### COURT OF WORKERS' COMPENSATION CLAIMS DIVISION OF WORKERS' COMPENSATION

EMPLOYEE: Dustin Chambers EMPLOYER: Advantage Human Resources DOCKET#: 2014-07-0018 STATE FILE#: 59773-2014 DATE OF INJURY: July 31,2014 INSURANCE CARRIER: New Hampshire Ins. Co. I 

### Broadspire

EXPEDITED HEARING ORDER THIS CAUSE camebefore the undersigned Workers' CompensationJudge upon the Request for Expedited Hearing filed by Dustin Chambers (Mr. Chambers), the Employee, on December 9, 2014, with the Tennessee Court of Workers' Compensation Claims, Division of Workers' Compensation, pursuant to Tennessee Code Annotated section 50-6-239, to determine if the initiation ofmedical and temporary disability benefits is appropriate. The Court conducted an evidentiary hearing on January 15, 2015. Mr. Chambers appeared with his Counsel, Jeffrey P. Boyd. Advantage Human Resources (Advantage), the Employer, and NewHampshire Insurance Company, the Carrier, appeared with their Counsel, Allen Callison. Mr. Chambers testified on his own behalf. Ms. Heather Tinker testified on behalf of Advantage. Advantage additionally offeredthe sworn affidavits ofMr. Eddie Carter and Mr. Robert Yarbrough. Consideringthepositions ofthe parties, the applicable law, and all ofthe evidence submitted, the Courtherebyfinds that Mr. Chambers properlyreported aninjury onJuly 31, 2014 andis entitled to apanel ofneurosurgeons for evaluation. The Court further finds thatMr. Chambers isnotentitled to temporary disability benefits at this time. 

### ANALYSIS Issues 1

. Whether Mr

. Chambers is entitled to apanel of neurosurgeons to evaluate his injury. 2. Whether Mr

. Chambers is entitled to temporary benefitsfor theperiodof August 15, 2014 topresent, and ongoing.

1Evidence Submitted The Court designated the following as the technical record:

• Petition for Benefit Determination (PBD) • Dispute Certification Notice (DCN) • Request for Expedited Hearing (REH) The following documents were admitted into evidence by stipulation ofthe parties: Exhibit 1: Affidavit ofDustin Chambers Exhibit 2: Medical Records ofRegional Hospital ofJackson and Madison Family Practice Exhibit 3: Notice ofDenial ofCompensation (C-23) Exhibit 4: Wage Statement and supporting documentation (comparable employee) Exhibit 5: Affidavit ofRobert Yarbrough Exhibit 6: Affidavit ofEddie Carter Exhibit 7: Advantage's "Injured Employee's Statement" History ofClaim Mr. Chambers worked for Advantage, a temporary employment agency, and assignedto ARJ Manufacturing (ARJ). On July 31, 2014, Mr. Chambers alleges an injury while moving a pallet. Advantage denied the incident occurred as well as any resulting anatomic condition. Mr. Chambers is a 29-year old resident ofJackson with an 11th-grade education. He was assigned to work at ARJ as a "material handler." Thejob required him to move "tubs" with a cart and place them on pallets at the dock. On July 31, 2014, at approximately 3 AM, he proceeded to "the back ofthe dock" to retrieve a pallet. He testified that he previouslyreceived instruction from his trainer regarding the method to use to retrieve a pallet. He "jumped up and down" to knock a pallet from a high stack. The pallet stacked second from the top fell, striking his leg. Thoughhe felt pain in his leg, he stooped to lift the pallet and then "drug it" behind him towards the dock area. While doing so, his back began hurting and the pain increased as he proceededto his work area. He "laidthe pallet down," then attempted to lift a tub, and felt excruciatingpain in his lowerand middle back toward the right side. His legs gave way and he remained on the floor for 10-15 minutes. Mr. Chambers rose and used the cart "as a walker" to find Eddie Carter, his trainer. He reported the injury to Mr. Carter, who told him that "pulledmuscles" are commoninthejob. Since Mr. Chambers was in-training, Mr. Carter directed him to simply sit and observe. Mr. Chambers stayed at ARJ for the remainder ofhis shift and then went home. He took an Epsom salt bath as recommendedby Mr. Carter and tried to sleep. He returned to work the following evening, July 31, 2014, at 7:00PM. He reported to Mr. Carter that he was still in pain and could not perform the material handlingjob. Mr. Carter spoke to another employee, who Mr. Chambers believes was a shift supervisor, to inquire if there were other jobs which Mr. Chambers might perform. Mr. Carter returned to advise that there were no otherjobs available and then asked Mr. Chambers lift a tub to evaluate his ability to do so. Mr. Chambers could not lift the tub. He was then escorted to ARJ 2employees, who advisedthat Mr. Chambers must wait for Mr. Savage, the shift supervisor, to advise ofthe availability ofany otherpositions. When the shift supervisor failed to appear, Mr. Chambers returned to Mr. Carter and spoke to "another guy" who stated, "there was no reason for him to be here." Mr. Chambers left and wentto Regional Hospital (Regional). While driving to Regional, Mr. Chambers called the Advantage toll free number to report the injury, without success. The affidavit completed by Mr. Chambers is consistent with his direct testimony. On cross examination, Mr. Chambers admitted that he had been terminated from another temporary agency in June 2014 after a criminal background check. He applied at Advantage onJune 27, 2014. He admitted that during the application process he was asked whether he had any felony convictions. Mr. Chambers testified, inresponse to a questionthat he had misrepresentedhis record, that he had actually admitted prior felony convictions occurring in another state. Mr. Chambers admitted that he did not call Advantage to report the injury immediately upon its occurrence as instructed in a training session whenhe was hiredjusttwo days earlier. Mr. Chambers recalls being told that he might leave the plant on the evening ofAugust 1, 2014 by a "large black man." He testified his priorback issues were a pulled muscle in 2007 and that he did not recall undergoing an MRI in June 2013. He deniedthat the symptoms in 20 13 were lowbackpainbut, insteadhe had pain in his right leg behind the knee cap. Mr. Chambers presented at the Regional emergency room onJuly 31, 2014 at 11 :04 PM. He reported low back and left leg pain "sustained at work." The symptoms began "acutely, today." He reported previous back pain and stated "it aggravated today at work by lifting heavy things." The emergency room providers diagnosed him with "Acute Low Back Pain" and discharged home. The emergencyroom providers further instructed him to follow up with a primary care physician intwo to three (2 to 3) days. (Ex.2 at 2 and 7). 1 On August 1, 20 14, Mr. Chambers contacted Advantage, reported to the office, and completed ahandwritten statement. Mr. Chambers listedthe date andtime ofinjury as July 31,2014 at 3:00AM. When asked on the statement, "what were you doing when the injury occurred", he stated: I was pushing a load oftotes to the dock. There wasn't a pallet so I went and got one from the dock. I grabbed the one on top which was a wood pallet. I then carried it to area where I needed it and I unload [sic] my totes. When he was asked to "[d]escribe inyour own words howthe injury/accident occurred," he wrote: After I got the pallet down and started to drag it to the area I started feeling pain in my back

I The Court notes that Exhibit 2, a collective exhibit of the medical records, does not contain a table ofcontents and is not numbered in accordance with Rule 0800-02-21-.16(c) and also mandated by Rule 7.0I.A. ofthe "Practice and Procedures" ofthis Court. The Court also notes that it requested, at the hearing, that the parties confer, agree to and organize the records earlier stipulated as the collective exhibit. The parties complied but there is neither a Table of Contents nor numbering ofthe pages. The Court numbered the records contained in Exhibit 2, sequentially, in the lower right comer. The Court reminds counsel ofthe provisions ofthe rules for future reference. 

### 3(Ex.7). and thighs but when I started to unloadthe totes is whenthe painreally kick [sic] and started hurting. According to Mr. Chambers, Advantage provided him with a panel oftwo providers. He testified he was told to see Madison Family Practice (Madison). He saw a nurse practitioner on August 4, 2014. The note reads: "He states he injuredhis back on Friday, August 1staround 3 am. He had been lifting and pulling wooden pallets.

....He did continue his shift until 7am and then went home to rest. Pain did not let up so then he went back to work that night and they sent him to Regional ER." He was diagnosed with "backpain," given a steroid pack, and placed onrestrictions ofno lifting or pulling. (Ex. 2 at 11). Mr. Chambers returned to Madison on August 12, 2014. His conditionremained unchanged. Theprovider continuedhis restrictions and discussedreferral for an MRI. (Ex.2 at 12). OnAugust 14, 2014, an MRI revealed a disc lesion at L5-S 1. The radiologistrecommended clinical correlation for "radiculopathy in this distribution." The report also mentions, without elaboration, a "comparison" from June 15, 2013. Following the MRI, Mr. Chambers returned to Madison onAugust 15, 2014. The provider continued Mr. Chambers' restrictions and stated: "refer to neuro surgeon to evaluate back pain." (Ex.2 at 16). Madison's office staffinstructed Mr. Chambersto call Broadspire, the claim administrator, to coordinate the neurological referral. He received no response from Broadspire. He worked two weeks inthe Advantage office on light duty until August 15, 2014, whenAdvantage terminatedhim. He has not worked since August 15, 2014. He received no further medical treatmentbut continuesto have back and leg pain. Ms. Heather Tinkertestified onbehalfofAdvantage. She is the branchmanagerand familiar with the ARJ assignment. ARJ does not accept employees with felony ormisdemeanor convictions within the previous seven (7) years. Advantage would not have hired Mr. Chambers ifhe reported his previous felony record Advantage performed a background check on Mr. Chambers within the county criminal, sex offender registry and social security databases. It was negative. Ms. Tinker was familiar with the ARJ location. She visited the area where Mr. Chambers allegedly sustained his injury. She was not familiar with the term "dock" as she understoodhis work area was located in the "middle ofthe plant." The area ofthe alleged injury was located in a busy area ofthe plant. On cross examination, Ms. Tinker confirmed there was nothing inMr. Chambers' criminal background performed by Advantage that would have prevented his assignment to ARJ. Advantage offered the affidavit of Mr. Robert Yarbrough. (Ex.5). In his affidavit, Mr. Yarbrough deposed that he was "working in the general vicinity ofMr. Chambers on the night in question." Mr. Chambers came to him "and stated he wanted to run a machine." It was Mr. Yarbrough's first night as Team Leader, so he asked Mr. Chambers what hisjob duties were. Mr. Chambers advised he worked "outside loading." Mr. Yarbrough advised thathe couldnot "authorize him to run a machine and that he would have to speak withthe group leader, Mike Savage, when he arrived." Mr. Chambers returned "about an hour later" and reported he hurt his back "the night 

### 4before" when lifting "skid tops." Mr. Yarbrough "took Mr. Chambers to see...Mr. Carter" and he advised both Mr. Carter and Mr. Chambers that Mr. Chambers should not lift anything until the group leader arrived. About 45 minutes later, Mr. Yarbrough "wentto checkonMr. Chambers," and "Mr. Carten [sic] told me that Mr. Chambers musthave leftbecause he had not seenhimina while." Mr. Yarbrough denied assisting Mr. Chambers to his car orthatMr. Chambers requestedpermission to leave. Mr. Chambers "did not have an answer" as to why he had not reported the injury the night before. Mr. Carter testified by affidavit. (Ex.6). Mr. Carter deposed that he was Mr. Chambers' immediate supervisor on "the evening ofJuly 30,2014 and the earlymorning ofJuly 31,2014, when he allegedly injured his back." Mr. Chambers left ARJ "inthe early morninghours ofJuly 31, 20 14" without telling him or "anyone else." Mr. Carter considered Mr. Chambers a "walk-out." Mr. Chambers never told Mr. Carter that he sustained an injury on the job. Mr. Carter learned ofthe allegations "two days later" when told by Mr. Savage that Mr. Chambers claimed an injury. Advantage offered a June 13, 2013, emergency room record of Regional where Mr. Chambers presented with ahistory of"BACKPAIN-LOWER, HX OF SAME". The date ofonset was "1 day(s) ago." The emergency room provider diagnosed Mr. Chambers with an acute lumbar myofascial strain and advised him to follow up with Dr. Keith Nord in three (3) days. On August 21, 2014, Advantage filed a C-23 Notice ofDenial ofClaimfor Compensation. It stated as the basis for denial: "No injury arising out ofthe course and scope ofemployment." Mr. Chambers filed the PBD on October 9, 2014. 

### Mr. Chamber's Contentions Mr. Chambers contends he sustained an injury while moving pallets in the early morning hours of July 31, 2014. He reported his injury to Mr. Carter and the history provided to both Regional and Madison are consistent with the events of July 31. He denies any diagnosis of a herniated disc prior to the MRl ofAugust 14, 2014. When the MRl revealed the disc lesion, and Madison made the neurological referral, Advantage "pulled the plug" on the claim. Mr. Chambers admitted prior back issues to the providers. However, he asserts that the Regional note confirms the July 31 injury aggravated the prior back conditions. More likely, he argues the July 31 injury constitutes a new anatomic condition, a herniation at L5-S 1. Mr. Chambers worked light duty at Advantage until August 15, 2014, buthe has notworked since. This period oflightduty is evidence that Advantage had light duty available but didnotofferit to Mr. Chambers after its denial ofthe claim. Mr. Chambers contends his prior criminal history does not preclude a recovery ofworkers' compensation benefits. Further, he was forthcoming with his answers to questions regarding his criminal history during the application process with Advantage. 

### Advantage's Contentions
5Advantage claims the description ofinjury given by Mr. Chambers is inconsistent. He gave differing accounts ofthe injury at differenttimes. Because ofthese inconsistencies, his credibility is too questionable to support a finding ofan injury arising out oforinthe course ofhis employment. He did not immediatelyreporthis alleged injuryto Advantage as instructed intrainingjusttwo days earlier. The affidavits ofMr. Yarbrough and Mr. Carter are evidence that Mr. Chambers' version of the alleged injury is inaccurate. Neither Mr. Carter nor Mr. Yarbrough's testimony supports Mr. Chambers properly reporting or otherwise advising them ofan injury on July 31, 2014. Mr. Chambers did not fully disclose his criminal background to Advantage. Ifhe had, he would not have been assigned to ARJ. His criminal record reflects negatively upon his credibility. Mr. Chambers had prior back problems. He received treatment in 2013 and underwent an MRI. Moreover, Advantage requested medical records from a local hospital, which it has not yet received. Advantage contends these records will show a priorback injury that is the actual cause of Mr. Chambers' current condition. Findings ofFact and Conclusions ofLaw StandardApplied When determining whether to award benefits, the Judge must decide whether the moving party is likelyto succeed onthe merits attrial giventhe information available. See generally, McCall v. Nat'!Health Care Corp., 100 S.W. 3d209,214 (Tenn. 2003). In a workers' compensation action, pursuantto Tennessee Code Annotated section 50-6-239(c)(6), the employee shallbeartheburdenof proving each and every element ofthe claim by a preponderance ofthe evidence. The employee must showthat the injury arose primarily out ofand inthe course and scope ofemployment. Tenn. Code Ann.§ 50-6-102(13)(2013). Factual Findings Mr. Chambers reported his injury to Eddie Carter onJuly 31, 2014. OnAugust 1, 2014, Mr. Chambersprovidedwrittennotice ofthe injury onAdvantage's "InjuredEmployee Statement." The date, time and description ofthe injury on said statementis consistentwith Mr. Chambers' testimony at the hearing regarding his earlier reporting to Mr. Carter. Mr. Chambers' history at Regional and Madison is also consistent with his testimony at the hearing, his affidavit, and with the "Injured Employee Statement." The affidavits ofMr. Carter and Mr. Yarbrough are inconsistent with each other and do not support Advantage's contentions. Ms. Tinker testified credibly. She confirmed that the criminal background checkperformed on Mr. Chambers was negative and that there was nothing in his background check to prohibit his assignment to ARJ.

6An authorized treating physician referred Mr. Chambers to a neurosurgeon. He has not received a panel ofneurosurgeons from Advantage. There is no causation opinion in the record. Application of Law to Facts Inthis case, the Courtmust first resolve the parties' disagreement as to the occurrence ofan incident on July 31, 2014. Mr. Chambers contends he injured his back while moving a pallet; Advantage contests the occurrence oftheincident. Advantagepointsto Mr. Chambers' general lack ofcredibilitybecause ofhis criminalrecord andto whatit calls inconsistentversions ofthe facts. For the following reasons, the Courtfinds the evidencepreponderates infavor ofMr. Chambers as tothe occurrence ofthe incident in question. First, Mr. Chambers' own evidence is more convincing. He testified consistently at the hearingwithwhathe reported inthe statementgivenAdvantage onAugust 1, 2014, one day afterthe alleged event and withthe statements inhis earlier affidavit. The description ofinjury was, oneach occasion, that he retrieved a pallet and felt pain while dragging it to his work area. His most severe painoccurred whenbendingto movethe tubs, or "totes", inhis work area. Mr. Chambers described these events atthe hearingwithouthesitationand with clarity. There was nothing inhis demeanor at the hearing which would indicate any prevarication as to the occurrence ofthe event. His tone of voice remained constant andhe admitted adverse facts oncross-examinationregarding his criminal past. The Court considered the various arguments of the parties as to the import of the prior criminal record ofMr. Chambers. In so doing, the Courtis unable to find any authority to the effect that a priorcriminal record wouldpreventthe award ofworkers' compensationbenefits. Moreover, thoughTennessee law allows for a witness to be impeachedbyevidence ofconvictionofcrimes2

, the evidence in this case is limited to vague references to prior felonies ofMr. Chambers which he essentially admitted at the hearing. Interestingly, the background check performed by Advantage revealed no criminal record in the databases it searched. Ifthe alleged out-of-state felonies were important, Advantage might have expanded its search. Second, Advantage's witnesses, testifying by affidavit, are inconsistent. Mr. Carter, the immediate supervisor ofMr. Chambers, deposed that Mr. Chambers, inthe early morning hours of July 31, 2014, left ARJ's premises without notice and "without telling me or anyone else." Conversely, Mr. Yarbrough, the "Team Leader" and Advantage's other witness, deposed that Mr. Chambers came to him to report an injury which occurred "the night before" and that, after this reporting, that he "took Mr. Chambers to see his trainer, Eddie Canten [sic], and instructed Mr. Canton [sic] and Mr. Chambers that Mr. Chambers was not to lift ortouch anything until the group leader arrived." Later, Mr. Yarbrough was told by Mr. Carter that "Mr. Chambers must have left because Mr. Carter had not seen him in a while." Notably, Mr. Yarbrough deposed he "was working in the general vicinity ofMr. Chambers

2 Tennessee Rule ofEvidence 609 provides that, "[f]or the purpose ofattacking the credibility ofa witness, evidence that the witness has been convicted ofa crime may be admitted" subject to certain limitations. Among the acceptable limitations are certain felony convictions. 7on the night ofhis alleged injury at work"; he does not specify the date or specific area ofthe plant. Further, and more importantly, it does not stand to reason, that if Mr. Yarbrough "took Mr. Chambers to see" Mr. Carter, thatthere was no discussion ofan injury. However, Mr. Carterdeposes that he did not learn of any alleged injury until two (2) days later. In any event, it is clear Mr. Chambers reported an injury on July 1, 2014, either in the early morning hours to Mr. Carter, as testified to by Mr. Chambers, or in the evening hours as admitted by Mr. Yarbrough. Tennessee Code Annotated section 50-6-201 (a)(l) provides that an injured employee "shall, immediately upon the occurrence ofan injury, or as soon thereafter as practicable, give or cause to be given to the employer who has no actual notice, written notice ofthe injury

... within thirty (30) days after the occurrence ofthe accident." The notice shouldreasonably conveythe idea that the employee has suffered an injury arising out of and in the course of his employment. Masters v. Industrial Garments Mfg. Co., Inc., 595 S.W.2d 811, 816 (Tenn. 1980). The reason for the notice requirement is to allow the employer an opportunity to investigate the alleged injury while evidence is available and to provide timely medical care to the employee. 

### !d. at 815. Mr. Chambers reported an injury within 24 hours ofits occurrence. The Court finds Mr. Chambers reported an injury within hours ofits occurrence. Having found adequate proofofan event and the reporting ofsame, the Courtturns to the reliefrequested. Each issue will be addressed in turn. Panel ofNeurosurgeons The notice provisions ofthe statute do not require anemployee to present medical proofof an injury before an employer is required to provide medical benefits. Rather, the statute contemplates that an employer will provide medical care upon receipt ofnotice ofthe injury, and then, during the course oftreatment and examination, the panel doctor will render an opinion on causation. See Tenn. Code Ann.§ 50-6-102(13)(2014). Otherwise, anemployee wouldbe forced to seek medical care on his own to begin a claim, which the statute does not contemplate. Here, Advantage argued extensivelythatMr. Chambers' priorback injuries were the actual orpossible cause ofhis back condition. These arguments are premature because, ifMr. Chambers gave proper notice, then the statute requires Advantage to provide a panel of physicians for evaluationand treatment. To date, Advantage has notprovidedapanel meetingtherequirements of the statute. Advantage provided an evaluation by a nursepractitioner, but subsequently denied the claim afterthe nurse practitionerreferred Mr. Chambers to a neurosurgeon. Advantage did notbase the denial upon any finding bythe authorized provider, but upon Advantage's own determination that the injury did not arise out ofthe employment. It is not enough for an employer to provide a panel and an initial medical visit; it must provide a medical evaluation sufficient to afford the providerwith an opportunityto reach an opinionregarding causation. Not only did Advantage fail to provide Mr. Chambers an evaluation by a medical doctor competent to opine on causation, it denied the claim before sending him to the recommended specialist who would be able to do so. Advantagemusttherefore provide Mr. Chambers with apanel ofneurosurgeons from whichhe may choose a physician to opine on causation and provide treatment as appropriate.



### 8Temporary Disability Benefits Temporary total disability (TTD) is payable to an injured employee who is totally disabledto workbyhis injury and while he is recovering as far as the nature ofthe injurypermits. Cleek v. Wal-Mart Stores, Inc., 19 S.W.3d 770, 776 (Tenn. 2000). Under Tennessee law, to establish entitlement to temporary total benefits, the employee must show he was (1) totally disabled to work by a compensable injury; (2) that there was a causal connection between the injury andhis inability to work; and (3) the duration ofthat period ofdisability." 

### !d. (emphasis added). When an employee demonstrates the ability to return to work or attains MMI, then TTD benefits are terminated. Simpson v. Satterfield, 564 S.W.2d 953, 955 (Tenn. 1978). Inthis case, theparties agree thatMr. Chambers was nottotally disabled as ofAugust 15,2014. Rather, hehad restrictions of no lifting or pulling. Therefore, by definition, Mr. Chambers is not eligible to receive TTD benefits. Temporary partial disability (TPD) refers to the time during which the injured employee is able to resume some gainful employmentbuthas notyet reached maximumrecovery. Williams v. Saturn Corp., No. M2004-01215-WC-R3-CV, 2005 LEXIS 1032, *3 (Tenn. Workers' Comp. Panel, November 15, 2005). As with TTD, there must be adequate proofofa causal connection between the injury and disability for an award of TPD. To date, there is no medical opinion establishing that Mr. Chamber's injury arose primarily out ofhis employment. The records of Regional containno causationopinion. Therecords ofMadisoncontainonlythe opinionofa nurse practitioner and not a physician. The Court recognizes Mr. Chambers did not receive a proper panel. Nevertheless, in the absence of medical proofthat the injury arose primarily out ofthe employment, Mr. Chambers cannot establish causation for the payment oftemporary benefits under the statute. The issue of whether Mr. Chambers is entitled to temporary total disability benefits shall be held in abeyance pending the causation opinion ofthe selected panel physician.



### IT IS, THEREFORE, ORDERED as follows: 1. Advantage shallprovide Mr. Chambers withmedical treatmentfor these injuries as required byTennessee Code Annotated section 50-6-204, to be initiatedbyAdvantage orits workers' compensation carrier providing Mr. Chambers with a panel of orthopedic physicians as required by that statute. Medical bills shall be furnished to Advantage or its workers' compensation carrier by Mr. Chambers or the medical providers. 2. The claim for temporary benefits is denied at this interlocutory stage ofthe proceedings. 3. This matter is set for Initial Hearing on April 16, 2015 at 2:00p.m. 4. 

### Unless interlocutory appeal ofthe Expedited Hearing Order is filed, compliance with this Order must occur no later than seven (7) business days from the date ofentry of this Order as required by Tennessee Code Annotated section 50-6-239(d)(3). The Insurer or Self-Insured Employer must submit confirmation ofcompliance with this
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### Order to the Division by email to WCCompliance.Program@tn.gov no later than the seventh (7th) business day after entry ofthis Order. Failure to submit the necessary confirmation within the period ofcompliance may result in a penalty assessment for non-compliance. 5. For questions regarding compliance, please contact the Workers' Compensation ComplianceUnitviaemail WCCompliance

.Program@tn.gov orby calling (615) 253- 1471 or (615) 532-1309. 

### ENTERED this the 9th 

### day of

Initial Hearing: An Initial Hearing has been set with 

### Judge Allen Phillips, Court of Workers Compensation. You must dial in at731-422-5263 or 855-543-5038 toll free atto participate in your scheduled conference. Please Note: You must call in on the scheduled date/time to participate. Failureto call in may resultin a determination oftheissues withoutyourfurther participation. All conferences are set using Central Time (CT). Right to Appeal: Tennessee Law allows anyparty who disagrees withthis ExpeditedHearing Orderto appealthe decision to the Workers' Compensation Appeals Board. To file a Notice ofAppeal, you must: 1. Complete the enclosed form entitled: "Expedited Hearing Notice ofAppeal". 2. File the completed form withthe Court Clerkwithin seven (7) business days ofthe date the Expedited Hearing Order was entered by the Workers' Compensation Judge. 3. Serve a copy ofthe Request for Appeal upon the opposing party
. 4. The parties, having the responsibility ofensuring a complete record on appeal, may request from the Court Clerkthe audio recording ofthe hearing for the purpose ofhaving atranscript prepared by a licensed court reporter and filing it with the Court Clerk within ten (1 0) calendar days ofthe filing ofthe Expedited Hearing Notice ofAppeal. Alternatively, the parties may file a statement ofthe evidence withinten (10) calendar days ofthe filing ofthe

10Expedited HearingNotice ofAppeal. The statement ofthe evidencemustbe approvedbythe Judge before the record is submitted to the Clerk ofthe Appeals Board. 5. Ifthe appellant elects to file a position statement in support ofthe interlocutory appeal, the appealing party shall file such position statement with the Court Clerk within three (3) business days ofthe filing ofthe Expedited HearingNotice ofAppeal, specifying the issues presented for review and including any argument in supportthereof. Ifthe appellee electsto file a response in oppositionto the interlocutory appeal, appellee shall do so withinthree (3) business days ofthe filing ofthe appellant's position statement.

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### CERTIFICATE OF SERVICE I hereby certify that a true and correct copy ofthe Expedited Hearing Order was sent to the following recipients by the following methods ofservice on this the 91h day ofFebruary, 2015.

Name



### J. Allen Callison Certified First Mail Class Mail Via Fax Via Email Address Fax Number Email



### eraclides.com

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