                                                                                            FILED
                                                                                         Aug 01, 2019
                                                                                         11:54 AM(CT)
                                                                                      TENNESSEE COURT OF
                                                                                     WORKERS' COMPENSATION
                                                                                            CLAIMS




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

TERRY V. ADAMS,                                   )   Docket No. 2019-03-0154
          Employee,                               )
v.                                                )
EAST TENNESSEE PERSONAL                           )
CARE SERVICE, LLC,                                )   State File No. 27353-2018
         Employer,                                )
And                                               )
ACCIDENT FUND GENERAL                             )
INSURANCE COMPANY,                                )   Judge Pamela B. Johnson
         Carrier.                                 )
                                                  )


          EXPEDITED HEARING ORDER GRANTING MEDICAL BENEFITS


       This case came before the Court for an Expedited Hearing on July 10, 2019. The
Court must decide whether Ms. Adams came forward with sufficient evidence
demonstrating that she is entitled to additional benefits. For the reasons below, the Court
holds Ms. Adams is entitled to ongoing medical benefits.

                                         History of Claim

        Ms. Adams worked as a personal aide for East Tennessee Personal Care Service
(ETPCS). 1 Her duties involved assisting clients with transportation and activities of daily
living. On March 5, 2018, another vehicle struck Ms. Adams's personal vehicle while
transporting an ETPCS client. Ms. Adams immediately called the police and reported the
accident to her supervisor. After the police completed its report, Ms. Adams transported
her client and herself to the emergency room.

      Although the police report indicated the parties were not injured, Ms. Adams
emailed her supervisor on the evening of the accident and stated, "The impact was so

1
    Two months after Ms. Adams's injury, ETPCS joined Associated Home Care, an Amedisys company.



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hard, I knew I needed to get checked out due to having thoracic stents in my body. " 2 She
provided her supervisor the hospital discharge paperwork and the traffic accident report
number. Ms. Adams completed a Tennessee Department of Safety and Homeland
Security Owner/Driver Report and noted that the accident resulted in injuries. She
additionally provided a written statement on March 23 and advised, "I had emergency
medical care, due to a pre-existing medical problem, but I may need additional medical
care." In her statement, she requested that "the correct person who handles Workers'
Compensation contact me as soon as possible."

       ETPCS prepared a First Report of Work Injury on April 16 and noted, "INJURED
WORKER STATES CHEST, HEAD AND LOWER LEG PAIN." (Emphasis in
original). That same day, the owner ofETPCS told Ms. Adams that the only provider she
could see was Farragut Family, but he did not give her an appointment date or any
documentation from workers' compensation. In July, she contacted ETPCS's carrier and
spoke to the adjuster, who told her the claim was "opened and closed." On July 31, Ms.
Adams received a note with a telephone number for Farragut Family. However, when
she called to schedule an appointment, Farragut Family said that it needed her employer's
authorization.

        She ultimately received authorization and saw Dr. Gerald Russell at Farragut
Family on August 2. She reported neck and mid-back pain radiating down her left arm
after the March car accident. Dr. Russell ordered a cervical and thoracic MRI and
assigned restrictions. On August 30, Dr. Russell reviewed the MRI, which showed
degenerative disc disease in her cervical spine, and he suggested physical therapy and
"possible physiatry referral."

      Ms. Adams filed her Petition for Benefit Determination on February 5, 2019,
seeking additional medical treatment. At the Expedited Hearing, she asserted that
ETPCS unreasonably delayed authorization of her initial treatment and payment of her
medical bills. Ms. Adams acknowledged that she received a panel of physiatrists in
October 20 18 and selected a physician.

       ETCPS denied it unreasonably delayed Ms. Adams's treatment or payment of
related bills. It asserted Ms. Adams did not initially request treatment, and the police
report noted no injuries. It also introduced its carrier's claim payment report
demonstrating payment of benefits to or on Ms. Adams's behalf. Specifically, the report
indicated it paid the ER physician's March 5, 2018 charges on May 10, 2018, and the
corresponding March 5, 2018 hospital bill on July 1, 2019. It argued the bill was


2
  Ms. Adams testified she suffered from a preexisting aortic aneurysm and needed medical treatment
immediately.


                                                2
improperly sent to Ms. Adams's automobile insurer, who declined to pay the hospital
charges. ETCPS further noted it paid Ms. Adams's mileage.

       At the conclusion of the hearing, ETPCS confirmed its willingness to provide
additional treatment with Dr. Russell and a panel-selected physiatrist for Ms. Adams's
work-related injuries. However, it argued other than continued authorized, causally-
related medical care for Ms. Adams's injuries, no other benefits were due.

                       Findings of Fact and Conclusions of Law

       To prevail at an Expedited Hearing, Ms. Adams must show she would likely
prevail at a hearing on the merits that she is entitled to additional benefits. See Tenn.
Code Ann. § 50-6-239(d)(l) (2018).

       It became clear to the Court during the hearing that Ms. Adams filed the Petition
for Benefit Determination because she believed ETCPS neglected her. She testified she
took immediate action to ensure her client received prompt medical attention. She
contacted her supervisor from the scene of the accident to report the accident, and the
same day she sent the traffic accident report number and discharge papers. In contrast,
she said ETCPS showed little concern for her well-being. She testified it did not
immediately offer her treatment or pay her emergency room care.

       ETCPS argued that the police report noted no injuries, and Ms. Adams did not ask
for treatment. However, the evidence showed Ms. Adams requested treatment as of
March 23, but ETCPS did not provide it until August 2.

       The Court finds Ms. Adams a credible employee who placed her client's needs
above her own. While Ms. Adams ensured her client was evaluated and treated if
necessary, ETCPS did not extend the same courtesy to her. ETCPS eventually provided
authorized medical treatment and paid her emergency room bills and mileage, but the
delay caused discord between the parties and led to litigation.

       The Workers' Compensation Law requires an employer to provide an injured
employee with medical treatment made reasonably necessary by a work accident. Tenn.
Code Ann. § 50-6-204. To do so, following notice of injury and request for medical care,
the employer must provide the injured employee with a panel of physicians within three
business days. Tenn. Comp. R. & Regs. 0800-02-01-.06(1). Additionally, medical bills
must be paid within thirty calendar days of receipt of a properly submitted and complete
bill. Tenn. Comp. R. & Regs. 0800-02-17-.10(7) (2018). Failure to timely provide a
panel of physicians and medical treatment exposes the employer to penalties under
Tennessee Code Annotated section 50-6-118.



                                           3
       The Court finds ETCPS failed to timely provide Ms. Adams medical treatment
and to timely pay her medical bills. Ms. Adams gave ETCPS notice and requested
treatment by March 23, 2018, but ETCPS did not authorize it until shortly after July 31,
2018-a four-month delay. ETCPS further did not pay Ms. Adams's March 5, 2018
emergency room bills until July 1, 2019 - an almost fifteen-month delay. Accordingly,
the Court refers this case to the Compliance Unit for investigation and assessment of
penalties under Tennessee Code Annotated section 50-6-118 and Tennessee Compilation
Rules and Regulations 0800-02-01 et seq. Further, the Court holds Ms. Adams is entitled
to ongoing medical treatment under Tennessee Code Annotated section 50-6-204.

IT IS, THEREFORE, ORDERED as follows:

   1. ETCPS shall provide ongoing medical treatment for Ms. Adams's work injuries by
      authorizing a return appointment with Dr. Russell and scheduling an appointment
      with Ms. Adams's selection from the previously-provided panel ofphysiatry.

   2. This case is set for a Status Conference on November 18, 2019, at 1:30 p.m.
      Eastern Time. The parties must call 865-594-0091 or 855-543-5041 toll-free to
      participate in the Status Conference. Failure to appear by telephone might result
      in a determination of the issues without the party's participation.

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

      ENTERED August 1, 2019.




                                  P MELA B. JOHNSON, JUDGE
                                  Court of Workers' Compensation Claims




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                                     APPENDIX

Technical Record:
      1. Petition for Benefit Determination
      2. Attachment-Employee Issues
      3. Employer Correspondence-Employer/Fund Issues
      4. Employee Correspondence
      5. Employee Correspondence
      6. Dispute Certification Notice
      7. Request for Expedited Hearing
      8. Notice of Expedited Hearing
      9. Employer's Response in Opposition to Request for Expedited Hearing
      10. Employee's Reply to Employer's Response
      11. Subsequent Injury Fund's Expedited Prehearing Statement

Exhibits:
       1. Affidavit of Terry V. Adams
      2.  First Report of Work Injury
      3.  Tennessee Electronic Traffic Crash Report
      4.  Notice of Workers' Compensation Injury
      5.  Tennessee Department of Safety and Homeland Security Owner/Driver Report
      6.  Department of Intellectual and Developmental Disabilities Reportable Incident
      7.  Notice ofHospital Lien
      8.  Marked for Identification Only: Medical Records of Physicians Regional
          Medical Center
      9. Medical Records of Summit Medical Group, Internal Medicine Associates
      10.Medical Records ofDr. Gerald Russell, Farragut Family Practice
      11. Marked for Identification Only: Medical Records of Therapy Plus
      12. Marked for Identification Only: Medical Expenses
      13. Marked for Identification Only: Correspondence from Humana Financial
          Recovery & Subrogation
      14. Correspondence from United Heartland
      15. Marked for Identification Only: Joe Neubert Collision Repair Preliminary
          Estimate
      16.Email Communications between Employee and Employer
      17. Correspondence of Associated Home Care
      18. United Heartland Claim Payment Report
      19.Deposition Transcript ofTerry V. Adams




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                          CERTIFICATE OF SERVICE

      I certify that a copy of the Expedited Hearing Order was sent as indicated on
August 1, 2019.

Name                      u.s.     Fax       Email   Service sent to:
                          Mail
Terry V. Adams,            X                  X      5929 Loice Lane
Self-Represented                                     Knoxville, TN 37924
Employee                                             adamsterry3 67 @gmail.com
Tiffany B. Sherrill,                          X      tbsherrill@mij s.com
Employer's Attorney

Robert Davies,                                X      robert.davies@tn.gov
Fund Attorney



                                          ,!) JJv~ -
                                      PE~0, Court Clerk
                                      WC.Cou~~~L.f:@tn.gov




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