Court Opinion

ID: 4696197
Source: CourtListenerOpinion
Date Created: 2021-06-16 19:39:20.39343+00
Date Added: 2024-06-11T08:05:39.217568
License: Public Domain

FILED
                                                                                 Jun 16, 2021
                                                                                 07:15 AM(CT)
                                                                              TENNESSEE COURT OF
                                                                             WORKERS' COMPENSATION
                                                                                    CLAIMS

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

 Charles Amsler,                             )   Docket No. 2020-06-1410
       Employee,                             )
 v.                                          )
 United Ground Express,                      )   State File No. 55289-2019
       Employer,                             )
 And                                         )
 New Hampshire Insurance Co.,                )   Judge Kenneth M. Switzer
       Carrier.                              )

              EXPEDITED HEARING ORDER DENYING BENEFITS

       This case is principally about which party should be responsible for bills related to
past medical treatment. Charles Amsler asserted that United Ground Express should pay
medical bills he incurred for treatment of sudden, severe pain in his foot while walking at
work. United Ground Express initially authorized treatment but later denied the claim.
After the denial, Mr. Amsler continued seeing the authorized provider, including seeking
emergency treatment due to complications he believed stemmed from the alleged work
injury. After an expedited hearing on June 10, 2021, the Court finds that Mr. Amsler is not
likely to prevail at trial in showing that United Ground Express is responsible for the
medical bills he incurred after the date of denial.

                                    History of Claim

      Mr. Amsler worked for United Ground Express as a customer service lead at its
worksite, the Nashville International Airport. He testified that, on July 29, 2019, at
approximately 4:30 a.m., his left foot “popped” while walking toward an airline gate,
causing immediate, intense pain.

       On his petition, Mr. Amsler wrote that the injury was caused “possibly by stepping
on something on [the] floor.” He wrote on his affidavit, “I did not look to see if I stepped
on anything because I could barely walk.” Mr. Amsler testified that the carpeting where
his foot felt sudden pain was in poor condition and was later replaced, along with the

                                             1
damaged concrete below it. But he agreed on cross-examination that he did not tell the
authorized doctor or the claims adjuster that he slipped, tripped or stepped on anything.

       At approximately 5:30 a.m., Mr. Amsler reported the injury to his supervisor, who
insisted that he complete his shift and then go to a nearby occupational clinic, not the
emergency room. His shift ended at 2:45 p.m.

       According to Mr. Amsler, United Ground Express never offered a panel. It offered
no contrary evidence, other than testimony from claims adjuster Megan Diehl, who stated
that she believed his need for treatment was “emergent.”

       Mr. Amsler underwent treatment with Dr. Chae Ko and physical therapy for the next
several weeks beginning on July 29. Dr. Ko wrote that Mr. Amsler “felt his left midfoot
pop while walking,” while the physical therapy notes read, “Pt. reports he was simply
walking at work, when he felt something give in L foot.” Dr. Ko diagnosed a left-foot
sprain. In October, he placed Mr. Amsler at maximum medical improvement.

        Ms. Diehl testified that she denied the claim on August 5 and sent Mr. Amsler a
denial letter the same day. He testified he never received the letter but agreed that it bears
the correct address. Mr. Amsler’s affidavit states he learned of the denial on October 15,
in a letter concerning a medical bill instructing him to promptly pay the amount owed.

       It is unknown whether Dr. Ko’s office received notice of the denial in early August
or why it continued to treat Mr. Amsler. Treatment records after August 5 through the last
visit state as “reason for visit” that the clinic designated the claim as “workers
compensation.” Mr. Amsler’s affidavit states he was “never asked for [his] insurance
card.” According to Ms. Diehl, the carrier only paid for visits on July 29 and July 31.1

      In mid-September, Mr. Amsler underwent treatment at the Intensive Care Unit at
Vanderbilt University Medical Center. Providers there diagnosed and treated a pulmonary
embolism and deep vein thrombosis in his left leg. Mr. Amsler believes this event was
caused by the work accident.

       Mr. Amsler asked that the Court order payment for all medical bills incurred for the
injury, including treatment at Vanderbilt and Dr. Ko’s office after the denial. He
introduced numerous medical bills and a recap totaling the amounts owed. However, they
were not admitted into evidence. In Eaves v. Ametek, 2018 TN Wrk. Comp. App. Bd.
LEXIS 53, at *8 (Sept. 14, 2018), the Appeals Board held that medical bills were
inadmissible, when not signed by a physician, accompanied by a proper certification, or
attached to an affidavit from a medical provider attesting to their accuracy or completeness,

1
 Mr. Amsler did not see a provider on July 31. The Court presumes this refers to physical therapy on July
30.
                                                   2
and the employee offered no proof that the medical bills were reasonable, necessary, or
causally-related to the work accident. Mr. Amsler’s bill compilation did not satisfy these
requirements.

        Mr. Amsler contended: “The injury occurred as I was moving from one station to
the other at work. And, in good faith, I did what the company told me to do, to go to the
doctor that they directed me to. And everything beyond that was a result of being pointed
in that direction.” He continued, “They didn’t follow the letter of the law or the spirit of
the law. And ultimately, at the end of this, I have . . . medical bills I would’ve dealt with
differently if I had seen my own doctor.”

                          Findings of Fact and Conclusions of Law

      Mr. Amsler must show that he is likely to prevail at a hearing on the merits regarding
United Ground Express’s liability for medical benefits. See Tenn. Code Ann. § 50-6-
239(d)(1) (2020); McCord v. Advantage Human Resourcing, 2015 TN Wrk. Comp. App.
Bd. LEXIS 6, at *7-8, 9 (Mar. 27, 2015).

       A bedrock of the Workers’ Compensation Law is that the employer must furnish
medical treatment for work-related injuries. Tenn. Code Ann. § 50-6-204(a)(1). United
Ground Express argued that Mr. Amsler’s injury was not work-related but rather was
idiopathic.

       “An idiopathic injury is one that has an unexplained origin or cause, and generally
does not arise out of the employment unless ‘some condition of the employment presents
a peculiar or additional hazard.’” Veler v. Wackenhut Servs., No. E2010-00965-WC-R3-
WC, 2011 Tenn. LEXIS 78, at *9 (Tenn. Workers’ Comp. Panel Jan. 28, 2011). An injury
that occurs due to an idiopathic condition is compensable “if an employment hazard causes
or exacerbates the injury.” McCaffery v. Cardinal Logistics, 2015 TN Wrk. Comp. App.
Bd. LEXIS 50, at *10 (Dec. 10, 2015). Further, the Tennessee Supreme Court, addressing
what constitutes a hazard of employment in the context of injuries that occur while walking,
has observed that “Tennessee courts have consistently held that an employee may not
recover for an injury occurring while walking unless there is an employment hazard, such
as a puddle of water or a step, in addition to the injured employee’s ambulation.” Wilhelm
v. Kroger, 235 S.W.3d 122, 128-29 (Tenn. 2007).

        Here, Mr. Amsler credibly testified that his left foot “popped while walking” toward
an airline gate, causing immediate pain. On his petition, Mr. Amsler wrote that the injury
was caused “possibly by stepping on something on [the] floor.” He wrote on his affidavit,
however, that “I did not look to see if I stepped on anything because I could barely walk.”2

2
  Mr. Amsler attempted to introduce photos of the condition of the carpeting in the area where he became
injured, but United Ground Express objected to their admissibility. The Court sustained the objection
                                                   3
He conceded that he did not slip, trip or fall.

       Considering the testimony and pleadings, Mr. Amsler candidly admitted he is not
certain that he stepped on anything that might have caused his foot pain. Therefore, Mr.
Amsler has not identified an employment hazard beyond his simple act of walking. He is
unlikely to prevail at a hearing on the merits that he suffered an injury arising primarily out
of and in the course and scope of his employment. See Tenn. Code Ann. § 50-6-102(14).
In other words, although he was “moving from station to station,” that act, in and of itself,
does not necessarily mean an injury incurred while doing so arose primarily out of
employment.

        Nonetheless, Mr. Amsler convincingly argued that United Ground Express did not
offer a panel, and that he should not be responsible for treatment that he did not choose but
underwent at his employer’s direction.

       Ms. Diehl testified she denied the claim on August 6 and sent the notice to Mr.
Amsler by letter the same day; he testified he never received the notice. Both witnesses
were credible; therefore, the Court cannot discern whose testimony to accept without
additional corroborating evidence. Given that Mr. Amsler bears the burden of proof, and
based on the evidence currently before it, the Court cannot find that United Ground Express
should be responsible for the medical bills after the denial date.

        As a final matter, Mr. Amsler testified that United Ground Express directed him to
Dr. Ko. United Ground Express did not introduce a signed panel. Ms. Diehl’s testimony
that no panel was offered because his need for treatment was “emergent” is unpersuasive,
since Mr. Amsler was required to work his entire shift before going to Dr. Ko’s office. The
Court finds United Ground Express did not offer a panel and had no reasonable justification
for its failure to do so.

        Tennessee Compilation Rules and Regulations 0800-02-01-.06(2) (May 2018)
provides that where the employer “fails to provide an appropriate initial panel of physicians
to the employee within three (3) business days from the date the employer has notice of a
work-related injury and the employee expressed a need for medical care, . . . the employer
may be assessed a civil penalty[.]” The Court refers the case to the Compliance Program
for consideration of a penalty.

because he did not authenticate the photos during his testimony.
                                                    4
IT IS, THEREFORE, ORDERED as follows:

   1. Mr. Amsler’s requested relief is denied at this time.

   2. This case is set for a scheduling hearing on September 13, 2021, at 9:15 a.m.
      Central. You must call 615-532-9552 or toll-free at 866-943-0025 to participate.
      Failure to call might result in a determination of the issues without your
      participation.

   3. A copy of this order shall be sent to the Compliance Program for consideration of
      the imposition of penalty for United Ground Express’s failure to offer a panel of
      physicians.

      ENTERED June 16, 2021.

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

                                      APPENDIX

Exhibits:
   1. Affidavit of Charles Amsler
   2. Employer/Carrier’s Exhibits
      a. Concentra Medical Center Records
      b. Payment History
      c. Denial
      d. Electronic Data Interchange History
      e. Petition for Benefit Determination for DOI July 27, 2019
   3. Medical records-Concentra-physical therapy
   4. Employee’s Exhibits
      a. July 31 letter from Carrier/TPA to Mr. Amsler (Identification only)
      b. Concentra documents, August 29, 2019 (Identification only)
      c. Concentra report, July 29, 2019
      d. Concentra Therapy Appointment Detail, August 20, 2019
      e. Outpatient Diagnostic Center, August 21, 2019
      f. Photos (Identification only)
      g. VUMC letter, Dr. Monahan
      h. Discharge summary
   5. Bills and summary page (Identification only)

                                            5
Technical record:
   1. Petition for Benefit Determination
   2. Dispute Certification Notice and Employee’s Additional Issue
   3. Request for Expedited Hearing
   4. Pretrial Hearing Order, April 16, 2021
   5. Employer’s/Carrier’s Brief
   6. Pretrial Hearing Order, May 21, 2021

                            CERTIFICATE OF SERVICE

       I certify that a copy of the Expedited Hearing Order was sent as indicated on June
16, 2021.

          Name            Certified Regular     Email Service sent to:
                           Mail      Mail
  Charles Amsler,            X                    X     martinamsler@yahoo.com
  Employee                                              1530 Oxford Court
                                                        Gallatin TN 37066
  Stephanie Rockwell,                             X     stephanie@speed-seta.com
  Employer’s Attorney
  Compliance Program                              X     WCCompliance.Program@tn.gov

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

                                           6
                                              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