Utah Code 34A-2-601. Medical panel, director, or consultant — Findings and reports — Objections to report — Hearing — Expenses
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(1)
Terms Used In Utah Code 34A-2-601
- Commission: means the Labor Commission created in Section 34A-1-103. See Utah Code 34A-1-102
- Compensation: means the payments and benefits provided for in this chapter or Chapter 3, Utah Occupational Disease Act. See Utah Code 34A-2-102
- Decision: includes :(1)(d)(ii)(A) an award or denial of a medical, disability, death, or other related benefit under this chapter or Chapter 3, Utah Occupational Disease Act; or(1)(d)(ii)(B) another adjudicative ruling in accordance with this chapter or Chapter 3, Utah Occupational Disease Act. See Utah Code 34A-2-102
- Director: means the director of the division, unless the context requires otherwise. See Utah Code 34A-2-102
- Disability: means an administrative determination that may result in an entitlement to compensation as a consequence of becoming medically impaired as to function. See Utah Code 34A-2-102
- Division: means the Division of Industrial Accidents. See Utah Code 34A-2-102
- Evidence: Information presented in testimony or in documents that is used to persuade the fact finder (judge or jury) to decide the case for one side or the other.
- Indemnification: In general, a collateral contract or assurance under which one person agrees to secure another person against either anticipated financial losses or potential adverse legal consequences. Source: FDIC
- Order: means an action of the commission that determines the legal rights, duties, privileges, immunities, or other interests of one or more specific persons, but not a class of persons. See Utah Code 34A-2-102
- Person: means :(24)(a) an individual;(24)(b) an association;(24)(c) an institution;(24)(d) a corporation;(24)(e) a company;(24)(f) a trust;(24)(g) a limited liability company;(24)(h) a partnership;(24)(i) a political subdivision;(24)(j) a government office, department, division, bureau, or other body of government; and(24)(k) any other organization or entity. See Utah Code 68-3-12.5
- State: when applied to the different parts of the United States, includes a state, district, or territory of the United States. See Utah Code 68-3-12.5
- Testimony: Evidence presented orally by witnesses during trials or before grand juries.
- United States: includes each state, district, and territory of the United States of America. See Utah Code 68-3-12.5
- Writing: includes :(48)(a) printing;(48)(b) handwriting; and(48)(c) information stored in an electronic or other medium if the information is retrievable in a perceivable format. See Utah Code 68-3-12.5
(1)(a) The Division of Adjudication may refer the medical aspects of a case described in this Subsection (1)(a) to a medical panel appointed by an administrative law judge:
(1)(a)(i) upon the filing of a claim for compensation arising out of and in the course of employment for:
(1)(a)(i)(A) disability by accident; or
(1)(a)(i)(B) death by accident; and
(1)(a)(ii) if the employer or the employer’s insurance carrier denies liability.
(1)(b) An administrative law judge may appoint a medical panel upon the filing of a claim for compensation based upon disability or death due to an occupational disease.
(1)(c) A medical panel appointed under this section shall consist of one or more physicians specializing in the treatment of the disease or condition involved in the claim.
(1)(d) A member of a medical panel appointed under this section, when acting within the scope of duties of a medical panel member, is considered an employee of this state for purposes of indemnification under Title 63G, Chapter 7, Governmental Immunity Act of Utah.
(1)(e) As an alternative method of obtaining an impartial medical evaluation of the medical aspects of a controverted case, the division may employ a medical director or one or more medical consultants:
(1)(e)(i) on a full-time or part-time basis; and
(1)(e)(ii) for the purpose of:
(1)(e)(ii)(A) evaluating medical evidence; and
(1)(e)(ii)(B) advising an administrative law judge with respect to the administrative law judge’s ultimate fact-finding responsibility.
(1)(f) If all parties agree to the use of a medical director or one or more medical consultants, the medical director or one or more medical consultants is allowed to function in the same manner and under the same procedures as required of a medical panel.
(2)
(2)(a) A medical panel, medical director, or medical consultant may do the following to the extent the medical panel, medical director, or medical consultant determines that it is necessary or desirable:
(2)(a)(i) conduct a study;
(2)(a)(ii) take an x-ray;
(2)(a)(iii) perform a test; or
(2)(a)(iv) if authorized by an administrative law judge, conduct a post-mortem examination.
(2)(b) A medical panel, medical director, or medical consultant shall make:
(2)(b)(i) a report in writing to the administrative law judge in a form prescribed by the Division of Adjudication; and
(2)(b)(ii) additional findings as the administrative law judge may require.
(2)(c) In an occupational disease case, in addition to the requirements of Subsection (2)(b), a medical panel, medical director, or medical consultant shall certify to the administrative law judge:
(2)(c)(i) the extent, if any, of the disability of the claimant from performing work for remuneration or profit;
(2)(c)(ii) whether the sole cause of the disability or death, in the opinion of the medical panel, medical director, or medical consultant results from the occupational disease; and
(2)(c)(iii)
(2)(c)(iii)(A) whether any other cause aggravated, prolonged, accelerated, or in any way contributed to the disability or death; and
(2)(c)(iii)(B) if another cause contributed to the disability or death, the extent in percentage to which the other cause contributed to the disability or death.
(2)(d)
(2)(d)(i) An administrative law judge shall promptly distribute full copies of a report submitted to the administrative law judge under this Subsection (2) by mail to:
(2)(d)(i)(A) the applicant;
(2)(d)(i)(B) the employer;
(2)(d)(i)(C) the employer’s insurance carrier; and
(2)(d)(i)(D) an attorney employed by a person listed in Subsections (2)(d)(i)(A) through (C).
(2)(d)(ii) Within 20 days after the day on which the report described in Subsection (2)(d)(i) is deposited in the United States post office, the following may file with the administrative law judge a written objection to the report:
(2)(d)(ii)(A) the applicant;
(2)(d)(ii)(B) the employer; or
(2)(d)(ii)(C) the employer’s insurance carrier.
(2)(d)(iii) If no written objection is filed within the period described in Subsection (2)(d)(ii), the report is considered admitted in evidence.
(2)(e)
(2)(e)(i) An administrative law judge may base the administrative law judge’s finding and decision on the report of:
(2)(e)(i)(A) a medical panel;
(2)(e)(i)(B) the medical director; or
(2)(e)(i)(C) one or more medical consultants.
(2)(e)(ii) Notwithstanding Subsection (2)(e)(i), an administrative law judge is not bound by a report described in Subsection (2)(e)(i) if other substantial conflicting evidence in the case supports a contrary finding.
(2)(f)
(2)(f)(i) If a written objection to a report is filed under Subsection (2)(d), the administrative law judge may set the case for hearing to determine the facts and issues involved.
(2)(f)(ii) At a hearing held pursuant to this Subsection (2)(f), any party may request the administrative law judge to have any of the following present at the hearing for examination and cross-examination:
(2)(f)(ii)(A) the chair of the medical panel;
(2)(f)(ii)(B) the medical director; or
(2)(f)(ii)(C) the one or more medical consultants.
(2)(f)(iii) For good cause shown, an administrative law judge may order the following to be present at the hearing for examination and cross-examination:
(2)(f)(iii)(A) a member of a medical panel, with or without the chair of the medical panel;
(2)(f)(iii)(B) the medical director; or
(2)(f)(iii)(C) a medical consultant.
(2)(g)
(2)(g)(i) A written report of a medical panel, medical director, or one or more medical consultants may be received as an exhibit at a hearing described in Subsection (2)(f).
(2)(g)(ii) Notwithstanding Subsection (2)(g)(i), a report received as an exhibit under Subsection (2)(g)(i) may not be considered as evidence in the case except as far as the report is sustained by the testimony admitted.
(2)(h) For a claim referred under Subsection (1) to a medical panel, medical director, or medical consultant before July 1, 1997, the commission shall pay out of the Employers’ Reinsurance Fund established in Section 34A-2-702:
(2)(h)(i) expenses of a study or report of the medical panel, medical director, or medical consultant; and
(2)(h)(ii) the expenses of the medical panel’s, medical director’s, or medical consultant’s appearance before an administrative law judge.
(2)(i)
(2)(i)(i) For a claim referred under Subsection (1) to a medical panel, medical director, or medical consultant on or after July 1, 1997, the commission shall pay out of the Uninsured Employers’ Fund established in Section 34A-2-704 the expenses of:
(2)(i)(i)(A) a study or report of the medical panel, medical director, or medical consultant; and
(2)(i)(i)(B) the medical panel’s, medical director’s, or medical consultant’s appearance before an administrative law judge.
(2)(i)(ii) Notwithstanding Section 34A-2-704, the expenses described in Subsection (2)(i)(i) shall be paid from the Uninsured Employers’ Fund whether or not the employment relationship during which the industrial accident or occupational disease occurred is localized in Utah as described in Subsection 34A-2-704(20).
(3)
(3)(a) The commission may employ a qualified physician as medical panel director who, in addition to the other duties outlined in this section for a medical director, is responsible for:
(3)(a)(i) assisting the commission in creating and enforcing standards for medical panels and medical consultants;
(3)(a)(ii) training members of medical panels or medical consultants;
(3)(a)(iii) increasing the number of physicians who participate on medical panels;
(3)(a)(iv) ensuring medical panels include appropriate specialists; and
(3)(a)(v) monitoring the quality of medical panel and medical consultant reports.
(3)(b) The commission shall pay the expenses of employing a medical panel director described in this Subsection (3) out of the Uninsured Employers’ Fund established in Section 34A-2-704.