DECISION
PER CURIAM:
1 1 Petitioner Jose Ramirez challenges the Utah Labor Commissions (the Commission) decision denying him workers compensation benefits. This case is before the court on Respondents motion for summary disposition.
1 2 On August 2, 2010, Ramirez was working with Auction Direct Automotive, Inc. (Auction Direct) as a car detailer. While at work, Ramirez felt a spasm in his low back and fell to the ground in pain. Dr. James Arango examined Ramirez on August 2, and diagnosed him with acute myofascial strain of the low back. Dr. Arango did not state that there was a causal relationship between Ramirezs work activities on August 2, 2010, and his back strain and did not complete a Physicians Initial Report of Work Injury. On August 13, 2010, Dr. Jay Yates evaluated Ramirez as having low back strain, but he also did not complete a Physicians Initial Report of Work Injury. The Administrative Law Judge (ALJ) found that Dr. Yates did not make any statements connecting Ramirezs back strain and his employment. On May 24, 2011, Dr. Deborah Mattingly performed an independent medical examination in which she concluded, There is no causal medical connection between Mr. Ramirezs current complaints and the alleged industrial accident. The ALJ found that while Ramirez initially denied any back problems pri- or to August 2, 2010, he later admitted that he had worn a back brace for low back pain. The ALJ found by a preponderance of the evidence that prior to August 2, 2010, Ramirez suffered routine bouts of low back pain for which he wore a back brace one to four times per month. Ramirez also admitted, and the ALJ so found, that he suffered back pain on August 1, the day before the incident. Because there was no medical opinion stating a causal connection between Mr. Ramirezs complaints of low back pain and his work activities on August 2, 2010, the ALJ found that Mr. Ramirez failed to meet his burden of establishing by a preponderance of the evidence that a medical causal connection exists between his low back problems and anything he did at work for Auction Direct on August 2, 2010.
T3 The Labor Commission affirmed the ALJs decision. The Commission found that while Dr. Arango diagnosed Ramirez with an acute myofascial strain of his low back, he did not opine that Mr. Ramirezs low-back condition was medically caused by his work for Auction Direct. Although Dr. Yatess treatment notes stated that Ramirez was drying a car when he apparently ... overdid it and injured his back, the Commission read that statement as Dr. Yates recounting the alleged accident as described by Mr. Ramirez, not [as] an opinion connecting the medical cause of Mr. Ramirezs low-back condition to his employment. Finally, the Commission concluded, Mr. Ramirez made no proffer of medical evidence supporting the position that his employment medically caused his low-back condition other than Dr. Yatess ambiguous statement and the treatment report of Dr. Arango, who likewise found no medically demonstrable causal connection between Mr. Ramirezs low-back condition and his employment. The Commission also rejected Ramirezs claim that the ALJ abused his discretion by not appointing a medical panel.
T4 An employee who is injured ... by accident arising out of and in the course of the employees employment, may recover compensation. Utah Code Ann. § 34A-2-401(1) (2011). Limiting compensation to accidents arising out of and in the course of ... employment, see Utah Code Ann. § 34A-2-401(1), requires the party seeking compensation to prove both an accident and a causal connection between the injury and the employment Murray v. Labor Commn, 2012 UT App 33, ¶ 7, 271 P.3d 192 (quoting Allen v. Indus. Commn, 729 P.2d 15, 18 (Utah 1986)). [Clausation is a two-fold concept encompassing both medical causation and legal causation. Id. To demonstrate medical causation, a claimant must show by evidence, opinion, or otherwise that the stress, strain, or exertion required by his or her occupation led to the resulting injury or disability. Allen, 729 P.2d at 27 (Utah 1986). If a claimant cannot show a medical causal connection, compensation should be denied. Id. That symptoms unrelated to work activities develop while an employee is at work does not in itself establish medical causation. See id. at 25. If we determine that the Commission properly concluded that medical causation was not established, it is not necessary to consider legal causation. See Hymas v. Labor Commn, 2008 UT App 471, ¶ 8, 200 P.3d 218.
T5 Ramirez disputes the Commissions determination that the medical records did not establish medical causation. We review the Commissions application of the causation test for an abuse of discretion, applying a test of reasonableness and rationality. See Murray, 2012 UT App 33, ¶ 27, 271 P.3d 192; see also Smiths Food & Drug, Inc. v. Labor Commn, 2011 UT App 67, ¶ 6, 250 P.3d 1008 (stating that the Commissions determination will be upheld unless it exceeds the bounds of reasonableness and rationality). We conclude that the Commissions determination that Ramirez did not provide sufficient evidence to establish medical can-sation by a preponderance of the evidence was both reasonable and rational and therefore must be upheld.
¶ 6 Ramirez also claims that the ALJ abused his discretion by not referring the case to a medical panel. Rule 602-2-2 of the Utah Administrative Code requires referral to a medical panel where one or more significant medical issues may be involved, which must generally be shown by conflicting medical reports. Utah Admin. Code R602-2-2. Whether there are conflicting medical reports is a question of fact. Brown & Root Indus. Serv. v. Industrial Commn, 947 P.2d 671, 677 (1977). The Commission found that based upon the information before the ALJ at the time of the hearing, there were no conflicting medical reports. See generally Hymas, 2008 UT App 471, ¶ 12, 200 P.3d 218. That factual finding is clearly supported by the record. Accordingly, the Commissions decision that the ALJ was not required to submit the case to a medical panel does not exceed the bounds of reason and rationality. See id.
T7 We grant Respondents motion for summary affirmance and affirm the Labor Commissions decision.
. Ramirez argues that he should recover compensation for injuries in any way contracted, sustained, aggravated, or incurred by the employee in the course of or because of or arising out of the employees employment. See Utah Code Ann. § 34A-2-105(1) (2011). However, section 34A-2-105(1) is the exclusive remedy provision, which is intended to describe the wide range of actions and claims that are unavailable to an employee seeking to recover against an employer for an alleged industrial injury by any means other than a workers compensation proceeding.