Provo City v. Utah Labor Comm'n, 20120724.

Citation2015 UT 32,345 P.3d 1242
Decision Date06 February 2015
Docket NumberNo. 20120724.,20120724.
PartiesPROVO CITY and Workers Compensation Fund, Petitioners, v. UTAH LABOR COMMISSION and Duane Serrano, Respondents.
CourtSupreme Court of Utah

Hans M. Scheffler, Salt Lake City, for petitioners.

Alan L. Hennebold, Jaceson R. Maughan, Gary E. Atkin, Marsha S. Atkin, Salt Lake City, for respondents.

Justice DURHAM authored the opinion of the Court, in which Chief Justice DURRANT, Associate Chief Justice NEHRING, Justice PARRISH, and Justice LEE joined.

Justice DURHAM, opinion of the Court:

INTRODUCTION

¶ 1 While driving a truck within the scope of his employment with Provo City, Duane Serrano was injured in a car accident. He later applied for and received permanent total disability benefits. Provo City and the Workers Compensation Fund (collectively, WCF) appealed from the Utah Labor Commission's order awarding benefits, arguing that (1) Mr. Serrano failed to prove the elements of a permanent total disability claim; (2) the administrative law judge abused her discretion because she initially denied Mr. Serrano's claim, but then awarded benefits after the labor commission instructed her to reconsider the evidence; and (3) any award of benefits should not commence on the date that he was deemed to be permanently and totally disabled because of the extraordinary delay in resolving Mr. Serrano's claim. We conclude that none of these arguments merit reversal, and we affirm the labor commission's award of benefits.

BACKGROUND

¶ 2 Mr. Serrano was employed by Provo City as a facility service technician. While driving a truck within the scope of his employment, he was injured in an automobile accident. Mr. Serrano alleged that the accident aggravated a congenital spine condition, leading to chronic pain and other disabilities. After the accident, Mr. Serrano continued to work for Provo City. But more than four years later, he concluded that his symptoms were no longer manageable and requested an assignment to a less physically demanding job. When Provo City replied that a suitable position was not available, Mr. Serrano quit.

¶ 3 Mr. Serrano subsequently applied for permanent total disability compensation under the Workers' Compensation Act, alleging that by the time he quit, his condition had deteriorated to the point that he could no longer work. The administrative law judge assigned to adjudicate his claim received into evidence over twenty medical evaluations made by doctors and other experts. Although the evaluators generally agreed that Mr. Serrano suffered from continuing impairment caused by the accident, they differed as to its degree. Some doctors opined that Mr. Serrano was malingering, and that he could work if certain restrictions were observed.

Another expert concluded that Mr. Serrano suffered from chronic pain and other ailments aggravated by even basic work activities and that, as a result, he was permanently and totally disabled.

¶ 4 After reviewing this evidence, the administrative law judge found that Mr. Serrano had not proven all of the required elements to receive permanent total disability compensation and dismissed his claim with prejudice. Mr. Serrano filed a motion for review with the Utah Labor Commission. The labor commission set aside the administrative law judge's order because it concluded that the judge should have appointed a medical panel to review Mr. Serrano's claim. The labor commission therefore remanded the case back to the judge with directions to appoint a medical panel and to issue a new decision in light of the entire record.

¶ 5 On remand, the administrative law judge referred the case to a medical panel for review. After reviewing the medical panel's report and the medical evidence, the administrative law judge found that the preponderance of the evidence showed that Mr. Serrano was permanently and totally disabled as a result of his accident and awarded him permanent disability payments. The WCF filed a motion for review with the labor commission, asserting that the judge's order was in error. The commission affirmed the administrative law judge's order. The WCF appealed, and the court of appeals certified the case to this court.

ANALYSIS
I. PERMANENT TOTAL DISABILITY

¶ 6 The elements of a permanent total disability claim are laid out in Utah Code section 34A–2–413(1)(b) :

To establish entitlement to permanent total disability compensation, the employee shall prove by a preponderance of evidence that:
(i) the employee sustained a significant impairment or combination of impairments as a result of the industrial accident or occupational disease ...;
(ii) the employee has a permanent, total disability; and
(iii) the industrial accident or occupational disease is the direct cause of the employee's permanent total disability.

The statute further provides that permanent total disability is comprised of four elements. In order to “establish that an employee has a permanent, total disability[,] the employee shall prove” that:

(i) the employee is not gainfully employed;
(ii) the employee has an impairment or combination of impairments that limit the employee's ability to do basic work activities;
(iii) the industrial or occupationally caused impairment or combination of impairments prevent the employee from performing the essential functions of the work activities for which the employee has been qualified until the time of the industrial accident or occupational disease that is the basis for the employee's permanent total disability claim; and
(iv) the employee cannot perform other work reasonably available.

Utah Code § 34A–2–413(1)(c). Thus, taken as a whole, the permanent total disability statute requires workers to prove six elements: (1) “the employee sustained a significant impairment;” (2) “the employee is not gainfully employed;” (3) “the employee has an impairment or combination of impairments that limit the employee's ability to do basic work activities;” (4) the impairment or impairments “prevent the employee from performing the essential functions of the work activities for which the employee” had been qualified at the time of the accident; (5) “the employee cannot perform other work reasonably available;” and (6) “the industrial accident or occupational disease is the direct cause of the employee's permanent total disability.” Id. § 34A–2–413(1)(b)(c).

¶ 7 The WCF argues that the labor commission erred when it awarded permanent total disability payments because Mr. Serrano failed to prove any of the six necessary elements for such an award. In analyzing the WCF's arguments, we first determine the standard of review for each element of a permanent total disability claim. We then apply the appropriate standard of review to each of the WCF's assertions of error.

A. Standard of Review

¶ 8 Utah Code section 63G–4–403(4) authorizes appellate courts to grant relief to a party substantially prejudiced by an error in the final disposition of a claim adjudicated by an administrative agency. This statute lists several categories of remediable errors and implies a standard of review for some, but not all, of these errors. Murray v. Utah Labor Comm'n, 2013 UT 38, ¶ 19, 308 P.3d 461. The statute, for example, authorizes appellate courts to grant relief where an “agency action is based upon a determination of fact, made or implied by the agency, that is not supported by substantial evidence when viewed in light of the whole record before the court.”Utah Code § 63G–4–403(4)(g). Thus, a challenge to an administrative agency's finding of fact is reviewed for substantial evidence. Murray, 2013 UT 38, ¶ 19, 308 P.3d 461. “A decision is supported by substantial evidence if there is a quantum and quality of relevant evidence that is adequate to convince a reasonable mind to support a conclusion.” Becker v. Sunset City, 2013 UT 51, ¶ 10, 309 P.3d 223 (internal quotation marks omitted). “In conducting a substantial evidence review, we do not reweigh the evidence and independently choose which inferences we find to be the most reasonable.” Id. ¶ 21 (internal quotation marks omitted). “Instead, we defer to [an administrative agency's] findings because when reasonably conflicting views arise, it is the [agency's] province to draw inferences and resolve these conflicts.” Id. (internal quotation marks omitted).

¶ 9 Other remediable errors identified in section 63G–4–403(4), however, are not accompanied by a standard of review. When reviewing these types of errors, we apply our traditional standards of review. Murray, 2013 UT 38, ¶ 21, 308 P.3d 461. One example is subsection (4)(d), which permits appellate courts to grant relief where an “agency has erroneously ... applied the law.” Utah Code § 63G–4–403(4). When reviewing this kind of alleged agency error, we employ one of our established standards of review for mixed questions of law and fact. Murray, 2013 UT 38, ¶ 24, 308 P.3d 461. The level of deference we afford to an agency's resolution of mixed questions varies depending upon the nature of the mixed question under review. Id. ¶ 36.

¶ 10 In order to determine the appropriate standard of review for the WCF's challenges to the labor commission's findings on the six elements of a permanent total disability claim, we must decide whether each element presents either a pure question of fact or a mixed question of law and fact. “Factual questions are generally regarded as entailing the empirical, such as things, events, actions, or conditions happening, existing, or taking place, as well as the subjective, such as state of mind.” State v. Pena, 869 P.2d 932, 935 (Utah 1994). A mixed question of law and fact, on the other hand, involves the application of a legal standard to an established set of facts. Id. at 936. In other words, the characteristic that distinguishes a mixed question from a question of fact is “the existence of an articulable legal issue.” Martinez v. Media–Paymaster Plus, 2007 UT 42, ¶ 27, 164 P.3d 384.

¶ 11 Because the third, fourth, and fifth elements of a...

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