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TENNESSEE BUREAU OF WORKERS’ COMPENSATION

IN THE COURT OF WORKERS’ COMPENSATION CLAIMS

AT MURFREESBORO

ANGELA DOUGLAS, ) Docket No. 2018-05-0914

Employee, )

v. )

)

ADIENT USA, LLC, ) State File No. 66160-2017

Employer, )

And )

)

OLD REPUBLIC INS. CO., ) Judge Dale Tipps

Carrier. )

EXPEDITED HEARING ORDER DENYING REQUESTED BENEFITS

This matter came before the Court on November 14, 2018, for an Expedited 

Hearing focusing on Ms. Douglas’s entitlement to medical benefits. The central legal 

issues are whether Ms. Douglas’s claim is barred by failure to give proper notice and, if 

not, whether she is likely to establish at a hearing on the merits that her injury arose 

primarily out of and in the course and scope of her employment. For the reasons below, 

the Court holds Ms. Douglas is not entitled to the requested benefits at this time.

History of Claim

Ms. Douglas testified that she suffered a left-knee injury while working for 

Adient. She was initially unsure about the exact date of injury but later determined that it 

occurred on July 24, 2017, the same day Adient had a visitor from Nissan, for whom 

Adient built car seats. Ms. Douglas described working at two stations that were just a 

few steps apart. As she turned to go from one station to the other, she felt a pop in her 

left knee. This caused her to step off the line for a few moments, but she returned to 

work and finished her shift. When, Ms. Douglas returned to work the next week, her

knee was painful and swollen. She began icing it in Adient’s first aid station during her 

work breaks.

FILED

Nov 21, 2018

10:38 AM(CT)

TENNESSEE COURT OF

WORKERS' COMPENSATION

CLAIMS
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Ms. Douglas had an annual medical checkup on August 21 with her personal 

physician, Dr. Dana Chandler. Dr. Chandler noted an approximately three-week history 

of sharp and severe left knee pain. Ms. Douglas reported difficulty with stairs and said 

her knee would “give out” at times. Although Ms. Douglas testified that she told Dr. 

Chandler about injuring her knee at work, Dr. Chandler noted “no overt trauma.” Dr. 

Chandler ordered x-rays and prescribed Prednisone.

The next day, Ms. Douglas reported the injury to Human Resources and filled out 

an injury report. Adient subsequently denied the claim, and Ms. Douglas sought 

treatment on her own with Dr. Cason Shirley.

Dr. Shirley’s October 19 record gave a July 24 onset date, when Ms. Douglas 

“was putting a cushion in a seat and twisted her knee and it popped.” He diagnosed a 

medial meniscus tear and gave her a lidocaine injection.

David Miller, Adient’s Health and Safety Lead, and Steve Williams, Production 

Superintendent, testified that they knew Ms. Douglas was icing her knee during her work 

breaks. However, Adient was unaware that Ms. Douglas’s knee problem was workrelated until she filled out her injury report on August 22. They also explained that the 

delay in learning of the alleged injury impaired their ability to investigate the claim. 

Specifically, they were unable to review any video or speak to any witnesses with 

memory of the incident.

Ms. Douglas asked the Court to order Adient to provide medical treatment for her 

knee.

Adient contended that Ms. Douglas’s claim is barred by her failure to provide

proper notice of an injury. It also argued that, even if notice was legally adequate, Ms. 

Douglas’s injury is not compensable because it was idiopathic. Finally, Adient 

maintained that Ms. Douglas failed to meet her burden of proving that her knee injury 

arose primarily out of and in the course and scope of her employment. For these reasons, 

it asked the Court to deny her request.

Findings of Fact and Conclusions of Law

Standard applied

Ms. Douglas need not prove every element of her claim by a preponderance of the 

evidence in order to obtain relief at an expedited hearing. Instead, she must present 

sufficient evidence she is likely to prevail at a hearing on the merits. See Tenn. Code 

Ann. § 50-6-239(d)(1) (2018); McCord v. Advantage Human Resourcing, 2015 TN Wrk. 

Comp. App. Bd. LEXIS 6, at *7-8, 9 (Mar. 27, 2015). 
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Notice

Tennessee Code Annotated section 50-6-201(a)(1) provides that an injured 

employee must give written notice of an injury within fifteen days unless it can be shown 

that the employer had actual knowledge of the accident or that “reasonable excuse for 

failure to give the notice is made to the satisfaction of the tribunal.” 

When the employer raises lack of notice as a defense, the burden is on the 

employee to show either the employer had actual notice, that she provided notice, or that 

her failure to give notice was reasonable under the circumstances. Hosford v. Red Rover 

Preschool, 2014 TN Wrk. Comp. App. Bd. LEXIS 1, at *15 (Oct. 2, 2014). Our Appeals 

Board explained the notice requirement “exists so that an employer will have an 

opportunity to make a timely investigation of the facts while still readily accessible, and 

to enable the employer to provide timely and proper treatment for an injured employee.” 

Id. Guided by this authority, the Court must determine whether Ms. Douglas rebutted 

Adient’s notice defense.

The Court first finds Adient had no “actual notice” of the injury. There is no 

evidence that any representative of Adient authorized to receive notice knew of the 

incident when it occurred. 

Second, the Court turns to whether Ms. Douglas provided notice to Adient within 

fifteen days. On this point, Ms. Douglas acknowledged she provided no written notice of 

her alleged July 24 injury until August 22. Accordingly, the Court finds she failed to

provide timely notice.

Next, the Court finds no reasonable excuse for Ms. Douglas’s failure to provide 

timely notice of her injury. In Buckner v. Eaton Corp., 2016 TN Wrk. Comp. App. Bd. 

LEXIS 84 (Nov. 9, 2016), the employee sustained an injury on July 21, 2015, at a 

“specific time and place performing a specific task.” However, he did not report his 

injury until September 2, 2015, forty-three days later. Id. at *3. Under such 

circumstances, the Appeals Board concluded “that Employee’s excuse for failing to 

provide timely notice of his work injury was not ‘reasonable,’ the standard mandated by 

the legislature in section 50-6-201(a)(1).” Id. at *11. Specifically, “this was not a case 

where symptoms developed gradually over time or were not immediately apparent.” 

Rather, the employee “was immediately aware he hurt his back and shortly thereafter was 

. . . unable to work.” Id. 

The facts of this case are similar. Like the employee in Buckner, Ms. Douglas 

alleged an injury at a specific time and place while performing a specific task. She 

testified that she felt her knee pop on July 24, 2017, which caused her to take a short 

break from her duties. Although she kept working that day, she soon developed swelling 
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and pain. Thus, any delayed reporting of her injury is not excused on grounds that her

“symptoms developed gradually over time or were not immediately apparent.” See

Buckner, at *11. 

However, the inquiry does not end there. Tennessee Code Annotated section 50-

6-201(a)(3) provides that the failure to give timely notice of a work-related injury will not 

bar compensation “unless the employer can show, to the satisfaction of the workers' 

compensation judge before which the matter is pending, that the employer was prejudiced 

by the failure to give the proper notice, and then only to the extent of the prejudice.”

Accordingly, the Court must determine whether Adient suffered prejudice, and if so, to 

what extent any such prejudice affects the benefits to which Ms. Douglas may be entitled. 

Prejudice may be found if the employer is denied the opportunity to make an 

investigation while the facts are accessible or to enable it to provide timely and proper 

treatment for the injured employee. Masters v. Industrial Garments Mfg. Co., 595 

S.W.2d 811, 815 (Tenn. 1980) citing York v. Federal Chemical Co., 216 S.W.2d 725 

(Tenn. 1949).

Adient did not contend that the late notice prevented it from providing proper 

medical treatment for Ms. Douglas. Instead, Mr. Miller testified that he didn’t have a 

chance to conduct a proper investigation because “six weeks later, nobody can remember 

anything” and video of the incident was not available due to the time elapsed. This 

testimony is not entirely persuasive, as Mr. Miller overstated the number of weeks 

between the alleged injury and the date of notice, which was actually less than thirty 

days. Further, Mr. Miller did not testify that he actually tried to identify and interview 

the witnesses to the incident, but implied that it would have been difficult or unfruitful to 

do so. This inference is speculative and not proof of actual prejudice.

The testimony about the video, however, is substantive. Adient had a right to 

evaluate Ms. Douglas’s claim, including reviewing video of her work area to determine 

whether her description of the injury was credible. The video was unavailable because of 

her delay in reporting the injury. While the prejudicial effect appears slight in this case,

the fact remains that the delay impaired Adient’s ability to investigate the claim. The 

Court must conclude, therefore, that Ms. Douglas appears unlikely to rebut Adient’s

notice defense.

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IT IS, THEREFORE, ORDERED as follows:

1. Ms. Douglas’s claim against Adient and its workers’ compensation carrier for the 

requested medical benefits is denied at this time. 

 

1 Because Ms. Douglas appears unlikely to overcome the notice defense, the Court need not address 

Adient’s causation arguments.
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2. This matter is set for a Scheduling Hearing on January 15, 2019, at 10:00 a.m. 

You must call 615-741-2112 or toll-free at 855-874-0473 to participate. Failure to 

call may result in a determination of the issues without your further 

participation. All conferences are set using Central Time (CT).

ENTERED this the 21st day of November, 2018.

_____________________________________

Judge Dale Tipps

Court of Workers’ Compensation Claims

APPENDIX

Exhibits:

1. Affidavit of Angela Douglas

2. October 18, 2017 office note of Dr. Cason Shirley

3. Medical records from Dr. Dana Chandler

4. Affidavits of David Miller, Steve Williams, Aaron Cowart, and Tony Simeri

5. Injury report

Technical record:

1. Petition for Benefit Determination

2. Dispute Certification Notice

3. Request for Expedited Hearing

4. Adient’s Pre-Hearing Statement

5. Adient’s Witness and Exhibit List

CERTIFICATE OF SERVICE

I hereby certify that a true and correct copy of the Expedited Hearing Order was

sent to the following recipients by the following methods of service on this the 21st day of

November, 2018.
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Name Certified 

Mail

Fax Email Service sent to:

Angela Douglas,

Employee

X X 108 East Merchant St.

Mt. Pleasant, TN 38474

angeladouglass2009@yahoo.com

Kitty Boyte,

Employer’s Attorney

X kboyte@constangy.com

_____________________________________

Penny Shrum, Clerk of Court

Court of Workers’ Compensation Claims

WC.CourtClerk@tn.gov
Expedited Hearing Order Right to Appeal:

If you disagree with this Expedited Hearing Order, you may appeal to the Workers’ 

Compensation Appeals Board. To appeal an expedited hearing order, you must:

1. Complete the enclosed form entitled: “Expedited Hearing Notice of Appeal,” and file the 

form with the Clerk of the Court of Workers’ Compensation Claims within seven 

business days of the date the expedited hearing order was filed. When filing the Notice 

of Appeal, you must serve a copy upon all parties. 

2. You must pay, via check, money order, or credit card, a $75.00 filing fee within ten 

calendar days after filing of the Notice of Appeal. Payments can be made in-person at 

any Bureau office or by U.S. mail, hand-delivery, or other delivery service. In the 

alternative, you may file an Affidavit of Indigency (form available on the Bureau’s 

website or any Bureau office) seeking a waiver of the fee. You must file the fullycompleted Affidavit of Indigency within ten calendar days of filing the Notice of 

Appeal. Failure to timely pay the filing fee or file the Affidavit of Indigency will 

result in dismissal of the appeal.

3. You bear the responsibility of ensuring a complete record on appeal. You may request 

from the court clerk the audio recording of the hearing for a $25.00 fee. If a transcript of 

the proceedings is to be filed, a licensed court reporter must prepare the transcript and file 

it with the court clerk within ten business days of the filing the Notice of 

Appeal. Alternatively, you may file a statement of the evidence prepared jointly by both 

parties within ten business days of the filing of the Notice of Appeal. The statement of 

the evidence must convey a complete and accurate account of the hearing. The Workers’ 

Compensation Judge must approve the statement before the record is submitted to the 

Appeals Board. If the Appeals Board is called upon to review testimony or other proof 

concerning factual matters, the absence of a transcript or statement of the evidence can be 

a significant obstacle to meaningful appellate review.

4. If you wish to file a position statement, you must file it with the court clerk within ten

business days after the deadline to file a transcript or statement of the evidence. The 

party opposing the appeal may file a response with the court clerk within ten business 

days after you file your position statement. All position statements should include: (1) a 

statement summarizing the facts of the case from the evidence admitted during the 

expedited hearing; (2) a statement summarizing the disposition of the case as a result of 

the expedited hearing; (3) a statement of the issue(s) presented for review; and (4) an 

argument, citing appropriate statutes, case law, or other authority.

For self-represented litigants: Help from an Ombudsman is available at 800-332-2667.


ll 

. 

Tennessee Bureau of Workers' Compensation 

220 French Landing Drive, 1-B 

Nashville, TN 37243-1002 

800-332-2667 

AFFIDAVIT OF INDIGENCY 

.. I 

I, , having been duly sworn according to law, make oath that 

because of my poverty, I am unable to bear the costs of this appeal and request that the filing fee to appeal be 

waived. The following facts support my poverty. 

1. Full Name: ___________ _ 2. Address:-------------

3. Telephone Number:--------- 4. Date of Birth:-----------

5. Names and Ages of All Dependents: 

----------------- Relationship:-------------

----------------- Relationship:-------------

---------------- - Relationship:-------------

----------------- Relationship:-------------

6. I am employed by: ------------------------------,-

My employer's address is:-------------------------

My employer's phone number is:-----------------------

7. My present monthly household income, after federal income and social security taxes are deducted, is: 

$ _______ __ 

8. I receive or expect to receive money from the following sources: 

AFDC $ per month beginning 

SSI $ per month beginning 

Retirement $ per month beginning 

Disability $ per month beginning 

Unemployment $ per month beginning 

Worker's Camp.$ per month beginning 

Other $ per month beginning 

LB-1108 (REV 11/15) RDA 11082 
9. My expenses are: ' ; !• 

' 

Rent/House Payment $ per month Medical/Dental $ per month 

Groceries $ per month Telephone $ per month 

Electricity $ per month School Supplies $ per month 

Water $ per month Clothing $ per month 

Gas $ per month Child Care $ per month 

Transportation $ per month Child Support $ per month 

Car $ per month 

Other $ per month (describe: 

10. Assets: 

Automobile $ ____ _ 

Checking/Savings Acct. $ ____ _ 

House 

) 

Other 

11. My debts are: 

Amount Owed 

$ _ ___ _ 

$ ____ _ 

To Whom 

(FMV) - ---------

(FMV) ----------

Describe: _____ _____ _ 

I hereby declare under the penalty of perjury that the foregoing answers are true, correct, and complete 

and that I am financially unable to pay the costs of this appeal. 

APPELLANT 

Sworn and subscribed before me, a notary public, this 

___ dayof _____________ ,20 ___ _ 

NOTARY PUBLIC 

My Commission Expires: _ _ _____ _ 

LB-1108 (REV 11/15) RDA 11082