The opinion
FILED
Aug 08, 2024
03:18 PM(ET)
TENNESSEE COURT OF
WORKERS' COMPENSATION
CLAIMS
TENNESSEE BUREAU OF WORKERS’ COMPENSATION
IN THE COURT OF WORKERS’ COMPENSATION CLAIMS
AT KNOXVILLE
KATTREA PINTHANOND, ) Docket No. 2018-03-0035
Employee, )
v. ) State File No. 20717-2017
COVENANT HEALTH, )
Employer. ) Judge Lisa A. Lowe
COMPENSATION ORDER DENYING BENEFITS
(Decision on the Record)
Ms. Pinthanond asked the Court to order Covenant to pay Blue Cross/Blue Shield’s
lien for past medical expenses after a settlement on her permanent disability benefits.
Covenant Health did not respond to the request. For the following reasons, the Court denies
Ms. Pinthanond’s request.
History of Claim
On March 15, 2017, Ms. Pinthanond, a registered nurse at Covenant, suffered an
allergic asthma attack after being exposed to dust and fumes at work. She suffered
pulmonary injuries and received authorized treatment. Later, the parties reached a
settlement with open future medical treatment. The agreement contained the following
language:
At the time of settlement, the parties agreed that medical expenses were
incurred in the amount of $25,436.23, all of which have been or will be paid
by Covenant Health. Ms. Pinthanond showed that she submitted expenses
from Dr. Rao and Methodist Medical Center, which were claimed as related,
but unpaid. The parties agreed that the charges will be evaluated, and if
authorized, will be paid. Additionally, Covenant Health agreed that Dr. Carla
Sevin would be designated as the authorized treating provider.
In June 2024, Ms. Pinthanond filed a hearing request seeking a decision on the
1
record for payment of BCBS’s lien.1 She submitted a 2019 letter from BCBS showing its
lien totals $14,389.91. She also submitted a BCBS Paid Claims Report.
Findings of Fact and Conclusions of Law
Ms. Pinthanond must prove by a preponderance of the evidence that she is entitled
to the requested benefits. Willis v. All Staff, 2015 TN Wrk. Comp. App. Bd. LEXIS 42, at
*18 (Nov. 9, 2015).
An employer shall furnish, free of charge to the employee, “treatment . . . made
reasonably necessary” by the work accident. Tenn. Code Ann. § 50-6-204(a)(1)(A) (2023).
Here, Ms. Pinthanond offered BCBS’s lien amount and claims report. However, she did
not provide any evidence to establish that the treatment BCBS paid for was reasonable,
necessary, and related to her work injury. See Eaves v. Ametek, Inc., 2018 TN Wrk. Comp.
App. Bd. LEXIS 53, at *8-9 (Sept. 14, 2018) (Court erred by ordering repayment of
medical expenses when employee “offered no proof that the medical bills or the
compilation of medical expenses prepared by her health insurer were reasonable,
necessary, or causally-related to the work accident.”). Ms. Pinthanond did not meet her
burden, so the Court denies her request for payment of BCBS’s lien.
Costs of $150.00 are taxed to Covenant, to be paid within five business days after
this order becomes final. Unless appealed, this order becomes final in 30 days.
IT IS ORDERED.
ENTERED August 8, 2024.
_____________________________________
JUDGE LISA A. LOWE
Court of Workers’ Compensation Claims
1
Ms. Pinthanond filed a request for Expedited Hearing. However, since Expedited Hearings result in
interlocutory orders, the Court considers the request as a Compensation Hearing.
2
APPENDIX
The Court reviewed the following documents, marked as exhibits for ease of
reference:
Exhibits:
1. Petition for Benefit Determination
2. Dispute Resolution Statement
3. Panel of Physicians
4. Medical Records of Ear, Nose & Throat
5. Petition for Benefit Determination, July 3, 2018
6. Mediated Settlement Agreement
7. Petition for Benefit Determination – Settlement Approval Only
8. First Report of Work Injury
9. Wage Statement
10. Medical Records of Dr. Vijoydeep T.V. Rao
11. Statistical Data Form, SD-2
12. Order Approving Workers’ Compensation Settlement Agreement
13. Workers’ Compensation Settlement Agreement
14. Petition for Benefit Determination, November 9,2023
15. Employer’s Disputed Issues
16. Dispute Certification Notice
17. Hearing Request
18. Rule 72 Declaration of Ms. Pinthanond
19. BCBS Correspondence regarding Subrogation Lien
20. BCBS Paid Claims Report
21. Docketing Notice
CERTIFICATE OF SERVICE
I certify that a copy of the order was sent as indicated on August 8, 2024.
Name Mail Email Service sent to:
Mandy Hancock, X mandy@mandyhancocklaw.com
Employee’s Attorney
R. Kim Burnette, X kburnette@arnettbaker.com
Employer’s Attorney
______________________________________
PENNY SHRUM, Court Clerk
WC.CourtClerk@tn.gov
3
Right to Appeal:
If you disagree with the Court’s 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 before the expiration of the deadline.
If the order being appealed is “expedited” (also called “interlocutory”), or if the
order does not dispose of the case in its entirety, the notice of appeal must be filed
within seven (7) business days of the date the order was filed.
If the order being appealed is a “Compensation Order,” or if it resolves all issues
in the case, the notice of appeal must be filed within thirty (30) calendar days of
the date the Compensation Order was filed.
When filing the Notice of Appeal, you must serve a copy on 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. 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. If you choose to submit a transcript as part of your
appeal, which the Appeals Board has emphasized is important for a meaningful review of
the case, a licensed court reporter must prepare the transcript, and you must file it with the
Court Clerk. The Court Clerk will prepare the record for submission to the Appeals Board,
and you will receive notice once it has been submitted. For deadlines related to the filing of
transcripts, statements of the evidence, and briefs on appeal, see the applicable rules on the
Bureau’s website at https://www.tn.gov/wcappealsboard. (Click the “Read Rules” button.)
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.
If neither party timely files an appeal with the Appeals Board, the Court Order
becomes enforceable. See Tenn. Code Ann. § 50-6-239(d)(3) (expedited/interlocutory
orders) and Tenn. Code Ann. § 50-6-239(c)(7) (compensation orders).
For self-represented litigants: Help from an Ombudsman is available at 800-332-2667.