Medical Probability

A challenge made pertaining to a medical panel's failure to support a recommendation for cognitive behavioral therapy.

In C.R. England, Respondents challenged a medical panel’s report arguing that the panel failed to adequately support its recommendation for cognitive behavioral therapy. In support of the recommendation, the medical panel stated its belief that cognitive behavior therapy “may be beneficial” to the claimant. Respondents argued that the use of the word “may” indicated that its recommendation was not made to the “standard reasonable medical probability” and could therefore, not support a finding that the treatment was medically necessary to treat the claimant’s injuries.

The Utah Court of Appeals (the Court) disagreed, stating the use of terms like “may” and “possible” in relation to a particular aspect of its report does not necessarily indicate that its conclusion is based on mere “probability” as opposed to a “medical probability.

Utah Court of Appeals

See Danny’s Drywall v. Labor Comm’n, 2014 UT App 277, 339 P.3d 624.

The Court cited other sections of the medical panel report that indicated that its recommendations were “evidence-based” and developed in consultation with the “American College of Occupational Medicine Guidelines Treatment of Chronic Pain.” The Court also cited the section of the report where the panel opined that the recommendations would help to improve the worker’s chronic pain, enable her to “return to basic work activities,” and that because no single intervention is likely to be effective in patients with chronic low back pain, a use of “may” fits the context. For these reasons, the Court held that the medical panel’s report supported its recommendation of cognitive behavioral therapy to a reasonable medical probability.

C.R. England Inc. v. Labor Comm’n, 529 P.3d 1260 (Utah Ct. App. 2023).

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