     FILED
   Apr 30, 2019
   02:41 PM(CT)
 TENNESSEE COURT OF
WORKERS' COMPENSATION
       CLAIMS
       It is undisputed that Dr. Micek ordered surgery to repair the meniscus three times
and utilization review denied the requests. The parties did not introduce into evidence the
records of the utilization review physician(s).

       Ms. Gammel contended her symptoms have persisted and requested the Court
order Bratton to approve the surgery recommended by Dr. Micek. Bratton stated its
claims adjusters are precluded from overriding a utilization review decision and could not
approve Ms. Gammel's surgery without a court order. Bratton contended it could not
stipulate to provide the surgery, but it did not oppose it.

                       Findings of Fact and Conclusions of Law

       Here, the sole issue is whether Ms. Gammel is likely to prevail at trial in
establishing the recommended surgery was reasonable and necessary for her knee injury.
The only medical opinion came from Dr. Micek, who concluded Ms. Gammel suffered an
acute medial meniscus tear from her work injury and requires arthroscopic surgery to
repair it. As the authorized treating physician, Dr. Micek's treatment recommendations
are presumed to be medically necessary. See Tenn. Code Ann. § 50-6-204(A)(3)(H)
(2018).

       While the parties acknowledged the existence of conflicting utilization review
opinions, Bratton did not introduce any medical proof into evidence to rebut Dr. Micek's
opinion. Thus, the Court holds Ms. Gammel is likely to prevail at trial and grants her
request for surgery.

IT IS, THEREFORE, ORDERED as follows:

   1. Bratton shall provide continued medical treatment for Ms. Gammel's left-knee
      injury as required by Tennessee Code Annotated section 50-6-204, to include the
      memscus surgery.

   2. Unless interlocutory appeal of the Expedited Hearing Order is filed, compliance
      with this Order must occur ·no later than seven business days from the date of entry
      of this Order as required by Tennessee Code Annotated section 50-6-239(d)(3).
      The Insurer must submit confirmation of compliance with this Order to the Bureau
      by email to WCCompliance.Program@tn.gov no later than the seventh business
      day after entry of this Order. Failure to submit the necessary confirmation within
      the period of compliance may result in a penalty assessment for non-compliance.
      For questions regarding compliance, please contact the Workers' Compensation
      Compliance Unit via email at WCCompliance.Program@tn.gov.



                                            2
       ENTERED April 30, 2019.




                                       . Court of Workers' Compensation Claims


                                     APPENDIX

Exhibits:

   1. Dr. Micek's medical records (collective exhibit)
   2. Dr. Micek's causation opinion

Technical Record:
   1. Petition for Benefit Determination
   2. Dispute Certification
   3. Request for Expedited Hearing

                           CERTIFICATE OF SERVICE

      I certify that a copy of this Order was sent to the following recipients by these
methods of service on April 30, 2019.

                Name                       Via Email
Richard Click, Employee's Attorney             x
 Ga   H. Nichols, Em lo er' s Attome           x




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