Welch, Mark v. Frito-Lay, Inc.

2016 TN WC 63
CourtTennessee Court of Workers' Compensation Claims
DecidedMarch 14, 2016
Docket2015-05-0340
StatusPublished

This text of 2016 TN WC 63 (Welch, Mark v. Frito-Lay, 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
Welch, Mark v. Frito-Lay, Inc., 2016 TN WC 63 (Tenn. Super. Ct. 2016).

Opinion

IN THE COURT OF WORKERS’ COMPENSATION CLAIMS AT MURFREESBORO

MARK WELCH, ) Docket No.: 2015-05-0340 Employee, ) v. ) State File Number: 39263-2015 FRITO-LAY, INC., ) Employer, ) Judge Dale Tipps And ) AGRI GEN. INS. CO. ) Insurance Carrier/TPA. ) )

EXPEDITED HEARING ORDER GRANTING MEDICAL BENEFITS

This matter came before the undersigned workers’ compensation judge on March 3, 2016, on the Request for Expedited Hearing filed by the employee, Mark Welch, pursuant to Tennessee Code Annotated section 50-6-239 (2015). The present focus of this case is the compensability of Mr. Welch’s right shoulder injury and his entitlement to medical benefits. The central legal issue is whether the evidence is sufficient for the Court to determine that Mr. Welch is likely to establish at a hearing on the merits he suffered an injury arising primarily out of and in the course and scope of his employment. For the reasons set forth below, the Court finds Mr. Welch is entitled to the requested medical benefits.1

History of Claim

Mr. Welch is a fifty-three-year-old resident of Giles County, Tennessee. He testified he worked as a truck driver for Frito-Lay for twenty-two days when he suffered a work injury to his right shoulder on April 28, 2015. He also testified he never had any prior problems with his right shoulder. In addition, he passed numerous DOT physicals.

On April 28, 2015, while Mr. Welch was unloading boxes from a trailer, a box fell from the top of the stack. He caught the box with his right hand over his head and pushed it off to one side. While doing this, another box fell and struck the first box, jerking his arm down, and causing him to drop both boxes. He felt a sharp pain in his shoulder and 1 A complete listing of the technical record and exhibits admitted at the Expedited Hearing is attached to this Order as an appendix.

1 saw a knot in his bicep area. Mr. Welch reported the injury to his supervisors, and Frito- Lay provided on-site treatment with the plant nurse for several weeks. It subsequently provided a medical panel from which Mr. Welch selected Dr. Derek Riley. (Ex. 6.)

Dr. Riley first saw Mr. Welch on May 20, 2015, for complaints of right bicep pain. Mr. Welch reported a box falling and pulling his arm on April 28, 2015. His pain was mainly at the right elbow. Dr. Riley noted a possible partial biceps rupture and ordered an MRI. Mr. Welch returned on June 8, 2015, stating he had severe pain with flexion. The pain was worse at his elbow, but he felt it extended up his arm. The MRI showed “distal biceps edema but intact.” Dr. Riley diagnosed biceps tendon strain. (Ex. 4.)

On June 29, 2015, Mr. Welch returned to Dr. Riley, reporting that his elbow had improved, but his shoulder had worsened. Dr. Riley ordered an MRI of the shoulder, which showed a rotator cuff tear and a long head biceps rupture. Dr. Riley discussed surgery with Mr. Welch on July 20, 2015, and recommended surgical repair on August 12, 2015. He noted:

It is unlikely that a[n] intact RTC without underlying pathology would tear from what was reported to me on paper as “lifting a 5-7 pound box.” He describes verbally the event as being from catching a falling box, which would increase the force across his shoulder. He does describe being symptom free before this event and symptomatic beginning with the event. I am unable to say with certainty that the event in question caused > 51% of his pathology, however I cannot say that it absolutely did not. It may be of benefit for him to get a second opinion on this matter.

Dr. Riley also noted Frito-Lay informed Mr. Welch it would not pay for any shoulder procedure “as he had underlying pathology prior to his injury.” Id.

Mr. Welch testified that, because Frito-Lay was denying his medical treatment, he went to see Dr. William Ledbetter on September 22, 2015. Dr. Ledbetter’s records show he did not treat Mr. Welch on that date because he needed to confirm whether the workers’ compensation carrier would cover his treatment. Mr. Welch returned on October 2, 2015, with complaints of right shoulder pain. Dr. Ledbetter noted:

Injured on the job April 28, 2015, approximately 5 months ago. Seen by an orthopaedic surgeon. He initially had an MRI scan of his right elbow. This demonstrated an injury to the biceps tendon. Due to persistent problems which then became more significant about the shoulder, he then had an MRI scan of his right shoulder, which demonstrated rotator cuff tear. This has been denied by Workmen’s Comp. He has now been let go by the company. Previously was on light duty. Underwent a course of physical therapy. No other specific treatment that he described. He reports no major

2 problems with his right shoulder prior to his injury.

Dr. Ledbetter diagnosed a complete tear of the right rotator cuff. He told Mr. Welch he no long performs surgery and recommended a consultation with an orthopedic surgeon. (Ex. 3.)

Mr. Welch returned to Dr. Ledbetter on November 3, 2015. Dr. Ledbetter recorded a detailed history of Mr. Welch’s condition and treatment, including a description of the April 28, 2015 accident. After examining Mr. Welch and reviewing his imaging results, Dr. Ledbetter stated: “It is my opinion that there is greater than 50% likelihood that his rotator cuff tear and rupture long head biceps tendon occurred as a result of his on-the-job injury. I recommend surgical repair.” Dr. Ledbetter reiterated this opinion in his office note of December 28, 2015. Id.

In response to a request from Frito-Lay’s attorney, Dr. Riley signed an undated letter stating: “The biceps tendon and the rotator cuff are intricately related. The injuries likely have the same underlying cause but I am unsure if >51% of the pathology was from this specific incident. I think it would be worthwhile for your claimant to seek a second opinion.” (Ex. 5.)

Mr. Welch filed a Petition for Benefit Determination seeking medical benefits. The parties did not resolve the disputed issues through mediation, and the Mediating Specialist filed a Dispute Certification Notice. Mr. Welch filed a Request for Expedited Hearing, and this Court heard the matter on March 3, 2015.

At the Expedited Hearing, Mr. Welch asserted he is entitled to medical treatment for a rotator cuff tear arising primarily out of and in the course and scope of his employment. He acknowledged he selected Dr. Riley from a panel offered by Frito-Lay, but he disputed Frito-Lay’s interpretation of Dr. Riley’s conclusions. Mr. Welch contended Dr. Riley, when asked about causation, was unable say whether or not Mr. Welch’s work caused his torn rotator cuff or biceps tendon rupture. In other words, the authorized treating physician (ATP) in this matter has not given any causation opinion at all. In the absence of any such opinion, Mr. Welch argued Dr. Ledbetter’s opinion establishes the required causal link. Consequently, he requested an order compelling Frito-Lay to authorize the recommended surgery. In the alternative, Mr. Welch requested an order for a second opinion with an authorized physician, as recommended by Dr. Riley.

Frito-Lay countered that Mr. Welch is not entitled to any workers’ compensation benefits because he failed to present evidence his injury arose primarily out of and in the course and scope of his employment. It argued there are two causation opinions in this case and, pursuant to Tennessee Code Annotated section 50-6-102(14)(E) (2015), Dr. Riley’s opinion is presumed to be correct. Frito-Lay characterized Dr. Riley’s opinion as

3 his conclusion that catching a box of potato chips was unlikely to be the cause of Mr. Welch’s injuries. Frito-Lay also contended Dr. Ledbetter gave a summary opinion without any explanation, which is insufficient to overcome the presumption of correctness attached to Dr. Ledbetter’s opinion.

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Related

§ 50
Tennessee § 50
§ 50-6
Tennessee § 50-6
§ 50-6-102
Tennessee § 50-6-102(14)(A)
§ 50-6-116
Tennessee § 50-6-116

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Bluebook (online)
2016 TN WC 63, Counsel Stack Legal Research, https://law.counselstack.com/opinion/welch-mark-v-frito-lay-inc-tennworkcompcl-2016.