Cox v. Labor Comm'n
Decision Date | 14 September 2017 |
Docket Number | No. 20150788-CA,20150788-CA |
Citation | 405 P.3d 863 |
Parties | Lavon G. COX, Petitioner, v. LABOR COMMISSION, St. George Truss Co., and Workers Compensation Fund, Respondents. |
Court | Utah Court of Appeals |
Virginius Dabney, St. George and Stony V. Olsen, Attorneys for Petitioner.
Floyd W. Holm, Attorney for Respondents St. George Truss Co. and Workers Compensation Fund
2
Amended Opinion1
¶ 1 Petitioner Lavon G. Cox seeks judicial review of the denial of his workers' compensation claim. We conclude that the Labor Commission did not apply the correct medical causation standard. We therefore set aside the Commission's order and direct it to reconsider Cox's claim under the correct legal standard.
¶ 2 In 2013 Cox worked as a maintenance mechanic for Respondent St. George Truss Company. On May 7, 2013, while removing an 80-pound brake drum from a semi truck, Cox "felt a burning, popping sensation" in his back. He "dropped the drum and sunk to his knees for a couple minutes." He "tried walking it off" and went to the shop to take four 200mg tablets of ibuprofen. He asked a coworker for help with the brake drum and completed his shift doing "light maintenance" work.
¶ 3 The next day Cox "felt another burning, popping sensation" in his back while removing another brake drum. He again walked around, went to the shop, and took ibuprofen. He struggled to complete his work because his back hurt, with his pain at 4 on a scale of 1 to 10. He again completed his shift doing lighter work. Cox worked the remaining two days of the work week with "quite a bit of pain," rested in bed over the weekend, and worked the following week.
¶ 4 On May 17, 2013, Cox first reported his pain to WorkMed, an occupational health services clinic, after he fell to the ground at work while picking up a hose. Four days later Cox again reported to WorkMed when he blacked out while bending down to tie his shoe. The WorkMed doctor diagnosed Cox with a lumbar spine strain, prescribed pain medications, and referred him to physical therapy. The doctor gave Cox a light-duty work release with the following restrictions: "No bending or twisting, [n]o lifting/working above shoulder level, [and] [n]o lifting more than 15 pounds." Cox's modified duty entailed operating a forklift, which includes manually adjusting 60-to-70-pound forks and sitting on a solid-axle forklift seat with no suspension. Cox worked ten-hour days with his pain reaching 8 on a scale of 1 to 10.
¶ 5 After several follow-up visits throughout May and June, the WorkMed doctor referred Cox to a physiatrist. In early July the physiatrist ordered further work restrictions, limiting Cox to four hours of work per day. Cox began working half-days with pain varying from 4 to 8 on a scale of 1 to 10. During this time, Cox "started losing bowel and bladder control ... almost every day ... for a while." He also started blacking out and getting lightheaded.
¶ 6 During a two-week period beginning in late July, Cox went to the emergency room three times because he was concerned about his back. After his first visit, his physiatrist directed him to get an MRI. The MRI revealed "severe spinal canal and neural foraminal narrowing" as well as disc bulging on four lumbar levels. He went to the emergency room again the following week because he experienced lower-back pain at home after bending over.
¶ 7 The following month Cox fell while getting out of his truck at work. At the time he fell, his back pain level was 8 on a scale of 1 to 10. Cox drove himself to the emergency room, where a second MRI was taken. The MRI revealed "severe spinal canal stenosis," and the doctor recommended that Cox obtain a neurosurgical consultation. The surgeon admitted Cox to the hospital that same day and scheduled lower back surgery for three days later. After surgery Cox spent three days in the hospital and a week in a rehabilitation facility. He wore a back brace for 8 to 10 weeks, continued treatment with the surgeon, and participated in physical therapy thereafter. Cox has not worked since his fall, and he testified that he continued to have back pain varying from 4 to 8 on a scale of 1 to 10.
¶ 8 Cox experienced two prior incidents involving his back. In 1977 he injured his back in a car accident. He spent about five days in traction before returning to work with no pain. In 2009 he injured his back and ankle in an accident involving an all-terrain vehicle. The ankle injury required surgery. Cox's treating doctor made notes listing chronic lower back pain as a symptom in at least two subsequent visits. After the ankle surgery, Cox's back pain appeared to have mostly resolved.
¶ 9 Cox filed a claim with the Workers Compensation Fund. WCF denied the claim, citing the following reasons: (1) Pre-existing condition: "severe degenerative disc disease and severe stenosis," and (2) Other: "no acute findings to suggest surgery was for this claim." Cox requested a hearing before the Commission to challenge the denial of his claim. In the meantime the WCF medical examiner issued a report concluding that "[t]he claimant's industrial accident of 5/7/13 ... [was] not the cause, aggravator or contributor to the claimant's underlying and pre-existing low back condition." But Cox's surgeon and his physician's assistant both asserted a causal relationship between the industrial accident and Cox's back problems. And Cox's surgeon later opined that "[w]hile the role that these preexisting conditions played in [Cox's] symptoms after his injury is debatable, the fact is [his] symptoms worsened after his injury to the point that he required further treatment and surgery." He further opined that "[w]ithout a worsening of symptoms, he may not have required surgery at this time despite the preexisting degenerative changes."
¶ 10 An Administrative Law Judge held an evidentiary hearing in May 2014. Because the medical opinion of Cox's surgeon conflicted with that of the WCF medical examiner on the medical cause of Cox's condition, the ALJ ordered a medical panel evaluation. A panel of two doctors concluded that "the injury of May 2013 did not cause Mr. Cox's substantial lumbar spinal problems," because "[s]pinal stenosis ... takes years to develop." The ALJ issued findings and an order denying benefits and concluding that "[t]he mechanism of injury including the two identified accidents and [Cox's] overall work exertions in his job would not cause the extensive damage seen at multiple levels." The ALJ thus agreed with the medical panel and the WCF medical examiner that Cox's problems "found during his August 2013 emergency room visit and the need for surgery and his condition post-surgery were caused by chronic and long standing degenerative disc disease."
¶ 11 Cox petitioned for review by the Commission. In August 2015, it affirmed the ALJ's decision denying Cox's claim for benefits. The Commission agreed that "the medical evidence shows that the relatively minor low-back strain from the work accidents is not the medical cause of any disability or [Cox's] need for surgery." Cox now petitions for judicial review.
¶ 12 Cox contends that the Commission did not apply the correct legal standard for medical causation where, as here, an injury aggravates a pre-existing condition. "[W]hether the Commission has applied the correct legal standard in reaching its medical causation finding is a legal question, which we review for correctness." Hutchings v. Labor Comm'n, 2016 UT App 160, ¶ 24, 378 P.3d 1273.
¶ 13 Cox contends that the Commission applied the incorrect legal standard for medical causation by "refusing to follow appellate court decisions holding that aggravation of a preexisting condition is sufficient to establish medical causation in an industrial case."
¶ 14 The Workers' Compensation Act requires the employer to cover the medical expenses of an employee "who is injured ... by accident arising out of and in the course of the employee's employment." Utah Code Ann. § 34A-2-401 (LexisNexis 2015). The phrase " ‘arising out of or in the course of employment’ requires that there be a causal connection between the injury and the employment." Allen v. Indus. Comm'n, 729 P.2d 15, 18 (Utah 1986). The claimant bears the burden of proving causation by a preponderance of the evidence. See Virgin v. Board of Review of Indus. Comm'n, 803 P.2d 1284, 1288 (Utah Ct. App. 1990). To prove causation, the claimant must show that the industrial accident was both the legal cause and the medical cause of the injury. See Allen, 729 P.2d at 25.
¶ 15 Simply put, the "medical cause" test requires a showing that the injury was work-related. See id. at 27 (). Thus, the "key question in determining causation" is whether the employee's on-the-job exertion "in fact contributed to the injury." Id. at 24.
¶ 16 Cox argues that "medical causation" presents a "low bar" comparable to "but-for cause." (Internal quotation marks omitted.) Cox summarizes the essential inquiry for medical causation as follows: "In short, was the industrial accident ‘a’ cause, even a minor one?" According to Cox, the medical causation standard requires the Commission to determine whether "the three industrial accidents and the two months of light duty work on the fork lift—‘cumulative trauma’ [3 ]—have any connection, even a de minimis one, to [Cox's] subsequent medical care and surgery[.]"
¶ 17 WCF agrees that a showing that Cox's work-related activity "medically caused some injury to Cox" would satisfy the medical causation standard, but argues that the medical cause inquiry begins, rather than ends, with that determination. WCF maintains that the medical...
To continue reading
Request your trial-
Utah Am. Energy Inc. v. Labor Comm'n
...medical causation exists "so long as the employee's condition is not solely the result of a pre-existing condition." Cox v. Labor Comm'n , 2017 UT App 175, ¶ 18, 405 P.3d 863 (quotation simplified); accord Hutchings , 2016 UT App 160, ¶¶ 18, 21, 378 P.3d 1273. Indeed, we have previously sta......
-
JBS Carriers v. Labor Comm'n
...the Injury, then he does not; in that event, a simple showing of medical causation will suffice. See id. ¶¶ 45–46 ; see also Cox v. Labor Comm'n , 2017 UT App 175, ¶¶ 16, 18, 405 P.3d 863 (explaining that medical causation requires an employee to show that the workplace injury was "a cause—......
-
Morris v. Labor Comm'n
...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 Com......
-
Yesco v. Labor Comm'n
...had been met. Whether the Commission applied the correct legal standard is a question of law we review for correctness. See Cox v. Labor Comm'n , 2017 UT App 175, ¶ 12, 405 P.3d 863. But whether the Commission properly found that medical causation exists is a question of fact we review for ......