Court Opinion

ID: 9392046
Source: CourtListenerOpinion
Date Created: 2023-05-03 20:33:36.584847+00
Date Added: 2024-06-11T17:18:30.288234
License: Public Domain

FILED
                                                                                                May 03, 2023
                                                                                                01:10 PM(CT)
                                                                                            TENNESSEE COURT OF
                                                                                           WORKERS' COMPENSATION
                                                                                                  CLAIMS

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

    SHERRY MILLEDGE,                                   )   Docket Number: 2022-02-0181
             Employee,                                 )
    v.                                                 )
    K-VA-T FOOD STORES,                                )
    INCORPORATED OF TENNESSEE,                         )   State File Number: 72475-2021
             Employer,                                 )
    And                                                )
    SAFETY FIRST INSURANCE                             )
    COMPANY,                                           )   Judge Brian K. Addington
             Carrier.                                  )

                                 EXPEDITED HEARING ORDER

      Ms. Milledge asked the Court to order K-VA-T to provide specific medical benefits
and pay past medical bills during an expedited hearing on April 27, 2023.1 For the reasons
below, the Court finds she is entitled to medical benefits.

                                              Claim History

       Ms. Milledge worked in the floral department at a K-VA-T Food City store. On
September 20, 2021, she lost her footing and slipped in water but was able to stop herself
from falling to the floor. She reported the incident and was given a panel. She selected an
occupational urgent care clinic and was seen the same day. The urgent care doctor ordered
an x-ray of her low back and diagnosed “uncomplicated lumbar strain.”

      After her third visit, her pain had not improved. A nurse practitioner noted that Ms.
Milledge had not taken the medicines she prescribed and that Ms. Milledge “does not seem
to want to follow restrictions or directions to improve her injury.” She referred Ms.
Milledge to physical therapy. Ms. Milledge attended therapy but did not report any major

1
    Ms. Milledge also asked for mileage reimbursement but said at the hearing it was no longer an issue.

                                                      1
pain relief. In response, the nurse practitioner ordered an MRI, after which she referred Ms.
Milledge to an orthopedist and restricted her lifting to two pounds.2

       Ms. Milledge selected Dr. Jody Helms, a neurosurgeon, from a panel. She saw him
in December 2021. He noted, “[she] has not acutely distorted the anatomy of her spine,”
and the MRI showed “an age-appropriate spine.” He prescribed pain medicine and ordered
a TENS Unit and more physical therapy. When Ms. Milledge returned to Dr. Helms, he
reported she was still in pain “in the original spot of her injury,” and he ordered an injection,
which Ms. Milledge declined.

       During physical therapy in January 2022, the therapist noted Ms. Milledge had
decreased strength in her trunk and legs. Ms. Milledge later reported to her therapist that
she had pain in both legs radiating to her feet. Ms. Milledge described altering her gait to
ease her leg pain and reported periods of complete numbness in her left leg.3

        Dr. Helms last saw Ms. Milledge in February 2022. At that visit, he wrote: “Patient
claims continued low back pain . . . She continues to describe the worst spot being to the
right over her sacrum in the lower facet region. She still does not describe any leg pain.”
Dr. Helms assigned maximum medical improvement and released her to full-duty work.
However, after the appointment, she reconsidered the injection, and Dr. Helms scheduled
it with Dr. William Platt.

      Dr. Platt examined Ms. Milledge and noted her primary complaint as “right low
back pain.” He further wrote:

        I don’t feel I have anything to offer [for] treatment. Although she complains
        of right lumbosacral area pain with weight bearing, Ms. Milledge seems to
        be able to use the extremity without pain or noticeable dysfunction when
        distracted. I am not able to clearly isolate a pain generator . . . There is not a
        diagnostic test that points towards a specific structure.

      Dr. Platt declined to administer the injection, after which Dr. Helms again
determined that Ms. Milledge had reached maximum medical improvement.

      Since then, Ms. Milledge has complained of pain in her leg. She wants to get the
problem fixed. She also requested payment of past-due bills from Holston Medical Group,

2
  Ms. Milledge had seven total visits to urgent care. The records from each visit lists “low back” as her chief
complaint. They also state that Ms. Milledge was warned about “red flag symptoms,” such as weakness or
loss of sensation or function in an extremity, and she was told to seek immediate medical attention if any
symptom occurred.
3
  This is the first notation of leg pain, numbness, or weakness in the medical records.

                                                      2
the physical therapy provider.4 She stated that HMG sent her bills and made repeated calls
and texts for payment of authorized treatment before referring her account to collections.

       K-VA-T argued that it provided Ms. Milledge appropriate medical treatment, and
without a specific recommendation from the authorized physician, it does not owe Ms.
Milledge additional treatment. It also contended that Ms. Milledge has not always complied
with treatment recommendations or did so after some length of time. Lastly, it explained
that her failure to sign a medical authorization has delayed investigation and payment of
any outstanding bills.

                          Findings of Fact and Conclusions of Law

       At an Expedited Hearing, Ms. Milledge must prove she is likely to prevail at a
hearing on the merits that she is entitled to the requested benefits. Tenn. Code Ann. § 50-
6-239(d)(1) (2022).

       Tennessee Code Annotated section 50-6-204(a)(1)(A) states that an employer shall
furnish free of charge to the employee “treatment . . . made reasonably necessary” by the
work accident.

       The Court must first address the issue that Ms. Milledge has not always complied
or agreed with the providers’ treatment recommendations. She may do so but runs the risk
of a suspension of benefits during the period of her noncompliance. Tenn. Code Ann. § 50-
6-204(d)(7). Considering that Ms. Milledge may have misunderstood her injury and the
recommendations, the Court does not find her to be noncompliant.

       Here, Ms. Milledge requested treatment for leg pain that she asserts is related to her
work injury. She may justifiably have been confused that her leg pain was caused by low
back generators, for which K-VA-T has provided medical benefits. The Court holds that
Ms. Milledge is entitled to continued treatment for her back as recommended by Dr. Helms,
so long as he primarily relates the need for treatment to her work injury. Since Ms. Milledge
now has a better understanding of what is causing her pain, the Court holds that she may
return to Dr. Helms with her current complaints.

      As for the medical bills from HMG, Ms. Milledge was billed for physical therapy.
Although the bills are not certified, K-VA-T did not object to their introduction as
evidence. It also committed to make every effort to investigate their non-payment, since it
now has Ms. Milledge’s medical authorization. K-VA-T may use the services of the
Bureau’s Medical Payment Committee or the Medical Director to resolve the issue. Tenn.
Code Ann. §§ 50-6-125, -126.

4
 The bills were not certified. The statements showed that K-VA-T paid a portion of them, but a balance
remains.

                                                  3
       Further, HMG sent Ms. Milledge multiple statements and made telephone calls and
text messages to collect the balance, before eventually referring the account for collections.

       The Bureau’s Compliance Program is specifically authorized to assess penalties
under the Workers’ Compensation Law as well as the General Rules of the Workers’
Compensation Program. So, the Court refers Holston Medical Group to the Compliance
Program for possible penalty assessments regarding its handling of Ms. Milledge’s claim.
Specifically, the Program should consider whether HMG pursued a private claim against
Ms. Milledge for collection of a compensable medical bill in violation of Tennessee Code
Annotated section 50-6-122(b).

       It is ORDERED as follows:

       1. K-VA-T shall authorize a return visit for Ms. Milledge to Dr. Helms.

       2. K-VA-T shall investigate and pay any unpaid HMG bill for authorized physical
          therapy.

       3. The case is referred to the Compliance Program for the possible assessment of a
          penalty as outlined above.

       4. This case is set for a Status Hearing on June 7, 2023, at 10:00 a.m. Eastern
          Time. The parties or their counsel must call 855-543-5044 to participate. Failure
          to call may result in a determination of the issues without the party’s
          participation.

       5. 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
          WCCompliance.Program@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 by email at WCCompliance.Program@tn.gov.

       ENTERED May 3, 2023.

                                             /s/ Brian K. Addington
                                           ______________________________________
                                           BRIAN K. ADDINGTON, JUDGE
                                           Court of Workers’ Compensation Claims
                                              4
                                         Appendix

    Exhibits:
       1. Ms. Milledge’s affidavit
       2. HMG medical bills
       3. Medical records:
                a. BHMA Occupational Medicine
                b. Dr. Jody Helms
                c. Dr. William Platt
       4. Holston Medical Group-Physical Therapy records

    Technical Record:
       1. Petition for Benefit Determination
       2. Dispute Certification Notice
       3. Hearing Request
       4. Employer’s Pre-Hearing Statement
       5. Employee’s Pre-Hearing Statement

                         CERTIFICATE OF SERVICE

            I certify that a copy of this Order was sent on May 3, 2023.

        Name             Certified Fax       Email            Service sent to:
                          Mail
Sherry Milledge,            X                 X      1113 Lomax St.
Employee                                             Apt. C8
                                                     Kingsport, TN 37660
                                                     scmill422@aol.com
Ramesh Murthy,                                X      rmurthy@pennstuart.com
Employer’s Attorney                                  eyarber@pennstuart.com
Compliance Program                            X      WCCompliance.Program@tn.gov

                                      ______________________________________
                                      PENNY SHRUM, COURT CLERK
                                      wc.courtclerk@tn.gov

                                         5
                                              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