Court Opinion

ID: 9375462
Source: CourtListenerOpinion
Date Created: 2023-02-27 20:06:57.43215+00
Date Added: 2024-06-11T16:49:01.782464
License: Public Domain

FILED
                                                                                Feb 27, 2023
                                                                               01:28 PM(CT)
                                                                             TENNESSEE COURT OF
                                                                            WORKERS' COMPENSATION
                                                                                   CLAIMS

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

 JOSE MENDEZ,                              )    Docket Number: 2018-02-0214
          Employee,                        )
 v.                                        )
 ESKOLA ROOFING,                           )
          Employer,                        )    State File Number: 24741-2018
 and                                       )
 AMERICAN CASUALTY                         )
 COMPANY,                                  )
          Carrier.                         )    Judge Brian K. Addington

 ______________________________________________________________________

             EXPEDITED HEARING ORDER DENYING BENEFITS

       Mr. Mendez requested a decision on the record to determine if he is entitled to
temporary disability benefits from September 2021 to the present and ongoing. To succeed,
Mr. Mendez must show he is likely to prevail at a hearing on the merits in his request for
additional temporary disability benefits. Eskola denies he is entitled to the requested
benefits. For the reasons below, the Court holds Mr. Mendez is not likely to prevail at a
hearing on the merits on the issue of additional temporary disability benefits, and his
request is denied.

                                     Claim History

       On April 2, 2018, Mr. Mendez fell from the roof of a building causing multiple
injuries. Eskola covered medical treatment with multiple doctors including neurosurgeon
Kenneth Smith. In January 2020, Dr. Smith noted that Mr. Mendez’s condition did not
require surgery and referred him for a neuropsychological evaluation. Mr. Mendez has yet
to complete a neuropsychological evaluation due to Covid, communication problems, and
Mr. Mendez’s refusal to undergo the evaluation.

        Mr. Mendez saw Dr. Smith again in May 2022. At that appointment, Dr. Smith’s
office referred him to pain management for treatment of occipital neuralgia and again to a

                                            1
neuropsychiatrist.1 Dr. Smith’s office note stated, “There are no further recommendations
or treatment from this office as you are nonsurgical in nature.” But Dr. Smith also wrote
that he did not consider Mr. Mendez to be at maximum medical improvement because he
had not completed the recommended treatment.

        Mr. Mendez selected Dr. Wayne Woodbury from a panel, and his first appointment
was in January 2023. Dr. Woodbury diagnosed septal neuralgia and recommended an
injection for pain.

        Mr. Mendez last received temporary disability benefits in September 2021. He
requested benefits from September 2021 through the present and ongoing. He argued he
has not reached maximum medical improvement and that Dr. Woodbury’s request for an
injection represents active treatment of his physical injuries.

      Eskola argued that under Tennessee Code Annotated section 50-6-207(1)(E) (2022),
Mr. Mendez is only receiving pain management and according to the Workers’
Compensation Law is at maximum medical improvement. Thus, he is not eligible for
temporary disability benefits.

                          Findings of Fact and Conclusions of Law

      To be successful, Mr. Mendez must show that he is likely to prevail at a hearing on
the merits. See McCord v. Advantage Human Resourcing, 2015 TN Wrk. Comp. App. Bd.
LEXIS 6, at *9 (Mar. 27, 2015).

       Tennessee Code Annotated section 50-6-207(1)(E) states an employee “shall be
conclusively presumed to be at maximum medical improvement when the treating
physician ends all active medical treatment and the only care provided is for treatment of
pain or for a mental injury that arose primarily out of a compensable physical injury.”
(Emphasis added).

       This Court held on February 9, 2022, that Mr. Mendez was conclusively presumed
to be at maximum medical improvement under Tennessee Code Annotated section 50-6-
207(1)(E) because Dr. Smith stated there was nothing to offer him from a surgical
standpoint and referred him to pain management.

      Mr. Mendez again requests the Court order temporary disability and asserts that
because his pain management doctor ordered an injection, he is receiving active treatment.
The Court disagrees.

1
 The office note is signed by Carla Cheek, NP, but states that Mr. Mendez was seen by Dr. Smith at the
appointment.

                                                  2
        While Mr. Mendez may be attending appointments and receiving treatment from a
doctor, it is for pain management purposes only. Dr. Woodbury offered the injection to
treat Mr. Mendez’s pain (headaches). Thus, the Court again finds that Mr. Mendez reached
maximum medical improvement when Dr. Smith referred him to pain management. His
right to temporary benefits terminated at that time.

IT IS, ORDERED as follows:

   1. Mr. Mendez’s request for temporary benefits is denied.

   2. This case is to be set for a Scheduling Hearing. The Court’s staff attorney will
      contact the parties to schedule the hearing within the next sixty days.

ENTERED February 27, 2023.

                                             /s/ Brian K. Addington
                                           ______________________________________
                                           BRIAN K. ADDINGTON, JUDGE
                                           Court of Workers’ Compensation Claims

                                      Appendix

Exhibits:
   1. Affidavit of Mr. Mendez
   2. Medical record of Dr. Wayne Woodbury
   3. Medical record of Dr. Kenneth Smith (January 2020-May 2022)
   4. Medical record of Dr. Rachel Lacey

Technical Record:
   1. Petition for Benefit Determination
   2. Hearing Request
   3. Position Statement

                                             3
                         CERTIFICATE OF SERVICE

           I certify that a copy of this order was sent February 27, 2023.

        Name             Certified           Email   Service sent to:
                          Mail     Fax
Jose Mendez,                X                 X      jmendez2018.wc@gmail.com
Employee                                             112 Boone Street
                                                     Apt. 2
                                                     Jonesborough, TN 37659
Richard Clark,                                X      rclark@eraclides.com
Employer’s Attorney                                  jenniferdavis@eraclides.com

                                      ______________________________________
                                      PENNY SHRUM, COURT CLERK
                                      wc.courtclerk@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: “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 fully-
      completed 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.
                                              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