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TENNESSEE BUREAU OF WORKERS’ COMPENSATION

IN THE COURT OF WORKERS’ COMPENSATION CLAIMS

AT GRAY

SALVADOR ENRIQUEZ, ) Docket Number: 2020-02-0318

Employee, )

v. )

DEFENDER SERVICES, INC., ) State File Number: 101315-2019

Employer, )

And )

AMERICAN CASUALTY 

COMPANY OF READING, PA, 

)

)

Judge Brian K. Addington

Carrier. )

EXPEDITED HEARING ORDER DENYING BENEFITS

Mr. Enriquez requested the Court order left-knee surgery recommended by his 

authorized physician. Defender Services, Inc. asserted Mr. Enriquez’s need for knee 

surgery did not arise primarily out of his employment. After an expedited hearing on June 

30, 2021, the Court holds that Mr. Enriquez has not presented sufficient evidence at this 

time that he is likely to succeed at a hearing on the merits in proving the requested surgery 

is causally related to his work-injury. Therefore, the request is denied.

History of Claim

Defender Services employed Mr. Enriquez as a machine operator. On September 

19, 2019, he fell from a ladder. He most seriously injured his left leg. He worked a few 

hours after the injury but needed treatment due to an inability to walk well and increasing 

pain. Defender Services took him to the emergency room, where providers found his injury 

to be outside their specialty. Given a choice between a physician in North Carolina and 

Appalachian Orthopedics, Mr. Enrique chose Appalachian and came under the care of Dr. 

Larry Waldrop.1

1 Mr. Enriquez did not explain who provided the choice. No signed physician panel was introduced. 

FILED

Jul 07, 2021

12:39 PM(CT)

TENNESSEE COURT OF

WORKERS' COMPENSATION

CLAIMS
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Mr. Enriquez worked light-duty until January 3, 2020, when Defender Services 

terminated him. When his left-leg condition did not improve, Dr. Waldrop performed 

medial patellofemoral ligament surgery on January 6 and restricted him from work.

Dr. Waldrop recommended, and Mr. Enriquez attended, physical therapy after the 

surgery. On March 24, Dr. Waldrop allowed Mr. Enriquez to return to desk work only. 

He continued physical therapy and follow-up visits until June 9, when Dr. Waldrop placed 

him at maximum medical improvement. At that time, Dr. Waldrop changed his restrictions 

to weight-bearing as tolerated, no deep bending or twisting of the left knee, and no lifting 

over five pounds. He noted that Mr. Enriquez may need knee replacements in the future.

After a June 9 appointment, Mr. Enriquez began yard work, including running a 

grass trimmer at home and for his neighbor, and a six-hour job with a gardener for pay. 

This activity inflamed his left knee. He told both his physical therapist and Dr. Waldrop 

that the work increased his pain, and he testified that it caused swelling. Dr. Waldrop 

recommended a follow-up MRI and took him off work effective July 14. 

In a follow-up visit in October, Dr. Waldrop noted a swollen left knee and explained 

that Mr. Enriquez suffered an acute worker’s compensation injury, but he also had preexisting arthritis in the knee. He stated that, for pain-management, he was recommending 

a total knee replacement and placed Mr. Enriquez on light-duty restrictions.

Later, in January 2021, he ordered the surgery. He stated in his records that, “It is 

work related especially the retropatellar space and the treatment would be the same even 

despite having some degenerative knee issues prior to the injury even if that were the case.” 

Genex performed a Utilization Review of the surgery request and certified it. Later, Dr. 

Waldrop checked a box on a letter from Mr. Enriquez’s attorney that the total left-knee 

arthroplasty was reasonable and necessary.

Defender Services denied the surgery request and sent Mr. Enriquez to an

examination with Dr. William Hovis. Dr. Hovis examined Mr. Enriquez and read and 

considered his prior records, reports, and imaging. He concluded that Mr. Enriquez

suffered from degenerative and arthritic changes in his knees. He felt Mr. Enriquez had 

congenital lateral subluxation of the left patella and was significantly overweight. He 

found Mr. Enriquez’s need for surgery primarily related to his pre-existing arthritis but did 

note that the injury aggravated or exacerbated his pre-existing condition. Dr. Hovis 

confirmed his written opinions in his deposition and testified that Mr. Enriquez worked 

outside his restrictions when he trimmed grass for himself and others.

Findings of Fact and Conclusions of Law

To prevail, Mr. Enriquez must present evidence from which this Court can 

determine that he is likely to prove at trial that his current need for a total left-knee 

replacement is primarily due to his September 2019 work accident. See McCord v. 
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Advantage Human Resourcing, 2015 TN Wrk. Comp. App. Bd. LEXIS 6, at *9 (Mar. 27, 

2015).

Mr. Enriquez’s surgery request rests upon the expert opinions concerning medical 

causation. Proving medical causation requires a physician’s opinion within a reasonable 

degree of medical certainty that the employment contributed more than fifty percent as to 

the cause of the need for surgery. A reasonable degree of medical certainty means that, in 

the physician’s opinion it is more likely than not that the work caused the injury considering 

all causes, as opposed to speculation or possibility. See Tenn. Code Ann. § 50-6-

102(14)(B)-(D).

In determining medical causation, the law provides a rebuttable presumption of 

correctness to the causation opinion given by the physician an injured employee chooses 

from a panel. See Tenn. Code Ann. § 50-6-102(14)(E). Mr. Enriquez testified that he was 

given a choice between a physician in North Carolina or Appalachian Orthopedics, and he 

chose Appalachian. This procedure does not follow the Workers’ Compensation Law’s 

requirement of providing a panel of three physicians. See Tenn. Code Ann. § 50-6-

204(3)(A)(i). The parties did not introduce a signed panel into evidence. Although Dr. 

Waldrop was authorized to treat Mr. Enriquez, only a valid panel doctor has a presumption 

of correctness on causation. See Barnes v. Jack Cooper Transport, 2020 TN Wrk. Comp. 

App. Bd. LEXIS 16, at *6 (Mar. 24, 2020). 

Because the medical opinions differ regarding causation, the Court has the 

discretion to which testimony to accept. See Bass v. The Home Depot U.S.A., Inc., 2017 

TN Wrk. Comp. App. Bd. LEXIS 36, at *9 (May 26, 2017).

In reviewing Dr. Waldrop’s records, he did not give the opinion that Mr. Enriquez’s 

need for surgery was primarily related to the work injury. He merely wrote that it was 

work-related, although he did state that the surgery was reasonable and necessary. He 

stated that the original injury had been addressed, but that pain from the pre-existing 

arthritis had worsened, and to relieve Mr. Enriquez’s pain, he recommended a total knee 

replacement.

In contrast, Dr. Hovis specifically testified that the need for surgery was not 

primarily related to the injury but rather to congenital issues and arthritis. He was very 

detailed in relating how he came to his conclusion, although he did say Mr. Enriquez’s 

injury aggravated his arthritis. 

Considering Dr. Waldrop’s records do not reflect that the surgery was primarily 

related to his injury, and that his opinion carries no presumption, as it was not proven that 

he was a panel physician, the Court adopts Dr. Hovis’s opinion as the more accurate 

statement on causation. His deposition testimony was clear, while the Court had to piece 

together Dr. Waldrop’s opinion. Further, the Court is concerned that the physicians did 

not fully address Mr. Enriquez’s grass trimming activities and its effect, if any, on causation
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for the requested surgery, as required by the Workers’ Compensation Law. See Tenn. Code 

Ann. § 50-6-102(14)(D).

Therefore, the Court holds that Mr. Enriquez has not presented sufficient evidence 

at this time that he is likely to succeed at a hearing on the merits in proving the requested 

surgery is causally related to his work-injury.

IT IS THEREFORE ORDERED as follows:

1. Mr. Enriquez’s request for surgery is denied at this time.

2. This case is set for a Status Hearing on August 25, 2021, at 2:00 p.m. Eastern

time. The parties must dial 855-543-5044 to participate in the hearing. 

Entered July 7, 2021. 

______________________________________

BRIAN K. ADDINGTON, JUDGE

Court of Workers’ Compensation Claims

APPENDIX

Exhibits:

1. Affidavit

2. Undated opinion of Dr. Larry Waldrop

3. Appalachian Orthopaedic Associates medical records

4. Employee’s designated medical records

a. Appalachian Orthopaedic Associates

b. Genex Utilization Review

c. Dr. Larry Waldrop opinion, May 12, 2021

d. Dr. William Hovis Independent Medical Exam

5. Physical Therapy Services medical records

6. Independent Medical Exam of Dr. William Hovis and exhibits

7. Dr. Waldrop medical records

8. Dr. William Hovis Deposition transcript and video

9. Dr. Larry Waldrop January 26, 2021, medical note

Technical Record:

1. Petition for Benefit Determination
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2. Dispute Certification Notice

3. Status Hearing Order, May 28, 2021

4. Request for Expedited Hearing

5. Employee’s Position Statement

6. Employee’s Exhibit List

7. Employee’s Witness List

8. Employer’s Expedited Hearing Brief

9. Employer’s Witness and Exhibit List

10.Notice of Filing Transcript and Video recording of Dr. William Hovis 

11.Notice of Filing-Physical Therapy Services records

12.Notice of Filing-medical records of Dr. Larry Waldrop

CERTIFICATE OF SERVICE

I certify that a copy of the Order was sent on July 7, 2021.

Name Certified 

Mail

Fax Email Service sent to:

Daniel Bieger,

Employee’s Attorney

X dan@biegerlaw.com

paige@biegerlaw.com

J. Brent Moore,

Employer’s Attorney

X bmoore@ortalekelley.com

______________________________________

PENNY SHRUM, COURT CLERK

wc.courtclerk@tn.gov
LB-1099 rev. 01/20 Page 1 of 2 RDA 11082 

NOTICE OF APPEAL 

Tennessee Bureau of Workers’ Compensation

www.tn.gov/workforce/injuries-at-work/ 

wc.courtclerk@tn.gov | 1-800-332-2667 

Docket No.: ________________________

State File No.: ______________________ 

Date of Injury: _____________________ 

___________________________________________________________________________ 

Employee

v.

___________________________________________________________________________ 

Employer

Notice is given that ____________________________________________________________________ 

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

appeals the following order(s) of the Tennessee Court of Workers’ Compensation Claims to the 

Workers’ Compensation Appeals Board (check one or more applicable boxes and include the date filestamped on the first page of the order(s) being appealed):

□ Expedited Hearing Order filed on _______________ □ Motion Order filed on ___________________

□ Compensation Order filed on__________________ □ Other Order filed on_____________________

issued by Judge _________________________________________________________________________. 

Statement of the Issues on Appeal 

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

________________________________________________________________________________________

________________________________________________________________________________________

________________________________________________________________________________________

________________________________________________________________________________________

Parties

Appellant(s) (Requesting Party): _________________________________________ ☐Employer ☐Employee 

Address: ________________________________________________________ Phone: ___________________ 

Email: __________________________________________________________ 

Attorney’s Name: ______________________________________________ BPR#: _______________________ 

Attorney’s Email: ______________________________________________ Phone: _______________________ 

Attorney’s Address: _________________________________________________________________________ 

* Attach an additional sheet for each additional Appellant *
LB-1099 rev. 01/20 Page 2 of 2 RDA 11082 

Employee Name: _______________________________________ Docket No.: _____________________ Date of Inj.: _______________ 

Appellee(s) (Opposing Party): ___________________________________________ ☐Employer ☐Employee 

Appellee’s Address: ______________________________________________ Phone: ____________________ 

Email: _________________________________________________________ 

Attorney’s Name: _____________________________________________ BPR#: ________________________ 

Attorney’s Email: _____________________________________________ Phone: _______________________ 

Attorney’s Address: _________________________________________________________________________ 

* Attach an additional sheet for each additional Appellee *

CERTIFICATE OF SERVICE 

I, _____________________________________________________________, certify that I have forwarded a 

true and exact copy of this Notice of Appeal by First Class mail, postage prepaid, or in any manner as described 

in Tennessee Compilation Rules & Regulations, Chapter 0800-02-21, to all parties and/or their attorneys in this 

case on this the __________ day of ___________________________________, 20 ____. 

 ______________________________________________ 

[Signature of appellant or attorney for appellant]