Appeals Board Decides 2 Cases of Entitlement to Treatment

Oct 10, 2017 | Featured, News, Workers' Compensation

By: Jared Renfroe

In two recent cases decided by the Tennessee Workers’ Compensation Appeals Board, the court was called upon to decide issues of whether an injured worker was entitled to future medical treatment when the authorized treating physician either refused to continue seeing the employee after the employee reached maximum medical improvement, or when the physician essentially opined that the employee only had an increase in pain from the work injury transposed over a pre-existing condition. In both cases, which were interlocutory (i.e., a party appealed after an expedited hearing was held, but the compensation period had not been held), the Appeals Board held in favor of the employee.

George Limberakis v. Pro-Tech Security, Inc.

Filed September 12, 2017

In this case, the Appeals Board considered the issue of an injured worker’s entitlement to continued medical treatment when the authorized physician refused to provide further treatment.

The injured worker sustained an injury to his low back while lifting a security fence in the course and scope of his employment. His claim was accepted as compensable and he received conservative medical treatment from Dr. Ashley Park.

After the employee completed a functional capacity evaluation and demonstrated the ability to work in the light physical demand category, Dr. Park released him to work without restrictions and discharged him from further care, and thereafter refused to schedule additional appointments for the employee despite repeated requests. Dr. Park stated that he did not believe that the employee “will require further medical treatment as it directly relates to his work-related injury.”

The employer argued that it had no further obligation to provide medical benefits, and the parties participated in an expedited hearing. The trial court found that the employee was likely to prevail at trial and ordered the employer to replace Dr. Park on the panel of physicians. The employer appealed.

The Appeals Board started its analysis by noting that in Tennessee, it is well-settled that an injured employee is entitled to medical benefits “made reasonably necessary by accident,” and that whether a particular treatment is made reasonably necessary must be answered based upon the proof presented at the time the treatment is proposed. Moreover, the court will consider that an employee’s assessment of his own physical condition is competent testimony that should not be disregarded. Additionally, it noted that the employer cannot unilaterally terminate an employee’s entitlement to reasonable and necessary medical benefits after a compensable work injury.

The Appeals Board explained that Dr. Park’s opinion as of the employee’s last visit cannot be considered to have forever foreclosed the possibility that he may need further treatment causally related to the work injury in the future. Significantly, the Appeals Board explained, “It is not only significant, but it is determinative in our opinion that the hearing in question was interlocutory in nature, as opposed to a trial on the merits, and Employer has accepted the claim as being compensable.”

This case did not involve an issue of whether a particular treatment is reasonable and necessary; it was an interlocutory dispute over whether an injured worker with a compensable claim is entitled to an authorized treating physician who will agree to see the employee. Thus, the Appeals Board affirmed the holding of the trial court.

Darlene Noel v. EAN Holdings, LLC

Filed September 13, 2017

In this case, an employee sustained two injuries at work within a week, injuring her head and back. After evaluation by the authorized treating physicians, the employer filed a motion to terminate authorized medical treatment, arguing that the physicians had opined that the injured worker did not reasonably need medical treatment as a result of the alleged work accidents, and attached signed medical records from the physicians. The motion was unopposed, but the trial court denied the motion, so the employer appealed.

The Appeals Board was called upon to address whether medical treatment could be terminated, but also clarified the procedural avenues for motions such as the one filed by the employer.

With regard to the issue of whether the trial court erred in denying the motion to terminate the medical treatment, the Appeals Board noted that an unopposed motion must not be granted as a matter of course, but the trial court can consider the fact that the motion is unopposed when deciding whether to grant or deny the motion, and further explained that a party acts at its own peril when electing not to respond to a party’s request for a trial court to take some action.

The Appeals Board held that the medical records and questionnaire responses presented by the employer were equivocal as to the need for additional medical treatment. One of the physicians had recommended that the employee continues with physical therapy and changed her medications. Additionally, the Appeals Board noted that although he opined that the condition was not likely the result of a work-related accident, he clarified by stating that the employee may have had some increase in pain and injury superimposed on a chronic problem, and thus, the employer did not establish at this interlocutory stage of the case that it was likely to prevail at trial.

With regard to the procedural question of when a motion such as the one filed by the employer, in this case, is proper, the Appeals Board noted that Tenn. Comp. R. & Regs. 0800-02-21-.14(3) does not restrict the filing of motions for summary judgment to only those cases in which there is a denial of the claim and a finding by the trial court of non-compensability. Instead, parties have several options for seeking relief from the court prior to trial. One such option is a motion for summary judgment, but another option is to file an interlocutory motion pursuant to Tenn. Code Ann. § 50-6-239(d).

Jared Renfroe focuses on Workers’ Compensation, Premises Liability and Litigation (Insurance Defense, Employment Practices, and Business & Commercial) law in the Memphis, Tennessee office.


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