TENNESSEE BUREAU OF WORKERS' COMPENSATION 

IN THE COURT OF WORKERS' COMPENSATION CLAIMS 

AT GRAY 

TIMOTHY MAYS, 

Employee, 

) Docket Number: 2018-02-0659 

) 

v. 

MATTHEW PEARSON, d/b/a 

HANDYMAN CONSTRUCTION, 

Employer. 

) 

) State File Number: 93196-2018 

) 

) 

) Judge Brian K. Addington 

) 

EXPEDITED HEARING ORDER 

DECISION ON THE RECORD 

This case came before the Court on April 24, 2019, on Mr. Mays' request for 

benefits. The issue is his entitlement to medical and temporary benefits from Mr. 

Pearson, an uninsured employer. For the reasons below, the Court holds that Mr. Mays is 

likely to succeed at trial in proving he was an employee of an uninsured employer; he 

suffered an injury that arose primarily out of and in the course and scope of his 

employment; and he is entitled to medical but not temporary disability benefits. 

History of Claim 

Mr. Mays worked one month for Mr. Pearson remodeling homes. Mr. Mays cut 

the middle and index fingers on his left hand with a table saw on September 12, 2018. 

After visiting an urgent care and emergency room near Knoxville, he treated at the 

emergency room in Kingsport, Tennessee. 1 Dr. Samuel Hilton diagnosed a fracture of 

the index finger and multiple lacerations. Dr. Hilton stitched the lacerations and provided 

splints. Later, Mr. Mays sought conservative treatment on his own with Dr. Ashraf 

Youseff. His treatment cost $1,562.82. 

Concerning Mr. Mays' work, Mr. Pearson paid him by cash. The parties dispute 

the total amount Mr. Mays earned, but both acknowledged he earned $10.00 per hour. 

1 The parties did not supply medical records from urgent care or the first emergency room. 

1 

FILED

Apr 26, 2019

07:49 AM(CT)

TENNESSEE COURT OF

WORKERS' COMPENSATION

CLAIMS
According to the Expedited Request for Investigation Report, Mr. Pearson did not have 

insurance; the injury occurred after July 1, 2015; Mr. Mays resided in Tennessee at the 

time of accident; and he notified the Bureau of his injury on November 28, 2018. 

Further, Mr. Pearson controlled the work, possessed the right of termination, provided the 

tools and equipment, and scheduled the working hours. Following the injury, Mr. 

Pearson would not let Mr. Mays return to work because he believed he was an unsafe 

worker. 

Mr. Mays contended he was Mr. Pearson's employee and is entitled to medical 

and temporary disability benefits from him and/or the Uninsured Employer's Fund. Mr. 

Pearson countered that Mr. Mays was an independent contractor, not his employee; he 

offered to pay for Mr. Mays' medical treatment but he refused; and he would not allow 

Mr. Mays to return to work because he was an unsafe worker. 

Findings of Fact and Conclusions of Law 

At an Expedited Hearing, Mr. Mays must present sufficient evidence that he is 

likely to prevail at a hearing on the merits. Tenn. Code Ann.§ 50-6-239(d)(l) (2018). 

First, regarding whether Mr. Mays was an employee or independent contractor, the 

evidence supports his position that he was an employee. The factors a court must 

consider in determining whether a person is an employee or independent contractor are in 

Tennessee Code Annotated section 50-6-102(12)(D)(i). The applicable statutory factors 

are that Mr. Pearson directed the method of payment, controlled the schedule and the 

work, and provided the tools. The Court holds that Mr. Mays is likely to succeed at trial 

in proving he was Mr. Pearson's employee. 

Second, because Mr. Pearson did not provide medical benefits, Mr. Mays sought 

treatment at the emergency room and with Dr. Youseff. Because ofMr. Pearson's failure 

to provide medical benefits, Mr. Mays was reasonable in seeking his own treatment. See 

Hackney v. Integrity Staffing Solutions, 2016 TN Wrk. Comp. App. Bd. LEXIS 29, at *8-

9 (July 22, 2016). Because Dr. Youseff has already provided substantial care to Mr. 

Mays, the Court designates him the authorized physician and orders Mr. Pearson to pay 

for any reasonable and necessary medical expenses incurred due to the injury. 

Third, Mr. Mays requested temporary disability benefits. For temporary total 

disability benefits, Mr. Mays must show he is likely to prove: ( 1) a disability from 

working as the result of a compensable injury; (2) a causal connection between the injury 

and the inability to work; and (3) the duration of the period of disability. Shepherd v. 

Haren Const. Co., Inc., 2016 TN Wrk. Comp. App. Bd. LEXIS 15, at *13 (Mar. 30, 

2016). The medical records fail to establish that Mr. Mays could not work. Rather, the 

evidence shows Mr. Pearson would not let Mr. Mays work because Mr. Pearson believed 

2 
he was unsafe. The Court holds Mr. Mays is unlikely to succeed at trial in proving 

entitlement to temporary disability benefits. 

Finally, Mr. Mays requested payment by UEF. The Court notes that it can only 

issue a judgment against an uninsured employer. It is an employee's option to seek 

benefits from UEF once he obtains the judgment and appeals are finished. See Tenn. 

Code Ann. § 50-6-802(a). An injured employee may receive benefits from UEF if the 

factors set out in Tennessee Code Annotated 50-6-803( d) are met. One of those factors 

requires an employee to provide notice to the Bureau within sixty days of his injury. 

Tenn. Code Ann. § 50-6-803(d)(l). However, based on the evidence, the Court finds he 

failed to give notice to the Bureau within sixty days of his injury. 

IT IS, THEREFORE, ORDERED as follows: 

1. The Court designates Dr. Youseff as Mr. Mays' authorized physician. Mr. 

Pearson shall pay all reasonable and necessary medical treatment provided or 

recommended by Dr. Youseff. He shall pay Dr. Youseff $1,562.82 for past 

medical treatment 

2. Mr. May's request for temporary disability benefits is denied at this time. 

3. This matter is set for a Scheduling Hearing on June 10, 2019, at 10:00 a.m. (EDT). 

You must call toll-free at 855-543-5044 to participate in the Hearing. Failure 

to call in may result in a determination of the issues without your further 

participation. 

4. Unless interlocutory appeal of the Expedited Hearing Order is filed, compliance 

with this Order must occur no later than seven business days from the date of entry 

of this Order as required by Tennessee Code Annotated section 50-6-239(d)(3). 

The Insurer or Self-Insured Employer must submit confirmation of compliance 

with this Order to the Bureau by email to WCCompliru1ce.Proe:ram@tn.gov no 

later than the seventh business day after entry of this Order. Failure to submit the 

necessary confirmation within the period of compliance may result in a penalty 

assessment for non-compliance. For questions regarding compliance, please 

contact the Workers' Compensation Compliance Unit via email at 

WCCompliance_Program@ltn.gov. 

3 
ENTERED this the 26th day of April, 2019. 

IS/ Brian K. Addington 

BRIAN K. ADDINGTON, JUDGE 

Court of Workers' Compensation Claims 

APPENDIX 

Exhibits: 

1. Mr. Mays' Affidavit 

2. Medical Records 

3. Expedited Request for Investigation Report 

Technical Record: 

1. PBD 

2. Dispute Certification Notice 

3. Request for Expedited Hearing 

4. Docketing Notice 

CERTIFICATE OF SERVICE 

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

recipients by the following methods of service on April 26, 20 19. 

Name Certified 

Mail 

Timothy Mays, X 

Employee 

Matthew Pearson, X 

Employer 

Fax Email Service sent to: 

10 17 West Stone Drive, 

Apt. 323 

Kingsport, TN 3 7 660 

1794 Big Moccasin Road 

Nickelsville, VA 24271 

./) ffi~ ~ 

~ RUM, COURT CLERK 

w;.'"~~~~;f{ r.k tn. gov 

4 
Expedited Hearing Order Right to Appeal:

If you disagree with this Expedited Hearing Order, you may appeal to the Workers’ 

Compensation Appeals Board. To appeal an expedited hearing order, you must:

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

form with the Clerk of the Court of Workers’ Compensation Claims within seven 

business days of the date the expedited hearing order was filed. When filing the Notice 

of Appeal, you must serve a copy upon all parties. 

2. You must pay, via check, money order, or credit card, a $75.00 filing fee within ten 

calendar days after filing of the Notice of Appeal. Payments can be made in-person at 

any Bureau office or by U.S. mail, hand-delivery, or other delivery service. In the 

alternative, you may file an Affidavit of Indigency (form available on the Bureau’s 

website or any Bureau office) seeking a waiver of the fee. You must file the fullycompleted Affidavit of Indigency within ten calendar days of filing the Notice of 

Appeal. Failure to timely pay the filing fee or file the Affidavit of Indigency will 

result in dismissal of the appeal.

3. You bear the responsibility of ensuring a complete record on appeal. You may request 

from the court clerk the audio recording of the hearing for a $25.00 fee. If a transcript of 

the proceedings is to be filed, a licensed court reporter must prepare the transcript and file 

it with the court clerk within ten business days of the filing the Notice of 

Appeal. Alternatively, you may file a statement of the evidence prepared jointly by both 

parties within ten business days of the filing of the Notice of Appeal. The statement of 

the evidence must convey a complete and accurate account of the hearing. The Workers’ 

Compensation Judge must approve the statement before the record is submitted to the 

Appeals Board. If the Appeals Board is called upon to review testimony or other proof 

concerning factual matters, the absence of a transcript or statement of the evidence can be 

a significant obstacle to meaningful appellate review.

4. If you wish to file a position statement, you must file it with the court clerk within ten

business days after the deadline to file a transcript or statement of the evidence. The 

party opposing the appeal may file a response with the court clerk within ten business 

days after you file your position statement. All position statements should include: (1) a 

statement summarizing the facts of the case from the evidence admitted during the 

expedited hearing; (2) a statement summarizing the disposition of the case as a result of 

the expedited hearing; (3) a statement of the issue(s) presented for review; and (4) an 

argument, citing appropriate statutes, case law, or other authority.

For self-represented litigants: Help from an Ombudsman is available at 800-332-2667.


ll 

. 

Tennessee Bureau of Workers' Compensation 

220 French Landing Drive, 1-B 

Nashville, TN 37243-1002 

800-332-2667 

AFFIDAVIT OF INDIGENCY 

.. I 

I, , having been duly sworn according to law, make oath that 

because of my poverty, I am unable to bear the costs of this appeal and request that the filing fee to appeal be 

waived. The following facts support my poverty. 

1. Full Name: ___________ _ 2. Address:-------------

3. Telephone Number:--------- 4. Date of Birth:-----------

5. Names and Ages of All Dependents: 

----------------- Relationship:-------------

----------------- Relationship:-------------

---------------- - Relationship:-------------

----------------- Relationship:-------------

6. I am employed by: ------------------------------,-

My employer's address is:-------------------------

My employer's phone number is:-----------------------

7. My present monthly household income, after federal income and social security taxes are deducted, is: 

$ _______ __ 

8. I receive or expect to receive money from the following sources: 

AFDC $ per month beginning 

SSI $ per month beginning 

Retirement $ per month beginning 

Disability $ per month beginning 

Unemployment $ per month beginning 

Worker's Camp.$ per month beginning 

Other $ per month beginning 

LB-1108 (REV 11/15) RDA 11082 
9. My expenses are: ' ; !• 

' 

Rent/House Payment $ per month Medical/Dental $ per month 

Groceries $ per month Telephone $ per month 

Electricity $ per month School Supplies $ per month 

Water $ per month Clothing $ per month 

Gas $ per month Child Care $ per month 

Transportation $ per month Child Support $ per month 

Car $ per month 

Other $ per month (describe: 

10. Assets: 

Automobile $ ____ _ 

Checking/Savings Acct. $ ____ _ 

House 

) 

Other 

11. My debts are: 

Amount Owed 

$ _ ___ _ 

$ ____ _ 

To Whom 

(FMV) - ---------

(FMV) ----------

Describe: _____ _____ _ 

I hereby declare under the penalty of perjury that the foregoing answers are true, correct, and complete 

and that I am financially unable to pay the costs of this appeal. 

APPELLANT 

Sworn and subscribed before me, a notary public, this 

___ dayof _____________ ,20 ___ _ 

NOTARY PUBLIC 

My Commission Expires: _ _ _____ _ 

LB-1108 (REV 11/15) RDA 11082