FILED Sep 03, 2020 09:11 AM(ET)
TENNESSEE COURT OF WORKERS' COMPENSATION CLAIMS
TENNESSEE BUREAU OF WORKERS’ COMPENSATION IN THE COURT OF WORKERS’ COMPENSATION CLAIMS
AT KNOXVILLE SHANE M. DAVIS, ) Docket No. 2020-03-0054 Employee, ) v. ) State File No. 9633-2018 HARVEST PARTY RENTALS, ) Uninsured Employer. ) Judge Pamela B. Johnson
EXPEDITED HEARING ORDER DENYING BENEFITS Decision on the Record
Shane Davis fell at work, but Harvest Party Rentals did not provide workers’ compensation benefits. Mr. Davis filed this claim seeking payment of his medical bills, additional treatment, and temporary total disability benefits. After a review of the record, the Court holds Mr. Davis is not entitled to the requested benefits at this time because he did not file medical records or other documentary evidence that satisfies his burden of proof.
History of Claim
The Court gleaned the history from the Petition for Benefit Determination, the Expedited Request for Investigation Report, and the affidavits of Mr. Davis, Mr. Hancock, and the bookkeeper. Neither party filed medical records or bills, so much is unknown on this record.
What is known and undisputed is that on September 7, 2019, Mr. Davis lost his footing while exiting the back of an equipment truck. He landed on both knees and his right wrist, and he immediately felt pain in his wrist. John Hancock, the owner of Harvest Party Rentals, told him to go to the emergency room and agreed to pay his medical bills and wages until he returned to work. Mr. Davis received emergency care and ultimately required surgery to repair his broken wrist. His treating physician was Dr. William Oros.
The parties disputed Mr. Davis’s ability to return to work. In his affidavit, Mr. Davis stated that he cannot lift or hold objects with his right hand, or perform his normal job
l duties, and therefore, he has not returned to work. In contrast, Mr. Hancock wrote in his affidavit that he paid Mr. Davis wages after the injury although he had not returned to work. Mr. Hancock further stated that he offered Mr. Davis a job answering phones, which Mr. Davis refused. Mr. Hancock stated that Mr. Davis voluntarily quit his job, which the bookkeeper confirmed.
Findings of Fact and Conclusions of Law
At an Expedited Hearing, Mr. Davis must prove that he is likely to prevail at a hearing on the merits that he is entitled to the requested medical and temporary disability benefits. See McCord v. Advantage Human Resourcing, 2015 TN Wrk. Comp. App. Bd. LEXIS 6, at *7-8, 9 (Mar. 27, 2015).
Turning first to medical benefits, the Workers’ Compensation Law requires an employer to provide medical and surgical treatment made reasonably necessary by a work injury. Tenn. Code Ann. § 50-6-204(a)(1)(A) (2019). Further, a work injury must arise primarily out of and in the course and scope of employment, and it must be shown to a reasonable degree of medical certainty. See Tenn. Code Ann. § 50-6-102(14).
Here, despite the fact that the parties agree that Mr. Davis fell at work, injured his wrist, and received medical treatment, Mr. Davis did not introduce any medical records documenting his treatment or the resulting charges. Importantly, Mr. Davis did not introduce any opinion from a medical doctor that causally relates his need for treatment to the work incident and confirms that the medical treatment was reasonable and necessary. At this time, the Court holds Mr. Davis did not show that he is likely to prevail at a hearing on the merits that he is entitled to payment of his medical bills.
Turning to his request for ongoing treatment, the Workers’ Compensation Law additionally requires that when the employee has suffered an injury and expressed a need for medical care, the employer shall provide a panel of three physicians from which the injured employee shall select one to be the treating physician. Jd. at 50-6-204(a)(3). If an employer elects to deny a claim, it runs the risk that it will be responsible for medical benefits obtained from a provider of the employee’s choice and/or that it may be subject to penalties for failure to provide a panel and/or benefits in a timely manner. McCord, at *10.
Applying these principles, Mr. Davis was justified in seeking treatment on his own when Harvest Party Rentals did not provide a panel of physicians. However, before the Court can order Harvest Party Rentals to provide ongoing treatment, Mr. Davis must prove that the need for continuing treatment is causally related to work.
Harvest Party Rentals did not meet its obligations under the Workers’ Compensation Law. After learning of Mr. Davis’s injury, it did not provide medical benefits or a panel. Therefore, the Court refers Harvest Party Rentals to the Compliance Program for
2 investigation and assessment of a penalty for its failure to provide a panel.
In addition to medical benefits, Mr. Davis seeks temporary disability benefits. An injured employee is eligible for temporary disability benefits if: (1) the injured employee became disabled from working due to a compensable injury; (2) a causal connection exists between the injury and the inability to work; and (3) the injured employee established the duration of the period of disability. Jones v. Crencor, 2015 TN Wrk. Comp. App. Bd. LEXIS 48, at *7 (Dec. 11, 2015).
As stated above, Mr. Davis did not introduce medical records showing he became disabled due to a work injury and the causal connection between the injury and his inability to work. Therefore, at this time, the Court holds Mr. Davis did not show that he is likely to prevail at a hearing on the merits that he is entitled to temporary disability benefits.
IT IS, THEREFORE, ORDERED as follows: 1. Mr. Davis’s requested benefits are denied at this time.
2. Harvest Party Rentals is referred to the Compliance Program for investigation and assessment of a penalty for its failure to provide a panel of physicians.
3. This case is set for a Scheduling Hearing on January 4, 2021, at 2:00 p.m. Eastern Time. The parties must call (toll-free) (855) 543-5041 to participate in the Scheduling Hearing. Failure to appear by telephone might result in a determination of the issues without the parties’ participation.
ENTERED September 3, 2020.
Pamele E. (zeae JUDGE PAMELA #/ JOHNSON Court of Workers’ Compensation Claims
APPENDIX
The Court reviewed the entire case file in reaching its decision. Specifically, the Court reviewed the following documents, marked as exhibits for ease of reference:
Exhibits: 1. Petition for Benefit Determination 2. Expedited Request for Investigation Employer’s Objection to Dispute Certification Notice Dispute Certification Notice Show Cause Order Expedited Request for Investigation Report Amended Show Cause Order Order Setting Deadline to File Request for Hearing Request for Expedited Hearing a. Employee’s List of Co-Workers b. Affidavit of Shane Davis 10. Docketing Notice for Decision on the Record 11.Employer’s Response a. Affidavit of James Hancock i. Harvest Party Rental Pay Stub b. Affidavit of Kristy Lavella i. Text Message of Shane Davis
Bo! On! [ON fom ge
CERTIFICATE OF SERVICE
I certify that a copy of this order was sent as shown on September 3, 2020.
Name U.S. Mail Email Service sent to:
Shane M. Davis, xX 406 First Street Self-Represented Seymour, TN 37865 Employee
Mary Elizabeth Maddox, x mmaddox@fmsllp.com
Employer’s Attorney
Compliance Program xX WCCompliance.Program@tn.gov
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FILED Sep 03, 2020 09:11 AM(ET)
TENNESSEE COURT OF WORKERS' COMPENSATION CLAIMS
TENNESSEE BUREAU OF WORKERS’ COMPENSATION IN THE COURT OF WORKERS’ COMPENSATION CLAIMS
AT KNOXVILLE SHANE M. DAVIS, ) Docket No. 2020-03-0054 Employee, ) v. ) State File No. 9633-2018 HARVEST PARTY RENTALS, ) Uninsured Employer. ) Judge Pamela B. Johnson
EXPEDITED HEARING ORDER DENYING BENEFITS Decision on the Record
Shane Davis fell at work, but Harvest Party Rentals did not provide workers’ compensation benefits. Mr. Davis filed this claim seeking payment of his medical bills, additional treatment, and temporary total disability benefits. After a review of the record, the Court holds Mr. Davis is not entitled to the requested benefits at this time because he did not file medical records or other documentary evidence that satisfies his burden of proof.
History of Claim
The Court gleaned the history from the Petition for Benefit Determination, the Expedited Request for Investigation Report, and the affidavits of Mr. Davis, Mr. Hancock, and the bookkeeper. Neither party filed medical records or bills, so much is unknown on this record.
What is known and undisputed is that on September 7, 2019, Mr. Davis lost his footing while exiting the back of an equipment truck. He landed on both knees and his right wrist, and he immediately felt pain in his wrist. John Hancock, the owner of Harvest Party Rentals, told him to go to the emergency room and agreed to pay his medical bills and wages until he returned to work. Mr. Davis received emergency care and ultimately required surgery to repair his broken wrist. His treating physician was Dr. William Oros.
The parties disputed Mr. Davis’s ability to return to work. In his affidavit, Mr. Davis stated that he cannot lift or hold objects with his right hand, or perform his normal job
l duties, and therefore, he has not returned to work. In contrast, Mr. Hancock wrote in his affidavit that he paid Mr. Davis wages after the injury although he had not returned to work. Mr. Hancock further stated that he offered Mr. Davis a job answering phones, which Mr. Davis refused. Mr. Hancock stated that Mr. Davis voluntarily quit his job, which the bookkeeper confirmed.
Findings of Fact and Conclusions of Law
At an Expedited Hearing, Mr. Davis must prove that he is likely to prevail at a hearing on the merits that he is entitled to the requested medical and temporary disability benefits. See McCord v. Advantage Human Resourcing, 2015 TN Wrk. Comp. App. Bd. LEXIS 6, at *7-8, 9 (Mar. 27, 2015).
Turning first to medical benefits, the Workers’ Compensation Law requires an employer to provide medical and surgical treatment made reasonably necessary by a work injury. Tenn. Code Ann. § 50-6-204(a)(1)(A) (2019). Further, a work injury must arise primarily out of and in the course and scope of employment, and it must be shown to a reasonable degree of medical certainty. See Tenn. Code Ann. § 50-6-102(14).
Here, despite the fact that the parties agree that Mr. Davis fell at work, injured his wrist, and received medical treatment, Mr. Davis did not introduce any medical records documenting his treatment or the resulting charges. Importantly, Mr. Davis did not introduce any opinion from a medical doctor that causally relates his need for treatment to the work incident and confirms that the medical treatment was reasonable and necessary. At this time, the Court holds Mr. Davis did not show that he is likely to prevail at a hearing on the merits that he is entitled to payment of his medical bills.
Turning to his request for ongoing treatment, the Workers’ Compensation Law additionally requires that when the employee has suffered an injury and expressed a need for medical care, the employer shall provide a panel of three physicians from which the injured employee shall select one to be the treating physician. Jd. at 50-6-204(a)(3). If an employer elects to deny a claim, it runs the risk that it will be responsible for medical benefits obtained from a provider of the employee’s choice and/or that it may be subject to penalties for failure to provide a panel and/or benefits in a timely manner. McCord, at *10.
Applying these principles, Mr. Davis was justified in seeking treatment on his own when Harvest Party Rentals did not provide a panel of physicians. However, before the Court can order Harvest Party Rentals to provide ongoing treatment, Mr. Davis must prove that the need for continuing treatment is causally related to work.
Harvest Party Rentals did not meet its obligations under the Workers’ Compensation Law. After learning of Mr. Davis’s injury, it did not provide medical benefits or a panel. Therefore, the Court refers Harvest Party Rentals to the Compliance Program for
2 investigation and assessment of a penalty for its failure to provide a panel.
In addition to medical benefits, Mr. Davis seeks temporary disability benefits. An injured employee is eligible for temporary disability benefits if: (1) the injured employee became disabled from working due to a compensable injury; (2) a causal connection exists between the injury and the inability to work; and (3) the injured employee established the duration of the period of disability. Jones v. Crencor, 2015 TN Wrk. Comp. App. Bd. LEXIS 48, at *7 (Dec. 11, 2015).
As stated above, Mr. Davis did not introduce medical records showing he became disabled due to a work injury and the causal connection between the injury and his inability to work. Therefore, at this time, the Court holds Mr. Davis did not show that he is likely to prevail at a hearing on the merits that he is entitled to temporary disability benefits.
IT IS, THEREFORE, ORDERED as follows: 1. Mr. Davis’s requested benefits are denied at this time.
2. Harvest Party Rentals is referred to the Compliance Program for investigation and assessment of a penalty for its failure to provide a panel of physicians.
3. This case is set for a Scheduling Hearing on January 4, 2021, at 2:00 p.m. Eastern Time. The parties must call (toll-free) (855) 543-5041 to participate in the Scheduling Hearing. Failure to appear by telephone might result in a determination of the issues without the parties’ participation.
ENTERED September 3, 2020.
Pamele E. (zeae JUDGE PAMELA #/ JOHNSON Court of Workers’ Compensation Claims
APPENDIX
The Court reviewed the entire case file in reaching its decision. Specifically, the Court reviewed the following documents, marked as exhibits for ease of reference:
Exhibits: 1. Petition for Benefit Determination 2. Expedited Request for Investigation Employer’s Objection to Dispute Certification Notice Dispute Certification Notice Show Cause Order Expedited Request for Investigation Report Amended Show Cause Order Order Setting Deadline to File Request for Hearing Request for Expedited Hearing a. Employee’s List of Co-Workers b. Affidavit of Shane Davis 10. Docketing Notice for Decision on the Record 11.Employer’s Response a. Affidavit of James Hancock i. Harvest Party Rental Pay Stub b. Affidavit of Kristy Lavella i. Text Message of Shane Davis
Bo! On! [ON fom ge
CERTIFICATE OF SERVICE
I certify that a copy of this order was sent as shown on September 3, 2020.
Name U.S. Mail Email Service sent to:
Shane M. Davis, xX 406 First Street Self-Represented Seymour, TN 37865 Employee
Mary Elizabeth Maddox, x mmaddox@fmsllp.com
Employer’s Attorney
Compliance Program xX WCCompliance.Program@tn.gov
| () Hor peo TH rcee un pur HA dy, PENN ¥ SHRUM, Court Clerk Pairs Wc. SERUM, Ce 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:
|. Complete the enclosed form entitled: “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.
NOTICE OF APPEAL Tennessee Bureau of Workers’ Compensation
www. tn.pov/workforce/Injurles-at-work/ wc.courtclerk@tn.gov | 1-800-332-2667
Docket No.: State File No.:
Date of Injury:
Employee
Employer
Notice is given that
[List name(s) of all appealing party({ies). Use separate sheet if necessary.]
appeals the following order(s) of the Tennessee Court of Workers’ Compensation Claims to the Workers’ Compensation Appeals Board (check one or more applicable boxes and include the date file- stamped on the first page of the order(s) being appealed):
O Expedited Hearing Order filed on O Motion Order filed on
C1 Compensation Order filed on O Other Order filed on
issued by Judge
Statement of the Issues on Appeal Provide a short and plain statement of the issues on appeal or basis for relief on appeal:
Parties Appellant(s) (Requesting Party): [Oo Employer{_: Employee Address: Phone:
Email:
Attorney's Name: BPR#:
Attorney’s Email: Phone:
Attorney's Address:
* Attach an additional sheet for each additional Appellant *
LB-1099 rev. 01/20 Page 1 of 2 RDA 11082 Employee Name: Docket No.: Date of Inj.;
Appellee(s) (Opposing Party): || Employer [_/Employee Appellee’s Address: Phone:
Attorney’s Name: BPR#:
Attorney’s Address:
* Attach an additional sheet for each additional Appellee *
I, , certify that | have forwarded a true and exact copy of this Notice of Appeal by First Class mail, postage prepaid, or in any manner as described in Tennessee Compilation Rules & Regulations, Chapter 0800-02-21, to all parties and/or their attorneys in this case on this the day of ,20
[Signature of appellant or attorney for appellant]
LB-1099 rev. 01/20 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 All Dependents:
Relationship:
6. 1 am 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 SSI $ 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 | 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