Opinion ID: 1867704
Heading Depth: 1
Heading Rank: 5

Heading: Evidence Regarding the BRC

Text: Jones testified by deposition that she was an insurance adjuster at Inservices, Inc. at the time of Dennis' accident. She stated that she was the adjuster assigned to Dennis' claim and that she handled the claim from the time of the accident through the BRC. Jones recalled that in 2000 Dennis approached her about settling his claim to receive a lump sum rather than weekly benefits. She said that Dennis had reached maximum medical improvement about a year before he approached her and that she had worked with his attorney on that issue. Once Dennis discharged his attorney she dealt with him directly. She stated that the settlement was not reached prior to the BRC and recalled that the settlement was based upon 400 weeks of benefits. Jones testified that she never advised Dennis to terminate his relationship with his lawyer. She also stated that she never advised Dennis as to the maximum or minimum benefits he could receive. She testified: We basically just explained to him what he would be entitled to if he were to request a hearing or go before the benefit review conference. But there was no minimum or maximum. He could be entitled to benefits for the rest of his life or he couldthey could find that he would be capped at 400 weeks because he wanted to start his own business and go to work for himself. Jones testified again in response to a question from Dennis' attorney that she had advised Dennis that he could get benefits for the rest of his life, but said she had not done so in writing. She also testified that she gave Dennis the Tennessee DOL's phone number and advised him to speak with an ombudsman regarding his claim. Byas, the mediator, also testified by deposition. She stated that she had been with the DOL since 1988 and was currently a Workers' Compensation Specialist I. Byas testified that she did not remember whether Dennis ever asked her about permanent total disability benefits and does not remember whether she volunteered the information. When asked if she ever told Dennis the maximum he could receive was 400 weeks, Byas stated I probably did, but I am not sure of that either. (Emphasis added.) She stated that she did not ask him if he wanted to be represented by an attorney, explaining, I assume that if they come in without an attorney, they understand. That's their choice. Byas said that she normally does not volunteer information to claimants about permanent total disability benefits but will explain the benefits if she is asked. She did not recall if Dennis asked. Like Dennis, Byas recalled that the only persons present at the BRC were Jones, Dennis, and herself. She recalled that at the BRC, Jones offered Dennis 400 weeks of benefits and he accepted the offer. The bulk of the BRC was taken up with structuring how to pay the 400 weeks of benefits. She recalled that the BRC lasted about an hour. Gaines testified by deposition that he is employed with the DOL. He was a Workers' Compensation Specialist senior to Byas at the time of Dennis' BRC. He stated that he did not recall whether he participated in Dennis' BRC but that it would not have been normal practice for him to be present. Gaines explained that he signed the settlement agreement on Byas' behalf because she was not available and that he also signed the document approving the settlement on behalf of the DOL. He did not recall discussing permanent disability benefits or discussing any specifics of the agreement with Dennis. Gaines acknowledged that under the statute it is the responsibility of either the mediator or the person approving the settlement to explain to the employee the scope of benefits available, but did not recall whether he did so or not. Gaines explained that in his view, the role of the mediator is not to approve the settlement per se, but to facilitate it and to record it. It is not the mediator's job to advocate or decide whether the agreement is fair. The specialist who approves the agreement is responsible for ensuring that the employee is receiving substantially the benefits he is entitled to receive. Gaines conceded that [t]here is not anything in the documents I have [regarding Dennis' settlement] that mentions permanent total disability benefits.