Court Opinion

ID: 9614226
Source: CourtListenerOpinion
Date Created: 2023-08-22 04:23:35.452763+00
Date Added: 2024-06-11T18:03:34.300958
License: Public Domain

ZIMMERMAN, Chief Justice,
dissenting:
In concluding that the ALJ violated rule 568-1-9 in refusing to convene a medical panel, the majority disregards the general rule that “[i]ssues not raised before the administrative agency are waived on appeal.” Gibson v. Board of Review of Indus. Comm’n, 707 P.2d 675, 677 (Utah 1985) (per curiam); accord Pease v. Industrial Comm’n, 694 P.2d 613, 616 (Utah 1984). Although Willardson did ask the ALJ to convene a medical panel, he did so on the sole ground that because he presented “Conflicting medical reports of permanent physical impairment which vary more than 5% of the whole person,” medical-panel referral was mandatory under rule 568-l-9(A)(l)(a). Wil-lardson did not ask the Commission to interpret that rule as requiring medical-panel referral whenever medical reports conflict as to medical causation, and accordingly, the Commission did not address the issue. In light of our well-established precedent precluding *676our consideration of issues not raised below, I would not reach this issue.
An additional reason for not reaching the question of whether the ALJ violated rule 568-1-9 is that we normally defer to an agency’s reasonable interpretation of its own rules, Union Pac. R.R. v. Tax Comm’n, 842 P.2d 876, 879 (Utah 1992), and here, the Commission has not been given the opportunity to interpret rule 568-1-9. The Commission might reasonably have concluded that medical causation, at least where supported by such weak and perfunctory evidence as is present here, is not always a significant medical issue that requires an ALJ to convene a medical panel. Indeed, it seems unlikely that the Commission would conclude that its rule requires medical-panel referral any time a question is raised about medical causation. Such an interpretation would largely eviscerate the 1982 amendment to section 35-1-77, under which rule 568-1-9 was promulgated and which made medical-panel referral discretionary rather than mandatory as it was prior to the amendment. Compare Utah Code Ann. § 35-1-77 (1981) with Utah Code Ann. § 35-1-77 (1994).
If I were to reach the substance of the majority’s ruling, I would find that the rule does not limit the discretion conferred on the ALJ by section 35-1-77 as to whether to convene a panel under the circumstances presented here and I would find that the ALJ did not abuse her discretion. While it is true that “where the evidence of causal connection between the work-related event and the injury is uncertain or highly technical, failure to refer the case to a medical panel may be an abuse of discretion,” Champion Home Builders v. Industrial Comm’n, 703 P.2d 306, 308 (Utah 1985), there is no abuse of discretion on the facts of this case.
In Champion Home Builders, the Commission awarded the claimant medical expenses and temporary total disability benefits after he suffered a perforated duodenal ulcer, allegedly while lifting a heavy beam at work. Id. at 306. The only expert testimony before the Commission relating to the issue of medical causation was that of the doctor who first examined the claimant following his injury. This doctor testified that he “knew of no medical data which cites lifting as a cause of ulcer perforation, [but that] he was aware that lifting causes an increase in stomach pressure, and that ulcers perforate more often when there is an increase in stomach pressure.” Id. at 307. On these facts, this court held that the Commission did not abuse its discretion in refusing to convene a medical panel. Id. at 308. Because I cannot see how the evidence of medical causation in the instant ease was more uncertain or technical than that in Champion Home Builders, I would hold that the ALJ did not abuse her discretion in refusing to convene a medical panel.
I now comment on the merits of the issue Willardson properly raised on appeal, as opposed to the issue he did not preserve below but which is addressed by the majority. Wil-lardson argues that rule 568-l-9(A)(l)(a) requires medical-panel referral whenever a claimant presents conflicting medical reports as to the level of the claimant’s permanent physical impairment. Willardson argues that because he presented such conflicting reports — Dr. Heiner rated Willardson as thirty percent impaired, while Dr. Gaufin rated him as fifteen percent impaired — the ALJ violated rule 568-l-9(A)(l)(a) in refusing to convene a medical panel. Although the majority does not reach this issue, the court of appeals did. I would affirm the court of appeals.
Because a claimant must establish medical causation to recover under Utah’s workers’ compensation scheme, Allen v. Industrial Comm’n, 729 P.2d 15, 22-27 (Utah 1986), a discrepancy in reports of physical impairment is immaterial to the outcome of the proceeding until medical causation is shown. Willardson’s claim was dismissed because the ALJ found no credible evidence of medical causation; the conflict in Willardson’s impairment ratings was irrelevant to that decision. Therefore, the real issue in this case is not the degree of Willardson’s impairment, but whether Willardson’s accident caused that impairment. It is illogical to read rule 568-l-9(A)(l)(a), as Willardson contends, to require the futile act of referral to a panel of the logically secondary issue of the degree of Willardson’s impairment when Willardson could not have recovered under any circum*677stances without first proving medical causation.
Moreover, nothing in rule 568-l-9(A)(l)(a) suggests that an ALJ must refer the logically prior issue of medical causation to a medical panel simply because there happens to be a conflict in the evidence concerning the claimant’s impairment rating. As the court of appeals noted, medical causation is the “critical threshold issue which precedes the requirement of review by a medical panel” under rule 568-l-9(A)(l)(a). Willardson v. Industrial Comm’n, 856 P.2d 371, 377 (Ct. App.1993), cert, granted, 870 P.2d 957 (Utah 1994). Because the ALJ found no “credible evidence of medical causation” and because Willardson does not challenge that finding,11 do not think the ALJ violated rule 568-1-9(A)(1)(a) in refusing to convene a medical panel.
For the foregoing reasons, I would affirm the decision of the court of appeals upholding the Commission’s dismissal of Willardsoris claim.

. The majority erroneously concludes that Wil-lardson's challenge to the ALJ's factual finding is fairly included in the question presented for cer-tiorari review. As the majority recognizes, Wil-lardson appealed "only that portion of the court of appeals' decision below which deals with the limited issue of the standard for referral ... to a medical panel.” (Emphasis added.) This issue embodies a purely legal question and cannot reasonably be said to include Willardson’s challenge to the ALJ’s factual finding. Because we consider "[o]nly the questions set forth in the petition or fairly included therein,” Utah R.App.P. 49(a)(4), I would hold that Willardson has not appealed the ALJ's factual finding.