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JP'S Landscaping and Auto Owners Insurance v. Labor Commission

Court of Appeals of Utah

March 30, 2017

JP's Landscaping and Auto Owners Insurance, Petitioners,
Labor Commission and Alberto Mondragon, Respondents.

         Original Proceeding in this Court

          Mark R. Sumsion and Cody G. Kesler, Attorneys for Petitioners.

          Jaceson R. Maughan and William Barlow, Attorneys for Respondent Labor Commission

          Judge Stephen L. Roth authored this Opinion, in which Judges J. Frederic Voros Jr. and David N. Mortensen concurred.


          ROTH, Judge

         ¶1 JP's Landscaping (JPL) requests review of the Labor Commission's award for workers' compensation benefits arising out of an industrial accident that occurred in May 2012 involving one of JPL's employees. We decline to disturb the Commission's decision.


         ¶2 On May 22, 2012, the first day of his employment, JPL employee Alberto Mondragon suffered an injury. The accident occurred as Mondragon, "almost running, " pushed a wheelbarrow full of gravel over uneven ground. Mondragon slipped, and as he did, the wheelbarrow "tipped over." Mondragon claimed that, as the wheelbarrow tipped, its "handles [took] hold of him in different directions, " which caused "pressure on his [right] knee." At that point, Mondragon claims "he felt a sudden pop in the knee." Although he did not "fall to the ground" and was instead "able to catch himself, " Mondragon reported that the inside area of his right knee-both front and back-began to immediately swell.

         ¶3 Mondragon reported the incident to his supervisor when she arrived at the site, and, within three hours of the incident, he reported to a WorkMed clinic. The physician who examined him, Dr. Britt, noted Mondragon's explanation that the injury involved a wheelbarrow full of gravel that tilted and caused pressure on Mondragon's right knee and that there was a "sudden pop" in that knee. Dr. Britt then noted that there was "no visible bruising" but that there "may be slight swelling above the joint line medially" and that Mondragon had "diffuse tenderness . . . around the medial joint line area." He also noted that, although Mondragon was able to extend and flex the knee, "[a]ny attempts at rotation and extension cause[d] [Mondragon] to have marked pain." Dr. Britt diagnosed Mondragon with a right knee sprain and stated that the sprain was the "result of the industrial injury/exposure described." He prescribed a knee support and pain medication. He also referred Mondragon to an orthopedic specialist for further evaluation and released him to light-duty work. Because JPL did not have light-duty work available, it terminated Mondragon's employment. Mondragon was out of work until July 15, 2012, when he began working for another employer.

         ¶4 In August 2012, Mondragon requested a hearing before an administrative law judge (the ALJ) to determine his entitlement to workers' compensation benefits related to the accident. Mondragon represented himself at the hearing. When asked to explain how the accident occurred, he explained that he was "almost running" while pushing a wheelbarrow full of gravel and that the wheelbarrow tipped to the side, catching his knee between the two handles. He testified that he "felt [his] knee popping and twisting to the side" or that "maybe only nerves got twisted, " and that there was immediate swelling around his right knee. He also testified that Dr. Britt later informed him that he had suffered a "severe sprain." On cross-examination, however, JPL demonstrated that the mechanism of injury Mondragon had described-that his right knee became caught between the two handles of the wheelbarrow-was physically impossible. Specifically, counsel for JPL asked Mondragon to demonstrate how his accident had occurred using a comparable wheelbarrow that JPL produced at the hearing. It became obvious that Mondragon's knee could not have been caught between the two handles, because as the wheelbarrow tipped, the left handle would have been significantly higher than his right knee and could not have caught his right knee or struck it. Mondragon stated, however, that even if he did not know "how [the wheelbarrow] caught [his knee], " his right knee still "got caught . . . and the wheelbarrow tipped over to the side" and that the right handle "was the one that hit [him], " which was when he felt his "[right] knee kind of popping towards the outside."

         ¶5 In her interim findings of fact and conclusions of law issued after the hearing, the ALJ concluded that although "[t]he exact mechanism of injury is unclear" and Mondragon mistakenly "believed that one of the handles of the wheel barrow hit his right knee, " Mondragon had nevertheless suffered an injury that "arose out of an industrial accident." The ALJ also concluded that there were conflicting opinions regarding the medical cause of Mondragon's continuing knee problems, with Mondragon's treating physicians stating that the accident caused Mondragon's injury and the need for further treatment, while an independent medical examiner that JPL hired had concluded that, at most, the accident aggravated preexisting knee conditions. The ALJ therefore referred the case to a medical panel to consider the question of medical causation. In the charging letter, the ALJ asked the panel to answer whether there was "a medically demonstrable causal connection between [Mondragon's] medical problem and the industrial accident as described in [the] Interim Order"; to "identify the medical care necessary to treat [Mondragon's] problems caused by the industrial accident"; and to "identify any and all future medical care . . . that will be necessary in treating [Mondragon's] problems caused by the industrial accident."

         ¶6 The ALJ found in her interim order that Mondragon could not have been injured by "one of the handles of the wheel barrow hit[ting] his right knee" and advised the medical panel in her charging letter that the panel was "bound by" the findings and conclusions in the interim order. In its report, the medical panel characterized Mondragon's injury as a "twisting type injury" and described the accident as occurring when the wheelbarrow's "handle caught [Mondragon's] right leg" as it tipped over and Mondragon "twisted to free himself from the flipped wheel barrow." On this basis, the medical panel concluded that there was a "causal connection between the injury suffered in 2012 and the ongoing knee problem." The panel had examined Mondragon and reviewed his medical history and determined that the type of pain he experienced- "mostly medial side pain" along with "recurrent swelling" in the joint-was consistent with meniscal knee injuries. It also noted that, although Mondragon had suffered a number of knee injuries in the past, "all previous injuries to the right knee were diagnosed contusions" that "improved in less than four months" with "no residual symptoms." Further, although arthritis could have been a cause of similar symptoms, the panel noted that radiographic images of the knee "show[ed] healthy joint weight bearing surfaces, with minimal arthritic changes consistent with age and heavy use" and opined that "the excellent joint space seen on [Mondragon's] radiographs" would weigh against a conclusion that arthritis was the cause. The medical panel concluded that "the twisting type injury with medial pain, the prolonged nature of the medial joint line pain and swelling, the findings on physical examination of medial pain, . . . all suggest an injury to the meniscus" from the accident, which "seldom heal[s] with time." As a consequence, the panel opined that Mondragon required further medical care to treat his knee injury, including an operation to repair the meniscal tear, follow-up physical therapy and medication, and other associated medical care.

         ¶7 JPL objected to the medical panel report, arguing that the case should have been dismissed before referral to the panel because Mondragon "did not meet his burden of proving that an accident occurred." JPL also argued that the panel's report should not be admitted in any event, because the medical panel "relied upon a mechanism of injury which did not occur" when it described the accident as involving the wheelbarrow's "handle" catching Mondragon's right leg as the wheelbarrow tipped over. The ALJ responded to JPL's contentions in her findings of fact and conclusions of law, reiterating and further explaining her conclusion that Mondragon had suffered an industrial accident on the day in question. In particular, the ALJ stated that she found Mondragon's "testimony regarding his work day to be believable and truthful." Although Mondragon's "description [of the accident] is flawed in the details, " she said, what "remained quite clear was that [Mondragon] did use his legs and body to try and keep control of the wheel barrow" and that "when the heavy load tipped" Mondragon was "jerked and tousled." She further explained that even though Mondragon might have had a "flawed recollection of the details . . . the case can be made that an accident took place from the facts known before and after the moment of injury, " which included "the nature of the heavy work being done, the pace of the work, the loss of control over the wheel barrow[, ] and the resultant pain and injury." The ALJ concluded that that evidence "proved that an industrial accident of substantial exertion took place." In addition, the ALJ rejected JPL's contention that the medical panel had relied on facts inconsistent with the "in court demonstration done with the wheel barrow, " in other words, that the panel had relied on Mondragon's discredited original description of the mechanism of injury. She therefore declined to hold a hearing on JPL's objection to the medical panel report and admitted it. The ALJ then ordered JPL to pay Mondragon's "past and future medical bills related to the necessary care of . . . Mondragon's right knee injury consistent with the medical panel's opinion."

         ¶8 JPL sought review of the ALJ's decision with the Commission. The Commission concluded, as had the ALJ, that Mondragon had suffered a right knee injury as a result of the work-site accident with the wheelbarrow. The Commission explained that, while the "exact mechanism of injury is somewhat unclear, . . . that uncertainty is not fatal" to Mondragon's claim, particularly where it was clear that Mondragon's "knee was subject to stress while the fully loaded wheelbarrow tipped over." Nonetheless, the Commission agreed with JPL that the medical panel's opinion was, at least in part, based "on a mechanism involving the wheelbarrow handles that is inaccurate." The Commission concluded that the panel needed to "reassess [Mondragon's] right knee injury in light of the Commission's and [the ALJ's] findings regarding the accident rather than [Mondragon's] inaccurate description" and then readdress whether the accident was a medical cause of the injury.

         ¶9 In her second charging letter, the ALJ advised the panel that the matter was being remanded "for further review by the medical panel" because the Commission had determined that the report "may have been based on facts which were not consistent with the [interim order] issued after the hearing." Specifically, the ALJ explained that the panel had described the accident as occurring when the tipping wheelbarrow's handle "caught [Mondragon's] right leg, and [Mondragon] twisted to free himself, " but that "[t]here is no evidence that Mr. Mondragon was caught in the wheelbarrow or that he twisted to free himself." Again advising the panel that it was bound by the findings of fact and conclusions of law in her order, the ALJ requested that the panel answer four questions, including the following question most pertinent to the issues in this review:

Assuming that the exact mechanism of injury is not clear but that Mr. Mondragon's right knee was subject to stress while a fully loaded wheelbarrow tipped over[, ] please determine if Mr. Mondragon's right knee problems were medically caused by the work accident or whether his current right knee problems are a continuation of his pre-existing condition and the transient pain he has experienced in the past?

         ¶10 The medical panel reconsidered the matter accordingly, and, in better alignment with the ALJ's interim findings, disclaimed its previous description of the accident, i.e., that Mondragon's knee had "been caught in the wheelbarrow or that he twisted to free himself." Instead, the panel now acknowledged that the "exact mechanism of injury was unclear" and that it had not been aware in the first evaluation that there was a controversy surrounding the "exact mechanism of injury." The panel further noted that "the interpretation of a twisting type injury" was the panel's conclusion, not Mondragon's. The medical panel again determined, however, that the industrial accident medically caused Mondragon's knee injury, that his condition had not yet stabilized, and that he would need additional treatment. With regard to the relationship between the known facts of the accident and injury, the panel explained that, due to the anatomical configuration of the meniscus, persons who suffer a meniscus tear often report "a sudden pop within the joint" and "often feel[] that [they have] been struck by something, " consistent with Mondragon's description. The person generally suffers "immediate pain on the side of the meniscus and swelling within the joint, " and it is "often difficult to extend the knee or place pressure on it, " just as Mondragon had reported right after the event. The panel further concluded that while Mondragon had suffered previous knee injuries, those injuries did not involve the same symptoms he exhibited after the May 2012 accident. The medical panel therefore rejected the suggestion that Mondragon's injury was caused by a preexisting knee condition. And the panel concluded, as it had before, that Mondragon's injury was consistent with a meniscal tear. After reviewing the medical panel's second report, the ALJ reaffirmed her previous order awarding benefits to Mondragon stemming from the May 2012 accident.

         ¶11 JPL sought review by the Commission's Appeals Board. The Board affirmed the ALJ's decision and denied JPL's request for reconsideration. JPL asks that we set aside the Board's decision and the award of benefits in Mondragon's favor.


         ¶12 JPL argues that the Commission erred in awarding benefits to Mondragon. The Commission's decision to award benefits is a mixed question of fact and law. Danny's Drywall v. Labor Comm'n, 2014 UT App 277, ¶ 9, 339 P.3d 624. "The standard of review we apply when reviewing a mixed question can be either deferential or non-deferential" depending upon whether the question is more fact-like or law-like. Jex v. Labor Comm'n, 2013 UT 40, ¶ 15, 306 P.3d 799 (citation and internal quotation marks omitted). Here, "[d]ue to the fact-intensive inquiry involved at the agency level" in determining whether it is appropriate to award benefits, including credibility determinations that an appellate court is "in an inferior position to review, " "this case does not lend itself to consistent resolution by a uniform body of appellate precedent." See Carbon County v. Workforce Appeals Board, 2013 UT 41, ¶ 7, 308 P.3d 477 (citation and internal quotation marks omitted). This decision is therefore more fact-like, and deference to the Commission's decision is warranted. See id.

         ¶13 The Commission is the ultimate fact finder in workers' compensation claims. See e.g., Danny's Drywall, 2014 UT App 277, ¶ 14 ("[T]he ALJ/Commission is always the ultimate fact finder." (alteration in original) (citation and internal quotation marks omitted)). We will uphold the Commission's "factual findings if such findings are supported by substantial evidence based upon the record as a whole." Ernest Health, Inc. v. Labor Comm'n, 2016 UT App 48, ¶ 10, 369 P.3d 462 (citation and internal quotation marks omitted). Substantial evidence exists when the findings are supported by "more than a mere scintilla of evidence, " and "[a]n administrative law decision meets the substantial evidence test when a reasonable mind might accept as adequate the evidence supporting the decision." Martinez v. Media-Paymaster Plus, 2007 UT 42, ¶ 35, 164 P.3d 384 (citations and internal quotation marks omitted).

         ¶14 "In order to determine whether a decision is supported by substantial evidence, the reviewing court must consider the whole record before the lower court, " which includes "evidence in support of the administrative finding, as well as evidence that detracts from the finding." Id. ¶ 36. However, "[i]t is not this court's place to substitute its judgment as between two reasonably conflicting views." EAGALA, Inc. v. Department of Workforce Servs., 2007 UT App 43, ¶ 16, 157 P.3d 334 (citation and internal quotation marks omitted). Rather, it is the "province of the [Commission], not appellate courts, to resolve conflicting evidence, and where inconsistent ...

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