     FILED
    Oct 02, 2019
   10:56 AM(ET)
 TENNESSEE COURT OF
WORKERS' COMPENSATION
       CLAIMS
        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) (20 18). 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 ).


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        Here, the evidence 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, Poblanos must pay for Ms. Mueller-Rice's past and ongoing medical treatment
for the 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 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 of Denial 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.




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                                   Payment ofBenefits

       Poblanos must provide medical benefits. However, since it did not have workers'
compensation insurance at the time of the injury, the Uninsured Employers Fund has
discretion to pay limited 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)(1)-(5).

       The Court finds that Ms. Mueller-Rice worked for an uninsured employer,
Poblanos, and that she is likely to prevail at a hearing on the merits that she suffered an
injury arising primarily from employment on September 30, 2017. She was a Tennessee
resident on that date, and she provided notice to the Bureau within sixty days of her
injury and of Poblanos lack of coverage. This order serves as a judgment for benefits.
Ms. Mueller-Rice satisfied all ofthe requirements of section 50-6-801(d).

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 Friday, October 18, 2019, at 1:30 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. The Court refers this matter to the Compliance Program for consideration of the
      imposition of penalties.

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  5. 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.

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

ENTERED October 2, 2019.




                                       AUDREY     HEADRICK
                                       Workers' Compensation Judge




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                                    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 of Dr. 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




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                             CERTIFICATE OF SERVICE

 I certify that a copy of this Expedited Hearing Order was sent as indicated below on
 October 2, 20 19.

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

Amanda Terry,                            X         WCComQliance.grogram@tn.gov
Compliance Program                                 Amanda.telTVCiiltn.gov

LaShawn Pender                           X         lashawn.g~nder@tn. gov




                                                   ~~
                                               PENNY S    UM, COURT CLE
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                                                   wc.courtclerk@tn.gov




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