Seeking Medical Treatment on Your Own During a Tennessee Workers’ Compensation Claim
Many Workers’ Compensation claimants are dissatisfied with their medical treatment for various reasons. Sometimes it is because the Workers’ Compensation insurance carrier won’t approve the medical treatment that is recommended from the Workers' Compensation doctor. Other times it is because the Workers’ Compensation doctor won’t address the claimant’s complaints, says there is nothing that can be done or says that the complaint can’t be addressed because Workers’ Compensation did not specifically approve payment for addressing the problem. Many claimants then ask whether they should go to their own doctor. As discussed below, that is typically not a good idea but there are some exceptions.
Under the Tennessee Workers’ Compensation law, you are entitled to a panel of physicians for your medical treatment. It is important to pick the right doctor from the panel because the doctor you pick is given some legal presumptions regarding his or her opinions in your claim. For example, the doctor is presumed to be correct on whether the work accident caused injury and whether certain treatment is medically necessary. The physician is also entitled to a presumption on your impairment rating. This is an important factor in how much money your case is worth in the end. These presumptions can be overcome but it takes a preponderance of evidence to do so. Therefore, it is important to have picked a physician you can be happy with.
The law says that the Employer shall provide medical treatment and the Employee shall accept the treatment. For this reason, it is generally a bad idea to get treatment outside of that provided by Workers’ Compensation. It puts you in violation of the law. There are some exceptions.
Benjamin Grissom At&t Servs., Inc., et al, No. 2021-05-0400, 2022 WL 3755740, at *1 (Aug. 25, 2022) deals with the exceptions in which the Workers’ Compensation doctor refuses to address a problem and the Workers’ Compensation Carrier refuses authorize that doctor to address the problem. In Grissom, the injured employee injured his shoulder with a “labral tear that extended from a SLAP into a superior Bankart tear.” He received surgery and physical therapy paid for by Workers’ Compensation. Mr. Grissom later “started developing some tingling and burning that radiates to the right side of his neck all the way into his long and ring fingers” and complained of weakness in his right hand. His Workers’ Compensation doctor advised him that “the next medical step would be to get an MRI of the cervical spine, but that does not appear to be part of this current claim for his right shoulder labral repair.” Mr. Grissom asked the Workers’ Compensation Carrier to provide the MRI and received no response. As a result, he went to his own doctor for treatment.
Mr. Grissom’s own doctor diagnosed Mr. Grissom with suprascapular neuropathy and impingement syndrome of the right shoulder. He recommended surgical intervention, including a suprascapular nerve release with debridement. This surgery was performed on March 1, 2022. Mr. Grissom’s own doctor provided necessary testimony that the diagnosis was more than 50% caused by Mr. Grissom's work-related injury.
Mr. Grissom filed a Request for an Expedited Hearing petitioning the Court to compel the Workers’ Compensation Carrier to authorize Mr. Grissom’s own doctor going forward and compel the Carrier to pay for the treatment that his doctor provided. The Court granted Mr. Grissom’s request. The Carrier appealed to the Tennessee Department of Labor Appellate Board and the Trial Court decision was upheld.
The moral of the story is that once the treatment is rejected by the Carrier, you may then go on your own for medical treatment as long as the diagnosis is found to be more than 50% caused by the work injury and the treatment is medically necessary.
If you need a Workers’ Compensation attorney in Tennessee, contact the Lawyer’s of Brown and Roberto at (865) 691-2777.