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IN THE SUPREME COURT OF TENNESSEE

AT KNOXVILLE

May 5, 2015 

CLAYTON ARDEN v. KENYA I. KOZAWA, M.D., ET AL.

Appeal by Permission from the Court of Appeals, Eastern Section

Circuit Court for Monroe County

No. V12284S J. Michael Sharp, Judge

No. E2013-01598-SC-R11-CV – Filed June 30, 2015

The primary issue presented is whether a health care liability case must be dismissed 

because the plaintiff sent the health care defendants pre-suit notice of the claim via a 

commercial carrier, FedEx, instead of using certified mail, return receipt requested, 

through the United States Postal Service. The defendants moved for summary judgment, 

asserting that the plaintiff failed to comply with the requirements of Tennessee Code 

Annotated sections 29-26-121(a)(3)(B) and (a)(4) (2012). The defendants did not allege 

they failed to receive notice or were prejudiced by the plaintiff‘s method of service. The 

trial court dismissed the complaint, holding that strict compliance with the manner and 

proof of service requirements of Tennessee Code Annotated sections 29-26-121(a)(3)(B) 

and (a)(4) was required. The Court of Appeals affirmed, holding that substantial 

compliance was sufficient to satisfy the statutory content requirements of the notice, but 

that the plaintiff‘s failure to send the notice by certified mail constituted deficient service.

We hold that the manner and proof of service prescribed by Tennessee Code Annotated 

sections 29-26-121(a)(3)(B) and (a)(4) may be achieved through substantial compliance.

The defendants received notice and were not prejudiced by the manner of service.

Therefore, the use of FedEx to deliver the notice and the filing of proof of service with 

the complaint constituted substantial compliance with the manner and proof of service 

requirements of the pre-suit notice statute. The judgment of the Court of Appeals is 

reversed, and the case is remanded to the trial court for further proceedings.

Tenn. R. App. P. 11 Appeal by Permission; Judgment of the Court of Appeals 

Reversed

SHARON G. LEE, C.J., delivered the opinion of the Court, in which CORNELIA A. CLARK,

GARY R. WADE, JEFFREY S. BIVINS, and HOLLY KIRBY, JJ., joined.

Donna Keene Holt and G. Turner Howard III, Knoxville, TN, for the appellant, Clayton 

Arden.
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Heidi A. Barcus, Hillary B. Jones, and J. David Watkins, Knoxville, TN, for appellees 

Kenya I. Kozawa, M.D., and Ken Kozawa, M.D., PC. 

Stephen Wayne Gibson, Gary George Spangler, and Carrie S. O‘Rear, Knoxville, TN, for 

appellee Sweetwater Hospital Association. 

OPINION

I.

Beginning on August 24, 2011, Deborah Arden was treated by Dr. Ken Kozawa, a

Sweetwater, Tennessee physician, for abdominal complaints. On August 28, 2011, Dr. 

Kozawa admitted her to Sweetwater Hospital Association for treatment. Mrs. Arden died 

on September 15, 2011, allegedly due to the negligence of Dr. Kozawa and Sweetwater 

Hospital Association.1 On August 1, 2012, Clayton Arden, Mrs. Arden‘s surviving 

spouse, sent letters to Dr. Kozawa and the Sweetwater Hospital Association, notifying 

them that Mr. Arden intended to file a health care liability action against them. Mr. 

Arden‘s attorney sent the notice letters via FedEx Priority service with tracking 

capability. The letters were delivered to Dr. Kozawa and Sweetwater Hospital on August 

2, 2012. 

On October 19, 2012, Mr. Arden filed a health care liability complaint in Monroe 

County Circuit Court against Dr. Kozawa, individually, Ken Kozawa, M.D., P.C., and 

Sweetwater Hospital Association (―the Defendants‖). Mr. Arden relied upon the 120-day 

extension of the statute of limitations provided by Tennessee Code Annotated section 

29-26-121(c).

2

 Attached to the complaint was a certificate of good faith, an affidavit of 

mailing notice, and FedEx receipts indicating delivery of the notice letters on August 2, 

2012. 

 

1

These facts are taken from allegations in the complaint filed by Mr. Arden. At this stage of the 

proceeding, there have been no findings of fact as to the truth of these allegations, and we must take all

allegations of fact as true. See Lind v. Beaman Dodge, Inc., 356 S.W.3d 889, 894 (Tenn. 2011) (citing 

Stein v. Davidson Hotel Co., 945 S.W.2d 714, 716 (Tenn. 1997)). 

2 Tennessee Code Annotated section 29-26-121(c) provides, in pertinent part: 

When notice is given to a [health care] provider as provided in this 

section, the applicable statutes of limitations and repose shall be 

extended for a period of one hundred twenty (120) days from the date of 

expiration of the statute of limitations and statute of repose applicable to 

that provider. Personal service is effective on the date of that service.

Tenn. Code Ann. § 29-26-121(c) (2012). 
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The Defendants moved for summary judgment, asserting that Mr. Arden failed to 

comply with the pre-suit notice requirements of Tennessee Code Annotated section 

29-26-121(a)(3)(B) and (a)(4) by sending the notice letters by FedEx rather than through 

the U.S. Postal Service, certified mail, return receipt requested.3 Mr. Arden responded 

that the method of service did not warrant dismissal because the Defendants were 

provided with actual, timely notice of the forthcoming lawsuit and suffered no prejudice. 

The trial court granted the Defendants‘ motions for summary judgment, finding 

that Mr. Arden was required to strictly comply with the notice requirements of Tennessee 

Code Annotated section 29-26-121(a)(2), (3), and (4), that he had failed to do so, and that 

he had not demonstrated extraordinary cause to excuse his noncompliance.4 The trial 

court dismissed the complaint as time-barred, finding that because Mr. Arden failed to 

provide statutory notice, he was unable to rely on the 120-day extension of the statute of 

limitations provided under Tennessee Code Annotated section 29-26-121(c). 

The Court of Appeals affirmed the trial court‘s decision to dismiss, holding that

substantial compliance was sufficient to satisfy the statutory content requirements of the 

notice, but that Mr. Arden‘s failure to send the notice by certified mail, return receipt 

requested, through the U.S. Postal Service constituted deficient service.5Arden v.

Kozawa, No. E2013-01598-COA-R3-CV, 2014 WL 2768636, at *8 (Tenn. Ct. App. June 

18, 2014). The intermediate appellate court noted that the statutory language is clear and

unambiguous and does not provide for any method of service other than certified mail. 

 

3 The Defendants also asserted that Mr. Arden failed to include his own address on the notice 

letter, as prescribed by Tennessee Code Annotated section 29-26-121(a)(2)(B); failed to send the notice to 

Dr. Kozawa‘s address indicated on the Tennessee Department of Health website, as prescribed by 

Tennessee Code Annotated section 29-26-121(a)(3)(B)(i); and failed to include the name and address of 

Sweetwater Hospital on the health care provider list filed with the complaint, as prescribed by Tennessee 

Code Annotated section 29-26-121(a)(2)(D). The Court of Appeals correctly held that Mr. Arden had 

substantially complied with the content requirements of the statute.

4 The trial court ruled before we issued our decision in Stevens ex rel. Stevens v. Hickman Comm.

Health Care Servs., Inc., 418 S.W.3d 547, 555 (Tenn. 2013), where we held that substantial compliance is

sufficient to satisfy the notice content requirement of Tennessee Code Annotated section 

29-26-121(a)(2)(E). 

5 The Court of Appeals reversed the trial court‘s decision insofar as it required strict compliance 

with the pre-suit notice content requirements of Tennessee Code Annotated section 29–26–121(a)(2). As 

the intermediate appellate court properly reasoned, ―unless strict compliance with a notice content 

requirement is essential to avoid prejudicing an opposing litigant, substantial compliance . . . will suffice.‖ 

Arden, 2014 WL 2768636, at *5 (quoting Thurmond v. Mid-Cumberland Infectious Disease Consultants, 

PLC, 433 S.W.3d 512, 520 (Tenn. 2014)) (internal quotation marks omitted). The Court of Appeals held 

that Mr. Arden substantially complied with the pre-suit notice content requirements, and as the 

Defendants have not alleged that they were prejudiced by the purported content deficiencies in the 

pre-notice, we do not disturb this ruling. 
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Id. at *6. The court was further persuaded by the Legislature‘s 2009 amendment to

section 29-26-121(a)(2), which omitted ―notice by overnight delivery using a nationally 

recognized carrier‖ as a prescribed method of service. Id. at *7. The 2008 version of the 

statute had included this language. Id. The Court of Appeals found this omission 

evidenced the Legislature‘s intent to require the use of certified mail through the U.S. 

Postal Service as the only acceptable means, other than hand delivery, of providing

service of pre-suit notice to health care defendants. Id. at *8. 

We granted Mr. Arden‘s application for permission to appeal to decide whether

effective service of pre-suit notice of a health care liability claim under Tennessee Code 

Annotated section 29-26-121(a)(3)(B) and (a)(4) may be accomplished through the use of 

a commercial carrier, such as FedEx, rather than by certified mail, return receipt 

requested, through the U.S. Postal Service. 

II.

At least sixty days before filing a complaint for health care liability, a person who 

is asserting the claim must give written notice of the claim to each health care provider 

that will be named as a defendant. Tenn. Code Ann. § 29-26-121(a)(1). Pre-suit notice is 

mandatory, and section 29-26-121(a)(1) demands strict compliance. Myers v. AMISUB 

(SFH), Inc., 382 S.W.3d 300, 309 (Tenn. 2012); see also Foster v. Chiles, No. 

E2012-01780-SC-R11-CV, 2015 WL 343872, at *4 (Tenn. Jan. 27, 2015). The 

consequence for failure to give pre-suit notice is dismissal of the lawsuit. Foster, 2015 

WL 343872, at *4. 

As to how pre-suit notice is to be delivered and service of notice proven, 

Tennessee Code Annotated sections 29-26-121(a)(3) and (a)(4) provide:

(3) The requirement of service of written notice prior to suit is deemed 

satisfied if, within the statutes of limitations and statutes of repose 

applicable to the provider, . . . the following occurs, as established by the 

specified proof of service, which shall be filed with the complaint:

. . . . 

(B) Mailing of the notice:

(i) To an individual health care provider at both the address 

listed for the provider on the Tennessee department of health 

web site and the provider‘s current business address, if 

different from the address maintained by the Tennessee

department of health; . . . or

(ii) To a health care provider that is a corporation or other 

business entity at both the address for the agent for service of 

process, and the provider‘s current business address, if 

different from that of the agent for service of process[.]
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(4) Compliance with subdivision (a)(3)(B) shall be demonstrated by filing a 

certificate of mailing from the United States [P]ostal [S]ervice stamped 

with the date of mailing and an affidavit of the party mailing the notice 

establishing that the specified notice was timely mailed by certified mail, 

return receipt requested. A copy of the notice sent shall be attached to the 

affidavit. It is not necessary that the addressee of the notice sign or return 

the return receipt card that accompanies a letter sent by certified mail for 

service to be effective.

Tenn. Code Ann. § 29-26-121(a)(3)-(4). 

The content and affidavit requirements of Tennessee Code Annotated sections

29-26-121(a)(2), (a)(3), and (a)(4) are not mandatory, but directory, and can be achieved 

through substantial compliance. See Thurmond v. Mid-Cumberland Infectious Disease 

Consultants, PLC, 433 S.W.3d 512, 520 (Tenn. 2014) (allowing substantial compliance 

with the affidavit requirement under Tennessee Code Annotated sections 

29-26-121(a)(3)(B) and (a)(4)); Stevens ex rel. Stevens v. Hickman Comm. Health Care 

Servs., Inc., 418 S.W.3d 547, 555 (Tenn. 2013) (allowing substantial compliance with the 

HIPAA form requirement under Tennessee Code Annotated section 29-26-121(a)(2)(E)). 

―[U]nless strict compliance with a notice content requirement  ̳is essential to avoid 

prejudicing an opposing litigant,‘ substantial compliance with a content requirement will 

suffice.‖ Thurmond, 433 S.W.3d at 520 (quoting Stevens, 418 S.W.3d at 555). 

The issues before us are whether the manner and proof of service prescribed by 

Tennessee Code Annotated sections 29-26-121(a)(3)(B) and (a)(4) may be satisfied 

through substantial compliance, and if so, whether service of pre-suit notice through a

private commercial carrier and the filing of documentation proving that service

constitutes substantial compliance with the statute. In making this determination, we 

consider the extent and significance of the plaintiff‘s deviation from the statute and 

whether the defendant was prejudiced by the plaintiff‘s noncompliance. See Thurmond, 

433 S.W.3d at 520; Stevens, 418 S.W.3d at 556.

This issue of statutory construction is a question of law, which we review de novo, 

with no presumption of correctness afforded to the lower court decisions. Hayes v. 

Gibson Cnty., 288 S.W.3d 334, 337 (Tenn. 2009) (citing Carter v. Bell, 279 S.W.3d 560, 

564 (Tenn. 2009). When determining the meaning of statutory language, we must 

ascertain and fully effectuate the intent of the Legislature, Thurmond, 433 S.W.3d at 517 

(citing Baker v. State, 417 S.W.3d 428, 433 (Tenn.2013)), taking care not to broaden a 

statute beyond its intended scope or unduly restrict its coverage. Shore v. Maple Lane 

Farms, LLC, 411 S.W.3d 405, 420 (Tenn. 2013) (citing State v. Strode, 232 S.W.3d 1, 9 

(Tenn. 2007)). 
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Our construction of a statute must begin with the words the Legislature has 

chosen. Lee Med., Inc. v. Beecher, 312 S.W.3d 515, 526 (Tenn. 2010) (citing 

Waldschmidt v. Reassure Am. Life Ins. Co., 271 S.W.3d 173, 176 (Tenn. 2008)). We 

presume that the Legislature intended each word in a statute to have a specific purpose 

and meaning. Cunningham v. Williamson Cnty. Hosp. Dist., 405 S.W.3d 41, 44 (Tenn. 

2013) (citing State v. Hawk, 170 S.W.3d 547, 551 (Tenn. 2005)). If the statutory 

language is clear and unambiguous, we apply its plain meaning, understood in its normal 

and accepted usage, without a forced interpretation. Baker, 417 S.W.3d at 433 (quoting 

Carter, 279 S.W.3d at 564). Where statutory language is ambiguous, we may decipher 

legislative intent in other ways, including consideration of the broader statutory scheme, 

legislative history, and other sources. Thurmond, 433 S.W.3d at 517 (citing Mills v. 

Fulmarque, Inc., 360 S.W.3d 362, 368 (Tenn. 2012)). 

We hold that the manner and proof of service requirements of Tennessee Code 

Annotated sections 29-26-121(a)(3)(B) and (a)(4) are not mandatory, but directory, and 

can be achieved through substantial compliance. Cf. Thurmond, 433 S.W.3d at 520; 

Stevens, 418 S.W.3d at 555. So long as a health care defendant is not prejudiced by a 

plaintiff‘s deviations from the statutorily prescribed method of service—―certified mail, 

return receipt requested‖—or the proof of service requirement—―filing a certificate of 

mailing from the United States [P]ostal [S]ervice‖—substantial compliance with these 

statutory requirements will suffice. See Thurmond, 433 S.W.3d at 518; Stevens, 418 

S.W.3d at 555; see also Henry v. Goins, 104 S.W.3d 475, 481 (Tenn. 2003) (recognizing 

the state public policy of deciding cases on their merits as opposed to dismissing on 

procedural technicalities).

Further, we hold that delivery of pre-suit notice by private commercial carrier, 

such as FedEx, and filing of proof with the complaint constitutes substantial compliance 

with sections 29-26-121(a)(3)(B) and (a)(4) of the pre-suit notice statute. As long as a 

defendant is not prejudiced, it does not matter whether a commercial carrier or the U.S. 

Postal Service delivers the notice. The overarching purpose of the pre-suit notice statute 

is to ensure that health care defendants receive timely notice of a forthcoming lawsuit. 

While the method of delivery could constitute deficient service of pre-suit notice if a 

health care defendant claims lack of notice or prejudice, that is not the case before us. 

Mr. Arden sent the pre-suit notice letters to the Defendants through FedEx Priority 

service, with tracking capability, and the notice letters were delivered to the Defendants 

the next day. Mr. Arden was able to track the letters‘ delivery and later provided proof of 

this service by filing the FedEx tracking documentation with his complaint. Defendants 

received the notice letters and suffered no prejudice by this manner of delivery.6 

 

6 Likewise, we hold that substantial compliance is sufficient to satisfy the requirement of section 

29-26-121(a)(3)(B)(i) that the notice be mailed to the health care provider‘s address as indicated on the 

Tennessee Department of Health website. While Mr. Arden mistakenly sent Dr. Kozawa‘s notice letter to 

the Sweetwater Hospital address, which was very similar to Dr. Kozawa‘s address, Dr. Kozawa made no
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Moreover, while we note that the language of sections 29-26-121(a)(3)(B) and 

(a)(4) is unambiguous, we do not find that the 2009 amendment to the pre-suit notice 

statute, which omitted ―delivery by a nationally recognized carrier‖ as a means of sending 

pre-suit notice, to be determinative. The 2009 amendment was a comprehensive overhaul 

of the pre-suit notice statute. Specifically, the omission of ―nationally recognized 

carriers‖ as a potential method of service was but a small change, among many others,7

intended to provide more certainty and guidance to attorneys.8 In Senate committee 

discussion of the 2009 amendment, Senator Doug Overbey explained, 

What this bill provides are some options to those who are giving the 60-day 

notice. I would say, first of all, we‘re not talking about service of process. 

We‘re not talking about service of the summons and complaint. We‘re 

talking about service of this notice that precedes the filing of a complaint 

based upon medical malpractice. We‘re giving options. 

 

allegation that he failed to receive notice or that he was prejudiced by this error. Accordingly, Mr. Arden 

substantially complied with this statutory requirement. 

7 Among the other changes were: (1) clarifying that pre-suit notice must be given to only those

who will be named as defendants in the forthcoming action; (2) requiring that the plaintiff file a HIPAA 

compliant medical authorization with the notice; (3) clarifying that service may be made to not only the 

health care provider, but to ―an identified individual whose job function includes receptionist for 

deliveries to the provider or arrival of the provider‘s patients at the provider‘s current practice location‖; 

(4) providing for a 120-day extension of the statute of limitations; and (5) requiring a certificate of good 

faith to be filed with the complaint, instead of within ninety days of the filing of the complaint. Compare

Tenn. Code Ann. §§ 29-26-121, -122 (2008), with Tenn. Code Ann. §§ 29-26-121, -122 (2012). 

8 As one commentator explained: 

[T]he 2008 Statute could be construed as providing that notice was not effective 

unless the health care provider was personally served, personally signed the receipt for 

the registered letter containing the notice, or personally signed the receipt for the letter 

delivered by a nationally recognized carrier. This created a real problem for plaintiff‘s 

lawyers, since (a) compliance with the statute was necessary to extend the statute of 

limitations; (b) there was anecdotal evidence that doctors were not cooperating with 

attempts at personal service; (c) there were disputes concerning who signed the receipt; 

and (d) there was no effective way of resolving uncertainty about whether notice was 

properly given absent personal service on the provider.

The 2009 Act solves that problem. Now, service of notice on an individual 

health care provider is effective upon . . . mailing notice to the provider by the method 

provided by statute. Importantly, it is not receipt of the written, mailed notice by the 

provider that extends the statute of limitations and statute of repose. Rather, it is the 

mailing of the letter in compliance with the statute that extends the statute of limitations.

John A. Day, Med Mal Makeover 2009 Act Improves on ’08, 45 TENN. B.J. 14, 15 (2009).
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Hearing on S.B. 2109 Before the Senate Judiciary Comm., 106th Gen. Assemb., Reg. 

Sess. (Tenn. May 27, 2009) (statement of Sen. Overbey). Similarly, in a House 

committee discussion, Representative Kent Coleman explained, ―[The amendment] 

eliminates uncertainty regarding the service of notice.‖ Hearing on H.B. 2233 Before the 

House Judiciary Comm., 106th Gen. Assemb., Reg. Sess. (Tenn. May 26, 2009) 

(statement of Rep. Coleman). Specifying the U.S. Postal Service was merely an attempt 

to provide attorneys with more guidance under the statute. 

Above all, these changes to the pre-suit notice statute were meant to ensure that 

notice is provided to health care defendants before suit is filed. As Senator Overbey 

explained, the Legislature was ―trying to make sure [the notice] gets delivered . . . to a 

responsible party,‖ Hearing on S.B. 2109, supra, and as Representative Coleman 

explained, the amendment ―improves the notice provisions so that physicians know that 

there are claims being made and lawyers know that the service of process is taking 

place,‖ Hearing on H.B. 2233, supra. See also Day, supra, at 16 (―The purpose of the 

Certificate of Mailing requirement is to eliminate the possibility that a lawyer could 

falsely claim that a letter had been mailed on a certain date when in fact it had not.‖). 

Given that a key purpose of the 2009 amendment was to better ensure that health 

care defendants receive timely notice, we do not regard the omission of ―nationally 

recognized carrier‖ from the statute as indicating the Legislature‘s intent to preclude the 

use of any carrier other than the U.S. Postal Service. Accordingly, we hold that Mr. 

Arden‘s timely provision of pre-suit notice to the Defendants through the use of FedEx

and filing of proof with the complaint constituted substantial compliance with the manner 

and proof of service requirements of the pre-suit notice statute. 

Conclusion

We reverse the judgment of the Court of Appeals dismissing Mr. Arden‘s 

complaint and remand the case to the trial court for further proceedings. Costs of this 

appeal are assessed to Kenya I. Kozawa, M.D., Ken Kozawa, M.D., P.C., and Sweetwater 

Hospital Association, for which execution may issue if necessary. 

 _________________________________

 SHARON G. LEE, CHIEF JUSTICE