Morris asserts that these elements are satisfied with 

respect to her chronic health issues and that, consequently, she

remains entitled to compensation. We disagree.

¶20 Morris cannot satisfy the second element of Cox because 

her accident did not permanently aggravate her preexisting 

condition. The Commission found that the aggravation caused 

by Morris’s accident had resolved by November 19, 2017, and 

 

(...continued)

by the record, she had the opportunity to object to their 

admission below. See Utah Code Ann. § 34A-2-601(2)(d)(ii)

(LexisNexis 2019). Morris failed to do so with respect to the first 

medical panel report. See id. § 34A-2-601(2)(d)(ii)–(iii) (“If no 

written objection is filed within [twenty days], the report is 

considered admitted into evidence.”). And although Morris did 

object to the panel’s supplemental report, she has not asked us to 

review the Commission’s decision to admit the report over her 

objection. Accordingly, we treat the medical panel reports as 

competent evidence on which the Commission was entitled to 

rely.
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that the remainder of her symptoms at that point were caused 

exclusively by her preexisting condition and later coughing 

episodes. Thus, the accident merely caused a temporary 

aggravation.

¶21 But Morris argues that the second prong is necessarily 

satisfied because she was “fully functional” immediately before 

the accident but, ever since, has had “chronic low back pain” 

and “persisting low back and leg” issues. Accordingly, Morris 

reasons that she has yet to “return to [her] baseline, pre-

[a]ccident condition” as described in Cox. We acknowledge that 

the definition of “baseline” we gave in Cox—“meaning the 

claimant’s condition immediately before the accident”—

seemingly supports Morris’s reasoning. See id. But that definition 

cannot be mechanically applied to the facts of this case without 

running afoul of the broader principle: “if a preexisting 

condition is only temporarily aggravated by an industrial 

accident, a claimant may only recover for the temporary 

aggravation, and not for unrelated symptoms or complications.”

Id. ¶ 19 (cleaned up). That principle is ultimately incompatible 

with Morris’s argument because, as the medical panel opined 

and the Commission found, the health issues she asserts have 

prevented her from returning to baseline are exclusively the 

result of her preexisting condition and non-industrial factors.

¶22 We take this opportunity to clarify the second element of 

the Cox test. By “baseline” we mean the claimant’s condition 

immediately before the accident, taking into account the natural 

course of any preexisting conditions. This includes subsequent 

aggravations or flare-ups not attributable to the accident. Put 

another way, an aggravation caused by a workplace accident is 

not permanent simply because the claimant begins to experience 

new symptoms of the same preexisting condition—symptoms 

that were not caused by the accident—before the symptoms 

caused by the accident are fully resolved. Were the rule 

otherwise, employees could argue that they are entitled to 
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permanent benefits simply because their general health has 

declined for reasons entirely unrelated to a workplace accident.

¶23 With that clarification, we conclude that Morris’s accident 

did not cause a permanent aggravation of her preexisting 

condition. As the Commission determined from the medical 

panel reports, Morris had “degenerative disc disease . . . , which 

manifests with a range of symptoms and commonly results in 

intermittent low-back pain.” The condition also made Morris

susceptible to additional flare-ups whenever lifting, coughing, or 

sneezing. And because the Commission attributed Morris’s 

ongoing health issues to her preexisting condition and coughing 

episodes, its findings support the conclusion that Morris 

returned to baseline by November 19, 2017. Therefore, Morris’s 

workplace accident did not cause a permanent aggravation.5

¶24 Finally, Morris invokes “the benefit-of-the-doubt 

presumption,” see Jex v. Labor Comm’n, 2013 UT 40, ¶¶ 52–57, 306 

P.3d 799, i.e., that the “Act is to be liberally construed and any 

doubt as to compensation is to be resolved in favor of the 

applicant,” Fred Meyer v. Industrial Comm’n, 800 P.2d 825, 828 

(Utah Ct. App. 1990) (cleaned up). Morris directs us to portions 

of her medical record that seemingly conflict with the medical 

 

5. Morris also claims that the Commission erred by determining 

that her first coughing episode “was an intervening, benefitsevering injury event.” We do not think the Commission made 

any such determination. Although the Commission stated that 

“the medical causal connection between Ms. Morris’s low-back 

condition and her work activities was severed,” it then awarded 

benefits until November 19, 2017, not October 24, 2017, the date 

of Morris’s coughing episode. (Emphasis added.) Accordingly, 

the Commission did not sever benefits due to an intervening 

injury; it merely ended them consistent with the principles of 

medical causation we articulate here.
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panel’s conclusions and argues that, presumption applied, the 

Commission should not have sided with the medical panel. But 

the benefit-of-the-doubt presumption applies only “[i]n the rare 

case where” the Commission’s assessment of facts and law 

“yields genuine doubt—in a dead heat without an apparent 

winner.” Jex, 2013 UT 40, ¶ 56. Even assuming that Morris’s 

medical records support her interpretation, the evidence was not 

so inconclusive that the Commission had no choice but to call 

the tie in Morris’s favor. The Commission has the “responsibility 

to resolve conflicts in the evidence” and “may choose to give 

certain evidence more weight than other evidence.” Cook v. Labor

Comm’n, 2013 UT App 286, ¶ 20, 317 P.3d 464 (cleaned up). Here, 

the Commission found the medical panel reports to be credible 

and was entitled to rely on them, even if other evidence in the 

record might have supported a different determination. See id.

CONCLUSION

¶25 We conclude the medical panel reports support the 

Commission’s findings that Morris’s accident caused a 

temporary aggravation of her preexisting condition, and that the 

aggravation resolved by November 19, 2017. Because there was 

substantial evidence to support the Commission’s medical cause 

determination and award of temporary benefits, we decline to 

disturb the Commission’s decision.