                                                                                              FILED
                                                                                           May 31, 2019
                                                                                           02:32 PM(CT)
                                                                                        TENNESSEE COURT OF
                                                                                       WORKERS' COMPENSATION
                                                                                              CLAIMS




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

Meagan Mueller-Rice,                                )   Docket No.: 2017-01-0750
          Employee,                                 )
v.                                                  )   State File No.: 82287-2017
MEDAT AG, Inc. d/b/a Poblanos                       )
Mexican Cuisine,                                    )   Judge Audrey Headrick
           Uninsured Employer.                      )




                               EXPEDITED HEARING ORDER
                                (DECISION ON THE RECORD)


       This case came before the Court on Meagan Mueller-Rice's Request for an
Expedited Hearing on the record. 1 The issue is whether Ms. Mueller-Rice is likely to
establish at trial that she is entitled to medical and temporary disability benefits for the
knee injuries sustained when she tripped over the leash of a customer's dog.
MEDATAG, Inc. d/b/a Poblanos Mexican Cuisine (Poblanos) did not respond to Ms.
Mueller-Rice's request for benefits. For the reasons below, the Court awards medical
benefits but denies her claim for temporary disability benefits.

                                         History of Claim

       While working as a server at Poblanos on September 30, 2017, Ms. Mueller-Rice,
a Tennessee resident, injured her knees when she tripped and fell over the leash of a
customer's dog. 2 Ms. Mueller-Rice notified manager Sabrina Holbrook of her injuries
and left work to seek emergency treatment. The provider took Ms. Mueller off work for
four days and referred her to see Dr. Thomas Brown, III, an orthopedist.



1
  The Court issued a docketing notice allowing the parties until May 29 to file objections or submit
position statements. Poblanos did not request an evidentiary hearing, and the Court determined it needed
no additional evidence to decide the issues.
2
  Poblanos allowed dogs on the premises.
        Text messages between Ms. Mueller-Rice and Ms. Holbrook show that she
attempted to prompt Ms. Holbrook to file a claim and provide her with the carrier's
information. Although Ms. Holbrook advised her of information needed by insurance to
"start [her] file," she ultimately referred her to Irma Hyde, a Poblanos' shareholder. Ms.
Hyde informed Ms. Mueller-Rice by text that she did not "work enough hours to qualify
for [workers' compensation] insurance so [her] agent [was] looking into a different
option."

       Ms. Mueller-Rice returned to the emergency room on October 9 and was taken off
work until she followed up with an orthopedist. Ms. Mueller-Rice then filed a Petition
for Benefit Determination on October 23, 2017. The Bureau's compliance section
investigated and prepared an Expedited Request for Investigation Report, noting that
Poblanos admitted it was uninsured at the time of Ms. Mueller-Rice's September 30,
2017 injury, and that it did not dispute the work injury.

        Ms. Mueller-Rice saw Dr. Brown on November 29 for ongoing left-knee pain. He
ordered an MRI, which showed a contusion and some edema, and he ordered physical
therapy. Ms. Mueller-Rice last saw Dr. Brown on February 14, 2018, when he released
her to return as needed.

       With the exception of payment for a physical therapy visit and a portion of the
MRI bill, Poblanos did not provide Ms. Mueller-Rice with any medical or temporary
disability benefits. Ms. Mueller-Rice requested payment of her medical bills as well as
temporary disability benefits.

                       Findings of Fact and Conclusions of Law

                                    Standard Applied

      To prevail at an expedited hearing, Ms. Mueller-Rice must present sufficient
evidence to prove she is likely to prevail at a hearing on the merits. See Tenn. Code Ann.
§ 50-6-239(d)(l) (2018). The Court holds she would likely prevail in her claim for
medical benefits but not temporary disability benefits.

                                    Medical Benefits

       Under the Workers' Compensation Law, an employer must "furnish, free of
charge to the employee, such medical and surgical treatment . . . made reasonably
necessary by accident[.]" Tenn. Code Ann. § 50-6-204(a). To receive benefits, Ms.
Mueller-Rice must show, to a reasonable degree of medical certainty, that the September
30, 2017 incident "contributed more than fifty percent (50%) in causing the . . .
disablement or need for medical treatment, considering all causes." Tenn. Code Ann. §
50-6-1 02(14 ).


                                            2
       Here, the evidence submitted is sufficient to show that the fall over a dog's leash
caused Ms. Mueller-Rice's September 30 work injury and need for medical treatment.
The Court notes that the Dispute Certification Notice does not list compensability as a
disputed issue, and it is unclear whether Poblanos participated in mediation. Based on
the evidence submitted, Poblanos must pay for Ms. Mueller-Rice's past and ongoing
medical treatment for the September 30 work injury.

                              Temporary Disability Benefits

       Ms. Mueller-Rice also requested temporary disability benefits. There are two
kinds: temporary total and temporary partial. To receive temporary total disability (TTD)
benefits, Ms. Mueller-Rice must prove (1) she became disabled from working due to a
compensable injury; (2) a causal connection exists between the injury and her inability to
work; and (3) she established the duration of her disability. Jones v. Crencor Leasing
and Sales, TN Wrk. Comp. App. Bd. LEXIS 48, at *7 (Dec. 11, 2015). Concerning
temporary partial disability (TPD) benefits, Ms. Mueller-Rice is eligible for benefits if
she earned less than her average weekly wage due to work restrictions. See Tenn. Code
Ann. § 50-6-207(2)(A).

      Here, Ms. Mueller-Rice might be entitled to past temporary disability benefits.
However, the parties submitted no proof of her wages. Due to this lack of evidence, the
Court must deny her request for temporary disability benefits at this time.

                                  Penalty Unit Referral

      The Penalty Program is specifically authorized to assess penalties under the
Workers' Compensation Law as well as the General Rules of the Workers' Compensation
Program. The Court finds that Poblanos is subject to possible penalty assessments under
Tennessee Code Annotated section 501-6-118 for the following:

      •   Failure to have workers' compensation coverage;
      •   Bad-faith denial of Ms. Mueller-Rice's claim;
      •   Failure to file a First Report of Work Injury, a Notice of Controversy, or a
          Notice ofDenial of Claim;
      •   Failure to timely provide medical treatment; and,
      •   Failure to timely provide a panel of physicians.

Therefore, the Court refers this matter to the Compliance Program for consideration of
these and any other applicable penalties.




                                            3
                                  Payment of Benefits

        Poblanos must provide medical and temporary disability benefits. However, since
it did not have workers' compensation insurance at the time of the injury, the Uninsured
Employers Fund (UEF) has discretion to pay limited temporary disability benefits and
medical expenses if certain criteria are met. (See attached Benefits Request Form.) Ms.
Mueller-Rice must establish, through her testimony, medical records, and the Bureau's
Compliance report, that she has proved or is likely to prove that she: 1) worked for an
uninsured employer; 2) suffered an injury arising primarily in the course and scope of
employment on or after July 1, 2015; 3) was a Tennessee resident on the date of injury; 4)
provided notice to the Bureau of the injury and of the employer's lack of coverage within
sixty days of the injury; and, 5) secured a judgment for workers' compensation benefits
against Poblanos for the injury. Tenn. Code Ann. § 50-6-801(d)(l)-(5).

IT IS, THEREFORE, ORDERED as follows:

   1. The Court denies Ms. Mueller-Rice's request for temporary disability benefits at
      this time.

   2. Dr. Thomas W. Brown, III shall be the authorized treating physician. Poblanos
      shall provide Ms. Mueller-Rice with ongoing medical treatment for her September
      30, 2017 work injury under Tennessee Code Annotated section 50-6-204. Further,
      upon presentment of bills by Ms. Mueller-Rice or her treating providers, Poblanos
      shall pay all past medical expenses incurred for treatment of her work-related
      injury by, or upon the direction of, the following: 1) Memorial Hospital; 2)
      Chattanooga Emergency Med, PLLC; 3) Diagnostic Imaging Consultants; 4)
      Thomas W. Brown, III, M.D.; 5) Chattanooga Outpatient Center; and, (6)
      Benchmark Physical Therapy.

   3. This case is set for a Status Hearing on Wednesday, July 31, 2019, at 1:00 p.m.
      Eastern Time. The parties must call (423) 634-0164 or toll-free at (855) 383-0001
      to participate. Failure to call may result in a determination of the issues without
      your participation.

   4. 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 Self-Insured Employer 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.



                                            4
  5. For questions regarding compliance, please contact the Workers' Compensation
     Compliance Unit via email at WCCompliance.Program@tn.gov.

ENTERED May 31, 2019.




                                    Workers' Compensation Judge




                                       5
                                    APPENDIX

Exhibits:
       1. Affidavit of Meagan Mueller-Rice
       2. Expedited Request for Investigation Report
      3. Billing statements:
             a. Benchmark PT
             b. Chattanooga Outpatient Center
             c. Memorial Hospital of Chattanooga
             d. Chattanooga Emergency Med, PLLC
             e. Diagnostic Imaging Consultants
             f. Thomas W. Brown, III, M.D., P.C./Chattanooga Sports Medicine &
                Orthopedics
      4. Secretary of State Filing Information
      5. Text messages between Ms. Mueller-Rice and Sabrina Holbrook, manager,
          September 30, 2017, to October 9, 2017
      6. Medical records of Memorial Hospital
      7. Medical records ofDr. Brown

Technical record:
      1. Petition for Benefit Determination
      2. Expedited Request for Investigation Report
      3. Dispute Certification Notice
      4. Show Cause Order
      5. Order on Show Cause Hearing
      6. Request for Expedited Hearing
      7. Docketing Notice




                                          6
                              CERTIFICATE OF SERVICE

 I certify that a copy of this Expedited Hearing Order was sent to these recipients as
 indicated below on May 3 1, 20 19.

        Name              Certified     Email       Service sent to:
                           Mail
Meagan Mueller-Rice,         X                      meganmueller@IDonail. com
Employee                                            809 Central A venue
                                                    Chattanooga, TN 37403
Poblanos,                     X                     i.hyde@hotmail.com
Uninsured Employer                                  Poblanos Mexican Cuisine
                                                    Attn: Irma Hyde
                                                    551 River Street
                                                    Chattanooga, TN 37405

Amanda Terry,                             X         WCComnliance. nrogram@tn.gov
Compliance Program                                  Amanda.terry@tn.gov

LaShawn Pender                            X         lashawn.Qender@tn. gov




                                                                 M, COURT CLERK
                                                       wc.co ·· clerk@tn.gov




                                                7
Filed Date Stamp Here
                                    Tennessee Bureau of Workers’ Compensation
                                      www.tn.gov/workforce/injuries-at-work
                                             wc.ombudsman@tn.gov
                                                 1-800-332-2667

                   REQUEST FOR BENEFITS FROM THE UNINSURED EMPLOYERS FUND

Eligible employees may use this form to request benefits from the Uninsured Employers Fund (UEF) if
they are injured while working for an employer that failed to provide:

    1.   Workers’ compensation insurance as required by the TN Workers’ Compensation Law; and,
    2.   Medical and/or disability benefits as required by the TN Workers’ Compensation Law.

This form MUST be completed and sent via certified mail to the following address:

                                    Tennessee Bureau of Workers’ Compensation
                                    ATTN: UEF Benefit Manager
                                    Uninsured Employers Fund
                                    220 French Landing Drive, Suite 1B
                                    Nashville, TN 37243-1002.

This form MUST be sent within sixty (60) calendar days after the claim is over and MUST include:

    1.   A court order stating your employer owes you benefits and that you may request UEF benefits;
    2.   A completed Internal Revenue Service (IRS) Form, W-9 Request for Taxpayer Information and
         Certification available at www.irs.gov; and
    3.   A completed Bureau of Workers’ Compensation Form C31 Medical Waiver and Consent available
         on the “Forms” link at www.tn.gov/workerscomp.


I certify that I believe I am eligible for benefits from the UEF; that my employer has not paid all or part of
the benefits I am due; and my employer has not complied with an order issued by the Court of Workers’
Compensation Claims.

I, _______________________________________, request benefits from the Uninsured Employers Fund.
                (Print Your Name)




____________________________________________________________________________________________________
Signature                                                         Date



Tennessee Law allows the State of Tennessee to recover payments made by the UEF for temporary
disability benefits or medical benefits. An agreement between you and your employer for payment of
benefits must be pre-approved by the UEF before being approved by a workers’ compensation judge.



LB-3284 (NEW 4/19)                                                                            RDA 10183
