BY:

Allen Callison | Attorney

Bureau of Workers’ Compensation Orders

Expedited Appeals Board Orders

James Peters v. Jonathan Mitchell d/b/a A Clean Connection

Docket: 2015-02-0209

Judge: Marshall Davidson

Appeal from: Brian Addington

Claimant’s Counsel: Pro se

Employer/Carrier’s Counsel: Michael Haynie

Briefly: The Appeals Board affirmed the Trial Court’s conclusion that the Claimant was an employee rather than an independent contractor, but reversed the Court’s order for a causation opinion, stating that the Workers’ Compensation Act does not require the Employer to pay for such an opinion. 

Summary: The Claimant had been working for the Employer for 15 years on and off.  He was paid by the job, but told where to work, how to work, and could be terminated at any time, as he was.  The Court performed an analysis of all of the independent contractor factors and reached the conclusion that the Claimant was more likely an employee than an independent contractor based upon those factors.  Therefore, the Court ordered ongoing medical benefits, but declined to award TTD benefits absent a showing of disability.

Nohemi Arciga v. AtWork Personnel Services

Docket: 2015-02-0217

Judge: Tim Conner

Appeal from: Brian Addington

Claimant’s Counsel: Russell Velman

Employer/Carrier’s Counsel: Mary Beth Maddox

Briefly: Appeals Board affirmed denial of TTD benefits because the Employee failed to offer medical evidence supporting a finding of causation.  Additionally, the Employee failed to file a transcript or statement of the evidence. 

Summary: Claimant alleged an at-work injury in January 2015.  She treated off and on for approximately 6 months on her own before the Employer provided a panel of physicians.  The Claimant had only been seen on one or two occasions by an occupational medicine provider, but no opinion had been given regarding medical causation.  Because medical causation was missing, the Court refused to order TTD benefits.   

Expedited Hearing Orders

Paul Mayhew v. New Action Mobile Industries and Berkshire Hathaway Homestate Ins.

Docket: 2015-06-0995

Judge: Ken Switzer

Claimant’s Counsel: Jason Denton

Employer/Carrier’s Counsel: Greg Fuller

Briefly:   Claimant sustained a back injury for which he obtained conservative care with a neurosurgeon.  After failing to improve, the ATP referred the Claimant to a pain management provider for ongoing care.  However, while the referral and authorization of treatment was pending, the ATP responded to two letters by stating that pain management was no longer indicated.  Therefore, the Court refused to authorize evaluation and treatment with a pain management provider.

Summary: Claimant sustained a compensable injury and selected Dr. Doug Mathews as his ATP.  Dr. Mathews provided conservative care for approximately 10 months before referring Claimant first for a second opinion (with Dr. Lien) and then for pain management.  However, while the pain management referral was pending, Dr. Mathews reconsidered and said it was no longer indicated.  Therefore, the Court felt it had no choice but to deny Claimant’s request for authorization of treatment with a pain management provider.  The Court did, however, find that the Insurer’s inaction in authorizing treatment for several months after it had been recommended was subject to potential penalties, thereby necessitating a referral to the penalty division. 

Thomas Kelly v. Catmur Development Co. and Builders Mutual Ins. Co.

Docket: 2015-08-0509

Judge: Jim Umsted

Claimant’s Counsel: Hope Calabro

Employer/Carrier’s Counsel: Devin Williams

Briefly: The Court issued an order stating that the Medical Director’s decision on UR matters was not binding on the Court of Workers’ Compensation.  However, the Court affirmed Dr. Snyder’s decision that the medical care provided was medically necessary.  Therefore, the Court not only ordered the payment of the $52,000.00 medical bill, but also awarded the Claimant’s counsel 20% of that medical bill. 

Summary: The Claimant sustained a lacerated thumb while working for Employer.  He was rushed the Med in Memphis, but the physicians on staff were unable to reattach the thumb.  Therefore, the decision was made to fly him to Nashville for surgery at Vanderbilt.  The thumb reattachment was unsuccessful.  The cost of the flight to Nashville was submitted to UR and the UR physician found the flight itself to be medically unnecessary.  The Claimant appealed the UR denial to the DOL’s medical director.  Dr. Snyder reversed the denial and ordered the Insurer to pay the medical bill.  The Insurer then filed a PBD with the Court of Workers’ Compensation.  The Court found that it did have jurisdiction to hear the matter and Dr. Snyder’s decision was not binding.  Further, the Court ordered the Insurer to pay the cost of the medical transport flight and awarded Claimant’s counsel 20% of that cost.  

Laury Navyac v. Universal Healthcare Services

Docket: 2015-06-0677

Judge: Josh Baker

Claimant’s Counsel: Will Hicky

Employer/Carrier’s Counsel: Greg Fuller

Briefly: Claimant was on a “special errand” to a location about an hour away when she stopped at a McDonalds to buy food and use the restroom.  While exiting the restaurant, she slipped on a puddle and broke her ankle.  Ultimately, the Court found that while she was in the course and scope of her employment, the injury did not arise primarily out of the employment, but, rather, due to the presence of water on the floor of McDonalds that caused the slip and fall.

Summary: Claimant was on a special errand to perform training at a location approximately an hour from her office when she stopped at McDonalds to purchase food and use the restroom.  While exiting the restaurant, she slipped and fell on a puddle of water, fracturing her ankle.  The Employer denied the claim, stating that she was on a personal errand or deviation or, alternatively, that the injury did not arise primarily out of the employment.  The Court disagreed with the first argument, finding that stopping at a fast food restaurant was an anticipated deviation as part of the special errand.  However, the Court found that it was the wet floor, rather than her mere presence in the restaurant, that contributed more than 50% in causing her to slip and fall. 

Anthony Leas v. Opus Inspection and Liberty Mut. Fire Ins. Co.

Docket: 2015-05-0415

Judge: Dale Tipps

Claimant’s Counsel: Pro se

Employer/Carrier’s Counsel: Shaterra Reed

Briefly: The Trial Court denied benefits, finding that the ATP, who is provided a presumption of correctness, determined that the injury did not primarily arise out of the employment.

Summary: Claimant provided multiple accounts of his date of injury and how he was injured.  Dr. Wieck, the ATP, responded to a questionnaire that the injury did not arise primarily out of the employment.  Therefore, the Court stated that it was unable to substitute its lay opinion for Dr. Wieck’s expert conclusion.  Therefore, benefits were denied.  

Christopher Tolbert v. MPW Industrial Services at Volkwagen

Docket: 2015-01-0199

Judge: Tom Wyatt

Claimant’s Counsel: Carmen Ware

Employer/Carrier’s Counsel: David Weatherman

Briefly: Claimant sought TTD and TPD benefits after Employer refused to accommodate while he was on narcotics, as well as when he was under the care of a pain management provider following placement at MMI from orthopaedic ATP.  The Court awarded benefits for the requested durations.

Summary: The Claimant fell from a ladder and sustained injuries his head and neck.  He was evaluated by an occupational provider who prescribed narcotics and a neck brace, as well work restrictions.  The Claimant returned to work and signed a modified duty agreement.  However, he was told that he could not work while taking narcotics, so he left.  Ultimately, Dr. Hodges, his ATP, placed him at MMI from an orthopaedic standpoint and referred the Claimant for pain management.  The Claimant sought benefits due to his being told that the Employer could not accommodate him while on narcotics, as well as while he was under the care of a pain management provider.  The Court ordered benefits for both durations, but failed to discuss T.C.A. § 50-6-207(1)(D), which provides that a Claimant has reached MMI when “the only care provided is for treatment of pain.”  

Deatrice Craddock v. Dialysis Clinic, Inc.

Docket: 2015-01-0177

Judge: Tom Wyatt

Claimant’s Counsel: Pro se

Employer/Carrier’s Counsel: Jonathan May

Briefly: The Trial Court denied medical and indemnity benefits because none of the medical records introduced indicated that the injury was caused by an event at work. 

Summary:  The Claimant alleges that she was assaulted by a coworker who grabbed her arm.  She alleged that she reported the injury and obtained medical care, but the claim was denied.  The Claimant failed to present any medical proof attributing her injury to an accident at work, and the medical reports did not indicate that the accident occurred at work.

Jim Collier v. Walden Security

Docket: 5015-01-0205

Judge: Audrey Headrick

Claimant’s Counsel: Ronnie Berke

Employer/Carrier’s Counsel: Bruce Williams

Briefly: The Claimant had a longstanding history of back problems that included pain management.  He alleged an aggravation while wrestling with a patient at Erlanger.  However, the medical records did not indicate that he had sustained a work injury for nearly three months after the DOI.  Based on the evidence, the trial court declined to order medical or indemnity benefits.  

Summary: Claimant had longstanding back problems stemming from a prior workplace injury in 2005 for which he continued to receive narcotics through a pain management provider.  The Claimant alleged an aggravation while in the course of his employment, including numbness in his lower extremities.  The Court found that the Claimant was unlikely to succeed in establishing that the accident contributed more than 50% in causing the aggravation. 

Margo Ratliff v. House-Hasson Hardware Co. and American Zurich Ins. Co.

Docket: 2015-03-0463

Judge: Pam Johnson

Claimant’s Counsel: Pro se

Employer/Carrier’s Counsel: Douglas Bergeron

Briefly: The Trial Court denied medical and indemnity benefits for a fall sustained while Claimant was climbing stairs and her knee “buckled.”  The Court found this was an idiopathic injury rather than caused by her employment..  

Summary: The Claimant had previous injuries to her left knee, including a 2010 date of injury for which she underwent arthroscopic repair and was diagnosed with severe arthritis.  She sustained a fall while climbing stairs at her employment, but told the adjuster that the stairs did not contribute to her injury.  Her treating physician stated that the employment did not contribute to the injury as the findings were chronic and related to the 2010 date of injury.  Therefore, based on those findings, the Trial Court denied indemnity and medical benefits. 

Elsa Arriaga v. Amazon.com, Inc.

Docket: 2014-01-0012

Judge: Tom Wyatt

Claimant’s Counsel: Pro se

Employer/Carrier’s Counsel: Charles Pierce

Briefly: The Trial Court ordered medical benefits, stating that the Claimant had rebutted the presumption of correctness afforded the ATP as Dr. Eck had provided care and obtained diagnostic testing in the course of his work-up of the Claimant’s medical condition.   

Summary: Claimant was a picker at the Amazon facility and reported walking in excess of 10 miles a day to pick items.  She reported a repetitive stress injury to her feet/ankles and neck/shoulder as the result of those duties.  She requested medical care, but was told to seek treatment on her own.  Eventually, Employer authorized evaluation with an occupational provider who stated that the injury was not work related.  Meanwhile, however, Dr. Eck, a spine surgeon, opined that the injury was work-related.  Therefore, the TDOL found that the Claimant had rebutted the presumption of correctness  

Joann Long v. Southeast Eye Specialists

Docket: 2015-03-0285

Judge: Pam Johnson

Claimant’s Counsel: James Friauf

Employer/Carrier’s Counsel: Byron Lindberg

Briefly: The Trial Court denied medical and indemnity benefits based on the ATP’s recommendation of conservative care and the Claimant obtaining unauthorized surgery with Dr. Damon Petty.  The Trial Court said that the Claimant had failed to overcome the presumption of correctness assigned to the ATP.

Summary: Claimant sustained an injury that included an avulsed hamstring tear for which she selected Dr. Hovis as her ATP.  Dr. Hovis recommended conservative care, but ordered a second opinion.  The second opinion doctor recommended surgical intervention, but Dr. Hovis did not agree with that and the Claimant also agreed.  However, she sought treatment with Dr. Petty on her own and sought to have the Employer pay for the surgery and for TTD while out of work.  The Court said that based on the evidence before it, it did not find Dr. Petty’s or Dr. Hovis’ opinion to be more persuasive.  Therefore, by default, Dr. Hovis’ opinion regarding reasonable medical care is presumed correct.   

Ronald Reese v. Waste Connections, Inc.

Docket: 2015-03-0231

Judge: Pam Johnson

Claimant’s Counsel: Pro se

Employer/Carrier’s Counsel: Gerald Jabaley

Briefly: The Claimant’s medical records admitted into evidence were either silent as to causation or stated that the injury was due to lifting groceries.  Therefore, the Court said it was unable to conclude that the injury primarily arose out of the employment. 

Summary: Claimant alleged a gradually occurring injury lifting trashcans and climbing into and out of the dump truck.  However, medical records suggested that he hurt his back lifting a sack of groceries.  The Claimant failed to disclose several medical records prior to the hearing, so the court refused to admit them.  Therefore, the trial court said that it only had a handful of medical records to rely upon.  Of those, only one discussed causation and it specifically stated that the Claimant hurt his back lifting groceries.  Therefore, benefits were denied.    

Jason Oswald v. LMI Tennessee, Inc.

Docket: 2015-07-0162

Judge: Allen Phillips

Claimant’s Counsel: Larry Hicks

Employer/Carrier’s Counsel: Travis Ledgerwood

Briefly: Trial Court denied benefits, finding that the Claimant’s medical proof was suspect because of inaccurate information and the Claimant’s testimony was refuted by other witnesses.  Therefore, the Claimant was unlikely to prevail at a compensation hearing.

Summary: Claimant had a significant history of preexisting back problems, including multiple surgeries.  He alleged an aggravation while moving a drive shaft that weighed approximately 50 lbs.  However, witnesses present at the time of the alleged accident refuted the Claimant’s testimony.  Further, medical proof in the form of a signed letter from Dr. Schwarz regarding causation was predicated on the Claimant’s statement that he had been entirely pain free for two years.  However, medical records revealed that the Claimant had been actively treating for acute pain in the months leading up to the date of injury.  Therefore, the Court could not conclude that the Claimant was more likely to prevail at a full compensation hearing.
Allen Callison | Attorney