Ramos v. Cobblestone Centre, 2020 UT 55, — P.3d —.

Factual and Procedural Summary:

Claimant moved metal trestles weighing about 300 pounds. One day, he and a co-worker were loading one such trestle onto a forklift when it fell, temporarily pinning Claimant and bending his left knee inward. He was diagnosed with an MCL tear and compressive bone marrow edema and microfractures. After treatment, he had a residual limp. There was a medical dispute over Claimant’s impairment rating, and the medical panel gave him a 1% rating.

Claimant appealed from the decision of the Labor Commission’s Appeals Board affirming the Administrative Law Judge ALJ’s decision to award claimant $1045.20 in PPD benefits, arguing that the process for deciding medical benefits was unconstitutional and that the ALJ should have increased the PPD award based on subjective pain. The Utah Court of Appeals certified this matter to the Supreme Court.

Issue 1: Whether the Labor Commission has unconstitutionally delegated authority to medical panels to decide benefits.

The process of using medical panels to decide benefits might be unconstitutional if the ALJ delegated that authority to the panel. But medical panels merely assist the Administrative Law Judge in exercising their authority. Even if their determinations are almost never rejected, this does not run afoul of the Utah Constitution. The adjudicative authority of ALJs has not been unconstitutionally delegated because (1) medical panel recommendations are only one part of the overall process of adjudication of benefits; (2) the Workers’ Compensation Act’s statutory structure allows parties to challenge a medical panel’s recommendation; and (3) the ALJ retains discretion to reject a medical panel’s recommendation. Id. at ¶ 31.

Issue 2: Whether the ALJ could augment the medical panel’s impairment rating based on a claimant’s subjective pain.

The ALJ could not have augmented the medical panel’s impairment rating based on the claimant’s subjective pain because the Labor Commission rules specifically reject the AMA guidelines for impairment ratings based on subjective pain. Id. at ¶55.

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

August 2020 Newsletter