Court Opinion

ID: 9950415
Source: CourtListenerOpinion
Date Created: 2024-03-13 20:46:57.858571+00
Date Added: 2024-06-11T14:37:03.020585
License: Public Domain

FILED
                                                                                Mar 12, 2024
                                                                                08:34 AM(CT)
                                                                             TENNESSEE COURT OF
                                                                            WORKERS' COMPENSATION
                                                                                   CLAIMS

           TENNESSEE BUREAU OF WORKERS’ COMPENSATION
          IN THE COURT OF WORKERS’ COMPENSATION CLAIMS
                           AT MEMPHIS

 ELISABETH CERVANTES,                       ) Docket No. 2022-08-0077
          Employee,                         )
 v.                                         )
 MATTHEW STEVEN PRUITT,                     )
          Employer,                         ) State File No. 2534-2021
 And                                        )
 ARCH INSURANCE CO.,                        )
          Carrier.                          )
                                            ) Judge Shaterra R. Marion

              EXPEDITED HEARING ORDER DENYING BENEFITS

        An Expedited Hearing was held on March 4, 2024, for injuries to Ms. Cervantes’s
left hip, low back, and head from a fall at work. Specifically, Ms. Cervantes requested
treatment with a new physician because she stated her authorized treating physician did not
have anything else to offer her. Mr. Pruitt countered that Ms. Cervantes cannot change
treating physicians and was not entitled to additional treatment because her authorized
treating physician released her twice, stating she has no need for future treatment.

       The Court holds that Ms. Cervantes is not likely to show at a hearing on the merits
that she is entitled to a new physician. However, the Court finds that her medical benefits
have not been terminated. She therefore can return to her authorized treating physician for
any reasonable and necessary treatment related to her work injury.

                                    History of Claim

       Ms. Cervantes suffered an injury on December 11, 2020, when she slipped on ice
and fell. She went to the emergency room with lower back and left hip pain. X-rays showed
no fractures, and she was diagnosed with sprains.

      Ms. Cervantes then saw panel physician Dr. Ramune Filipcic. Ms. Cervantes
complained of headaches, so Dr. Filipcic ordered a CT scan of the head, which showed
normal findings. Dr. Filipcic also ordered a spine MRI, which showed some small disc
bulges with mild arthropathy but no nerve impingement. However, she referred Ms.
Cervantes for specialty care.

       Ms. Cervantes chose Dr. Fereidoon Parsioon from a panel. He determined she did
not need surgery, and after sending her for work conditioning and a functional capacity
evaluation, placed her at maximum medical improvement. He assessed no permanent
impairment and anticipated no need for future medical treatment. He noted that he would
see her on an as-needed basis.

       Ms. Cervantes returned to Dr. Parsioon a month later with increased pain, but after
x-rays showed no fractures and very mild disc degeneration, the doctor reiterated that she
did not need surgery. He also stood by his opinion that she was at maximum medical
improvement with no permanent impairment.

       Ms. Cervantes testified that after she returned to work, her pain worsened. She stated
that she tried to return to Dr. Parsioon, but the carrier did not approve another visit. She
then returned to Dr. Filipcic, who, according to Ms. Cervantes, placed restrictions. Dr.
Filipcic offered to refer her to another specialist, but the carrier declined approval.

        After denial of the referral, Ms. Cervantes sought unauthorized treatment with Dr.
John Dockery. He reviewed her x-rays, planned to do an ultrasound, and performed a hip
injection. Dr. Dockery completed a questionnaire in which he stated that Ms. Cervantes’s
symptoms were more than 50% related to her work injury. Ms. Cervantes requested that
Dr. Dockery or a doctor other than Dr. Parsioon become the authorized treating physician.

       Mr. Pruitt argued that Ms. Cervantes previously admitted that he had provided all
treatment to which she was entitled, so she is precluded from asking for additional
treatment. Further, because Dr. Parsioon has released her twice, with no anticipated future
treatment, she is not entitled to a return visit.

                       Findings of Fact and Conclusions of Law

        Ms. Cervantes must show she is likely to prevail at trial in establishing that she is
entitled to have Dr. Dockery as her authorized treating physician. McCord v. Advantage
Human Resourcing, 2015 TN Wrk. Comp. App. Bd. LEXIS 6, at *7-8, 9 (Mar. 27, 2015).
The Court finds she has not met this burden.

        The law requires an injured employee “to accept the medical benefits” provided by
the employer, which includes a panel of “three or more independent reputable physicians .
. . from which the employee shall select one to be the treating physician.” Tenn. Code Ann.
§ 50-6-204(a)(3)(A)(i) (2023). Once selected, that physician is the authorized treating
physician until the physician declines to continue treating the employee. Limberakis v. Pro-
Tech Sec., Inc., 2017 TN Wrk. Comp. App. Bd. LEXIS 53, at *8-10 (Sept. 12, 2017). The
employer may also voluntarily provide a new panel of physicians.

       Neither situation occurred in Ms. Cervantes’s case. Dr. Parsioon has twice stated
that Ms. Cervantes is at maximum medical improvement, but he has not declined to see
her. The carrier has refused to allow her to see Dr. Parsioon. Additionally, Mr. Pruitt has
not voluntarily provided a new panel.

       In support of her position, Ms. Cervantes offered Dr. Dockery’s medical records
and causation letter. While Dr. Dockery related Ms. Cervantes’s current symptoms to her
work injury, no records state that Dr. Parsioon declined to treat her for these symptoms.
Thus, Ms. Cervantes did not carry her burden of proving that she is entitled to a new
authorized treating physician.

       The Court disagrees that the previous admission prohibits Ms. Cervantes from
seeking additional medical treatment. The Tennessee Court of Appeals has held that “[a]
party is not ordinarily bound by admissions or averments of legal conclusions.” Old
Hickory Coaches, LLC v. Star Coach Rentals, Inc., 652 S.W.2d 802, 813 (Tenn. Ct. App.
2021). Here, finding whether Ms. Cervantes already received all treatment she is entitled
to is a legal conclusion, so the Court holds that Ms. Cervantes is not bound by this
admission.

       Section 240(d) allows parties to settle the issue of future medical benefits once
reviewed and approved by a judge. But “[u]nless a court terminates an employee’s
entitlement to medical benefits or approves a settlement in which the parties reach a
compromise on the issue of future medical benefits, an injured worker remains entitled to
reasonable and necessary medical treatment causally-related to the work injury.”
Limberakis, at *7.

        Here, Ms. Cervantes testified that, after Dr. Parsioon released her to return to work,
her pain increased. She stated that she returned to Dr. Filipcic after the carrier denied her
return to Dr. Parsioon.

       The Court has not terminated Ms. Cervantes’s medical benefits, no settlement has
been reached terminating them, and Dr. Dockery relates her current complaints to her work
injury. Therefore, she has proven that she is still entitled to reasonable and necessary
medical treatment causally related to her work injury. That includes a return visit to her
authorized treating physician, Dr. Parsioon.

   IT IS THEREFORE ORDERED as follows:
   1. Ms. Cervantes’s request to have Dr. Dockery as her authorized treating physician is
      denied.
2. Ms. Cervantes is allowed to return to her authorized treating physician, Dr.
   Parsioon, for any reasonable and medical treatment he relates to her work injury.

3. The Court sets a status conference on April 9, 2024, at 1:30 p.m. Central Time.
   The parties must call 866-943-0014 to participate. Failure to call might result in a
   determination of the issues without the party’s participation.

4. Unless an 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
   Employer must submit confirmation of compliance with this Order to the Bureau by
   email to WCCompliance.Program@tn.gov no later than the seventh business day
   after entry of this Order. Failure to submit confirmation within seven business days
   may result in a penalty assessment for non-compliance. For questions as to
   compliance, contact the Workers’ Compensation Compliance Unit by email at
   WCCompliance.Program@tn.gov.

ENTERED March 12, 2024.

                               ________________________________________
                               Judge Shaterra R. Marion
                               Court of Workers’ Compensation Claims
                                      APPENDIX

Exhibits:
   1. Medical Records Submitted by Employer
   2. Medical Records Submitted by Employee
   3. First Report of Injury
   4. Requests for Admission

Technical Record:
   1. Petition for Benefit Determination
   2. Dispute Certification Notice
   3. Hearing Request, along with Affidavit of Elisabeth Cervantes, filed April 14, 2023
   4. Order on Status Hearing, filed December 5, 2023
   5. Order on Status Hearing, filed February 5, 2024
   6. Employer’s Prehearing Brief, Exhibit List, and Witness List
   7. Order Granting Motion to Deem Requests Admitted, filed March 8, 2023
   8. Employee’s Amended Responses to Requests for Admission, filed October 27, 2023
   9. Employer’s Response to Employee’s Amended Answers to Request for Admissions
      Propounded, filed November 6, 2023

                           CERTIFICATE OF SERVICE

      I certify that a copy of this Order was sent as indicated on March 12, 2024.

  Name                     Regular    Email    Service sent to:
                            Mail
  Elisabeth Cervantes,       X          X      387 Comanche Drive
  Employee                                     Millington, TN 38053
                                               elisadomingo@live.com
  Lauren Poole,                         X      lmpoole@mijs.com
  Employer’s attorney                          hjrowland@mijs.com

                                         ______________________________________
                                            PENNY SHRUM, COURT CLERK
                                                 wc.courtclerk@tn.gov
                                              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 file-
stamped 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 1 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]

LB-1099 rev. 01/20                                 Page 2 of 2                                        RDA 11082