If an employee’s workplace injuries contributed to the disability “at least in part,” then medical causation is satisfied.

In May of 2007, Adam Pilling, was injured while hurrying into a mine to work on machinery. There was a steel beam hanging downward from the ceiling and Pilling hit his head on the beam. Pilling had pre-existing chronic low back pain and hip pain. Following the accident, Pilling complained that he was suffering from neck, back, jaw and upper extremity pain that he had not experienced before. Pilling was treated with physical therapy, and continued to work, but eventually was laid off in March of 2008. Pilling later began working as a heavy-duty diesel mechanic, but quit after a few months because of pain.

In the years that followed, Pilling had several surgeries and received treatment for the pre-existing low back and hip issues. However, in addition he also sought treatment for the injuries he claimed he received from the industrial accident, including a fusion surgery of his spine. The medical records indicated that physicians struggled with determining how much of Pilling’s disability was caused by his pre-existing issues and how much was caused by the work accident.

In 2014, Pilling filed a claim for permanent total disability with the Utah Labor Commission (the Labor Commission). The matter proceeded to an evidentiary hearing. Because there was a medical dispute between Pilling’s and Respondents’ physicians over the cause and restrictions the matter was ultimately referred to a medical panel. The medical panel determined that Pilling suffered a 16% whole person impairment from the accident. The medical panel also determined that the injuries to the cervical spine and jaw were exclusively responsible for Pilling’s inability to perform overhead work or each above shoulder height. However, the medical panel also determined that these injuries worked in combination with the pre-existing issues to cause ten other work restrictions.

Ultimately, the ALJ agreed with the medical panel and found Pilling to be permanently and totally disabled. Respondents appealed challenging two aspects of the Commission’s determination (1) that Pilling sustained a significant impairment or combination of impairments as a result of the industrial accident; and (2) that the work accident was the “direct cause” of Pilling’s permanent disability.

The Utah Court of Appeals (the Court) addressed Respondents’ concern that the Labor Commission misinterpreted Utah Code Section 34A-2-413(1)(b)(i), or that Pilling sustained a significant impairment or combination of impairments as a result of the industrial accident that would give rise to the permanent total disability entitlement. Respondents argued that Pilling must prove not only a significant impairment, but also that the impairment gave rise to the permanent total disability entitlement. The Court disagreed for two reasons: First, the Court felt that the grammatical structure of the statute supports the contention that the injured worker only show that he suffered a significant impairment as a result of the accident. Second, another element in the permanent total disability statute already requires a showing of a causal link between the accident and the claimed permanent total disability, and to read the statute as Respondents contend would render that element meaningless.

Applying this interpretation to the facts of the case, the Court determined that there was substantial evidence to support the fact that Pilling had suffered a significant impairment, based on the 16% impairment rating and the work restrictions.

Next, the Court looked to Respondents’ argument that the work accident was not the “direct cause” of his permanent total disability. Respondents argued that the injury must be the sole or dominant cause of the disability. The Court disagreed stating that medical causation is established if the employee demonstrates that a work accident is “the but-for cause of the disability.” The Court did note that had the pre-existing condition been the sole cause of Pilling’s condition then he would not have been entitled to relief. Ultimately, if the employee’s workplace injuries contributed to the disability “at least in part,” then medical causation is satisfied. The Court then determined that under the substantial evidence standard, the Labor Commission did not err in determining there was a direct cause, and appropriately relied on the medical panel report in making its factual determination.

(It should be noted that Respondents did not challenge or appeal the determinations made on the other four elements of a permanent total disability claim).

Ultimately, the Court declined to disturb the Labor Commission’s award of permanent total disability benefits to Pilling.

Utah American Energy Inc. v. Labor Comm’n, 2021 UT App 33, –P.3d—

Want to know more? Contact Christin Bechmann at cbechmann@pollartmiller.com or 877-259-5693.

March 2021 Newsletter