Court Opinion

ID: 9939749
Source: CourtListenerOpinion
Date Created: 2024-02-12 17:42:02.356466+00
Date Added: 2024-06-11T13:41:55.095068
License: Public Domain

FILED
                                                                                Feb 07, 2024
                                                                                03:26 PM(ET)
                                                                              TENNESSEE COURT OF
                                                                             WORKERS' COMPENSATION
                                                                                    CLAIMS

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

 TIMOTHY TOWNSEND,                           )   Docket No. 2022-03-0693
         Employee,                           )
 v.                                          )   State File No. 35311-2022
 UNIVERSAL FOREST                            )
 PRODUCTS,                                   )   Judge Pamela B. Johnson
          Employer.                          )

                       ORDER DENYING ATTORNEY FEES

        Timothy Townsend seeks attorney fees for Universal Forest Products’s delay in
authorizing a recommended surgery under an open medical benefits provision in a
settlement agreement. The authorized treating physician recommended surgery in late
June; it took place in December. Whether that delay was too long is the subject of this
order. For the reasons below, the Court finds that under these circumstances, it was not.
Therefore, Mr. Townsend did not prove by a preponderance of the evidence that he is
entitled to attorney fees.

                                    History of Claim

        Mr. Townsend injured his low back while operating a forklift at work on June 2,
2020. After the claim settled, his authorized treating physician, Dr. Paul Johnson,
recommended surgery. Universal Forest did not immediately authorize it, so Mr. Townsend
filed a petition seeking medical benefits and attorney fees.

       The parties did not introduce Dr. Johnson’s post-settlement office notes, including
his surgery recommendation, or take his deposition. The facts are taken from the affidavits
of Mr. Townsend and his attorney and the parties’ prehearing briefs.

      According to Mr. Townsend, Dr. Johnson recommended surgery in late June and
scheduled it for early August.

      At the end of July, Universal Forest asked Dr. Johnson to address the cause for the

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need for a “S1 joint arthrodesis” surgery. In its letter, it noted that a recent MRI did not
show any obvious pathology explaining Mr. Townsend’s ongoing S1 joint pain. It asked
Dr. Johnson whether the June 2, 2020 work accident contributed more than 50% in causing
Mr. Townsend’s current need for S1 joint surgery. Dr. Johnson did not immediately
respond to the letter.

       Near the end of August, Mr. Townsend sent his own letter to Dr. Johnson. He
informed Dr. Johnson that he had lifetime medical benefits and asked whether the need for
surgery arose primarily from the “work-related injury of August 1, 2019” and whether the
surgery was both reasonable and medically necessary. (Emphasis added). The same day,
Dr. Johnson replied “yes” to both questions. Mr. Townsend sent Dr. Johnson’s response to
Universal Forest.

       After repeated requests for a response to its letter, Universal Forest received Dr.
Johnson’s response on the last day of October. Dr. Johnson marked “yes” and wrote that
Mr. Townsend’s S1 pain related to the L5-S1 fusion, which was necessitated by his work
injury. He further noted that the normal MRI was additional evidence of his current
problems not being due to other factors. Universal Forest notified Mr. Townsend in mid-
November that it authorized the surgery.

        Mr. Townsend argued the delay in authorizing surgery was unreasonable and asked
for attorney fees under Tennessee Code Annotated section 50-6-226(d).

                          Findings of Fact and Conclusions of Law

        Mr. Townsend has the burden of proof on all essential elements of his claim. Scott
v. Integrity Staffing Sols., 2015 TN Wrk. Comp. App. Bd. LEXIS 24, at *6 (Aug. 18, 2015).
He must prove by a preponderance of the evidence that he is entitled to the requested
benefits. Tenn. Code Ann. § 50-6-239(c)(6).

        Under the settlement, Mr. Townsend is entitled to lifetime medical treatment. The
treatment must be causally related to the original work injury and reasonable and necessary.
Id. at -204(a)(1)(A). The parties did not introduce any post-settlement office notes from
Dr. Johnson, including his surgery recommendation, and did not take his deposition.
Instead, each party sent Dr. Johnson a letter asking him to address the cause of the need for
the recommended surgery. 1

1
  Letters addressing medical causation and/or the reasonableness and necessity of treatment may be
excluded at a compensation hearing through valid objection under the Tennessee Rules of Evidence. Tenn.
Comp. R. & Regs. 0800-02-21-.15(2) (2023). Neither party objected to the causation letter submitted by
the opposing party. Therefore, the Court considers Dr. Johnson's response to each.

                                                  2
       Dr. Johnson did not immediately answer the letter first sent by Universal Forest,
which specifically asked him to explain the cause of the need for the recommended surgery
considering a recent normal MRI. Dr. Johnson finally responded two months after the
request, and after receiving his explanation, Universal Forest authorized the surgery.

        In the interim, Dr. Johnson replied to Mr. Townsend’s letter, which referenced an
August 2019 injury date different from the June 2020 injury date in the settlement. Mr.
Townsend’s letter did not ask for any explanation on why the most recent MRI was normal
at the same level as the proposed surgery level.

       Considering the authorization delay at issue, Dr. Johnson purportedly recommended
surgery in late June. Universal Forest sent Dr. Johnson its causation letter on that last day
of July and received his response on the last day of October. Then, Universal Forest
authorized the surgery in mid-November, which was performed a month later.

        Mr. Townsend argued that he is entitled to attorney fees under section 226(d)(1)(A)
and (B). Section 226(d)(1) states that the Court may award attorney fees when the
employer: (A) fails to furnish appropriate medical treatment to an employee provided for
in a settlement or (B) unreasonably denies a claim or unreasonably fails to timely initiate
medical benefits. Id. However, section 226(d)(1)(B) is inapplicable to post-settlement
future medical disputes. In this case, only section 226(d)(1)(A) applies.

       Applying these facts to section 226(d)(1)(A), Universal Forest did not fail to furnish
the recommended surgery. Instead, before authorizing the surgery, it asked Dr. Johnson to
address the cause for the need for surgery when the recent MRI was normal.

        Under these circumstances, the Court cannot find Universal Forest’s delay in
authorizing surgery unreasonable. Universal Forest authorized the surgery within two
weeks of Dr. Johnson’s response to its letter, which explained with specificity the cause
for the need for surgery. Moreover, Dr. Johnson’s response to Mr. Townsend’s causation
letter related the need for surgery to a 2019 injury date, not the 2020 injury date with
lifetime future medical benefits, and it did not explain the cause of the need for surgery
considering the recent normal MRI.

       The Court concludes Mr. Townsend did not prove by a preponderance of the
evidence that Universal Forest’s delay was unreasonable. Therefore, Mr. Townsend’s
request for attorney fees is denied. 2

2
  Mr. Townsend also requested that Universal Forest be referred to the Compliance Program for the
imposition of penalties. However, this is not one of the benefits/remedies available to injured workers under
sections 118, 204 or 207. In this case, since the Court did not find Universal Forest’s actions unreasonable,
a penalty referral is unwarranted.

                                                     3
IT IS, THEREFORE, ORDERED as follows:

   1. Mr. Townsend’s request for attorney fees is denied.

   2. Universal Forrest Products shall pay the $150.00 filing fee within five business days
      of entry of this order, for which execution may issue.

   3. Unless appealed, this order shall become final 30 calendar days after entry.

ENTERED February 7, 2024.

                                         _____________________________________
                                         JUDGE PAMELA B. JOHNSON
                                         Court of Workers’ Compensation Claims

                                      APPENDIX

Technical Record:

   1. Petition for Settlement Approval Only, June 21, 2022, (original award) with
       complete settlement documents attached
   2. Petition for Settlement Approval Only, June 20, 2023, (increased benefits) with
       complete settlement documents attached
   3. Petition for Benefit Determination, September 29, 2023
   4. Employee’s Additional Issue to Dispute Certification Notice
   5. Dispute Certification Notice
   6. Expedited Hearing Request
   7. Declaration of Timothy Townsend
   8. Employee’s Prehearing Brief
          Ex. 1 Prior Settlement Documents (redacted as duplicates)
          Ex. 2 Employee’s Causation Letter from Dr. Paul Jonson
          Ex. 3 Unsigned Fee Affidavit of Attorney Michael Fisher
   9. Employer’s Objection to Employee’s Expedited Hearing Request for On-The-
       Record Decision
   10. Order Denying Expedited Hearing Request and Setting Scheduling Hearing
   11. Docketing Notice for On-The-Record Compensation Hearing
   12. Employer’s Notice of Filing Medical Opinion Letter from Dr. Paul Johnson
   13. Employer’s Prehearing Brief

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                         CERTIFICATE OF SERVICE

    I certify that a copy of the Order was sent as shown on February 7, 2024.

Name                        Mail       Email   Service sent to:

Michael Fisher                           X     michael@rockylawfirm.com
Employee’s Attorney
Richard Clark                            X     rclark@eraclides.com
Employer’s Attorney

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

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                              Compensation Order Right to Appeal:
     If you disagree with this Compensation 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 within thirty calendar days of the date the
      Compensation Order was filed. When filing the Notice of Appeal, you must serve a copy
      upon 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. The Court Clerk
      will prepare the technical record and exhibits for submission to the Appeals Board, and you
      will receive notice once it has been submitted. 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.
      A licensed court reporter must prepare a transcript, and you must file it with the Court Clerk
      within fifteen calendar days of filing the Notice of Appeal. Alternatively, you may file a
      statement of the evidence prepared jointly by both parties within fifteen calendar days of
      filing the Notice of Appeal. The statement of the evidence must convey a complete and
      accurate account of the testimony presented at the hearing. The Workers’ Compensation
      Judge must approve the statement of the evidence before the record is submitted to the
      Appeals Board. If the Appeals Board must review testimony or other proof concerning
      factual matters, the absence of a transcript or statement of the evidence can be a significant
      obstacle to meaningful appellate review.

   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. You have fifteen
      calendar days after the date of that notice to file a brief to the Appeals Board. See the Rules
      governing the Workers’ Compensation Appeals Board on the Bureau’s website
If neither party timely files an appeal with the Appeals Board, the trial court’s Order will
become final by operation of law thirty calendar days after entry. Tenn. Code Ann. § 50-6-
239(c)(7).

       For self-represented litigants: Help from an Ombudsman is available at 800-332-2667.