Court Opinion

ID: 9369105
Source: CourtListenerOpinion
Date Created: 2023-02-07 20:41:57.438073+00
Date Added: 2024-06-11T17:16:12.833859
License: Public Domain

FILED
                                                                                 Feb 07, 2023
                                                                                 02:33 PM(CT)
                                                                                  TENNESSEE
                                                                             WORKERS' COMPENSATION
                                                                                APPEALS BOARD

            TENNESSEE BUREAU OF WORKERS’ COMPENSATION
               WORKERS’ COMPENSATION APPEALS BOARD

Sebastian Mitchell                           )   Docket No.      2020-01-0494
                                             )
v.                                           )   State File No. 46913-2020
                                             )
AECOM d/b/a Shimmick                         )
Construction, Inc., et al.                   )
                                             )
                                             )
Appeal from the Court of Workers’            )   Heard January 27, 2023
Compensation Claims                          )   in Nashville, Tennessee
Thomas L. Wyatt, Judge                       )

                                Affirmed and Remanded

In this second interlocutory appeal of this case, the employer questions the trial court’s
finding that it was non-compliant with the trial court’s prior orders and its award of
attorneys’ fees to the employee. The employee reported suffering a work-related injury to
his right hand that became infected, requiring emergency surgery. The claim was denied,
but, after an expedited hearing, the trial court determined that the employee was likely to
prevail at trial and ordered the payment of medical bills related to the employee’s
emergency medical treatment. We affirmed that order on appeal. Thereafter, the employer
paid some of the bills for the employee’s emergency treatment, and the parties negotiated
a tentative settlement agreement; however, other bills remained outstanding. The
employee filed two motions to compel compliance with the order for payment, both of
which the trial court granted. The trial court also awarded the employee attorneys’ fees
related to the second motion. The employer has appealed, arguing that it is not non-
compliant because the medical facility at which the employee received his emergency
treatment will not provide the bills consistent with applicable regulations, obstructing the
employer’s ability to pay. The employer also argues that the employee’s counsel is not
entitled to attorneys’ fees. We affirm the trial court’s order for medical benefits and
attorneys’ fees and remand the case.

Judge Meredith B. Weaver delivered the opinion of the Appeals Board in which Presiding
Judge Timothy W. Conner and Judge Pele I. Godkin joined.

Stephanie A. Rockwell, Lawrenceville, Georgia, for the employer-appellant, AECOM
d/b/a Shimmick Construction, Inc.

                                             1
Kathleen M. Reed, Chattanooga, Tennessee, for the employee-appellee, Sebastian Mitchell

                         Factual and Procedural Background

       Our previous opinion resolving the first interlocutory appeal set out a detailed
factual history of this case. For purposes of this opinion, we include excerpts to provide
context.

      Sebastian Mitchell (“Employee”) was hired as a laborer by AECOM, d/b/a
      Shimmick Construction, Inc. (“Employer”), to work on a construction
      project related to Tennessee Valley Authority’s enlargement of the lock at
      Chickamauga Dam in Hamilton County, Tennessee. The project included
      drilling holes in the river bottom into which pylons could be inserted.

       Employee alleged he sustained a laceration to his right thumb while shoveling
sludge on April 7, 2020, which he allegedly reported to his supervisor. Although his thumb
began to swell before he left work, he did not obtain any medical treatment that day. As
discussed in our prior opinion:

      The following day, Employee saw a nurse practitioner at a primary care
      facility in South Pittsburg, Tennessee. According to the medical report,
      Employee reported pain and swelling in his right thumb that started the
      previous day and was gradually worsening. The report stated that Employee
      “denies fever or recent injury,” and noted that on March 30, 2020, Employee
      had “acute idiopathic gout of right hand.” The April 8, 2020 report included
      “Indications” of “acute idiopathic gout of right hand” for which Employee
      was prescribed medication.

             Three days after his visit to the primary care facility, Employee
      presented to a local hospital emergency room and was admitted for
      emergency surgery, which was performed the following morning.
      Employee’s postoperative diagnosis was “Cellulitis, right forearm nearing
      infectious compartment syndrome, [c]arpal tunnel syndrome, [v]olar flexor
      tenosynovitis, and [t]enosynovitis to all five digits.”

Dr. Chris Pankiw, an orthopedic surgeon specializing in hand and upper extremity surgery,
performed the surgery and subsequently provided an affidavit stating that Employee’s “cut,
infection and sequelae of the infection arose primarily out of and in the course and scope
of his employment.”

       Employer denied the claim on the bases that notice was not properly given and that
the injury was not work related. The trial court determined that there was a reasonable
excuse for Employee’s failure to give timely notice and that Employer did not submit any

                                            2
evidence of prejudice allegedly caused by the late notice. The trial court concluded
Employee would likely prevail at trial in proving a compensable injury and ordered
Employer to pay all charges related to the emergency care Employee received, including
the initial surgery performed by Dr. Pankiw and related hospital expenses. The trial court
did not award any additional medical expenses at that time and declined to award
temporary total disability benefits. On appeal, we affirmed the trial court’s order in all
respects.

        After the issuance of our August 2021 opinion, Employer requested the outstanding
medical bills from Parkridge Medical Center, where Employee had obtained his emergency
care. Employer, the adjuster, Employer’s attorney, and Employer’s attorney’s staff all
provided affidavits detailing their efforts, including phone calls, letters, and emails to the
facility, to obtain the billing statements on a Form UB-92. 1 Despite these efforts, it appears
that Employer received only one Form UB-92 from Parkridge Medical Center for date of
service April 11, 2020, which it paid. 2

        Thereafter, Employee filed a motion to compel payment of the outstanding medical
bills and for attorneys’ fees pursuant to Tennessee Code Annotated section 50-6-
227(d)(1)(A). Employer filed a response, stating it still had not received the outstanding
bills on a proper form. After a review of the record, the court ordered the payment of the
outstanding bills within 30 business days regardless of receipt of the proper forms, and it
deferred a determination on the issue of attorneys’ fees. Despite this order, Employer did
not pay the medical bills within thirty days, prompting Employee to file another motion in
September 2022. 3 Thereafter, the trial court issued an order noting Employer did not
request billing statements on specific forms from Parkridge until January of 2022, over
four months after the initial order for payments of benefits. The court again ordered the
payment of the outstanding bills, this time within seven business days, and awarded
attorneys’ fees of $2,000 based on an affidavit submitted by Employee’s counsel pursuant
to Tennessee Code Annotated section 50-6-227(d)(1)(A). The court also referred
Employer to the Bureau’s penalty unit for consideration of penalties pursuant to Tennessee
Code Annotated section 50-6-118. 4 Employer has appealed.

1
 Although not specified in the most recent version of Tenn. Comp. R. and Regs. 0800-02-17-.10(4) as
appropriate for the processing of medical bills, a Form UB-92 is an industry standard form.
2
  Employer also paid Dr. Pankiw’s outstanding charges for services performed prior to Employee’s release
from the hospital.
3
 Employer would not proceed with approval of the settlement agreement until the Parkridge Medical Center
bills were paid. As such, Employee also asked in its motion for the court to order the parties to have the
settlement approved. The court denied that request, and Employee did not appeal that determination.
4
    At oral argument, counsel for Employer stated that the penalty referral has been resolved by agreement.
                                                      3
                                        Standard of Review

        The standard we apply in reviewing a trial court’s decision presumes that the court’s
factual findings are correct unless the preponderance of the evidence is otherwise. See
Tenn. Code Ann. § 50-6-239(c)(7) (2022). When the trial judge has had the opportunity
to observe a witness’s demeanor and to hear in-court testimony, we give considerable
deference to factual findings made by the trial court. Madden v. Holland Grp. of Tenn.,
Inc., 277 S.W.3d 896, 898 (Tenn. 2009). However, “[n]o similar deference need be
afforded the trial court’s findings based upon documentary evidence.” Goodman v.
Schwarz Paper Co., No. W2016-02594-SC-R3-WC, 2018 Tenn. LEXIS 8, at *6 (Tenn.
Workers’ Comp. Panel Jan. 18, 2018). Similarly, the interpretation and application of
statutes and regulations are questions of law that are reviewed de novo with no presumption
of correctness afforded the trial court’s conclusions. See Mansell v. Bridgestone Firestone
N. Am. Tire, LLC, 417 S.W.3d 393, 399 (Tenn. 2013). We are also mindful of our
obligation to construe the workers’ compensation statutes “fairly, impartially, and in
accordance with basic principles of statutory construction” and in a way that does not favor
either the employee or the employer. Tenn. Code Ann. § 50-6-116 (2022).

                                                Analysis

      Employer raises two issues on appeal, which we have restated as follows: (1)
whether Employer is obligated pay medical bills that are not submitted on the forms as
contemplated by Tenn. Comp. R. and Regs. 0800-02-17-.10(4); and (2) whether the court
can award attorneys’ fees pursuant to Tennessee Code Annotated section 50-6-
226(d)(1)(A) under these circumstances.

                             Court-Ordered Payment of Medical Bills

       Tenn. Comp. R. and Regs. 0800-02-17-.10(4) states that “[b]illing for provider
services shall be provided on industry standard billing forms; UB-04, CMS-1450, CMS-
1500 . . . or their official replacement forms.” Employer contends this rule has prevented
them from paying the medical bills as ordered by the trial court because they are not on the
proper form. We conclude this argument is without merit.

       The rule upon which Employer relies does not address an employer’s obligation to
furnish medical treatment, pay medical bills, or comply with court orders. Instead, it places
an obligation on medical providers to submit bills on “industry standard billing forms.” 5
We can find no authority that would allow an employer to use this particular rule as a shield
against payment of medical bills that are reasonable, necessary, and causally related to the

5
 We note that the rule at issue does not purport to contain a comprehensive list of all “industry standard
billing forms,” but instead lists current examples of such forms and includes the “official replacement[s]”
of such forms.
                                                    4
work accident, much less as justification for failing to comply with a court order requiring
the payment of those bills.

        Moreover, in cases where there is a dispute regarding the payment of a medical bill,
the statute provides a specific remedy in section 50-6-125, which establishes a medical
payment committee. This committee “shall hear disputes on medical bill payments
between providers and insurers.” Tenn. Code Ann. § 50-6-125(a)(1) (2022). Furthermore,
Tennessee Code Annotated section 50-6-126 addresses the authority of the Bureau of
Workers’ Compensation’s Medical Director, which includes, among other things, the
ability to “effect optimal treatment,” “recommend corrective action,” and address “the
disposition of complaints concerning other aspects of the medical management of a
workers’ compensation case.” Tenn. Code Ann. § 50-6-126 (2022).

       During oral argument, Employer’s counsel acknowledged that Employer has not
sought the assistance of the medical payment committee or the assistance of the Bureau’s
Medical Director. Employer also did not file a motion seeking the trial court’s assistance
by requesting the issuance of a subpoena for any of the outstanding medical bills. In short,
the record reflects that Employer has failed to comply with the orders of the trial court and
has failed to use the administrative processes available to it to effectuate compliance with
those orders. As such, the trial court’s order compelling Employer to pay the outstanding
medical expenses is affirmed.

                                      Attorneys’ Fees

        Tennessee Code Annotated section 50-6-226(d)(1) allows the court to award
reasonable attorneys’ fees and reasonable costs “incurred when the employer . . . fails to
furnish appropriate medical . . . care . . . provided for in a settlement, expedited hearing
order, compensation hearing order, or judgment.” Employer contends that no medical care
has been withheld because the only disputed issue is the payment of medical expenses after
care was already received. Employer submits that it provided a panel as ordered by the
trial court in its first expedited hearing order, and that Employee has not sought any further
medical treatment since it provided the panel.

        Although Employee did not seek any medical care following the trial court’s order,
that is not our only inquiry; we must also consider whether Employer failed to satisfy its
obligations to provide medical care as ordered by the trial court. Tennessee Code
Annotated section 50-6-204(a)(1)(A) requires that the employer “furnish, free of charge to
the employee, such medical care . . . made reasonably necessary” by a work-related injury.
In considering that language in conjunction with section 50-6-226(d)(1)(A), we must
decide whether the term “furnish” includes not only the authorization of reasonable and
necessary medical care but also the payment of the medical expenses incurred as a result
of such care. We conclude that the “furnish[ing]” of medical care as required by Tennessee
Code Annotated section 50-6-204(a)(1)(A) includes paying for it.

                                              5
         Recently, in Food Lion, Inc. v. Wilburn, No. E2021-01494-SC-R3-WC, 2023 Tenn.
LEXIS 2 (Tenn. Workers’ Comp. Panel Jan. 11, 2023), the Supreme Court’s Special
Workers’ Compensation Appeals Panel addressed a case in which the employee had
already settled her claim, the terms of which included her right to future medical benefits
with her authorized physician for treatment causally related to the work injury. Id. at *1.
Several years later, the employer obtained a medical examination by another provider. Id.
at *2. This medical examination resulted in a new diagnosis and a new expert opinion
regarding the cause of the employee’s condition. Id. at *5-6. As a result, the employer
filed a motion for a court order to terminate medical benefits. Id. at *7. The employee was
successful in defeating the motion, and her attorney sought an award of fees for his work
in the case. Id. at *9-10. The trial court denied the claim for attorney’s fees because the
employee’s medical care was never stopped and employer continued to pay for the medical
care. Id. at *10. The Appeals Panel affirmed, stating “[b]ecause the statute at issue allows
attorney’s fees only ‘when the employer fails to furnish’ appropriate medical treatment,
and it is undisputed that Food Lion continued paying for . . . [the] treatment of [Employee]
at all relevant times,” the trial court had properly denied the motion for attorneys’ fees. Id.
at *19-20 (emphasis added). The court, interpreting relevant statutory language now
contained in section 50-6-226(d)(1), explained that it only “applies to cases in which an
employer denies medical treatment, and the employee is forced to resort to judicial
proceedings to obtain that care.” Id. at *18.

        For purposes of our evaluation of this case, it is significant to note that the Appeals
Panel interpreted the “furnishing” of medical care as including both the authorization of
such care and the payment of medical expenses incurred as a result. Consequently, we
conclude that the word “furnish,” as used in both sections 204(a)(1)(A) and 226(d)(1)(A),
includes both the authorization and payment of reasonable and necessary medical care
causally related to the work injury. 6 Here, although Employee had already received the
care for which Employer was later deemed liable, it was only through judicial intervention
that Employer was ordered to pay for that care, and it was only through additional judicial
intervention, including two appeals, that Employer has repeatedly been ordered to pay for
that treatment. As such, we conclude it was not an abuse of discretion for the trial court to
award attorneys’ fees in the amount of $2,000. We further conclude that the award of
attorneys’ fees under these circumstances was appropriate at this stage of the case. See

6
 See also Minutella v. Ford Motor Credit Co., No. M2008-01920-WC-R3-WC, 2009 Tenn. LEXIS 724, at
*16 (Tenn. Workers’ Comp. Panel November 12, 2009) (The employer, “without valid reason,” failed to
authorize medical treatment, and “only by resorting to litigation was Employee successful in obtaining such
authorization,” thereby supporting an award of attorneys’ fees); Norfleet v. J. W. Goad Constr., No. M2001-
00425-WC-R3-CV, 2001 Tenn. LEXIS 811, at *11 (Tenn. Workers’ Comp. Panel Dec. 3, 2001) (“Where
an employer refuses to provide reasonably necessary medical benefits, it may be assessed attorney fees and
reasonable costs necessary to enforce a court order requiring the payment of expenses incurred by the
employee for the recovery [of] such expenses.” (emphasis added)).
                                                    6
Thompson v. Comcast Corp., No. 2017-05-0639, 2018 TN Wrk. Comp. App. Bd. LEXIS
1, at *31 (Tenn. Workers’ Comp. App. Bd. Jan. 30, 2018).

                                      Conclusion

      For the foregoing reasons, we affirm the trial court’s expedited hearing order and
remand the case. Costs on appeal are taxed to Employer.

                                           7
                 TENNESSEE BUREAU OF WORKERS’ COMPENSATION
                   WORKERS’ COMPENSATION APPEALS BOARD

Sebastian Mitchell                                    )      Docket No. 2020-01-0494
                                                      )
v.                                                    )      State File No. 46913-2020
                                                      )
AECOM d/b/a Shimmick                                  )
Construction, Inc., et al.                            )
                                                      )
                                                      )
Appeal from the Court of Workers’                     )       Heard January 27, 2023
Compensation Claims                                   )       in Nashville, Tennessee
Thomas L. Wyatt, Judge                                )

                                   CERTIFICATE OF SERVICE

I hereby certify that a true and correct copy of the Appeals Board’s decision in the referenced
case was sent to the following recipients by the following methods of service on this the 7th day
of February, 2023.

 Name                              Certified   First Class   Via   Via     Sent to:
                                   Mail        Mail          Fax   Email
 Stephanie A. Rockwell                                               X     stephanie@speed-seta.com
                                                                           melissa@speed-seta.com
 Katie Reed                                                          X     katiereed@mcmahanlawfirm.com
                                                                           brentburks@mcmahanlawfirm.com
 Thomas L. Wyatt, Judge                                              X     Via Electronic Mail
 Kenneth M. Switzer, Chief Judge                                     X     Via Electronic Mail
 Penny Shrum, Clerk, Court of                                        X     penny.patterson-shrum@tn.gov
 Workers’ Compensation Claims

Olivia Yearwood
Clerk, Workers’ Compensation Appeals Board
220 French Landing Dr., Ste. 1-B
Nashville, TN 37243
Telephone: 615-253-1606
Electronic Mail: WCAppeals.Clerk@tn.gov