Tucker, William v. LU, Inc.

2024 TN WC 11
CourtTennessee Court of Workers' Compensation Claims
DecidedFebruary 16, 2024
Docket2023-06-1704
StatusPublished

This text of 2024 TN WC 11 (Tucker, William v. LU, 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
Tucker, William v. LU, Inc., 2024 TN WC 11 (Tenn. Super. Ct. 2024).

Opinion

FILED Feb 16, 2024 01:16 PM(CT) TENNESSEE COURT OF WORKERS' COMPENSATION CLAIMS

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

William Tucker, ) Docket No. 2023-06-01704 Employee, ) v. ) LU, Inc., ) State File No. 44728-2022 Employer, ) And ) Bridgefield Cas. Ins. Co., ) Judge Kenneth M. Switzer Carrier. )

EXPEDITED HEARING ORDER GRANTING BENEFITS

In this multi-faceted case, William Tucker asked that the Court order his employer, LU, Inc., to pay temporary disability benefits after unauthorized neck surgery. He also asked that the Court designate the surgeon who performed the procedure, Dr. Margaret MacGregor, as the authorized treating physician for future treatment.

LU opposed his requests, asserting that the surgery was neither work-related nor medically necessary. But its central contention was that Mr. Tucker was not referred to Dr. MacGregor by another treating physician, so she should not be named the authorized treating physician.

After a February 6, 2024 expedited hearing, the Court holds that the surgery was work-related and reasonably necessary, so Mr. Tucker is entitled to temporary disability benefits after the procedure. In addition, a valid referral was made, and Dr. MacGregor is the authorized treating physician.

Claim History

The work incident and lay testimony

Before the work injury, Mr. Tucker underwent an anterior cervical discectomy and fusion, or “ACDF,” performed by Dr. MacGregor in October 2021. The doctor implanted

1 hardware during the procedure. By January 2022, Mr. Tucker returned to full-time, full- duty work at LU. He testified that he had no neck pain when he returned to work.

On June 24, 2022, Mr. Tucker was unloading a truck at work when he lost his footing and fell, injuring his neck, back, and ribs. LU offered a panel, and Mr. Tucker started authorized treatment at a clinic. He treated conservatively until late August. At his final visit, he was referred for specialized treatment.

LU offered several panels, one of which included Dr. Daniel Burval. At some point, Mr. Tucker asked the adjuster to see Dr. MacGregor but saw Dr. Burval instead. Although Mr. Tucker never returned a signed panel memorializing that choice, he saw Dr. Burval once before returning to Dr. MacGregor, believing he had a referral. Mr. Tucker denied that he requested to see Dr. MacGregor and maintained Dr. Burval referred him.

Dr. MacGregor ultimately performed another fusion surgery in November 2023.

Mr. Tucker testified that he worked without difficulty before the fall. Afterward, he felt pain in his neck and other body parts. He continued working despite those symptoms, saying, “I did the best I can at work.” Mr. Tucker also testified that he had trouble sleeping and “couldn’t do a lot at home like I usually do.” His symptoms improved after the second surgery, although he still experiences occasional, sharp pain in his neck and arms, and he remains treating with Dr. MacGregor. He has not worked since the surgery.

Post-fall specialist treatment/evaluation

At Mr. Tucker’s first visit with Dr. Burval in September 2022, Mr. Tucker told him about the previous surgery with Dr. MacGregor and his work accident. Dr. Burval took x- rays and noticed “a little bit of back out of 1 of the caudal screws” from the 2021 surgery. He did not have previous x-rays, however, for comparison. Dr. Burval did not recommend surgery. He wrote, “I will contact Worker’s Comp to see that he can be seen by his treating surgeon[.]” Dr. Burval noted that Dr. MacGregor should compare past and current diagnostic test results “to see if there is [sic] any anatomical changes. He concluded that he “highly recommended evaluation and treatment by treating spine surgeon. I wish him all the best.” (Emphasis added).

At Mr. Tucker’s first post-injury visit with Dr. MacGregor, which LU authorized, she compared x-rays taken after his fall with his pre-injury x-rays and noticed changes to his hardware. Dr. MacGregor wrote:

I reviewed his cervical spine x-rays that were completed at TOA [after the fall], and compared those to his last images performed at the hospital as part of routine follow up after his ACDF. He has a clear change in position of his

2 hardware, with some backing out of one of his screws, and fracture through his fusion mass at both levels, and his plate is anteriorly displaced when compared with imaging performed previously, now evident also subtle listhesis at C45 and C56.

Later that month, a claims adjuster sent Dr. MacGregor a letter asking several detailed causation questions, and Dr. MacGregor’s responded that she “agreed” that the fall at work was the cause of his neck pain and changes to his hardware. She further agreed that “the neck pain with left arm pain Mr. Tucker is experiencing is due to the backing out of the caudal screw.” Dr. MacGregor disagreed that Mr. Tucker’s condition was “at least 50% related to pre-existing issues,” noting that “patient [was] without complaints and working fulltime fullduty [sic] at time of injury.”

After a CT scan in January 2023, Mr. Tucker returned to Dr. MacGregor with worsening neck pain, and Dr. MacGregor recommended surgery. She noted that she disagreed with a radiologist’s interpretation of CT images and wrote that Mr. Tucker had “hardware failure after a work related injury, and has developed progressive change in position of his hardware from his pre-fall (i.e. pre work -related injury) postopimaging.”

LU requested utilization review, and the reviewing physician concluded that the surgery was not necessary. Mr. Tucker appealed to the Bureau’s medical directors, who upheld the denial. They wrote that Dr. MacGregor should confer with the radiologist to discuss the CT scan results and issue a joint amended report, followed by a new treatment plan.

After the utilization review in April, Dr. MacGregor wrote a letter stating that after the original ACDF in 2021, Mr. Tucker sustained a new injury while working in June 2022. X-rays after the fall showed “a definite change in the position of the hardware. There is greater than 50% certainty that this is due to the work injury[.]”

Around that same time, Mr. Tucker asked LU to authorize another visit with Dr. MacGregor, so she could follow the medical directors’ instructions. LU declined. It asserted that Dr. Burval was the authorized treating physician, and Mr. Tucker should return to him instead.

Mr. Tucker complied and saw Dr. Burval in May, who also reviewed the CT images from January and noticed the hardware changes. He wrote that the CT showed “the LEFT C-6 screw is loose (lucency) with collapse through the endplate into the C6-7 spondylotic disc space. The RIGHT C6 screw is backed out about 2 mm but has not penetrated the endplate or disc space. The 5-6 cage is pushed down into the C6 endplate consistent with endplate collapse.”

3 Dr. Burval also questioned his further involvement in the case, and he gave an opinion on causation and the need for surgery. He wrote that he did not know why the “original spine surgeon” was not allowed to treat Mr. Tucker, and he planned to request digital copies of x-rays taken after the fall to verify if changes in his spine occurred after the work incident. He concluded, “Once these pre-fall x-rays are confirmed to be his, it will be with a reasonable degree of medical certainty that the implant/hardware failure/loosening was more than 50% related to the reported work related fall in [June] 2022 and a revision of his C4-6 anterior instrumentation and fusing C6-7 is medically sound and indicated.” (Emphasis in original). On a WorkLink Physician Report, Dr. Burval wrote, “Patient must follow up with Dr. MacGregor as his treating physician.” The report also stated that Mr.

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2024 TN WC 11, Counsel Stack Legal Research, https://law.counselstack.com/opinion/tucker-william-v-lu-inc-tennworkcompcl-2024.