PINTHANOND, KATTREA v. COVENANT HEALTH

2024 TN WC 56

• Court: Tennessee Court of Workers' Compensation Claims
• Decided: August 8, 2024
• Docket: 2018-03-0035
• Status: Published

Opinion

FILED Aug 08, 2024 03:18 PM(ET) TENNESSEE COURT OF WORKERS' COMPENSATION CLAIMS

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

KATTREA PINTHANOND, ) Docket No. 2018-03-0035 Employee, ) v. ) State File No. 20717-2017 COVENANT HEALTH, ) Employer. ) Judge Lisa A. Lowe

COMPENSATION ORDER DENYING BENEFITS (Decision on the Record)

Ms. Pinthanond asked the Court to order Covenant to pay Blue Cross/Blue Shield’s lien for past medical expenses after a settlement on her permanent disability benefits. Covenant Health did not respond to the request. For the following reasons, the Court denies Ms. Pinthanond’s request.

History of Claim

On March 15, 2017, Ms. Pinthanond, a registered nurse at Covenant, suffered an allergic asthma attack after being exposed to dust and fumes at work. She suffered pulmonary injuries and received authorized treatment. Later, the parties reached a settlement with open future medical treatment. The agreement contained the following language:

At the time of settlement, the parties agreed that medical expenses were incurred in the amount of $25,436.23, all of which have been or will be paid by Covenant Health. Ms. Pinthanond showed that she submitted expenses from Dr. Rao and Methodist Medical Center, which were claimed as related, but unpaid. The parties agreed that the charges will be evaluated, and if authorized, will be paid. Additionally, Covenant Health agreed that Dr. Carla Sevin would be designated as the authorized treating provider.

In June 2024, Ms. Pinthanond filed a hearing request seeking a decision on the

1 record for payment of BCBS’s lien.1 She submitted a 2019 letter from BCBS showing its lien totals $14,389.91. She also submitted a BCBS Paid Claims Report.

Findings of Fact and Conclusions of Law

Ms. Pinthanond must prove by a preponderance of the evidence that she is entitled to the requested benefits. Willis v. All Staff, 2015 TN Wrk. Comp. App. Bd. LEXIS 42, at *18 (Nov. 9, 2015).

An employer shall furnish, free of charge to the employee, “treatment . . . made reasonably necessary” by the work accident. Tenn. Code Ann. § 50-6-204(a)(1)(A) (2023). Here, Ms. Pinthanond offered BCBS’s lien amount and claims report. However, she did not provide any evidence to establish that the treatment BCBS paid for was reasonable, necessary, and related to her work injury. See Eaves v. Ametek, Inc., 2018 TN Wrk. Comp. App. Bd. LEXIS 53, at *8-9 (Sept. 14, 2018) (Court erred by ordering repayment of medical expenses when employee “offered no proof that the medical bills or the compilation of medical expenses prepared by her health insurer were reasonable, necessary, or causally-related to the work accident.”). Ms. Pinthanond did not meet her burden, so the Court denies her request for payment of BCBS’s lien.

Costs of $150.00 are taxed to Covenant, to be paid within five business days after this order becomes final. Unless appealed, this order becomes final in 30 days.

IT IS ORDERED.

ENTERED August 8, 2024.

_____________________________________ JUDGE LISA A. LOWE Court of Workers’ Compensation Claims

1 Ms. Pinthanond filed a request for Expedited Hearing. However, since Expedited Hearings result in interlocutory orders, the Court considers the request as a Compensation Hearing. 2 APPENDIX

The Court reviewed the following documents, marked as exhibits for ease of reference:

Exhibits: 1. Petition for Benefit Determination 2. Dispute Resolution Statement 3. Panel of Physicians 4. Medical Records of Ear, Nose & Throat 5. Petition for Benefit Determination, July 3, 2018 6. Mediated Settlement Agreement 7. Petition for Benefit Determination – Settlement Approval Only 8. First Report of Work Injury 9. Wage Statement 10. Medical Records of Dr. Vijoydeep T.V. Rao 11. Statistical Data Form, SD-2 12. Order Approving Workers’ Compensation Settlement Agreement 13. Workers’ Compensation Settlement Agreement 14. Petition for Benefit Determination, November 9,2023 15. Employer’s Disputed Issues 16. Dispute Certification Notice 17. Hearing Request 18. Rule 72 Declaration of Ms. Pinthanond 19. BCBS Correspondence regarding Subrogation Lien 20. BCBS Paid Claims Report 21. Docketing Notice

CERTIFICATE OF SERVICE

I certify that a copy of the order was sent as indicated on August 8, 2024.

Name Mail Email Service sent to: Mandy Hancock, X mandy@mandyhancocklaw.com Employee’s Attorney R. Kim Burnette, X kburnette@arnettbaker.com Employer’s Attorney

______________________________________ PENNY SHRUM, Court Clerk WC.CourtClerk@tn.gov 3 Right to Appeal: If you disagree with the Court’s Order, you may appeal to the Workers’ Compensation Appeals Board. To do so, you must: 1. Complete the enclosed form entitled “Notice of Appeal” and file it with the Clerk of the Court of Workers’ Compensation Claims before the expiration of the deadline.  If the order being appealed is “expedited” (also called “interlocutory”), or if the order does not dispose of the case in its entirety, the notice of appeal must be filed within seven (7) business days of the date the order was filed.  If the order being appealed is a “Compensation Order,” or if it resolves all issues in the case, the notice of appeal must be filed within thirty (30) calendar days of the date the Compensation Order was filed. When filing the Notice of Appeal, you must serve a copy on the opposing party (or attorney, if represented).

2. You must pay, via check, money order, or credit card, a $75.00 filing fee within ten calendar days after filing 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 filing 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 your appeal.

3. You are responsible for ensuring a complete record is presented on appeal. If no court reporter was present at the hearing, you may request from the Court Clerk the audio recording of the hearing for a $25.00 fee. If you choose to submit a transcript as part of your appeal, which the Appeals Board has emphasized is important for a meaningful review of the case, a licensed court reporter must prepare the transcript, and you must file it with the Court Clerk. The Court Clerk will prepare the record for submission to the Appeals Board, and you will receive notice once it has been submitted. For deadlines related to the filing of transcripts, statements of the evidence, and briefs on appeal, see the applicable rules on the Bureau’s website at https://www.tn.gov/wcappealsboard. (Click the “Read Rules” button.)

4. After the Workers’ Compensation Judge approves the record and the Court Clerk transmits it to the Appeals Board, a docketing notice will be sent to the parties. If neither party timely files an appeal with the Appeals Board, the Court Order becomes enforceable. See Tenn. Code Ann. § 50-6-239(d)(3) (expedited/interlocutory orders) and Tenn. Code Ann. § 50-6-239(c)(7) (compensation orders).

For self-represented litigants: Help from an Ombudsman is available at 800-332-2667.