Court Opinion

ID: 9963366
Source: CourtListenerOpinion
Date Created: 2024-04-25 12:35:49.809708+00
Date Added: 2024-06-11T08:24:47.622274
License: Public Domain

FILED
                                                                               Apr 25, 2024
                                                                              07:00 AM(CT)
                                                                            TENNESSEE COURT OF
                                                                           WORKERS' COMPENSATION
                                                                                  CLAIMS

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

 Pamela Adams,                             )   Docket No. 2024-60-0763
             Employee,                     )
 v.                                        )
 LHC Group, a/k/a SunCrest                 )   State File No. 19187-2023
 Companion Services,                       )
             Employer,                     )
 And                                       )   Judge Kenneth M. Switzer
 Indemnity Insurance Co. of N.A.,          )
              Carrier.                     )

     EXPEDITED HEARING ORDER DENYING REQUESTED RELIEF
                  (DECISION ON THE RECORD)

      Pamela Adams requested an expedited hearing on the record without objection from
SunCrest Companion Services. Ms. Adams seeks panels of ear, nose, and throat specialists
and ophthalmologists, temporary disability benefits, and attorney’s fees. For the reasons
below, the Court denies her requests at this time.

                                    Claim History

      Ms. Adams, a licensed practical nurse, was assisting a patient on March 3, 2023,
when she injured her shoulder as she fell backward before landing on her elbows and right
arm. She also hit her head on a door as she fell. SunCrest accepted the claim, and Dr.
Matthew Willis performed shoulder surgery in May.

        For the head injury, Ms. Adams chose Dr. Subir Prasad from a panel. At her first
visit in October, Dr. Prasad ordered an MRI and prescribed medication. He noted visual
changes and tinnitus and wrote that he might order evaluations by an ophthalmologist and
ENT if the MRI results were normal and her symptoms did not improve from the
medication.

                                           1
      In November, Dr. Prasad made referrals to both an ENT and ophthalmologist after
the MRI results were normal, but apparently Ms. Adams’s symptoms continued.1

                                       Letters to Dr. Prasad

       Both attorneys sent Dr. Prasad letters asking about the referrals, which this decision
turns on.

        SunCrest sent the first letter to Dr. Prasad asking about the referrals and causation.
In his response, Dr. Prasad checked “yes” when asked, “Would you agree that a referral to
the ENT specialist for a diagnosis of tinnitus is not more than 50% related to the work
incident, which occurred on March 3, 2023?” (Emphasis in original). Dr. Prasad likewise
checked “yes” when asked, “Would you agree that the referral for blurry vision to an
ophthalmologist was not more than 50% related to the work incident on March 3, 2023?”
Based on these responses, SunCrest did not honor the referrals.

       Ms. Adams sent a follow-up letter to Dr. Prasad. The initial questions dealt with
the ENT referral as it relates to vestibular disorder. She asked, “Do you agree or disagree
that based on clinical findings and reports to you by Ms. Adams that she has dizziness[,]
which may be some form of vestibular disorder, you opine that she needs to see an ENT
specialist?” Dr. Prasad wrote “yes.” She then asked, “That because you profess not to be
an expert in vestibular disorders, do you agree or disagree that you cannot render an opinion
as to whether or not the causation of a potential vestibular disorder is causally related to
striking her head at work?” Dr. Prasad wrote, “disagree—I can opine on neurologic
etiologies of vestibular disorder.”

       The next pair of questions asked about tinnitus. “Do you agree or disagree that
based upon clinical findings and reports to you by Ms. Adams that she suffers from ringing
in her ears[,] which could be tinnitus, you opine that she needs to see a specialist most
likely an ENT, who can diagnose and treat tinnitus?” Dr. Prasad wrote “yes.” She then
asked, “That because you profess not to be an expert in tinnitus, do you agree or disagree
that you cannot render an opinion as to whether or not the causation of the tinnitus is
causally related to striking her head in her work injury?” Dr. Prasad wrote, “disagree—I
can opine on neurologic etiologies of tinnitus.”

       Ms. Adams’s final questions touched on her blurred vision. She asked, “Do you
agree or disagree that based upon clinical findings or reports by your patient that she suffers
from blurred vision, which may or may not be a consequence of a vestibular disorder or
tinnitus, that she should be referred to an ophthalmologist for that blurred vision?” Dr.
Prasad wrote “yes.” Finally, she asked, “That because you profess not to be an expert in

1
 The parties only offered slips documenting the referrals and not the complete medical records from this
visit.
                                                   2
blurred vision[,] which could be a consequence of trauma, vestibular disorder, or tinnitus,
do you agree or disagree that you cannot render an opinion as to whether or not the blurred
vision is causally related to her striking her head at work?” Dr. Prasad wrote, “disagree—
I can opine on neurologic etiologies of visual symptoms.”

                    Evidence regarding temporary disability benefits

       After the shoulder surgery, Dr. Willis placed work restrictions; his last note dated
December 5 stated that Ms. Adams cannot lift more than ten pounds. None of Dr. Prasad’s
records specifically states that he took her off work or limited her to restricted duty.

       In her petition for benefit determination, Ms. Adams alleged that she received
temporary disability benefits until December 14. She did not testify in her declaration
about the circumstances of SunCrest offering her modified duty and her response. Rather,
the parties submitted written communications as the sole proof on this issue.

       In a December 14, 2023 letter, SunCrest’s human resources specialist, Laney
Guidry, sent Ms. Adams a letter offering her nursing work beginning December 18 within
her ten-pound lifting restriction. The letter assured Ms. Adams that the tasks would be
within her restrictions and instructed her to contact Ms. Guidry or a supervisor if she were
asked to work beyond her restrictions.

       Later, a January 5 email from Ms. Adams to Ms. Guidry stated that Ms. Adams
recently received “new restrictions” from Dr. Willis, although Ms. Adams did not submit
records documenting them. Ms. Adams additionally wrote that she is “willing and ready
to work within those restrictions.” Ms. Guidry asked if she could return the very next day,
but Ms. Adams declined, stating she had doctor appointments (unrelated to the injury).

        Ms. Adams also asked about her work duties. Ms. Guidry responded, “We can
accommodate you starting tomorrow working in the field with patient care within your
restrictions.” The next email, from Ms. Adams, stated, “Per our phone conversation at
10:47am today, you will inform me of the assignments available by the end of the day.”

        On January 8, Ms. Adams emailed Ms. Guidry again to state that she had not heard
back from her. Ms. Adams wrote, “I have followed all of your instructions to email
medication list and restrictions. I have not denied or refuse[d] any work within the
restrictions in December 2023 nor have I refused or denied to work within my restrictions
since our last conversation January 4th at 10:47 am [sic].”

       Ms. Guidry disagreed with these statements in her same-day response. She wrote
that Ms. Adams “indicated when [they] spoke in December that [she] would not be able to
accept the light duty offered due to medication, which [she] believed impaired [her] ability
to drive, although this limitation was not notated [sic] by [her] physicians.” Ms. Guidry

                                             3
then offered a light-duty position visiting patients, where she would not have to work
outside of her restrictions. She added that this position had a “focus on medication or
otherwise will be hands off visits that will not require you to carry a nurse’s bag.” If these
visits were unavailable, Ms. Guidry wrote that Ms. Adams would perform “administrative
work, which will primarily include answering phones or auditing files.” No response to
this offer was included in the record, and Ms. Adams filed her petition on February 1. 2

                             Findings of Fact and Conclusions of Law

       To obtain the requested relief, Ms. Adams must show a likelihood of prevailing at
a hearing on the merits. Tenn. Code Ann. § 50-6-239(c)(6) (2023).

                                             Medical benefits

        The initial question is whether SunCrest must comply with Dr. Prasad’s referrals
for treatment of Ms. Perry’s vestibular disorder and tinnitus. The parties agree that Dr.
Prasad, an authorized treating physician, referred Ms. Adams to an ENT and
ophthalmologist. SunCrest asserts that it does not need to honor them because the need for
the specialist treatment is not causally related to the work accident.

       The Workers’ Compensation Law states that an employer must furnish medical
treatment made reasonably necessary by a work accident. Id. at -204(a)(1)(A). An “injury”
includes an “injury by accident . . . arising primarily out of and in the course and scope of
employment” that causes the need for medical treatment. Id. at -102(12)(A). An injury
causes the need for medical treatment “only if it has been shown to a reasonable degree of
medical certainty that it contributed more than fifty percent” in causing the need for
medical treatment, considering all causes. Id. at -102(12)(C).

        Here, both parties sent letters to Dr. Prasad. Turning first to SunCrest’s attorney’s
letter, Dr. Prasad checked “yes” when asked, “Would you agree that a referral to the ENT
specialist for a diagnosis of tinnitus is not more than 50% related to the work incident on
March 3, 2023?” (Emphasis in original). Dr. Prasad likewise checked “yes” when asked,
“Would you agree that the referral for blurry vision to an ophthalmologist was not more
than 50% related to the work incident on March 3, 2023?” Based on these responses,
SunCrest did not honor the referrals. It contended that the authorized treating physician,
whose opinion is presumed correct under section 50-6-102(12)(E), does not believe they
relate to work.

       Ms. Adams’s letter did not ask Dr. Prasad’s causation opinion linking the referrals
to the work accident. It instead asked compound questions about whether the referrals
were necessary and whether he is qualified to give causation opinions.

2
    SunCrest noted in its brief that Ms. Adams returned to work without restrictions on March 5, 2024.

                                                      4
       Ms. Adams first asked, “Do you agree or disagree that based on clinical findings
and reports to you by Ms. Adams that she has dizziness[,] which may be some form of
vestibular disorder, you opine that she needs to see an ENT specialist?” Dr. Prasad wrote
“yes.” The Court presumes that Dr. Prasad meant that he “agrees” that Ms. Adams needs
to see an ENT. Counsel then asked Dr. Prasad if he cannot give a causation opinion
regarding Ms. Adams’s vestibular disorder and her striking her head at work. Dr. Prasad
wrote, “I can opine on neurologic etiologies of vestibular disorder.”

       As for the tinnitus, Ms. Adams asked the doctor whether he agreed or disagreed that
she “suffers from ringing in her ears[,] which could be tinnitus,” and if “she needs to see a
specialist most likely an ENT, who can diagnose and treat tinnitus?” Dr. Prasad wrote
“yes”—again meaning “agree.” She asked Dr. Prasad if he cannot give an opinion as to
whether the tinnitus is causally related to striking her head in her work injury. Dr. Prasad
wrote, “I can opine on neurologic etiologies of tinnitus.”

       Ms. Adams’s final questions about the blurred vision asked the doctor whether he
agreed or disagreed that she should be referred to an ophthalmologist for it. Dr. Prasad
wrote “yes,” meaning “agree.” Finally, she asked the doctor if he is unable to give a
causation opinion on whether the blurred vision is causally related to her striking her head
at work. Dr. Prasad wrote, “I can opine on neurologic etiologies of visual symptoms.”

       Considering both letters as a whole, the Court finds, based on SunCrest’s letter, that
Dr. Prasad does not believe the referrals are related to Ms. Adams’s work accident.
Considering Ms. Adams’s letter, the Court finds that Dr. Prasad believes Ms. Adams needs
treatment from an ENT and an ophthalmologist. The Court further finds that Dr. Prasad
believes he is qualified to give causation opinions about whether vestibular disorder and
tinnitus might arise from a blow to the head.

       What Ms. Adams’s lawyer did not ask, unfortunately, is whether the referrals and
need for additional treatment of vestibular disorder and tinnitus arose primarily out of
employment—meaning that to a reasonable degree of medical certainty, striking her head
at work contributed more than 50% in causing Ms. Adams’s need for the referrals and
additional treatment, considering all causes.

       The Appeals Board has held that, when the only medical opinion addressing
causation in the record is contrary to an employee’s position, “this opinion must carry the
day, as there is no authority to award benefits in the face of undisputed medical evidence
that an injury did not arise primarily out of the employment.” Berdnik v. Fairfield Glade
Com’ty Club, 2017 TN Wrk. Comp. App. Bd. LEXIS 32, at *16 (May 18, 2017).

       Ms. Adams’s sole proof—Dr. Prasad’s responses to her letter—do not convey any
causation opinion, much less one that supports her position. She bears the burden of proof.

                                             5
Tenn. Code Ann. § 50-6-239(c)(6). Therefore, the Court cannot find on this record that
Ms. Adams has satisfied her burden to show that Dr. Prasad believes her need for treatment
by specialists is related to the work incident. The Court holds that she is unlikely to prevail
at trial on this request.

                                Temporary partial disability

        Temporary partial disability refers to “the time, if any, during which the injured
employee is able to resume some gainful employment but has not reached maximum
recovery.” Hackney v. Integrity Staffing Solutions, Inc., 2016 TN Wrk. Comp. App. Bd.
LEXIS 29, at *11 (July 22, 2016) The trial court considers whether an employee has made
a “meaningful return to work” to determine whether an employee is entitled to temporary
partial disability benefits “in the face of an offer of light-duty work.” Id. at *12. When
considering whether an employee made a meaningful return to work, the trial court must
assess “the reasonableness of the employer in attempting to return the employee to work
and the reasonableness of the employee in failing to return to work.” Id. at *12-13.
Ultimately, “[t]he resolution of what is reasonable must rest upon the facts of each case
and be determined thereby.” Id. at *13.

      Here, SunCrest offered Ms. Adams nursing work within her restrictions on
December 14, 2023. The letter advised her that she should contact a supervisor or Ms.
Guidry if she believed the work exceeded her restrictions.

        SunCrest repeated the offer on January 5, 2024, asking her to report to work the next
day. Ms. Adams declined due to personal, unrelated doctor appointments. Ms. Adams
also asked about her specific assignments and did not receive a response to that question.
However, in the January 8 email, Ms. Guidry again offered her work within her restrictions.
She specified that Ms. Adams’s duties would include visiting patients where she would not
have to work outside of her restrictions, with a “focus on medication or otherwise [would]
be hands off visits that will not require . . . [carrying] a nurse’s bag.” Ms. Guidry offered
an alternative if these types of patients were unavailable—to perform “administrative work,
which [would] primarily include answering phones or auditing files.”

       In sum, SunCrest made three separate offers of light duty, the last of which
specifically outlined her tasks. SunCrest also identified two individuals whom Ms. Adams
could contact if she believed the work exceeded her restrictions.

        In contrast, Ms. Adams offered no proof of “additional restrictions” from Dr. Willis,
and Dr. Prasad placed none. Her only proof on this issue is her vague assertion to Ms.
Guidry that she never refused or denied work, which rings hollow. The Court finds that
SunCrest reasonably attempted to return Ms. Adams to work, and she acted unreasonably
in failing to attempt a return. Therefore, at this time, Ms. Adams is unlikely to show at
trial that she is entitled to temporary partial disability benefits.

                                              6
      IT IS, THERFORE, ORDERED AS FOLLOWS:

      1. Ms. Adams’s requests for panels of specialists, temporary disability benefits,
         and attorney’s fees are denied at this time.

      2. A status hearing will take place on June 10, 2024, at 10:15 a.m. Central Time.
         The parties must call 615-532-9552 or 866-943-0025.

                                 ENTERED April 25, 2024.

                                 ________________________________________
                                 JUDGE KENNETH M. SWITZER
                                 Court of Workers’ Compensation Claims

                                        Appendix

The Court considered these documents:

   1. Petition for Benefit Determination
   2. Causation letter sent by employer to Dr. Prasad, February 27, 2024
   3. Employer’s position statement to mediation specialist, February 20, 2024
      a. LHC Group return-to-work offer letter, December 14, 2023
      b. Email communications between employee and Laney Guidry, January 4-8, 2024
      c. Medical records
         i.      Dr. Willis, March 21, 2023
         ii.     PA Bragdon, May 5, 2023
         iii.    PA Bragdon, June 9, 2023
         iv.     Dr. Willis, June 30, 2023
         v.      Dr. Willis, August 10, 2023
         vi.     Dr. Willis, October 26, 2023
         vii. Work release, September 12, 2023
         viii. Work release, October 26, 2023
         ix.     Work release, December 5, 2023
         x.      Dr. Prasad, October 11, 2023
         xi.     MRI brain without contrast, October 24, 2023
         xii. Order for shoulder MRI, December 5, 2023
   4. Dispute Certification Notice
   5. Hearing Request and attachments
      a. Affidavit/written testimony
      b. Employee letter to Dr. Prasad, March 1, 2024
   6. Docketing Order

                                           7
   7. Employer’s Pre-Hearing Brief and attachments
      A. Concentra, March 3, 2023
      B. CT-scan results, March 4, 2023
      C. C-42, March 21, 2023
      D. Dr. Prasad, October 11, 2023
      E. Referrals
      F. Return-to-Work Offer, December 14, 2024
      G. Emails communications between employee and Laney Guidry, January 4-8,
         2024
      H. Causation letter sent by employer to Dr. Prasad, February 27, 2024
      I. Employee letter to Dr. Prasad, March 1, 2024

                             CERTIFICATE OF SERVICE

       I certify that a copy of this Order was sent as indicated on April 25, 2024.

Name                   Certified   Regular       Email   Sent to
                       Mail        mail
Tim Bowden,                                        X     Bowden_law@bellsouth.net
Employee’s attorney                                      Bowden1eric@gmail.com

Troy Hart, Sarah                                   X     wth@mijs.com
Best, employer’s                                         shbest@mijs.com
attorneys                                                dmduignan@mijs.com

                                   _______________________________________
                                   Penny Shrum
                                   Clerk, Court of Workers’ Compensation Claims
                                   WC.CourtClerk@tn.gov

                                             8
                                          Right to Appeal:
      If you disagree with the Court’s Order, you may appeal to the Workers’ Compensation
Appeals Board. To do so, you must:
   1. Complete the enclosed form entitled “Notice of Appeal” and file it with the Clerk of the
      Court of Workers’ Compensation Claims before the expiration of the deadline.
               If the order being appealed is “expedited” (also called “interlocutory”), or if the
                 order does not dispose of the case in its entirety, the notice of appeal must be filed
                 within seven (7) business days of the date the order was filed.
               If the order being appealed is a “Compensation Order,” or if it resolves all issues
                 in the case, the notice of appeal must be filed within thirty (30) calendar days of
                 the date the Compensation Order was filed.
      When filing the Notice of Appeal, you must serve a copy on the opposing party (or attorney,
      if represented).

   2. You must pay, via check, money order, or credit card, a $75.00 filing fee within ten calendar
      days after filing 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 filing 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 your appeal.

   3. You are responsible for ensuring a complete record is presented on appeal. If no court
      reporter was present at the hearing, you may request from the Court Clerk the audio
      recording of the hearing for a $25.00 fee. If you choose to submit a transcript as part of your
      appeal, which the Appeals Board has emphasized is important for a meaningful review of
      the case, a licensed court reporter must prepare the transcript, and you must file it with the
      Court Clerk. The Court Clerk will prepare the record for submission to the Appeals Board,
      and you will receive notice once it has been submitted. For deadlines related to the filing of
      transcripts, statements of the evidence, and briefs on appeal, see the applicable rules on the
      Bureau’s website at https://www.tn.gov/wcappealsboard. (Click the “Read Rules” button.)

   4. After the Workers’ Compensation Judge approves the record and the Court Clerk transmits
      it to the Appeals Board, a docketing notice will be sent to the parties.
      If neither party timely files an appeal with the Appeals Board, the Court Order
      becomes enforceable. See Tenn. Code Ann. § 50-6-239(d)(3) (expedited/interlocutory
      orders) and Tenn. Code Ann. § 50-6-239(c)(7) (compensation orders).

       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