Court Opinion

ID: 9891417
Source: CourtListenerOpinion
Date Created: 2023-10-18 15:13:39.795756+00
Date Added: 2024-06-11T13:47:20.335622
License: Public Domain

FILED
                                                                                             Oct 18, 2023
                                                                                            10:03 AM(CT)
                                                                                          TENNESSEE COURT OF
                                                                                         WORKERS' COMPENSATION
                                                                                                CLAIMS

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

    TIMOTHY HOSS,                                   )   Docket Number: 2018-02-0051
             Employee,                              )
    v.                                              )
    ASR METALS,                                     )   State File Number: 87088-2014
             Employer,                              )
    And                                             )
    TECHNOLOGY INSURANCE                            )   Judge Brian K. Addington
    COMPANY,                                        )
             Carrier.                               )

                                    COMPENSATION ORDER

       The Court held a Compensation Hearing on October 12, 2023, in which Mr. Hoss
requested authorization for additional treatment for his 2014 back injury per the settlement
agreement. For the following reasons, the Court holds Mr. Hoss is entitled to the requested
benefits.

                                            Claim History

        Mr. Hoss injured his back, right knee, and left shoulder when he was involved in a
work-related motor vehicle accident. The Court approved the parties’ proposed settlement
with lifetime medical benefits in March 2020.

       ASR authorized Dr. Jim Brasfield to treat Mr. Hoss’s back injury. On December 13,
2021, Dr. Brasfield ordered an EMG to treat pain in both legs. Mr. Hoss testified that ASR
denied Dr. Brasfield’s referral to perform the EMG in his office. ASR then offered a panel
of neurologists. Mr. Hoss testified that he selected a doctor in Knoxville, but the adjuster
told him that she did not want him driving that far to an appointment and asked him to
select Dr. Michael Dew instead. 1

1
    The physician panel documents that Mr. Hoss selected Dr. Dew on February 13, 2023.

                                                    1
       Mr. Hoss agreed to see Dr. Dew, and the EMG of his right leg was performed in
May 2023. On August 23, he reported left foot weakness to Dr. Dew, who ordered an MRI
of the back to rule out neuropathy.

       At the hearing, counsel for ASR submitted an email as a late-filed exhibit without
objection. The email from Technology Insurance’s scheduling service confirmed the
company is setting up the MRI. 2

       Mr. Hoss testified that ASR’s adjuster has repeatedly denied or delayed his
treatment. She will not return his phone calls, and he is frustrated with the process of
obtaining the medical benefits to which he is entitled. He also requested mileage
reimbursement for his doctor visits but offered no proof.

        ASR asserted that Mr. Hoss is entitled to medical benefits under their agreement,
but it has no control over physician’s offices or how they schedule appointments.

                            Findings of Fact and Conclusions of Law

        At a compensation hearing, Mr. Hoss must show by a preponderance of the evidence
that he is entitled to the requested benefits. Tenn. Code Ann. § 50-6-239(c)(6) (2023). The
Court holds that he satisfied this burden.

       The Workers’ Compensation Law provides that, “the employer or the employer’s
agent shall furnish, free of charge to the employee, such medical and surgical treatment . .
. made reasonably necessary by accident [.]” Tenn. Code Ann. § 50-6-204(a)(1)(A). Here,
the parties agreed that Mr. Hoss is entitled to lifetime medical treatment for his 2014 back
injury and Dr. Dew is the authorized physician.

        An insurance company has four days to approve an MRI or send the request for
utilization review. Tenn. Comp. R. & Reg. 0800-02-06-.06(1)-(2) (February, 2022). Here,
the adjuster failed to timely authorize the MRI. Further, Mr. Hoss testified without
contravention that the adjuster will not return his calls. Therefore, the Court holds that
ASR shall promptly arrange the MRI Dr. Dew ordered.

       Mr. Hoss requested mileage reimbursement, but he did not submit an accounting of
the mileage he seeks. Section 50-6-204(I)(4)(A) states that, “upon request, the employee
shall be reimbursed for reasonable travel expenses.” The Court cannot award Mr. Hoss
mileage because he did not prove the underlying facts necessary to award this benefit. He
may submit a request for mileage reimbursement to ASR and, if appropriately documented,
the Court encourages ASR to reimburse Mr. Hoss’s mileage according to the Workers’
Compensation Law.

2
    The email was sent on October 11, 2023, one day before the Compensation Hearing.

                                                    2
       Finally, the Bureau’s Compliance Program is authorized to assess penalties under
the Workers’ Compensation Law as well as the General Rules of the Workers’
Compensation Program. The Court refers this case to the Compliance Program for possible
penalty assessments regarding its handling of Mr. Hoss’s claim. Specifically, the Program
should consider whether Technology Insurance Company repeatedly and generally failed
to timely provide medical benefits and failed to timely approve the MRI that Dr. Dew, the
authorized treating physician, ordered on August 23. See Tenn. Code Ann. § 50-6-
118(a)(8).
      IT IS THEREFORE, ORDERED as follows:

      1. ASR shall pay future medical benefits reasonably necessary for Mr. Hoss’s work
         injuries under Tennessee Code Annotated section 50-6-204(a)(1)(A).

      2. The Court taxes the $150.00 filing fee to ASR, to be paid to the Court Clerk
         under Tennessee Compilation Rules and Regulations 0800-02-21-.06 within five
         business days of this order becoming final, and for which execution might issue
         if necessary.

      3. ASR shall file an SD-2 with the Court Clerk within ten days of entry of this
         order.

      4. Unless appealed, this order shall become final thirty days after issuance.

      ENTERED October 18, 2023.

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

                                            3
                                           Appendix

     Exhibits:

     1. Medical Records-Dr. Jim Brasfield
     2. Medical Records-Dr. Michael Dew
     3. Employee’s Choice of Physician
     4. Email Correspondence

     Technical Record:

     1. Petition for Benefit Determination
     2. Request to Resume Mediation
     3. Dispute Certification Notice
     4. Hearing Request
     5. Status Hearing Order
     6. Pre-Compensation Hearing Statement

CERTIFICATE OF SERVICE

     I certify that a true and correct copy of this Order was sent on October 18, 2023.

       Name              Certified   Fax    Email             Service sent to:
                          Mail
Timothy Hoss,               X                  X    hossxx63@aol.com
Employee                                            23489 Green Spring Road
                                                    Abingdon, VA 24211
Matthew Morris,                                X    mmorris@wimberlylawson.com
Employer’s Attorney
WC Compliance                                  X    wccompliance.program@tn.gov
Program

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

                                           4
                                              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