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

Case No. 2016-07-0772
Regular Panel Decision
May 25, 2017

Jacks, Bonnie v. Camden Healthcare/Northpoint Senior Services, LLC

Bonnie Jacks, an employee of Northpoint, sustained a left shoulder injury in 2015. She requested an expedited hearing for additional medical benefits and approval of physician referrals to orthopedic and pain management specialists, as well as payment of outstanding medical bills. The employer, Northpoint, failed to provide a panel of physicians as required by law, instead offering Dr. Berry and later accepting a referral to Dr. Chandler. The Court found Ms. Jacks entitled to a panel of physicians for an orthopedic evaluation and ordered Northpoint to approve Dr. Berry’s referral to Tennessee Orthopedic Alliance. Additionally, Northpoint was ordered to pay Dr. Berry's outstanding bills totaling $340.00. The Court denied Ms. Jacks' counsel's request for attorney's fees but referred the case to the Penalty Unit for consideration of a penalty against Northpoint for failing to timely provide a panel of physicians.

Workers' CompensationMedical BenefitsExpedited HearingPhysician PanelOrthopedic ReferralPain ManagementAttorney's Fees DeniedPenalty Unit ReferralRotator Cuff TearShoulder Injury
References
3
Case No. 2022-08-0195
Regular Panel Decision
Sep 02, 2022

Evans, Antron v. Family Dollar Stores, Inc.

Mr. Antron Evans requested a panel of psychiatrists, attorney's fees, and payment of a medical bill following a store robbery where he sustained a head injury. Family Dollar, the employer, contended he was not entitled to a psychiatric panel without a referral from an authorized physician, disputed the medical bill, and denied wrongfully denying the claim for attorney's fees. The Court denied Mr. Evans's requests for a psychiatric panel and payment of the emergency room bill, citing the statutory requirement of a panel physician's referral for psychiatric services and lack of proof for the medical bill. However, the Court granted his request for attorney's fees due to Family Dollar's five-month delay in timely initiating medical benefits. Additionally, Family Dollar was referred to the Compliance Program for potential penalties concerning the late filing of the First Report of Injury and the untimely provision of a panel of physicians.

Workers' CompensationMedical Benefits DenialAttorney's Fees GrantEmployer PenaltiesExpedited HearingPsychiatric ReferralStatutory InterpretationLate Claim ProcessingFirst Report of Injury DelayPost-Traumatic Stress
References
6
Case No. 2020-06-0867
Regular Panel Decision
Sep 28, 2020

Randolph, Kevin v. R & M ELECTRIC, INC.

Kevin Randolph, an employee, suffered a severe injury when he fell approximately fifteen feet while working. He requested treatment with Dr. Sravani Mehta, a specialist in traumatic brain injuries, after a referral from Dr. James Ho, an optometrist. The employer, R & M Electric, Inc., and its insurer, The Hartford, denied the request, stating that the authorized treating physician, Dr. Anna-Louise Mollete, never made the referral. The Court affirmed that Tennessee law allows referrals only from physicians or chiropractors, not optometrists, and found that the employer did not waive its right to object by honoring prior non-physician referrals. Consequently, the Court denied Mr. Randolph's request for treatment with Dr. Mehta.

Workers' CompensationMedical BenefitsReferral PolicyOptometristPhysicianEmployer ResponsibilityWaiver DoctrineStatutory InterpretationTraumatic Brain InjuryTennessee Law
References
7
Case No. MISSING
Regular Panel Decision

Innoviant Pharmacy, Inc. v. Morganstern

Innoviant Pharmacy, Inc. sued its former sales executive, Max Morganstern, for unfair competition and breach of a non-compete agreement after he joined a competitor, Summit Pharmacy, Inc., and solicited Innoviant's customer referral sources. Innoviant sought a preliminary injunction to prevent Morganstern from contacting 114 key New York referral sources. The court found Innoviant unlikely to succeed on its breach of contract claim because the employment agreement was deemed unenforceable due to a later signed document. However, the court found Innoviant likely to succeed on its unfair competition claim, as Morganstern misappropriated a list of potential referral sources and business cards. Consequently, the court granted the preliminary injunction, restraining Morganstern from contacting the specified referral sources until February 24, 2006, conditioned on Innoviant posting a $100,000 security bond.

Preliminary InjunctionUnfair CompetitionBreach of ContractNon-compete ClauseTrade SecretsCustomer ListsConfidential InformationEmployment AgreementSales ExecutiveReferral Sources
References
50
Case No. 2016-05-1050
Regular Panel Decision
Oct 19, 2017

Tapley, Shane v. Transport National

This is an interlocutory appeal where the employer contested the trial court's decision regarding the designation of an authorized treating physician and the acknowledgment of a pain management referral under Tennessee Code Annotated sections 50-6-204(a)(3)(A)(ii) or 50-6-204(j). The employee, Shane Tapley, suffered a left knee injury and received treatment, including surgery, from Dr. Martin Fiala. Dr. Fiala later recommended a consult with Dr. Jeffrey Hazlewood concerning Complex Regional Pain Syndrome (CRPS) and potential pain management. The trial court concluded that Dr. Fiala's request for a consult did not constitute a statutory referral for pain management or a direct referral transferring care. The Appeals Board affirmed the trial court's decision, emphasizing that the statutory language for referrals implies treatment rather than just an opinion or consultation, and remanded the case for further proceedings.

Workers' CompensationMedical BenefitsPhysician ReferralPain ManagementAuthorized Treating PhysicianInterlocutory AppealStatutory InterpretationComplex Regional Pain SyndromeKnee InjuryMedical Consult
References
8
Case No. ADJ9549773
Regular
Nov 13, 2015

EDWARD BAUTISTA vs. ARLON GRAPHICS, TRAVELERS

The Appeals Board dismissed the applicant's petition for reconsideration or removal, finding the WCJ's order was not a final determination. The WCJ correctly ordered the applicant to first discuss his anxiety symptoms and need for psychological referral with his primary treating orthopedist. Applicant is not entitled to a second opinion from a psychologist until the primary treating physician has diagnosed the anxiety or determined a referral is unnecessary. Commissioner Sweeney dissented, believing the applicant had an absolute right to an MPN second opinion for his psychiatric condition without first obtaining a referral from his orthopedist.

ADJ9549773Arlon GraphicsTravelersPetition for ReconsiderationPetition for RemovalWorkers' Compensation Appeals BoardWCJLabor Code Section 4616.3Labor Code Section 4616.4Administrative Director Rules
References
4
Case No. 2019-01-0368
Regular Panel Decision
Apr 01, 2020

Ibarra, Grecia v. Amazon Fulfillment Services, Inc.

Employee Grecia Ibarra reported back pain after lifting totes at work and sought medical benefits. After initial treatment and a referral to an orthopedic specialist by Dr. Natasha Ballard, Amazon declined the referral, asserting Ibarra failed to provide proper notice or identify a specific injury incident. The trial court ordered Amazon to provide a panel of orthopedic specialists. The Appeals Board affirmed the trial court's order, finding Ibarra provided sufficient notice and evidence of a work-related condition resulting from a "set of incidents," and that the physician's referral was presumed medically necessary. The case was remanded for further proceedings.

Workers' CompensationBack InjuryMedical BenefitsOrthopedic ReferralNotice of InjuryCumulative TraumaExpedited HearingMedical CausationEmployer ObligationsEmployee Rights
References
6
Case No. 2017-01-0638
Regular Panel Decision
Sep 06, 2019

Rollins, Mark A. v. Scenic City Concrete Pumping, LLC

Mark A. Rollins, an employee, filed a request for an expedited hearing to compel his employer, Scenic City Concrete Pumping, LLC, to authorize a referral to Dr. Jerry Smith for a second impairment rating. Mr. Rollins had previously been rated at four-percent impairment by Dr. Benji Miller after a work-related ankle fracture. Dr. Matthew Buchanan subsequently referred Mr. Rollins to Dr. Smith for an impairment rating, a referral not authorized by the employer. The Court determined that the Workers' Compensation Law only mandates employer authorization for referrals for medical treatment, not for impairment ratings disputed by the employee. Consequently, the Court denied Mr. Rollins's request.

Impairment RatingMedical ReferralsExpedited HearingTreatment AuthorizationOrthopedic InjuryAnkle FractureMaximum Medical ImprovementPhysician PanelStatutory InterpretationEmployer Medical Responsibility
References
0
Case No. 2016-03-0885
Regular Panel Decision
Feb 07, 2017

Adams, Roy v. Beverly Park Place Health and Rehabilitation

Roy Adams, a Maintenance Assistant, sustained chemical burns to his hands while cleaning machinery with hazardous chemicals. He received treatment from Dr. King at Nova Medical Center, who diagnosed irritant dermatitis and cleared him for full duty. Despite Dr. King's assessment, Mr. Adams continued to experience pain, cramping, and difficulty grasping objects, prompting him to request a specialist referral and temporary disability benefits. Beverly Park Place Health and Rehabilitation argued that Dr. King had consulted with specialists and found no need for further referrals, and his medical opinion is presumed correct. The Court ultimately denied Mr. Adams' requests for both a specialist referral and temporary disability benefits, citing insufficient medical evidence to rebut Dr. King's opinion.

Chemical BurnIrritant DermatitisTemporary Disability BenefitsSpecialist ReferralMedical OpinionPhysician's PresumptionWorkers' CompensationExpedited HearingKnox CountyHand Injury
References
5
Case No. 2018-01-0349
Regular Panel Decision
Jan 24, 2019

Rhodes, Jason v. Amazon.com, LLC

Jason Rhodes, an employee of Amazon, sustained a foot injury and sought medical care and temporary partial disability benefits. The dispute arose when Mr. Rhodes declined to see an orthopedist referred by Amazon's authorized treating physician, Dr. Natasha Ballard, citing distance, and instead saw Dr. Jesse Doty. Mr. Rhodes argued that Amazon's practice of directing referrals to a single orthopedist effectively usurped his right to choose a physician under Tennessee law. The Court found Amazon's method of compelling referrals to a specific specialist by removing the treating physician's neutrality was contrary to the spirit of the direct-referral statute. Consequently, the Court ordered Amazon to provide a new panel of orthopedists and to pay Mr. Rhodes temporary partial disability benefits for the period he was out of work.

Workers' CompensationExpedited HearingMedical BenefitsTemporary Partial DisabilityPhysician ChoiceEmployer Referral PolicyOrthopedist PanelCommunity of ResidenceMedical Treatment DisputeFoot Injury
References
4
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