Gamez v. Labor Commission

2022 UT 20, 511 P.3d 1145
Utah Supreme Court·Decided May 26, 2022·No. Case No. 20200625·Published·Cited by 4 cases

Opinion

2022 UT 20

IN THE

SUPREME COURT OF THE STATE OF UTAH

LUIS G. GAMEZ, Petitioner, v. UTAH LABOR COMMISSION, B & S CONSTRUCTION, and WORKERS COMPENSATION FUND,1 Respondents.

No. 20200625 Heard September 17, 2021 Filed May 26, 2022

On Certification from the Court of Appeals

Attorneys: Virginius Dabney, St. George, Stony V. Olsen, Moroni, for petitioner Floyd W. Holm, St. George, for respondents B & S Construction and Workers Compensation Fund Christopher C. Hill, Salt Lake City, for respondent Utah Labor Commission

JUSTICE PETERSEN authored the opinion of the Court, in which CHIEF JUSTICE DURRANT, ASSOCIATE CHIEF JUSTICE LEE, JUSTICE HIMONAS, and JUSTICE PEARCE joined. JUSTICE HAGEN became a member of the Court on May 18, 2022, after oral argument in this matter, and accordingly did not participate.

__________________________________________________________ 1 Workers Compensation Fund is now known as WCF Mutual Insurance Company.  Justice Himonas sat on this case and voted prior to his retirement on March 1, 2022. GAMEZ v. LABOR COMMISSION Opinion of the Court

JUSTICE PETERSEN, opinion of the Court: INTRODUCTION ¶1 Luis G. Gamez2 sought workers‘ compensation benefits after he injured his left shoulder and low back in an industrial accident. Gamez‘s employer and its workers‘ compensation carrier accepted liability for Gamez‘s left-shoulder injury, but contested the compensability of his low-back injury. The administrative law judge (ALJ) assigned to the case appointed a medical panel to resolve the dispute. She appointed Dr. Jeremy Biggs, a board-certified occupational medicine physician, to serve as the panel chair. As chair, Dr. Biggs selected an orthopedic specialist to serve with him on the panel. ¶2 Gamez objected to the ALJ‘s appointment of Dr. Biggs and moved for interlocutory review of this decision. He argued that Dr. Biggs should be disqualified because he had a conflict of interest and because he did not specialize in low-back conditions. The Labor Commission Appeals Board (the Board) rejected Gamez‘s objections. It determined that Gamez had not made the requisite showing that Dr. Biggs had an ―actual bias.‖ And it concluded that Dr. Biggs could properly serve on the panel even if he was not a specialist because a medical panel need have only one member who specializes in the condition at issue, and that requirement was satisfied by the orthopedic specialist. ¶3 Ultimately, the medical panel concluded that the accident had temporarily aggravated Gamez‘s low back but had not caused permanent injury. The ALJ accepted the panel‘s conclusions. And the Board affirmed the ALJ‘s decision. ¶4 Gamez petitioned for review in the court of appeals, which certified the matter to us. Gamez argues that Dr. Biggs should have been disqualified from the medical panel due to a conflict of interest, and he asks us to overrule the ―actual bias‖ standard used by the Board to evaluate such claims. Gamez also asserts that the Workers‘ Compensation Act requires all members

__________________________________________________________ 2 Gamez‘s surname is listed on medical documentation, health insurance forms, and an accident report as ―Gamez-Alvarez.‖ However, he identified himself as ―Luis G. Gamez‖ in his application for a hearing before the Labor Commission, and ―Gamez‖ has been the surname used in subsequent proceedings.

2 Cite as: 2022 UT 20 Opinion of the Court

of a medical panel to be specialists in the condition at issue, so Dr. Biggs also should have been removed from the panel because he does not specialize in low-back injuries. Finally, Gamez appeals the outcome of the Labor Commission proceeding, contesting the conclusion that his low back had ―returned to baseline‖ when his back had never returned to the condition it was in prior to the accident. ¶5 We agree with the Board that the Workers‘ Compensation Act requires only one member of a medical panel to specialize in the condition at issue. So, even accepting Gamez‘s characterization of Dr. Biggs as a generalist who does not specialize in low-back injuries, this is not a basis to disqualify him from the medical panel here because there is no dispute that the other member of the panel qualifies as such a specialist. ¶6 However, we agree with Gamez that the actual bias standard applied by the Board to resolve his conflict-of-interest objection does not comport with the requirements of the statute. We hold that where a medical panelist‘s impartiality could reasonably be questioned, the requirement of an impartial medical evaluation has not been met. Accordingly, we reverse this portion of the Board‘s dismissal of Gamez‘s interlocutory objection. And we remand to the Board for reconsideration of this objection under this clarified legal standard. ¶7 Because we remand on this basis, we do not resolve Gamez‘s claim that Dr. Biggs had a conflict of interest or that the Board wrongly accepted the ALJ‘s conclusion that Gamez‘s low back had returned to baseline. BACKGROUND3 ¶8 Gamez was injured in a rollover automobile accident while employed as a subcontractor for B & S Drywall, Inc. (B & S).4 At the time of the accident, Workers Compensation Fund (WCF) served as the workers‘ compensation carrier for B & S.

__________________________________________________________ 3 In reviewing a workers‘ compensation order from the Board, we ―view the facts in the light most favorable to the Commission‘s findings and recite them accordingly.‖ Wright v. Labor Comm’n, 2021 UT App 43, n.1, 489 P.3d 211 (citation omitted). 4 B & S has consistently been referred to as ―B & S Construction‖ and ―B & S Construction Inc.‖ throughout the (continued . . .) 3 GAMEZ v. LABOR COMMISSION Opinion of the Court

¶9 Gamez was initially treated in a hospital emergency room for injuries to his left shoulder, left ankle, and head. He later sought care for ongoing pain in his shoulder and low back. ¶10 Gamez subsequently pursued workers‘ compensation benefits—including permanent partial disability benefits and medical expenses—for the injuries to his left shoulder and low back. WCF accepted Gamez‘s shoulder-related claim but contested his low-back claim, arguing that he ―suffered preexisting or independent medical problems that caused any disability‖ related to his low back. ¶11 Because of this dispute, the ALJ referred the matter to a medical panel. See UTAH ADMIN. CODE r. 602-2-2(A) (LexisNexis 2021) (―A panel will be utilized by the Administrative Law Judge where one or more significant medical issues may be involved.‖).5 She appointed Dr. Jeremy Biggs, a board-certified occupational and environmental medicine physician, to serve as the panel chair.6 Among other appointments, Dr. Biggs was affiliated with

proceedings. However, the company‘s legal name is ―B & S Drywall, Inc.‖ 5 ―Generally a significant medical issue must be shown by conflicting medical reports.‖ UTAH ADMIN. CODE r. 602-2-2(A) (LexisNexis 2021). In this case, Gamez‘s treating physician issued a report opining that Gamez‘s low-back symptoms were ―primarily the result of the motor vehicle rollover‖ and that ―any pre-existing condition would have been permanently aggravated‖ by the accident. He then assessed Gamez with a ―7% whole- person impairment for his lumbar injury.‖ A separate physician, engaged by WCF, opined to the contrary that the accident had neither medically caused nor further aggravated Gamez‘s low- back degeneration and assessed Gamez with a ―7% whole-person impairment for [the injury to] his left shoulder‖ only. 6 Occupational and Environmental Medicine (OEM) ―is a board-certified specialty . . . that focuses on the diagnosis and treatment of work-related injuries and illnesses.‖ What is OEM?, AM . COLL. OF OCCUPATIONAL & ENV‘T. MED., http://acoem.org/Careers/What-Is-OEM (last visited Sept. 10, 2021).

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Gamez v. Labor Commission, 2022 UT 20, 511 P.3d 1145 (Utah 2022).

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