FILED Aug 01, 2019 11:54 AM(CT)
TENNESSEE COURT OF WORKERS' COMPENSATION CLAIMS
TENNESSEE BUREAU OF WORKERS’ COMPENSATION IN THE COURT OF WORKERS’ COMPENSATION CLAIMS
AT KNOXVILLE TERRY V. ADAMS, ) Docket No. 2019-03-0154 Employee, ) V. ) EAST TENNESSEE PERSONAL ) CARE SERVICE, LLC, ) State File No. 27353-2018 Employer, ) And ) ACCIDENT FUND GENERAL ) INSURANCE COMPANY, ) Judge Pamela B. Johnson Carrier. ) )
EXPEDITED HEARING ORDER GRANTING MEDICAL BENEFITS
This case came before the Court for an Expedited Hearing on July 10, 2019. The Court must decide whether Ms. Adams came forward with sufficient evidence demonstrating that she is entitled to additional benefits. For the reasons below, the Court holds Ms. Adams is entitled to ongoing medical benefits.
History of Claim
Ms. Adams worked as a personal aide for East Tennessee Personal Care Service (ETPCS).' Her duties involved assisting clients with transportation and activities of daily living. On March 5, 2018, another vehicle struck Ms. Adams’s personal vehicle while transporting an ETPCS client. Ms. Adams immediately called the police and reported the accident to her supervisor. After the police completed its report, Ms. Adams transported her client and herself to the emergency room.
Although the police report indicated the parties were not injured, Ms. Adams emailed her supervisor on the evening of the accident and stated, “The impact was so
'Two months after Ms. Adams’s injury, ETPCS joined Associated Home Care, an Amedisys company. hard, I knew I needed to get checked out due to having thoracic stents in my body.”” She provided her supervisor the hospital discharge paperwork and the traffic accident report number. Ms. Adams completed a Tennessee Department of Safety and Homeland Security Owner/Driver Report and noted that the accident resulted in injuries. She additionally provided a written statement on March 23 and advised, “I had emergency medical care, due to a pre-existing medical problem, but I may need additional medical care.” In her statement, she requested that “the correct person who handles Workers’ Compensation contact me as soon as possible.”
ETPCS prepared a First Report of Work Injury on April 16 and noted, “INJURED WORKER STATES CHEST, HEAD AND LOWER LEG PAIN.” (Emphasis in original). That same day, the owner of ETPCS told Ms. Adams that the only provider she could see was Farragut Family, but he did not give her an appointment date or any documentation from workers’ compensation. In July, she contacted ETPCS’s carrier and spoke to the adjuster, who told her the claim was “opened and closed.” On July 31, Ms. Adams received a note with a telephone number for Farragut Family. However, when she called to schedule an appointment, Farragut Family said that it needed her employer’s authorization.
She ultimately received authorization and saw Dr. Gerald Russell at Farragut Family on August 2. She reported neck and mid-back pain radiating down her left arm after the March car accident. Dr. Russell ordered a cervical and thoracic MRI and assigned restrictions. On August 30, Dr. Russell reviewed the MRI, which showed degenerative disc disease in her cervical spine, and he suggested physical therapy and “possible physiatry referral.”
Ms. Adams filed her Petition for Benefit Determination on February 5, 2019, seeking additional medical treatment. At the Expedited Hearing, she asserted that ETPCS unreasonably delayed authorization of her initial treatment and payment of her medical bills. Ms. Adams acknowledged that she received a panel of physiatrists in October 2018 and selected a physician.
ETCPS denied it unreasonably delayed Ms. Adams’s treatment or payment of related bills. It asserted Ms. Adams did not initially request treatment, and the police report noted no injuries. It also introduced its carrier’s claim payment report demonstrating payment of benefits to or on Ms. Adams’s behalf. Specifically, the report indicated it paid the ER physician’s March 5, 2018 charges on May 10, 2018, and the corresponding March 5, 2018 hospital bill on July 1, 2019. It argued the bill was
* Ms. Adams testified she suffered from a preexisting aortic aneurysm and needed medical treatment immediately. improperly sent to Ms. Adams’s automobile insurer, who declined to pay the hospital charges. ETCPS further noted it paid Ms. Adams’s mileage.
At the conclusion of the hearing, ETPCS confirmed its willingness to provide additional treatment with Dr. Russell and a panel-selected physiatrist for Ms. Adams’s work-related injuries. However, it argued other than continued authorized, causally- related medical care for Ms. Adams’s injuries, no other benefits were due.
Findings of Fact and Conclusions of Law
To prevail at an Expedited Hearing, Ms. Adams must show she would likely prevail at a hearing on the merits that she is entitled to additional benefits. See Tenn. Code Ann. § 50-6-239(d)(1) (2018).
It became clear to the Court during the hearing that Ms. Adams filed the Petition for Benefit Determination because she believed ETCPS neglected her. She testified she took immediate action to ensure her client received prompt medical attention. She contacted her supervisor from the scene of the accident to report the accident, and the same day she sent the traffic accident report number and discharge papers. In contrast, she said ETCPS showed little concern for her well-being. She testified it did not immediately offer her treatment or pay her emergency room care.
ETCPS argued that the police report noted no injuries, and Ms. Adams did not ask for treatment. However, the evidence showed Ms. Adams requested treatment as of March 23, but ETCPS did not provide it until August 2.
The Court finds Ms. Adams a credible employee who placed her client’s needs above her own. While Ms. Adams ensured her client was evaluated and treated if necessary, ETCPS did not extend the same courtesy to her. ETCPS eventually provided authorized medical treatment and paid her emergency room bills and mileage, but the delay caused discord between the parties and led to litigation.
The Workers’ Compensation Law requires an employer to provide an injured employee with medical treatment made reasonably necessary by a work accident. Tenn. Code Ann. § 50-6-204. To do so, following notice of injury and request for medical care, the employer must provide the injured employee with a panel of physicians within three business days. Tenn. Comp. R. & Regs. 0800-02-01-.06(1). Additionally, medical bills must be paid within thirty calendar days of receipt of a properly submitted and complete bill. Tenn. Comp. R. & Regs. 0800-02-17-.10(7) (2018). Failure to timely provide a panel of physicians and medical treatment exposes the employer to penalties under Tennessee Code Annotated section 50-6-118. The Court finds ETCPS failed to timely provide Ms. Adams medical treatment and to timely pay her medical bills. Ms. Adams gave ETCPS notice and requested treatment by March 23, 2018, but ETCPS did not authorize it until shortly after July 31, 2018—a four-month delay. ETCPS further did not pay Ms. Adams’s March 5, 2018 emergency room bills until July 1, 2019 — an almost fifteen-month delay. Accordingly, the Court refers this case to the Compliance Unit for investigation and assessment of penalties under Tennessee Code Annotated section 50-6-118 and Tennessee Compilation Rules and Regulations 0800-02-01 et seq. Further, the Court holds Ms. Adams is entitled to ongoing medical treatment under Tennessee Code Annotated section 50-6-204.
IT IS, THEREFORE, ORDERED as follows:
1.
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FILED Aug 01, 2019 11:54 AM(CT)
TENNESSEE COURT OF WORKERS' COMPENSATION CLAIMS
TENNESSEE BUREAU OF WORKERS’ COMPENSATION IN THE COURT OF WORKERS’ COMPENSATION CLAIMS
AT KNOXVILLE TERRY V. ADAMS, ) Docket No. 2019-03-0154 Employee, ) V. ) EAST TENNESSEE PERSONAL ) CARE SERVICE, LLC, ) State File No. 27353-2018 Employer, ) And ) ACCIDENT FUND GENERAL ) INSURANCE COMPANY, ) Judge Pamela B. Johnson Carrier. ) )
EXPEDITED HEARING ORDER GRANTING MEDICAL BENEFITS
This case came before the Court for an Expedited Hearing on July 10, 2019. The Court must decide whether Ms. Adams came forward with sufficient evidence demonstrating that she is entitled to additional benefits. For the reasons below, the Court holds Ms. Adams is entitled to ongoing medical benefits.
History of Claim
Ms. Adams worked as a personal aide for East Tennessee Personal Care Service (ETPCS).' Her duties involved assisting clients with transportation and activities of daily living. On March 5, 2018, another vehicle struck Ms. Adams’s personal vehicle while transporting an ETPCS client. Ms. Adams immediately called the police and reported the accident to her supervisor. After the police completed its report, Ms. Adams transported her client and herself to the emergency room.
Although the police report indicated the parties were not injured, Ms. Adams emailed her supervisor on the evening of the accident and stated, “The impact was so
'Two months after Ms. Adams’s injury, ETPCS joined Associated Home Care, an Amedisys company. hard, I knew I needed to get checked out due to having thoracic stents in my body.”” She provided her supervisor the hospital discharge paperwork and the traffic accident report number. Ms. Adams completed a Tennessee Department of Safety and Homeland Security Owner/Driver Report and noted that the accident resulted in injuries. She additionally provided a written statement on March 23 and advised, “I had emergency medical care, due to a pre-existing medical problem, but I may need additional medical care.” In her statement, she requested that “the correct person who handles Workers’ Compensation contact me as soon as possible.”
ETPCS prepared a First Report of Work Injury on April 16 and noted, “INJURED WORKER STATES CHEST, HEAD AND LOWER LEG PAIN.” (Emphasis in original). That same day, the owner of ETPCS told Ms. Adams that the only provider she could see was Farragut Family, but he did not give her an appointment date or any documentation from workers’ compensation. In July, she contacted ETPCS’s carrier and spoke to the adjuster, who told her the claim was “opened and closed.” On July 31, Ms. Adams received a note with a telephone number for Farragut Family. However, when she called to schedule an appointment, Farragut Family said that it needed her employer’s authorization.
She ultimately received authorization and saw Dr. Gerald Russell at Farragut Family on August 2. She reported neck and mid-back pain radiating down her left arm after the March car accident. Dr. Russell ordered a cervical and thoracic MRI and assigned restrictions. On August 30, Dr. Russell reviewed the MRI, which showed degenerative disc disease in her cervical spine, and he suggested physical therapy and “possible physiatry referral.”
Ms. Adams filed her Petition for Benefit Determination on February 5, 2019, seeking additional medical treatment. At the Expedited Hearing, she asserted that ETPCS unreasonably delayed authorization of her initial treatment and payment of her medical bills. Ms. Adams acknowledged that she received a panel of physiatrists in October 2018 and selected a physician.
ETCPS denied it unreasonably delayed Ms. Adams’s treatment or payment of related bills. It asserted Ms. Adams did not initially request treatment, and the police report noted no injuries. It also introduced its carrier’s claim payment report demonstrating payment of benefits to or on Ms. Adams’s behalf. Specifically, the report indicated it paid the ER physician’s March 5, 2018 charges on May 10, 2018, and the corresponding March 5, 2018 hospital bill on July 1, 2019. It argued the bill was
* Ms. Adams testified she suffered from a preexisting aortic aneurysm and needed medical treatment immediately. improperly sent to Ms. Adams’s automobile insurer, who declined to pay the hospital charges. ETCPS further noted it paid Ms. Adams’s mileage.
At the conclusion of the hearing, ETPCS confirmed its willingness to provide additional treatment with Dr. Russell and a panel-selected physiatrist for Ms. Adams’s work-related injuries. However, it argued other than continued authorized, causally- related medical care for Ms. Adams’s injuries, no other benefits were due.
Findings of Fact and Conclusions of Law
To prevail at an Expedited Hearing, Ms. Adams must show she would likely prevail at a hearing on the merits that she is entitled to additional benefits. See Tenn. Code Ann. § 50-6-239(d)(1) (2018).
It became clear to the Court during the hearing that Ms. Adams filed the Petition for Benefit Determination because she believed ETCPS neglected her. She testified she took immediate action to ensure her client received prompt medical attention. She contacted her supervisor from the scene of the accident to report the accident, and the same day she sent the traffic accident report number and discharge papers. In contrast, she said ETCPS showed little concern for her well-being. She testified it did not immediately offer her treatment or pay her emergency room care.
ETCPS argued that the police report noted no injuries, and Ms. Adams did not ask for treatment. However, the evidence showed Ms. Adams requested treatment as of March 23, but ETCPS did not provide it until August 2.
The Court finds Ms. Adams a credible employee who placed her client’s needs above her own. While Ms. Adams ensured her client was evaluated and treated if necessary, ETCPS did not extend the same courtesy to her. ETCPS eventually provided authorized medical treatment and paid her emergency room bills and mileage, but the delay caused discord between the parties and led to litigation.
The Workers’ Compensation Law requires an employer to provide an injured employee with medical treatment made reasonably necessary by a work accident. Tenn. Code Ann. § 50-6-204. To do so, following notice of injury and request for medical care, the employer must provide the injured employee with a panel of physicians within three business days. Tenn. Comp. R. & Regs. 0800-02-01-.06(1). Additionally, medical bills must be paid within thirty calendar days of receipt of a properly submitted and complete bill. Tenn. Comp. R. & Regs. 0800-02-17-.10(7) (2018). Failure to timely provide a panel of physicians and medical treatment exposes the employer to penalties under Tennessee Code Annotated section 50-6-118. The Court finds ETCPS failed to timely provide Ms. Adams medical treatment and to timely pay her medical bills. Ms. Adams gave ETCPS notice and requested treatment by March 23, 2018, but ETCPS did not authorize it until shortly after July 31, 2018—a four-month delay. ETCPS further did not pay Ms. Adams’s March 5, 2018 emergency room bills until July 1, 2019 — an almost fifteen-month delay. Accordingly, the Court refers this case to the Compliance Unit for investigation and assessment of penalties under Tennessee Code Annotated section 50-6-118 and Tennessee Compilation Rules and Regulations 0800-02-01 et seq. Further, the Court holds Ms. Adams is entitled to ongoing medical treatment under Tennessee Code Annotated section 50-6-204.
IT IS, THEREFORE, ORDERED as follows:
1. ETCPS shall provide ongoing medical treatment for Ms. Adams’s work injuries by authorizing a return appointment with Dr. Russell and scheduling an appointment with Ms. Adams’s selection from the previously-provided panel of physiatry.
2. This case is set for a Status Conference on November 18, 2019, at 1:30 p.m. Eastern Time. The parties must call 865-594-0091 or 855-543-5041 toll-free to participate in the Status Conference. Failure to appear by telephone might result in a determination of the issues without the party’s participation.
3. Unless interlocutory appeal of the Expedited Hearing Order is filed, compliance with this Order must occur no later than seven business days from the date of entry of this Order as required by Tennessee Code Annotated section 50-6-239(d)(3). The Insurer or Self-Insured Employer must submit confirmation of compliance with this Order to the Bureau by email to WCCompliance.Program@tn.gov no later than the seventh business day after entry of this Order. Failure to submit the necessary confirmation within the period of compliance may result in a penalty assessment for non-compliance.
4. For questions regarding compliance, please contact the Workers’ Compensation Compliance Unit by email at WCCompliance.Program@tn.gov.
ENTERED August 1, 2019.
, fondo \2y Woe
PAMELA B. JOHNSON, JUDGE Court of Workers’ Compensation Claims APPENDIX
Technical Record: 1. Petition for Benefit Determination Attachment-Employee Issues Employer Correspondence-Employer/Fund Issues Employee Correspondence Employee Correspondence Dispute Certification Notice Request for Expedited Hearing Notice of Expedited Hearing Employer’s Response in Opposition to Request for Expedited Hearing 10. Employee’s Reply to Employer’s Response 11. Subsequent Injury Fund’s Expedited Prehearing Statement
CON DAARWH
Exhibits:
Affidavit of Terry V. Adams
First Report of Work Injury
Tennessee Electronic Traffic Crash Report
Notice of Workers’ Compensation Injury
Tennessee Department of Safety and Homeland Security Owner/Driver Report
Department of Intellectual and Developmental Disabilities Reportable Incident
Notice of Hospital Lien
Marked for Identification Only: Medical Records of Physicians Regional
Medical Center
9. Medical Records of Summit Medical Group, Internal Medicine Associates
10. Medical Records of Dr. Gerald Russell, Farragut Family Practice
11. Marked for Identification Only: Medical Records of Therapy Plus
12. Marked for Identification Only: Medical Expenses
13.Marked for Identification Only: Correspondence from Humana Financial Recovery & Subrogation
14. Correspondence from United Heartland
15.Marked for Identification Only: Joe Neubert Collision Repair Preliminary Estimate
16. Email Communications between Employee and Employer
17. Correspondence of Associated Home Care
18. United Heartland Claim Payment Report
19. Deposition Transcript of Terry V. Adams
OF Sa GN ba Se Be CERTIFICATE OF SERVICE
I certify that a copy of the Expedited Hearing Order was sent as indicated on
August 1, 2019.
Name US. Fax | Email | Service sent to:
Mail Terry V. Adams, x X | 5929 Loice Lane Self-Represented Knoxville, TN 37924 Employee adamsterry367@gmail.com Tiffany B. Sherrill, X | tbsherrill@mijs.com Employer’s Attorney Robert Davies, xX robert.davies@tn.gov Fund Attorney
Loy
Mum
PENNY SARI, Court Clerk WC.CourtCli’k@tn.gov
Expedited Hearing Order Right to Appeal:
If you disagree with this Expedited Hearing Order, you may appeal to the Workers’ Compensation Appeals Board. To appeal an expedited hearing order, you must:
1. Complete the enclosed form entitled: “Expedited Hearing Notice of Appeal,” and file the form with the Clerk of the Court of Workers’ Compensation Claims within seven business days of the date the expedited hearing order was filed. When filing the Notice of Appeal, you must serve a copy upon all parties.
2. You must pay, via check, money order, or credit card, a $75.00 filing fee within ten calendar days after filing of the Notice of Appeal. Payments can be made in-person at any Bureau office or by U.S. mail, hand-delivery, or other delivery service. In the alternative, you may file an Affidavit of Indigency (form available on the Bureau’s website or any Bureau office) seeking a waiver of the fee. You must file the fully- completed Affidavit of Indigency within ten calendar days of filing the Notice of Appeal. Failure to timely pay the filing fee or file the Affidavit of Indigency will result in dismissal of the appeal.
3. You bear the responsibility of ensuring a complete record on appeal. You may request from the court clerk the audio recording of the hearing for a $25.00 fee. If a transcript of the proceedings is to be filed, a licensed court reporter must prepare the transcript and file it with the court clerk within ten business days of the filing the Notice of Appeal. Alternatively, you may file a statement of the evidence prepared jointly by both parties within ten business days of the filing of the Notice of Appeal. The statement of the evidence must convey a complete and accurate account of the hearing. The Workers’ Compensation Judge must approve the statement before the record is submitted to the Appeals Board. If the Appeals Board is called upon to review testimony or other proof concerning factual matters, the absence of a transcript or statement of the evidence can be a significant obstacle to meaningful appellate review.
4. If you wish to file a position statement, you must file it with the court clerk within ten business days after the deadline to file a transcript or statement of the evidence. The party opposing the appeal may file a response with the court clerk within ten business days after you file your position statement. All position statements should include: (1) a statement summarizing the facts of the case from the evidence admitted during the expedited hearing; (2) a statement summarizing the disposition of the case as a result of the expedited hearing; (3) a statement of the issue(s) presented for review; and (4) an argument, citing appropriate statutes, case law, or other authority.
For self-represented litigants: Help from an Ombudsman is available at 800-332-2667. LB-1099
EXPEDITED HEARING NOTICE OF APPEAL Tennessee Division of Workers’ Compensation www. tn.gov/labor-wid/weomp.shtml wce.courtclerk@tn.gov 1-800-332-2667
Docket #: State File #/YR:
Employee
Vv.
Employer Notice Notice is given that
[List name(s) of all appealing party(ies) on separate sheet if necessary]
appeals the order(s) of the Court of Workers’ Compensation Claims at
to the Workers’ Compensation Appeals
Board. [List the date(s) the order(s) was filed in the court clerk’s office]
Judge
Statement of the Issues Provide a short and plain statement of the issues on appeal or basis for relief on appeal:
Additional Information Type of Case [Check the most appropriate item]
L] Temporary disability benefits L] Medical benefits for current injury LC Medical benefits under prior order issued by the Court
List of Parties Appellant (Requesting Party): At Hearing: LJEmployer LJEmployee
Address:
Party’s Phone: Email: Attorney's Name: BPR#: Attorney’s Address: Phone:
Attorney's City, State & Zip code:
Attorney’s Email:
* Attach an additional sheet for each additional Appellant *
rev. 10/18 Page 1 of 2 RDA 11082 Employee Name: SF#: DOI:
Appellee(s)
Appellee (Opposing Party): At Hearing: L]JEmployer LJEmployee
Appellee’s Address:
Appellee’s Phone: Email: Attorney’s Name: BPR#: Attorney’s Address: Phone:
Attorney’s City, State & Zip code:
* Attach an additional sheet for each additional Appellee *
CERTIFICATE OF SERVICE
I, Expedited Hearing Notice of Appeal by First Class, United States Mail, postage prepaid, to all parties
and/or their attorneys in this case in accordance with Rule 0800-02-22.01(2) of the Tennessee Rules of Board of Workers’ Compensation Appeals on this the day of , 20
, certify that | have forwarded a true and exact copy of this
[Signature of appellant or attorney for appellant]
LB-1099 rev. 10/18 Page 2 of 2 RDA 11082
Tennessee Bureau of Workers’ Compensation 220 French Landing Drive, I-B Nashville, TN 37243-1002 800-332-2667
AFFIDAVIT OF INDIGENCY
I, , having been duly sworn according to law, make oath that because of my poverty, | am unable to bear the costs of this appeal and request that the filing fee to appeal be waived. The following facts support my poverty.
1. Full Name: 2. Address:
3. Telephone Number: 4. Date of Birth: 5. Names and Ages of Ail Dependents:
Relationship:
6. lam employed by:
My employer’s address is:
My employer’s phone number is:
7. My present monthly household income, after federal income and social security taxes are deducted, is:
$
8. | receive or expect to receive money from the following sources:
AFDC $ per month beginning ssl $ per month beginning Retirement $ per month beginning Disability $ per month beginning Unemployment $ per month beginning Worker's Comp.$ per month beginning Other $ per month beginning
LB-1108 (REV 11/15) RDA 11082 9. My expenses are:
Rent/House Payment $ permonth Medical/Dental $ per month
Groceries $ per month Telephone $ per month
Electricity $ per month School Supplies $ per month
Water $ per month Clothing $ per month
Gas $ per month Child Care $ per month
Transportation $ per month Child Support $ per month
Car $ per month
Other $ per month (describe: ) 10. Assets:
Automobile $ (FMV)
Checking/Savings Acct. $
House $ __ (FMV)
Other $ Describe:
11. My debts are:
Amount Owed To Whom
| hereby declare under the penalty of perjury that the foregoing answers are true, correct, and complete and that I am financially unable to pay the costs of this appeal.
APPELLANT
Sworn and subscribed before me, a notary public, this
day of , 20
NOTARY PUBLIC
My Commission Expires:
LB-1108 (REV 11/15) RDA 11082