IN THE COURT OF WORKERS’ COMPENSATION CLAIMS

AT NASHVILLE

JOHN GARRARD, ) Docket No. 2015-06-0648

Employee, )

v. ) State File No. 201587484

MECHANICAL COMPONENTS OF

TENNESSEE,

)

) Judge Joshua Davis Baker

Employer, )

And )

CRUM AND FOSTER, )

Insurance Carrier. )

)

EXPEDITED HEARING ORDER GRANTING IN PART AND DENYING IN 

PART MEDICAL BENEFITS

This matter came before the undersigned workers’ compensation judge on the 

Request for Expedited Hearing filed by the employee, John Garrard, pursuant to 

Tennessee Code Annotated section 50-6-239 (2014). This matter concerns an accepted 

work-related claim. The present focus of this case is whether the employer, Mechanical 

Components of Tennessee (MCT), must provide treatment for Mr. Garrard’s hand and 

wrist conditions in addition to medical care provided for other injuries related to the 

workplace accident. Accordingly, the central legal issue is whether Mr. Garrard is likely 

to prevail at a hearing on the merits in proving the need for treatment of his hand and 

wrist conditions is causally related to the workplace injury. For the reasons set forth 

below, the Court finds Mr. Garrard is likely to prevail at hearing on the merits in proving 

entitlement to medical benefits for cervical pain and hand tingling related to his 

workplace injury. The Court finds Mr. Garrard is unlikely to prevail at a hearing on the 

merits in providing entitlement to medical benefits for his alleged wrist injury.

1

History of Claim

Mr. Garrard is a fifty-three-year-old resident of Robertson County, Tennessee. 

On November 19, 2014, around 6:00 p.m., while working second shift on the MTC 

production floor, an employee driving a tow motor crashed into Mr. Garrard’s 

 

1 A complete listing of the technical record and exhibits admitted at the Expedited Hearing is attached to this Order 

as an appendix.
2

workstation. Mr. Garrard avoided being hit as he had stepped out of his workstation just 

before the collision. Mr. Garrard claims he slipped and fell when the collision occurred. 

Mr. Garrard testified he told his supervisor about the incident immediately after it 

occurred, but the supervisor did not fill out an accident report. When his shift ended, 

however, Mr. Garrard told the supervisor that his neck had started hurting from where he 

“jumped out the way and slipped and fell.” At that time, the supervisor filled out an

incident investigation report and provided the following description of the accident: 

“While running AL20, an employee on the train hit the machine. John states machine did 

not hit him, but it startled him. He is stating by the end of the shift his neck had tensed 

up.” (Ex. 4.) The incident report does not show that Mr. Garrard reported falling down. 

MCT provided Mr. Garrard a panel of medical providers from which he chose 

Tristar Portland ER. Providers at Tristar diagnosed Mr. Garrard with a neck strain and 

released him to return to regular duty work. (Ex. 1, Vol. 1 at 3-7.) Mr. Garrard returned 

to Tristar on November 24, 2014, complaining of continued neck pain. Tristar instructed 

Mr. Garrard to use anti-inflammatory medication and excused him from work until 

November 25, 2014. Id. at 11. None of the records from these visits show that Mr. 

Garrard complained of falling down during a work-related accident.

On January 5, 2015, Mr. Garrard visited his primary care provider, Brandi Weber, 

a nurse practitioner. Id. at 109. According to the treatment notes, Mr. Garrard told NP 

Weber he suffered from persistent, moderate to severe, shoulder pain. He also 

complained that his finger “is going numb and [he] thinks it’s coming from his shoulder.” 

Id. He returned to NP Weber’s office again in February and March 2016 complaining of 

similar shoulder pain and finger numbness. Id. at 115, 120. Again, none of these records 

shows that Mr. Garrrard complained of falling down during a work accident.

On February 13, 2015, Mr. Garrard returned to Tristar. The medical notes 

indicated that Mr. Garrard complained of “left neck pain which radiate [sic] to his left 

shoulder and down his left arm with associated paresthesias [sic] in the left index finger 

and thumb.” Id. at 17. Mr. Garrard stated the pain began when he injured his neck and 

left shoulder, “when he jumped out of the way of a tow motor.” Id. 

In addition to this statement Mr. Garrard also told NP Weber that he thought he 

hurt his back and shoulder when he “almost fell.” Id. at 132. When questioned about this 

at the hearing, Mr. Garrard said the discussion concerned another incident where he 

slipped in the snow. 

MCT provided Mr. Garrard a panel of spine specialists to examine the cause of his 

radiating pain, paresthesia and numbness. He selected Dr. Jason R. Hubbard. Dr. 

Hubbard believed that his symptoms suggested a C6 radiculopathy. Id. at 33. He ordered

a MRI and CT myelogram of Mr. Garrard’s cervical spine to determine the cause of the
3

symptoms. The MRI showed “potential encroachment on the exiting left C7 nerve root.” 

Id. at 34. The CT myelogram revealed “possible left foraminal disc protrusion impinging 

onto the emerging left C7 nerve root. The central canal is not compromised.” Id. at 35. 

On July 17, 2015, Dr. Hubbard placed Mr. Garrard at maximum medical 

improvement. Dr. Hubbard also opined that Mr. Garrard retained no permanent 

impairment as a result of the workplace accident and returned him to work without 

restrictions. He included the following in his treatment notes:

He has been doing physical therapy for his neck. Unfortunately this has not 

given him much relief. He has an MRI that is normal, he has a CT that is 

normal. From a neurological standpoint, I do not have much to offer him. I 

would simply recommend continued pain management. He is already in 

pain management with Dr. Whitehouse.

Id. at 39-40, 44. Concerning causation, Dr. Hubbard opined that the November 14, 2014 

work-related incident was the major contributing cause of Mr. Garrard’s “cervical pain 

and tingling in in his hands.” Id. at 42. Specifically, Dr. Hubbard opined that the 

workplace incident was ninety percent the cause of this condition. Id. When asked 

whether the condition would require further treatment, Dr. Hubbard checked “yes” and 

wrote “symptomatic pain management.”2Id. 

In addition to the opinions on causation, Dr. Hubbard wrote the following in his 

July 17, 2015 treatment notes:

[Mr. Garrard’s] biggest complaint today is pain in his wrist. This is a new 

complaint. It is not one that he has told me [about] in the past. I did [sic] 

not think it is related to his previous injuries, but if this continues I would 

recommend he get [an] evaluation by an orthopedic hand doctor to see what 

may be going on.

Id. At trial, Mr. Garrard maintained that he told Dr. Hubbard about the pain in his wrist 

prior to this appointment. 

Mr. Garrard testified that he continued to experience problems with his hands and 

wrist. He complained that his hands often became numb during the night making it 

difficult for him to sleep. On May 12, 2015, Mr. Garrard sought treatment on his own 

from Dr. N.K. Singh. The treatment notes indicated Mr. Garrard told Dr. Singh that he 

fell down onto his right and left wrists and hands while jumping out of the way of a tow 

motor. (Ex. 3 at 4.) Dr. Singh diagnosed arthralgia and paresthesia in both hands, and 

possible bilateral carpal tunnel syndrome. Id. Dr. Singh did not provide an opinion in 

 

2 Dr. Hubbard made other notations on the page that are illegible in the copy provided to the Court. 
4

the medical notes on whether Mr. Garrard’s alleged fall at work caused these conditions. 

At the hearing, however, Mr. Garrard testified, without objection, that Dr. Singh told him 

he could have injured his wrist when he fell. 

Dr. Singh referred Mr. Garrard to Dr. Donald Lee for a surgical consultation. Dr. 

Lee performed a preliminary examination but declined to continue the examination upon 

learning that Mr. Garrard believed treatment should be covered under workers’ 

compensation. (Ex. 3 at 1.) He told Mr. Garrard his employer would need to approve 

payment under workers’ compensation before going forward and encouraged Mr. Garrard 

to return upon receiving approval for treatment under workers’ compensation. Id. 

Medical records show that prior to the workplace incident, Mr. Garrard received

pain management treatment for pain resulting from an automobile accident from 

Whitehouse Pain Institute (WPI) and North Regional Pain Management (NRPM). (Ex. 1, 

Vol. 2 at 164-244.) The medical records from NRPM indicated Mr. Garrard complained 

of pain in his left shoulder and lower back as well as weakness, numbness and tingling in 

his leg and between his fingers prior to the workplace incident. Id. at 216, 232, 239. 

When questioned about this report, Mr. Garrard denied complaining of tingling in his 

fingers to NRPM.

Mr. Garrard filed a Petition for Benefit Determination seeking medical benefits. 

The parties did not resolve the disputed issues through mediation, and the Mediating

Specialist filed a Dispute Certification Notice. Mr. Garrard filed a Request for Expedited 

Hearing, and this Court heard the matter on December 7, 2015. At the Expedited 

Hearing, Mr. Garrard argued that his hand injury arose out of his November 19, 2014 

workplace accident. MCT argued that Mr. Garrard failed to carry his burden of proving 

his wrist injury arose out of the accident. 

Findings of Fact and Conclusions of Law

The Workers’ Compensation Law shall not be remedially or liberally construed in 

favor of either party but shall be construed fairly, impartially and in accordance with 

basic principles of statutory construction favoring neither the employee nor 

employer. Tenn. Code Ann. § 50-6-116 (2014). The employee in a workers’ 

compensation claim has the burden of proof on all essential elements of a claim. Tenn. 

Code Ann. § 50-6-239(c)(6); Tindall v. Waring Park Ass’n, 725 S.W.2d 935, 937 (Tenn. 

1987);3Scott v. Integrity Staffing Solutions, No. 2015-01-0055, 2015 TN Wrk. Comp. 

 

3 The Tennessee Workers’ Compensation Appeals Board allows reliance on precedent from the Tennessee Supreme 

Court “unless it is evident that the Supreme Court’s decision or rationale relied on a remedial interpretation of preJuly 1, 2014 statutes, that it relied on specific statutory language no longer contained in the Workers’ Compensation 

Law, and/or that it relied on an analysis that has since been addressed by the general assembly through statutory 

amendments.” McCord v. Advantage Human Resourcing, No. 2014-06-0063, 2015 TN Wrk. Comp. App. Bd. 

LEXIS 6, at *13 n.4 (Tenn. Workers’ Comp. App. Bd. Mar. 27, 2015).
5

App. Bd. LEXIS 24, at *6 (Tenn. Workers’ Comp. App. Bd. Aug. 18, 2015); see also 

Buchanan v. Carlex Glass Co., No. 2015-01-0012, 2015 TN Wrk. Comp. App. Bd. 

LEXIS 39, at *5 (Tenn. Workers’ Comp. App. Bd. Sept. 29, 2015). An employee need 

not prove every element of his or her claim by a preponderance of the evidence in order 

to obtain relief at an expedited hearing. McCord v. Advantage Human Resourcing, No. 

2014-06-0063, 2015 TN Wrk. Comp. App. Bd. LEXIS 6, at *7-8, 9 (Tenn. Workers’ 

Comp. App. Bd. Mar. 27, 2015). At an expedited hearing, an employee has the burden to 

come forward with sufficient evidence from which the trial court can determine that the 

employee is likely to prevail at a hearing on the merits. Id.

MCT accepted Mr. Garrard’s neck injury claim and provided medical benefits;

only the extent of those benefits is at issue. Mr. Garrard maintains steadfastly that he fell, 

landing on his hands, during the November 19, 2014 workplace incident. Accordingly, 

he seeks additional medical attention for a wrist and a hand injury which he claims 

resulted from the incident. MTC claims Mr. Garrard did not fall to the ground and argues 

that it should not have to provide medical benefits for the wrist and hand conditions. The 

Court gives more credence to the documentary evidence. 

An accident report completed just after Mr. Garrard’s shift ended on the day of the 

accident does not mention Mr. Garrard reporting a fall when the tow motor struck his 

workstation. Instead, the report states the tow motor “startled him.” Similarly, when Mr. 

Garrard sought treatment for neck and left-shoulder pain at Tristar on February 13, 2015, 

Mr. Garrard stated the pain began, “when he jumped out of the way of a tow motor.” Id. 

Again, Mr. Garrard never stated he fell to ground. Mr. Garrard also visited NP Weber on 

May 6, 2015. At this visit Mr. Garrard described injuring his shoulder and back when he 

“almost fell.” Mr. Garrard, however, denied the comment concerned the workplace 

incident. Instead, he claimed to have been speaking about an incident where he slipped 

in the snow. 

These facts aside, however, the most troubling aspect of Mr. Garrard’s testimony 

insisting that he fell during the November 19, 2014 incident is the absence of any 

statement attributed to Mr. Garrard where he reported falling down. In fact, Mr. Garrard 

apparently never told anyone he fell down until he visited Dr. Singh on May 12, 2015. 

By that time, physicians at the ER, Dr. Hubbard and NP Weber had treated him on 

multiple occasions. In all those visits, none of the records shows that Mr. Garrard 

claimed to have fallen down. Accordingly, the Court finds that Mr. Garrard did not fall 

down during the November 19, 2014 workplace incident. 

The Court now turns to Mr. Garrard’s complaints of wrist pain. In addition to the 

dearth of information regarding Mr. Garrard’s alleged fall, the medical records also 

contain no complaints of wrist pain until July 17, 2015. Upon hearing Mr. Garrard’s 

complaints of wrist pain, Dr. Hubbard stated that he did not think the wrist pain is related 

to the workplace accident. 
6

Mr. Garrard bears the burden of proof in these proceedings. Except in “the most 

obvious, simple and routine cases,” a workers’ compensation claimant must establish by 

expert medical testimony that he or she is injured and that there exists a causal 

relationship between the injury and the claimant’s employment activity. Wheetley v. 

State, No. M2013-01707-WC-R3-WC, 2014 Tenn. LEXIS 476, at *5 (Tenn. Workers’ 

Comp. Panel June 25, 2014) (citing Excel Polymers, LLC v. Broyles, 302 S.W.3d 268, 

274 (Tenn. 2009); Cloyd v. Hartco Flooring Co., 274 S.W.3d 638, 643 (Tenn. 2008)). 

Normally, Mr. Garrard would not need to prove medical causation to establish eligibility 

for a particular medical benefit at the expedited hearing stage. See McCord, supra. 

Under these circumstances, however, where the authorized treating doctor “does not 

think” his wrist condition is casually related to the workplace accident, Mr. Garrard must 

present some countervailing evidence to contradict Dr. Hubbard’s opinion. See Tenn. 

Code Ann. § 50-6-102(13)(E) (2014) (“The opinion of the treating physician, selected by 

the employee from the employer’s designated panel of physicians pursuant to § 50-6-

204(a)(3), shall be presumed correct on the issue of causation but this presumption shall 

be rebuttable by a preponderance of the evidence.”). 

The only other evidence concerning Mr. Garrard’s wrist pain complaints came 

from the records of Drs. Singh and Lee. Neither doctor, however, opined a causal 

relationship between Mr. Garrard’s work and his wrist pain. At the hearing, Mr. Garrard 

claimed that either Dr. Singh or Dr. Lee told him that falling on his hand could have 

caused his wrist pain. Of course, this Court has already determined that Mr. Garrard did 

not fall on his hand during the workplace incident, so Dr. Lee’s alleged statement carries

no weight with this Court. Accordingly, Mr. Garrard has not rebutted the presumption of 

correctness attached to Dr. Hubbard’s causation opinion. For this reason, the Court finds 

he is unlikely to prevail at a hearing on the merits concerning his request for treatment of 

wrist pain. 

The final issue for consideration is whether MCT must provide Mr. Garrard 

treatment for cervical pain and tingling in his hands. Before addressing this issue, the 

Court notes the lack of credibility attached to Mr. Garrard’s testimony. Furthermore, as 

recounted in the claim history portion of this order, the Court is mindful of Mr. Garrard’s 

complaints of “finger tingling” predating the workplace incident. These facts and the 

credibility determination aside, the Court is faced with the statements in Dr. Hubbard’s 

medical records and his response to the causation letter submitted by the nurse case 

manager. 

Dr. Hubbard placed Mr. Garrard at maximum medical improvement on July 17, 

2015, and opined he retained no permanent impairment. He also noted that Mr. Garrard 

had a normal MRI and CT myelogram. Concerning causation of the cervical pain and 

hand tingling, however, Dr. Hubbard wrote “by history his work injury is the main 

etiology.” Percentage wise, Dr. Hubbard attributed ninety percent of the cause of Mr. 
7

Garrard’s cervical pain and hand tingling to the workplace incident. Further, Dr. 

Hubbard knew Mr. Garrard complained of cervical pain and finger tingling before 

November 19, 2014, because the nurse case manager informed him of this in her letter

requesting a causation opinion. 

Despite this knowledge, Dr. Hubbard opined that a causal relationship existed 

between Mr. Garrard’s cervical pain, finger tingling and the workplace accident. As the 

authorized treating physician, his opinion carries a presumption of correctness. See Tenn. 

Code Ann. § 50-6-102(13)(E) (2014). Thus, the Court finds, based on the evidence 

before it at this time, that Mr. Garrard is likely to prevail at a hearing on the merits in 

proving a causal relationship between his cervical pain, hand tingling and the workplace 

accident. 

Tennessee law requires an employer to provide, “free of charge to the employee 

such medical and surgical treatment . . . made reasonably necessary by accident as 

defined in this chapter[.]” Tenn. Code Ann. § 50-6-204(a)(l)(A) (2014). Further, any 

care prescribed by the authorized treating physician will be presumed to be reasonable 

and necessary for treatment of the employee’s work-related injury. See Russell v. 

Genesco, Inc., 651 S.W.2d 206, 211 (Tenn. 1983). When asked whether Mr. Garrard’s 

cervical pain and finger tingling would require further treatment, Dr. Hubbard checked 

“yes” on the causation letter and wrote “symptomatic pain management” in the area 

below that check mark. He also included the following in his treatment notes: “From a 

neurological standpoint, I do not have much to offer him. I would simply recommend 

continued pain management.” 

The Court finds that Dr. Hubbard recommended pain management treatment for 

Mr. Garrard’s cervical pain and finger tingling. This recommendation is presumed to be 

reasonable and necessary. The Workers’ Compensation Law provides the following 

concerning pain management treatment:

(j)(1) If a treating physician determines that pain is persisting for an injured 

or disabled employee beyond an expected period for healing, the treating 

physician may either prescribe, if the physician is a qualified physician as 

defined in subdivision (j)(2)(B), or refer, such injured or disabled employee 

for pain management encompassing pharmacological, nonpharmacological 

and other approaches to manage chronic pain.

(2)(A) In the event that a treating physician refers an injured or disabled 

employee for pain management, the employee is entitled to a panel of 

qualified physicians as provided in subdivision (a)(4)[.]

Tenn. Code Ann. § 50-6-204(j) (2014). 
8

Dr. Hubbard placed Mr. Garrard at maximum medical improvement and then 

recommended further pain management. While not stated in the specific statutory terms, 

the Court finds that this decision satisfies section 50-6-204(j)(1)’s requirement that the 

authorized treating physician determine that pain is persisting beyond the expected period 

for healing. The Court, therefore, finds MCT must provide Mr. Garrard a panel of pain 

management doctors that meets the requirements of Tennessee Code Annotated section 

50-6-204(j)(2) for treatment of his cervical pain and finger tingling. 

The Court appreciates that Mr. Garrard is already in pain management and realizes 

this will likely present some logistical problems because patients are generally not 

allowed to treat with more than one pain management doctor. Under the circumstances, 

however, the Court sees no other option. 

IT IS, THEREFORE, ORDERED as follows:

1. Mr. Garrard’s claim for medical benefits for his wrist pain against Mechanical 

Components of Tennessee and its workers’ compensation carrier is denied at this 

time. 

2. Mechanical Components of Tennessee shall provide Mr. Garrard with a panel of 

pain management physicians for treatment of his cervical pain and hand tingling. 

3. This matter is set for an Initial (Scheduling) Hearing on January 26, 2016, 2015, at 

9:00 a.m. (CST).

ENTERED this the 22nd day of December, 2015.

_____________________________________

Judge Joshua Davis Baker

Court of Workers’ Compensation Claims

Initial (Scheduling) Hearing:

An Initial (Scheduling) Hearing has been set with Judge Baker, Court of 

Workers’ Compensation Claims. You must call (615) 741-2113 or toll-free at (855) 

874-0474 to participate in the Initial Hearing.

Please Note: You must call in on the scheduled date/time to 

participate. Failure to call in may result in a determination of the issues without 

your further participation.
9

Right to Appeal:

Tennessee Law allows any party who disagrees with this Expedited Hearing Order 

to appeal the decision to the Workers’ Compensation Appeals Board. To file a Notice of

Appeal, you must:

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

2. File the completed form with the Court Clerk within seven business days of the 

date the Workers’ Compensation Judge entered the Expedited Hearing Order.

3. Serve a copy of the Expedited Hearing Notice of Appeal upon the opposing party. 

4. The appealing party is responsible for payment of a filing fee in the amount of 

$75.00. Within ten calendar days after the filing of a notice of appeal, payment 

must be received by check, money order, or credit card payment. Payments can be 

made in person at any Bureau office or by United States mail, hand-delivery, or 

other delivery service. In the alternative, the appealing party may file an Affidavit 

of Indigency, on a form prescribed by the Bureau, seeking a waiver of the filing 

fee. The Affidavit of Indigency may be filed contemporaneously with the Notice 

of Appeal or must be filed within ten calendar days thereafter. The Appeals Board 

will consider the Affidavit of Indigency and issue an Order granting or denying 

the request for a waiver of the filing fee as soon thereafter as is 

practicable. Failure to timely pay the filing fee or file the Affidavit of 

Indigency in accordance with this section shall result in dismissal of the 

appeal.

5. The parties, having the responsibility of ensuring a complete record on appeal, 

may request, from the Court Clerk, the audio recording of the hearing for the 

purpose of having a transcript prepared by a licensed court reporter and filing it 

with the Court Clerk within ten calendar days of the filing of the Expedited 

Hearing Notice of Appeal. Alternatively, the parties may file a joint statement of 

the evidence within ten calendar days of the filing of the Expedited Hearing 

Notice of Appeal. The statement of the evidence must convey a complete and 

accurate account of what transpired in the Court of Workers’ Compensation 

Claims and must be approved by the workers’ compensation judge before the 

record is submitted to the Clerk of the Appeals Board.

6. If the appellant elects to file a position statement in support of the interlocutory 

appeal, the appellant shall file such position statement with the Court Clerk within 

five business days of the expiration of the time to file a transcript or statement of 

the evidence, specifying the issues presented for review and including any 

argument in support thereof. A party opposing the appeal shall file a response, if 
10

any, with the Court Clerk within five business days of the filing of the appellant’s 

position statement. All position statements pertaining to an appeal of an 

interlocutory order 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.
11

APPENDIX 

Exhibits:

1. Medical records (2 volumes)

2. Affidavit of John Garrard Jr.

3. Additional medical records

4. Incident investigation report

Technical record:4

1. Petition for Benefit Determination

2. Dispute Certification Notice

3. Request for Expedited Hearing

4. Letter to Amanda Terry from counsel for Mechanical Components of Tennessee

 

4

The Court did not consider attachments to Technical Record filings unless admitted into evidence during the 

Expedited Hearing. The Court considered factual statements in these filings or any attachments to them as 

allegations unless established by the evidence.
12

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 _____ day 

of December, 2015.

Name Certified 

Mail

Via

Fax

Via 

Email

Service sent to:

John Garrard, Jr. X 1011 Fifth Ave. W.

Springfield, Tennessee 37172

James Tucker X jtucker@manierherod.com

_____________________________________

Penny Shrum, Clerk of Court

Court of Workers’ Compensation Claims

WC.CourtClerk@tn.gov