TENNESSEE BUREAU OF WORKERS’ COMPENSATION

IN THE COURT OF WORKERS’ COMPENSATION CLAIMS 

AT NASHVILLE 

MICHAEL SLEZAK, ) Docket No. 2017-06-2230

Employee, )

v. )

AMAZON, ) State File No. 94425-2017

Employer, )

and

SELECTIVE INSURANCE 

COMPANY OF SOUTH CAROLINA,

 Carrier.

)

)

)

)

Judge Joshua Davis Baker

EXPEDITED HEARING ORDER FOR MEDICAL BENEFITS

On September 12, 2018, the undersigned convened an expedited hearing where 

Mr. Slezak sought temporary disability and medical benefits. At issue is whether Mr. 

Slezak would likely prevail at a hearing on the merits in proving entitlement to those 

benefits. Amazon argued against an award of benefits, claiming Mr. Slezak failed to 

timely report his injury and to demonstrate a work-related injury. The Court holds Mr. 

Slezak would prevail at a hearing on the merits in proving entitlement to medical benefits

but denies his claim for temporary disability benefits at this time. 

Claim History

This claim concerned an alleged repetitive stress injury. Michael Slezak worked 

in the warehouse for Amazon when, at some point during the week before August 29, 

2017, he allegedly injured his right wrist while folding boxes for use in shipping orders. 

He had no problems with his right wrist at any time before this condition developed. 

On August 29, Mr. Slezak said he entered a leave request into Amazon’s online 

employee portal, referred to as the “HUB,” to let his supervisor know he would be out of 

work. He also claimed he reported the condition as work-related through the HUB. 

Amazon provided emails disputing whether Mr. Slezak entered a leave request, and 

whether he reported his injury at all. However, it called no witnesses to testify at the 

hearing. 

FILED

Sep 13, 2018

12:17 PM(CT)

TENNESSEE COURT OF

WORKERS' COMPENSATION

CLAIMS
2

Mr. Slezak missed work for a little more than a week, returning on “September 7th

or 8th,” and claimed he received no contact from Amazon concerning his condition during 

his absence. When Mr. Slezak returned to work, he continued to have problems with his 

wrist. He stated in his affidavit, “I started to contact the Leave Team to talk about my 

situation.” Additionally, he testified that he spoke to a “work-comp manager,” Ben 

Woods, and an attendant at AMCARE—Amazon’s in house clinic—about his condition. 

According to Mr. Slezak, the AMCARE representative told him that workers’ 

compensation would likely not be approved. 

On September 13, Mr. Slezak went to Dr. John Kane. Dr. Kane diagnosed him 

with wrist pain, excused him off work until September 16, and referred him to Dr. Shawn 

Mountain. Dr. Kane provided no opinion on the causal relationship between Mr. 

Slezak’s work and his wrist condition. In fact, he indicated the cause of Mr. Slezak’s 

wrist symptoms were unknown. 

Dr. Mountain diagnosed Mr. Slezak with tenosynovitis, gave him pain medication, 

and provided him a brace. Dr. Mountain also offered to inject his wrist. Mr. Slezak 

initially declined the injection but later accepted it. Like Dr. Kane, Dr. Mountain also

provided no opinion on medical causation. 

Amazon terminated Mr. Slezak for “job abandonment” on October 5. Several 

months after his termination, it completed a first report of injury and listed the 

mechanism of injury as “unknown.” Additionally, Amazon provided a panel of 

physicians but declined to schedule an appointment. On April 18, Amazon issued a 

notice denying the claim for “no evidence to support a work-related injury.” This suit 

followed. 

Findings of Fact and Conclusions of Law 

Mr. Slezak must present sufficient evidence to show he would likely prevail at the 

final hearing to receive relief at this expedited hearing. See Tenn. Code Ann. § 50-6-

239(d)(1) (2017); McCord v. Advantage Human Resourcing, 2015 TN Wrk. Comp. App. 

Bd. LEXIS 6, at *9 (Mar. 27, 2015). The Court holds he carried that burden regarding 

his request for medical benefits.

To establish causation, Mr. Slezak must show he suffered an injury “caused by a 

specific incident, or set of incidents, arising primarily out of and in the course and scope 

of employment . . . [that] is identifiable by time and place of occurrence.” An injury 

“arises primarily out of and in the course and scope of employment” only if the 

“employment contributed more than fifty percent (50%) in causing the injury, 

considering all causes[.]” Tenn. Code Ann. § 50-6-102(14) (2017). 
3

In his affidavit and testimony, Mr. Slezak claimed he injured his wrist while 

assembling boxes at Amazon. He testified he had no wrist pain before this condition 

developed. He further claimed he reported the injury but received no medical treatment. 

As Amazon called no defense witnesses, his version of the events leading to injury is 

uncontroverted. 

The Court further holds Mr. Slezak reported his injury to Amazon. The Workers’ 

Compensation Law requires an employee to report a workplace injury as soon as possible 

but in no event later than fifteen days after its occurrence absent a reasonable excuse for 

failing to do so. See id. at § 50-6-201(a)(1). Mr. Slezak testified he reported his injury 

through the HUB, in a conversation with Mr. Woods, and to an AMCARE provider. 

Amazon provided emails that somewhat contradicted Mr. Slezak but called no witnesses. 

While Mr. Slezak’s manner of speech made his testimony sometimes difficult to follow, 

the Court finds he provided credible testimony and credits his testimony over the content 

of email messages created by Amazon personal who were not subject to cross 

examination. 

When an employee suffers a workplace injury, Tennessee law requires the

employer to provide medical and surgical treatment “made reasonably necessary” by a 

workplace accident at no cost to the employee. This process generally begins with the 

employer giving the employee a list of three “independent reputable physicians” so that 

the employee may choose one to be the treating physician.” See Tenn. Code Ann. § 50-

6-204(a)(3)(A). Amazon claims Mr. Slezak cannot prove entitlement to medical care 

because he failed to produce a doctor’s opinion affirmatively linking his wrist condition 

to his work for Amazon. However, at an expedited hearing, an employee need not 

establish medical causation by a preponderance of the evidence. See Lewis v. Molly 

Maid, 2016 TN Wrk. Comp. App. Bd. LEXIS 19, at *8-9 (Apr. 20, 2016). Rather, if the 

employee comes forward with evidence showing that a work event resulted in injury, it 

may be sufficient to support an order compelling an employer to provide a panel. Id. 

Amazon’s argument concerning lack of evidence on medical causation is 

premature. The Court finds that Mr. Slezak presented sufficient evidence to establish 

that he is entitled to a panel of physicians. In this case, as Amazon already provided a 

panel, the Court orders Amazon to provide Mr. Slezak treatment with whomever he 

chooses from the panel previously provided.1 

Regarding temporary disability benefits, the Court finds that Mr. Slezak is not 

entitled to them at this time. An employee is entitled to receive temporary total disability 

benefits under Tennessee Code Annotated § 50-6-207(1) whenever the employee has 

suffered a compensable, work-related injury that has rendered the employee unable to 

work. See Young v. Young Elec. Co., 2016 TN Wrk Comp. App. Bd. LEXIS 41, at *11-

 

1 Neither party filed a copy of the panel. 
4

12 (Sept. 14, 2016). Mr. Slezak presented no proof that any doctor took him off of work 

due to his wrist condition with exception of the three-day absence approved by Dr. Kane. 

Only absences that exceed seven days qualify for temporary disability benefits. See 

Tennessee Code Annotated § 50-6-205(a). The Court, therefore, finds that Mr. Slezak is 

unlikely to prevail at a hearing on the merits for temporary disability benefits. 

It is ORDERED as follows:

1. Amazon shall provide Mr. Slezak a panel of physicians meeting the requirements 

of Tennessee Code Annotated section 50-6-204(a)(3)(A)(i) . 

2. The Court denies Mr. Slezak’s request for temporary disability benefits at this 

time. 

3. This matter is set for a status conference on Monday, November 26, 2018, at 9:30 

a.m. (CST). You must call 615-741-2113 or toll-free 855-874-0474 to 

participate in the Hearing. Failure to call may result in a determination of 

issues without your further 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 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. For questions regarding compliance, please 

contact the Workers’ Compensation Compliance Unit via email at

WCCompliance.Program@tn.gov.

ENTERED ON SEPTEMBER 13, 2018. 

___________________________________

Joshua Davis Baker, Judge

Court of Workers’ Compensation Claims
5

APPENDIX

Exhibits:

1. Medical records

2. Slezak Affidavit

3. Notice of Claim Denial

4. First Report of Injury

5. Wage Statement

6. Job Requirement Description

7. Letter Dated March 8, 2018

8. Medical Prescription

9. Medical Record Dated October 30, 2017

10.Termination Letter

11.Email Dated October 6, 2017

12.Chain of Emails Ending on October 23, 2017

13.Notice of Leave Denial

14.Screenshot of HUB Screen from September 18, 2017

Technical Record:

1. Petition for Benefit Determination

2. Dispute Certification Notice

3. Request for Expedited Hearing
6

CERTIFICATE OF SERVICE

I certify that a true and correct copy of this Order was sent to the following 

recipients by the following methods of service on September 13, 2018.

Name Certified 

Mail

Via

Fax

Via 

Email

Service sent to:

Michael Slezak X X 15208 Bartons Run

Lebanon, TN 37090

Mikeslezak2111@yahoo.com

Sarah H. Best,

Troy W. Hart

Employer’s Attorneys

X shbest@mijs.com; 

wth@mijs.com

____________________________________________

Penny Shrum, Court Clerk

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.
Filed Date Stamp Here EXPEDITED HEARING NOTICE OF APPEAL 

Tennessee Division of Workers' Compensation 

www.tn.gov/labor-wfd/wcomp.shtm l 

wc.courtclerk@tn.gov 

1-800-332-2667 

Docket#:----------

State File #/YR: ---- ----

RFA#: ____________ _ 

Date of Injury:----- ----

SSN: _______________ _ 

Employee 

Employer and Carrier 

Notice 

Noticeisg~enthat _______ -- ~~~--- ~~--------~ 

[List name(s) of all appealing party(ies) on separate sheet if necessary] 

appeals the order(s) of the Court of Workers' Compensation Claims at __ _ 

-~~~-----~~~~~~~~-to the Workers' Compensation Appeals Board. 

[List the date(s) the order(s) was filed in the court clerk's office] 

Judge __________________________________________ _ 

Statement of the Issues 

Provide a short and plain statement of the issues on appeal or basis for relief on appeal: 

Additional Information 

Type of Case [Check the most appropriate item] 

D Temporary disability benefits 

D Medical benefits for current injury 

D Medical benefits under prior order issued by the Court 

List of Parties 

Appellant (Requesting Party): _____________ .At Hearing: DEmployer DEmployee 

Address:. _______________________ ______________ __________ _ 

Party's Phone:. ____________________________ Email: ________________________ _ 

Attorney's Name: ________________________________ ___ BPR#: ------------

Attorney's Address:. _____ ~~-~~~~----~~---- Phone: 

Attorney's City, State & Zip code: _____________________ ___________ _____ _ 

Attorney's Email: _ _ ________ _ _ ________ _____ _ _ _____ _ 

*Attach an additional sheet for each additional Appellant* 

LB-1099 rev.4/15 Page 1 of 2 RDA 11082 
Employee Name:------------ SF#: __________ DOl: ___ __ _ 

Aopellee(s) 

Appellee (Opposing Party): ________ .At Hearing: OEmployer DEmployee 

Appellee's Address:------------------------------

Appellee's Phone: _______________ .Email: ________ ______ _ 

Attorney's Name: _______________ ______ BPR#: --------

Attorney's Address:. _____________________ Phone: 

Attorney's City, State & Zip code: - ------------------------ -

Attorney's Email:. _______________________________ _ 

* Attach an additional sheet for each additional Appellee * 

CERTIFICATE OF SERVICE 

I, certify that I have forwarded a true and exact copy of this 

Expedited Hearing Notice of Appeal by First Class, United States Mail, postage prepaid, to all parties 

and/or their attorneys in this case in accordance with Rule 0800-02-22.01(2) of the Tennessee Rules of 

Board of Workers' Compensation Appeals on this the day of__, 20_ . 

[Signature of appellant or attorney for appellant] 

LB-1099 rev.4/1S Page 2 of 2 RDA 11082 
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