The Tennessee Workers Compensation Board held in Moon v. First Fleet Inc., that the proof necessary to obtain medical benefits in a case is a lower standard of proof than that of a final trial.
This case concerns whether an employer must provide a panel of specialists after an authorized treating physician recommends further evaluation for a workplace injury. The central issue on appeal was whether Larnell Moon, an injured employee, presented sufficient evidence to require his employer, FirstFleet, Inc., to provide a panel of neuro-ophthalmologists to evaluate his complaints of blurred vision.
Situations involving denied medical referrals or disputed treatment recommendations are often complex, and a Knoxville workers’ compensation lawyer can help injured workers understand their rights under Tennessee law.
Moon was injured on December 28, 2022, while working as a commercial truck driver when he was involved in a single-vehicle accident. As a result of the accident, he sustained multiple injuries, including orthopedic issues affecting his knees and wrist, as well as a traumatic brain injury. He received authorized medical treatment for these conditions and was eventually referred to Dr. Erwin Manalo, a physical medicine and rehabilitation specialist, who became his authorized treating physician.
During the course of treatment, Moon began reporting symptoms of blurred vision. In response, Dr. Manalo completed a questionnaire in October 2025 indicating that, while he did not need to personally evaluate Moon further for this issue, he recommended that Moon be evaluated by a neuro-ophthalmologist. Based on this recommendation, Moon requested an expedited hearing seeking an order requiring his employer to provide a panel of neuro-ophthalmologists.
The employer denied the request, arguing that there was insufficient information linking Moon’s vision problems to his workplace injury. It also asserted that it had not received proper notice of the referral and suggested that Moon may have had pre-existing vision issues unrelated to the accident. The employer contended that, without clearer medical evidence establishing causation, it should not be required to provide the requested panel.
The trial court rejected these arguments and ordered the employer to provide a panel of neuro-ophthalmologists. In doing so, the court emphasized that medical determinations should be made by qualified physicians rather than by parties or their attorneys. It concluded that Dr. Manalo’s recommendation constituted a valid referral from an authorized treating physician and triggered a statutory presumption that the recommended evaluation was medically necessary. The court also referred the matter to the Bureau’s Compliance Program due to the employer’s failure to comply with this obligation, though it declined to award attorney’s fees at that stage.
Most importantly, the court held:
Employer’s arguments misconstrue Employee’s burden of proof at this stage of the litigation. Employee is not required to show that he is likely to succeed in proving that his vision issues are primarily caused by the accident or that any pre-existing vision issues are not the primary cause of his current complaints. Instead, Employee’s burden at this stage was to have suitable proof from which the court could conclude a referral had been made pursuant to section 204(a)(3)(H). The referral itself is presumed to be medically necessary, and it was Employer’s burden to offer sufficient proof to rebut that presumption. Beech v. G4S Secure Sols. (USA), Inc., No. 2020-05-0177, 2020 TN Wrk. Comp. App. Bd. LEXIS 71, at *9 (Tenn. Workers’ Comp. App. Bd. Dec. 16, 2020).
On appeal, the Workers’ Compensation Appeals Board affirmed the trial court’s decision. The Board clarified that, at this interlocutory stage, Moon was not required to prove that his blurred vision was caused primarily by the workplace accident. Instead, his burden was limited to demonstrating that an authorized treating physician had made a referral for additional evaluation. Under Tennessee law, such referrals are presumed to be medically necessary, and the burden shifts to the employer to rebut that presumption.
The Board found that the employer failed to meet this burden. Although it raised concerns about causation, lack of documentation, and possible pre-existing conditions, it presented no substantive evidence to overcome the statutory presumption in favor of the physician’s recommendation. The Board emphasized that questions about the ultimate cause of Moon’s vision problems could be addressed after the requested evaluation, not used to deny access to it.
In conclusion, the Appeals Board held that Moon was entitled to a panel of neuro-ophthalmologists based on the authorized physician’s referral. It affirmed the trial court’s order and remanded the case for further proceedings, reinforcing the principle that recommended medical evaluations are presumed necessary unless clearly rebutted by the employer.
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