Humphrey, Jr., Eddie v. Security Fire Protection Co, Inc.

2016 TN WC 293
CourtTennessee Court of Workers' Compensation Claims
DecidedDecember 7, 2016
Docket2016-03-0708
StatusPublished

This text of 2016 TN WC 293 (Humphrey, Jr., Eddie v. Security Fire Protection Co, Inc.) is published on Counsel Stack Legal Research, covering Tennessee Court of Workers' Compensation Claims primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Humphrey, Jr., Eddie v. Security Fire Protection Co, Inc., 2016 TN WC 293 (Tenn. Super. Ct. 2016).

Opinion

FILED December 7. 2016

TNCO URT OF W ORIITR.S ' CO !'JFENSATIO N C 1 .iill.l5

Time 10:30 .A.M

TENNESSEE BUREAU OF WORKERS' COMPENSATION IN THE COURT OF WORKERS' COMPENSATION CLAIMS AT KNOXVILLE

EDDIE HUMPHREY, JR. ) Docket No.: 2016-03-0708 Employee, ) v. ) SECURITY FIRE PROTECTION CO. INC., ) State File No.: 8732-2016 Employer, ) and ) INSURANCE CO. OF THE STATE OF PA, ) Judge Pamela B. Johnson Carrier. )

EXPEDITED HEARING ORDER GRANTING TEMPORARY PARTIAL DISABILITY AND MEDICAL BENEFITS

This matter came before the undersigned Workers' Compensation Judge on November 4, 2016, upon the Request for Expedited Hearing filed by Eddie Humphrey, Jr. pursuant to Tennessee Code Annotated section 50-6-239 (2015). The central legal issue is whether Mr. Humphrey sustained an injury arising primarily out of and in the course and scope of his employment with Security Fire Protection, entitling Mr. Humphrey to additional medical and temporary disability benefits. For the reasons set forth below, the Court holds Mr. Humphrey sufficiently demonstrated that he is likely to prevail at a hearing on the merits that his February 2, 2016 injury arose primarily out of and in the course and scope of his employment. Accordingly, this Court concludes Mr. Humphrey is entitled to the requested benefits. 1

History of Claim

Mr. Humphrey is a forty-eight-year-old resident of Knox County, Tennessee. Mr. Humphrey worked for Security Fire as a Sprinkler Fitter Foreman. His occupation frequently required crawling and squatting in the ceiling above the sprinkler systems in order to install or repair sprinkler systems for fire protection purposes.

1 The attached Appendix contains a complete listing of the Technical Record and Exhibits admitted at the Expedited Hearing.

1 On February 2, 2016, Mr. Humphrey responded to a service call at a nursing home. Working in the nursing home attic, he crawled around on his knees and squatted on wooden trusses for several hours, looking for a leak in the sprinkler system. As he worked, he developed soreness in left knee and leg. The next day, he reported the injury to his supervisor. (Ex. 1.)

Upon receiving notice of the work incident, Security Fire provided Mr. Humphrey with a panel of physicians, and he selected Dr. John Reynolds as his authorized treating physician (ATP). Dr. Reynolds evaluated Mr. Humphrey on two occasions. In March, Dr. Reynolds examined Mr. Humphrey, ordered and reviewed x-rays of the left knee, diagnosed "chronic left knee pain," "rule out internal derangement," and "mild osteoarthritis." 2 Given Mr. Humphrey's ongoing symptoms, Dr. Reynolds ordered a left knee MRI. (Ex. 2.) In a Worklink report, Dr. Reynolds restricted Mr. Humphrey to limited duty. (Ex. 9.)

Following the MRI, Mr. Humphrey returned to see Dr. Reynolds in April. Dr. Reynolds reviewed the MRI and noted chrondromalacia patella with no evidence of meniscal tear or ligamentous injury. Dr. Reynolds discussed the findings with Mr. Humphrey, advising, "Presumably, he has aggravated his chondromalacia. As we discussed, it is possible he could have some occult meniscal injury not visualized on the MRI." Dr. Reynolds ordered physical therapy and instructed Mr. Humphrey to return in one month. (Ex. 2.) In the Worklink report, Dr. Reynolds noted a diagnosis of "[left] knee chondromalacia/strain" and continued the limited duty restrictions. (Ex. 9.)

Dr. Reynolds did not examine Mr. Humphrey again following the April appointment but responded to questionnaires submitted by Security Fire's third-party workers' compensation administrator. On April 6, Dr. Reynolds listed Mr. Humphrey's diagnosis as "chondromalacia" and indicated Mr. Humphrey's "current condition DID NOT primarily arise out of claimant's employment 50% or under due to work." On April 12, Dr. Reynolds checked "No" when asked whether Mr. Humphrey's "knee strain work injury was fully recovered and if he is just left with the pre-existing non work condition of chondromalacia." (Ex. 3.)

Security Fire issued a Notice of Controversy on April 19 and denied benefits stating, "Claim denied as authorized treating physician has opined the condition is not work related." (Ex. 4.) Mr. Humphrey testified his temporary disability benefits stopped on April 5. Security Fire, through a nurse case manager, cancelled Mr. Humphrey's May appointment with Dr. Reynolds. (Ex. 5.)

Following Security Fire's denial of Mr. Humphrey's claim and cessation of 2 Mr. Humphrey reported a history ofleft knee arthroscopy, partial lateral meniscectomy, and patellar chondroplasty in I 999. He also had a right knee arthroscopy, partial lateral meniscectomy, removal of loose body, and chondroplasty. (Ex. 2 and Ex. 6.)

2 benefits, Mr. Humphrey sought medical treatment on his own for his ongoing symptoms. 3 In May, Mr. Humphrey saw Dr. Gregory Mathien, who ordered additional diagnostic testing and reviewed the MRI. Dr. Mathien diagnosed left knee pain with iliotibial band syndrome and patellofemoral chondromalacia. Dr. Mathien recommended physical therapy and a topical compounded anti-inflammatory analgesic. Dr. Mathien further recommended a "light-duty work environment" and to "return as scheduled." (Ex. 6.)

Mr. Humphrey returned to see Dr. Mathien in June with increased symptoms following completion of leg presses during physical therapy. Dr. Mathien noted, "In my opinion, it appears that his symptoms were related to his injury in February when he was working in the attic for a number of hours developing this leg pain, certainly historically related to the event." !d.

In July, Security Fire's counsel sent a third questionnaire to Dr. Reynolds, requesting clarification of his prior opinions. In his response, Dr. Reynolds responded "yes" to whether Mr. Humphrey's "knee strain primarily, meaning more than 50%, related to the 2/2/16 work-injury." However Dr. eynolds replied "no" to whether Mr. 4 Humphrey required additional care fonn th knee strain. (Ex. 7.)

During the hearing, Mr. Humphrey argued Security Fire summarily and without merit denied his claim, terminated his medical treatment with Dr. Reynolds, and stopped payment of his temporary disability benefits. When Security Fire wrongfully denied his claim and terminated his benefits, he rightfully sought medical treatment on his own with Dr. Mathien. Mr. Humphrey asserted he is entitled to substitute Dr. Mathien as his authorized treating physician, relying on Lambert v. Famous Hasp., Inc., 947 S.W.2d 852, 853 (Tenn. 1997), and US. Fid. and Guar. Co. v. Morgan, 795 S.W.2d 653, 654 (Tenn. 1990). In addition to entitlement to medical benefits, Mr. Humphrey averred he is entitled to temporary disability benefits from April 5, 2016, until such time as he returns to work or reaches maximum medical improvement.

Security Fire argued Mr. Humphrey selected Dr. Reynolds as his A TP from a panel of physicians. Dr. Reynolds diagnosed Mr. Humphrey with left knee chondromalacia and further opined the chondromalacia was pre-existing and not more than fifty percent or more related to Mr. Humphrey's employment. As such, it asserted it properly denied Mr. Humphrey's claim and terminated benefits.

Additionally, Security Fire averred Mr. Humphrey unilaterally chose to go to his 3 Mr. Humphrey testified during the hearing that he spoke to Security Fire personnel and advised that he felt like Dr. Reynolds was wrong and that he needed a second opinion. He further testified that his employer told him that the insurance carrier would not pay for a second opinion. On cross-examination, Mr.

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GAF Building Materials v. George
47 S.W.3d 430 (Tennessee Supreme Court, 2001)
United States Fidelity & Guaranty Co. v. Morgan
795 S.W.2d 653 (Tennessee Supreme Court, 1990)
Lambert v. Famous Hospitality, Inc.
947 S.W.2d 852 (Tennessee Supreme Court, 1997)

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