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Access over workers' compensation decisions, including En Banc, Significant Panel Decisions, and writ-denied cases.

Case No. Docket No. 2018-05-1127, State File No. 53470-2018
Regular Panel Decision
Apr 09, 2020

Barnes, William v. Jack Cooper Transport Co.

In this interlocutory appeal, the Tennessee Workers’ Compensation Appeals Board reviewed a case involving William Barnes, an employee who sustained a left knee injury at work, exacerbating pre-existing osteoarthritis. The employer, Jack Cooper Transport Co., and its current insurer, National Interstate Insurance Company, denied authorization for a total knee arthroplasty, arguing it was related to pre-existing conditions rather than the recent 2018 work incident. The trial court initially ordered authorization, but the Appeals Board reversed this specific order. While affirming the provision of reasonable and necessary medical benefits causally related to the 2018 injury, the Board found that the preponderance of medical evidence, particularly from the authorized treating physician Dr. Garside, did not support the conclusion that the 2018 incident was the primary cause (contributing more than 50%) for the need of the total knee arthroplasty, outweighing the opinion of Dr. Jones which the trial court credited.

Workers' Compensation AppealsKnee InjuryPre-existing ConditionOsteoarthritis ExacerbationTotal Knee ArthroplastyMedical CausationPanel Physician SelectionPresumption of CorrectnessAbuse of DiscretionExpert Medical Opinion
References
14
Case No. 2015-05-00582
Regular Panel Decision
Sep 16, 2016

Venable, Tim v. SUPERIOR ESSEX, INC

This case concerns Tim Venable's request for knee replacement surgery following a work-related left knee injury. The employer, Superior Essex, Inc., and its insurer, Sentry Casualty Co., denied the recommended total knee arthroplasty by treating physician Dr. Scott McCall based on utilization review (UR) findings. The Court of Workers’ Compensation Claims asserted its jurisdiction to review medical necessity, rejecting the argument that UR denials preclude judicial oversight. Finding that Superior failed to overcome the statutory presumption of medical necessity, the Court determined Mr. Venable is likely to prove the surgery is reasonable and necessary. Consequently, the Court ordered the employer and insurer to provide the total knee replacement as recommended.

Knee InjuryOsteoarthritisTotal Knee ReplacementUtilization ReviewMedical NecessityExpedited HearingTennessee LawPresumption of Medical NecessityTreating Physician OpinionCausation Opinion
References
4
Case No. 2024-60-3340
Regular Panel Decision
Dec 10, 2024

Wellington, Sylvia v. Dollar Tree Stires, Inc.

The parties in this case, Sylvia Wellington and Dollar Tree Stores, Inc., reached an agreement during an Expedited Hearing. The agreement stipulates that Ms. Wellington will receive a left total knee arthroplasty surgery for her left knee injury, as previously ordered by Dr. West on April 4, 2024. The court ordered that this surgery be authorized by the employer within fifteen calendar days from the date of the order. Additionally, the issue concerning the employee's attorney's fees, as per Tenn. Code Ann.§ 50-6-226(d)(l)(B), has been reserved for a later decision. The order was signed by Judge Kenneth Switzer.

knee injurysurgery authorizationagreed orderexpedited hearingworkers' compensation claimsattorney's feesTennesseearthroplastymedical treatmentemployer responsibility
References
0
Case No. 2017-06-1090
Regular Panel Decision
Dec 04, 2017

Henderson, Debbie v. South Central Communications

Ms. Henderson filed a Request for Expedited Hearing seeking knee and shoulder surgery and temporary total disability benefits following a work fall on July 19, 2016. Dr. Ronald Derr, the authorized treating physician, opined that her injuries to her right shoulder, left knee, left hand, and right foot stemmed from the fall, aggravating pre-existing conditions in her knee and causing soft tissue impingement in her shoulder that was previously asymptomatic. The Court found that Ms. Henderson is likely to prevail on causation, determining that her need for surgery arises primarily out of her employment. Consequently, the Court granted her requests for additional medical benefits, including the proposed shoulder and knee surgeries, and awarded her $3,516.54 in past temporary total disability benefits. A status conference is scheduled for February 5, 2018.

Medical BenefitsKnee InjuryShoulder InjuryTemporary Total DisabilityExpedited HearingCausationPre-existing Condition AggravationWork AccidentSurgeryEmployer Liability
References
4
Case No. MISSING
Regular Panel Decision

Claim of Caezza v. Via Health

Claimant, a hospital unit technician, sustained a back injury in 2002, leading to multiple additional injuries including consequential left knee issues. The Workers’ Compensation Board determined claimant had a permanent total disability. The self-insured employer and its third-party administrator appealed, challenging the timeliness of the left knee injury claim and the finding of permanent total disability. The court affirmed the Board's decision, ruling that the two-year limitation period does not bar amendments for consequential injuries. Furthermore, the court found substantial evidence, including medical testimony, supported the finding of permanent total disability.

Permanent total disabilityWorkers' compensation benefitsBack injuryKnee injuryConsequential injuryTime-barred claimMedical evidenceTreating physician testimonyAppellate DivisionSelf-insured employer
References
6
Case No. MISSING
Regular Panel Decision

Thompson v. Leon Russell Enterprises

Plaintiff Leonard Thompson, a bus driver for Defendant Leon Russell Enterprises, was injured in a bus accident on August 25, 1986, sustaining injuries to his back, hip, and legs, with persistent knee pain. After initial conservative treatment by Dr. Boylin, he underwent arthroscopic surgery on his left knee by Dr. Eyring on October 10, 1990. Dr. Eyring assessed a 20% permanent impairment to the left leg, while Defendant's physician, Dr. Bishop, assessed 10%. The trial court awarded 60% permanent partial disability to the body as a whole and 25 weeks of temporary total disability benefits. On appeal, the higher court affirmed the temporary total disability award but modified the permanent partial disability award to 80% to the left leg, reasoning that a body as a whole award requires expert testimony establishing permanent injury to an unscheduled body part, which was not sufficiently proven for the hip or back injuries.

Workers' CompensationPermanent Partial DisabilityTemporary Total DisabilityScheduled Member InjuryBody as a Whole DisabilityKnee SurgeryMedical Impairment AssessmentAppellate ReviewInjury ClassificationCausation
References
11
Case No. 2016-01-0218
Regular Panel Decision
Jun 06, 2016

Sanchez, Yonics v. Oz Construction Co.

Yonics Alexis Enriquez Sanchez, an undocumented worker, sought temporary total disability benefits for a left-knee injury sustained in November 2014 while working for Oz Construction Co. The Expedited Hearing, presided over by Judge Thomas Wyatt in Chattanooga, focused on his entitlement to benefits for the period between April 1, 2015, and December 15, 2015, following surgery by Dr. Benjamin S. Miller. The court awarded Mr. Sanchez temporary total disability benefits for the period from April 1, 2015, until May 19, 2015, based on medical records and testimony. However, his claim for the subsequent period until December 15, 2015, was denied due to discrepancies in work status information, resulting in a net award of $1,835.23.

Workers' CompensationTemporary Total DisabilityExpedited HearingKnee InjuryUndocumented WorkerMedical RecordsCredibility AssessmentCausal ConnectionDisability DurationOrthopedic Surgery
References
4
Case No. 2015-01-0245
Regular Panel Decision
Dec 22, 2015

Schultz, Larry Thomas v. Astec, Inc.

Larry Thomas Schultz, an employee, sustained a right knee sprain on May 1, 2015, while working for Astec, Inc. He later developed necrotizing fasciitis in his right leg and left arm, leading to extensive hospitalization and multiple surgeries. Astec denied liability, arguing the infection was due to pre-existing diabetes and unrelated to the work injury, relying on the opinion of the authorized treating physician, Dr. Hutcheson. The Court found Dr. Hutcheson's opinion to have limited weight due to incomplete information and lack of direct assessment of the fasciitis. The Court accepted the opinions of the treating physicians (Drs. Hunt, Sizemore, Nowotarski, and Jemison), who affirmed a work-related causation for both the knee injury and the subsequent infection. Consequently, the Court granted Mr. Schultz's request for temporary total disability benefits from June 2, 2015. However, the request for medical benefits for unauthorized treatment at Erlanger Hospital was denied at this time, citing a lack of evidence regarding communication with Astec prior to seeking emergency care, except for authorized treatment by Dr. Ricky L. Hutcheson.

Knee InjuryNecrotizing FasciitisMedical BenefitsTemporary DisabilityCausation DisputePre-existing ConditionExpert Medical OpinionExpedited HearingJudicial ReviewEmployee Rights
References
11
Case No. ADJ9519541
Regular
Jul 26, 2019

Sonia Young-Mitchell vs. SECURITAS SECURITY SERVICES

This case involves an applicant seeking permanent total disability benefits after an admitted industrial injury to her back, lower extremities, right ankle, and left knee. The applicant argues the Workers' Compensation Judge (WCJ) erred by apportioning 10% of her left knee disability to a pre-existing asymptomatic condition. The Appeals Board granted reconsideration, finding that the Agreed Medical Examiner (AME) impermissibly apportioned to the cause of the injury rather than pre-existing pathology. Consequently, the Board amended the award to find the applicant 100% permanently totally disabled, returning the matter for a new award.

Workers Compensation Appeals BoardSonia Young-MitchellSecuritas Security ServicesSedgwick Claims Management Servicespermanent total disabilityapportionmentleft knee injurycompensable consequencevocational evidenceAgreed Medical Examiner
References
4
Case No. MISSING
Regular Panel Decision

Duke v. Wilson

Mary Sue Wilson suffered a work-related injury to her right knee. During surgery at Medical Center Hospital, Dr. Richard Duke and his surgical team mistakenly operated on her left knee, leading to complications and the loss of her left kneecap. Wilson sued for medical negligence, and a jury found Dr. Duke 60% liable and the Hospital 40% liable, awarding total damages of $761,841.70. The trial court limited the Hospital's liability to $100,000, assessing the remainder against Dr. Duke, and denied Hartford's (the worker's compensation carrier) plea in intervention for subrogation. On appeal, the court affirmed the judgment against Dr. Duke, including the application of joint and several liability and prejudgment interest on future damages. However, the court reversed and remanded the denial of Hartford's plea, recognizing its subrogation right for payments made for the "extension injury" to the left knee.

Medical MalpracticeSurgical ErrorWrong-site SurgeryWorkers' CompensationSubrogationJoint and Several LiabilityPrejudgment InterestFuture DamagesComparative ResponsibilityGovernmental Immunity
References
20
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