Susan Coolidge v. City Winery Nashville, LLC
Docket No. 2015-06-1333
State File No. 18273-2015
Filed September 23, 2016
In this case, the Appeals Board reversed the trial court’s holding that an employee was entitled to a third panel of physicians when there was no proof that the treatment the employee was requesting was reasonably necessary to treat the work injury, as none of the physicians involved in the case had opined as such.
The employee in this case sustained an injury to her nose when a tray hit her in the face in the course and scope of her employment. The employer accepted the claim as compensable. Employee alleges that this resulted in a deformity requiring plastic surgery to correct. Employee had a history of five previous plastic surgeries to her nose. Employee was initially seen at CareSpot, and the physician’s assistant indicated that there was no need for plastic surgery. Employer provided a panel of physicians, and the selected physician did not offer an opinion regarding the need for plastic surgery but referred the employee to a plastic surgeon to evaluate whether surgery was necessary. The employer then provided a panel of plastic surgeons, and the selected physician opined that that no surgery or additional treatment was necessary but referred her for a second opinion. The physician who performed the second opinion agreed that no surgery or additional treatment was necessary. Subsequently, the employee sought an unauthorized evaluation from a plastic surgeon who stated that he would perform the surgery but did not opine that it was necessary as a result of the work injury, and he also did not accept the workers’ compensation fee schedule. Employee then requested a third panel of physicians.
The trial court held that the employee was likely to prevail at a trial on the merits, stating that the physicians who opined that surgery was unnecessary did not indicate why no treatment was necessary and required the employer to provide a third panel of physicians and possibly request a waiver of the fee schedule to allow a surgeon who does not accept the fee schedule. Employer appealed.
With regard to the issue of unauthorized treatment offered by an unauthorized provider to an employee whose injury is not disabling, the Appeals Board stated that the employee has the burden of presenting sufficient evidence to show that she is likely to prevail at trial in establishing that the offered treatment is reasonably required as a result of the work injury. Furthermore, the Appeals Board reiterated that an injured employee does not have a right to a panel of physicians solely for the purpose of an evaluation, and there is no right to a “causation opinion” even for an employee who meets the applicable statutory requirements of entitlement to medical benefits. The Appeals Board reversed the holding of the trial court, finding that not only was there no proof that any further treatment was reasonably required as a result of the work injury and, in fact, noted that there is substantial proof to the contrary.
Jared S. Renfroe is an attorney for Spicer Rudstrom PLLC. He focuses his legal practice on litigation throughout Tennessee. His concentrates primarily in premises liability, business and commercial representation, employment practices litigation, professional liability, insurance defense and workers’ compensation.