The opinion
FILED
Jun 25, 2025
07:22 AM(CT)
TENNESSEE COURT OF
WORKERS' COMPENSATION
CLAIMS
TENNESSEE BUREAU OF WORKERS’ COMPENSATION
IN THE COURT OF WORKERS’ COMPENSATION CLAIMS
AT NASHVILLE
Nicholas Arvin, ) Docket No. 2023-60-4432
Employee, )
v. )
Andrew Duenas ) State File No. 860273-2023
d/b/a Camacho’s Famous, )
Employer. )
) Judge Kenneth M. Switzer
EXPEDITED HEARING ORDER GRANTING BENEFITS
(Decision on the Record)
This Court considered Mr. Arvin’s request for an expedited hearing based on the
record under Tennessee Compilation Rules and Regulations 0800-02-21-.15(1)(e) (2023)
on June 23, 2025. Mr. Arvin sought payment of medical bills for injuries from severe burns
he suffered while working at Camacho’s Famous. Mr. Arvin also requested a finding that
he is eligible to apply for payment from the Uninsured Employers Fund (UEF). The Court
holds that he would likely prevail at a final hearing in proving entitlement to medical
benefits. Mr. Arvin is also eligible to apply for payment from the UEF.
Claim History
On June 16, 2023, Mr. Arvin suffered severe burns from a bucket of scalding water
while working for Camacho’s. He explained that when he began draining boiling water
from one of the fryers at work into a bucket, the water pressure caused the bucket to fall
over, burning his right leg.
Mr. Arvin’s mother, Kimberly Long, drove him to the emergency room, where he
was diagnosed with second-degree burns to his right leg. Providers treated Mr. Arvin’s
burns, released him, and recommended he return as needed.
Mr. Duenas did not dispute that he did not have an active workers’ compensation
policy at the time of Mr. Arvin’s injury and that Mr. Arvin was his employee. Mr. Duenas
1
also did not object to the medical bills and accepted responsibility for payment totaling
$8,965.53.
Mr. Arvin filed his petition on June 21, 2023, alleging his injury and that Mr. Duenas
did not have workers’ compensation coverage on the date of injury. Afterward, a Bureau
compliance specialist investigated and concluded that “coverage was not verified in the
[National Council on Compensation Insurance] database for the date of injury.”
Findings of Fact and Conclusions of Law
Mr. Arvin seeks payment of medical bills. He must provide sufficient evidence
showing he would likely prevail at a final hearing. Tenn. Code Ann. § 50-6-239(d)(1)
(2024); McCord v. Advantage Human Resourcing, 2015 TN Wrk. Comp. App. Bd. LEXIS
6, at *9 (Mar. 27, 2015).
Mr. Duenas must pay Mr. Arvin’s medical bills from his work injury. Under the
Workers’ Compensation Law, the employer “shall furnish, free of charge to the employee,
such medical and surgical treatment . . . made reasonably necessary by accident[.]” § 50-
6-204(a)(1)(A). An “injury” means “an injury by accident . . . arising primarily out of and
in the course and scope of employment that causes . . . the need for medical treatment.” §
50-6-102(14).
Here, Mr. Arvin’s medical records show that he suffered severe burns from scalding
water while working for Camacho’s Famous and that he incurred $8,965.53 in medical
bills for treatment of those burns.
The Court finds the treatment he received for his injury was reasonable and
medically necessary. Mr. Duenas did not pay for the treatment and admitted that he lacked
insurance to cover the costs. The Bureau’s investigation confirmed that he was uninsured
on the date of injury.
Therefore, the Court holds that Mr. Duenas must pay all the medical bills for Mr.
Arvin’s treatment, subject to the workers’ compensation fee schedule. See, e.g., Ducros v.
Metro Roofing and Metal Supply Co., Inc., TN Wrk. Comp. App. Bd. LEXIS 62, at *10
(Oct. 17, 2017) (“[A]n employer who does not timely provide a panel of physicians risks
being required to pay for treatment an injured worker receives on his own.”).
Having found that Mr. Arvin is likely to prove he is entitled to benefits, the Court
next examines his eligibility for assistance from the UEF. The Bureau has discretion to
pay limited medical benefits from the UEF to an employee injured while working for an
uninsured employer, provided the employee meets certain criteria:
1) He worked for an employer who failed to carry workers’ compensation
2
insurance;
2) He suffered an injury arising primarily in the course and scope of employment
on or after July 1, 2015;
3) He was a Tennessee resident on the date he was injured;
4) He provided notice to the Bureau of the injury and of the failure of the employer
to secure payment of compensation within a reasonable period, but no longer
than 60 days after the date of injury.
§ 50-6-801(d)(4).
Mr. Arvin offered proof of all four requirements: He worked for an uninsured
employer, was injured after July 1, 2015, resided in Tennessee on the date of injury, and
filed a petition for benefit determination within 60 days after the date of injury. He was
injured on June 16, 2023, and filed a petition for benefit determination on June 21, 2023.
Therefore, he qualifies to apply for payment from the UEF.
IT IS, THEREFORE, ORDERED as follows:
1. Andrew Duenas doing business as Camacho’s Famous shall pay the providers
$8,965.53 in medical expenses Mr. Arvin incurred from his accident, subject to the
fee schedule.
2. Mr. Arvin is eligible to apply for discretionary payments from the UEF.
3. The Court sets a status hearing on September 8 at 10:15 a.m. Central Time. You
must dial 615-532-9552 or 866-943-0025 to participate.
4. Unless interlocutory appeal of the expedited hearing order is filed, compliance with
this Order must occur no later than seven business days from the date of entry of
this Order as required by Tennessee Code Annotated section 50-6-239(d)(3). Mr.
Duenas must submit confirmation of compliance with this Order to the Bureau by
email to WCCompliance.Program@tn.gov no later than the seventh business day
after entry of this Order. Failure to submit the necessary confirmation within the
period of compliance may result in a penalty assessment for non-compliance. For
questions regarding compliance, please contact the Workers’ Compensation
Penalty Unit by email at WCCompliance.Program@tn.gov.
ENTERED June 26, 2025.
_______________________________________
Judge Kenneth M. Switzer
Court of Workers’ Compensation Claims
3
APPENDIX
1. Petition for Benefit Determination, photos, Request for Investigation
2. Request to Resume Mediation, Dispute Resolution Statement
3. Dispute Certification Notice
4. Hearing Request, Tennova Bill, emergency physician bill
5. Court Communication requesting a declaration/affidavit
6. Order Setting Status Hearing
7. Declaration of Kimberly Long
8. Status Order
9. Medical Records, Tennova Healthcare
10. Declaration of Nick Arvin
CERTIFICATE OF SERVICE
I certify that a copy of this Order was sent as indicated on June 26, 2025.
Name Certified Regular Email Sent to
Mail mail
Nicholas Arvin, X X 487 Kinslow Ct.
employee Clarksville, TN 37040
klong4125@yahoo.com
Camacho’s Famous, X X 1021 TN-76 Ste. 106
employer Clarksville, TN 37040
Camachosfamous@gmail.com
Uninsured X Lashawn.pender@tn.gov
Employers Fund
____________________________________________
Penny Shrum, Court Clerk
Court of Workers’ Compensation Claims
Wc.courtclerk@tn.gov
4
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.
¾ 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.
¾ 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.
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;ĐŚĞĐŬŽŶĞŽƌŵŽƌĞĂƉƉůŝĐĂďůĞďŽdžĞƐĂŶĚŝŶĐůƵĚĞƚŚĞĚĂƚĞĨŝůĞͲ
ƐƚĂŵƉĞĚŽŶƚŚĞĨŝƌƐƚƉĂŐĞŽĨƚŚĞŽƌĚĞƌ;ƐͿďĞŝŶŐĂƉƉĞĂůĞĚͿ͗
ප Expedited Hearing Order filed on _______________ ප Motion Order filed on ___________________
ප Compensation Order filed on__________________ ප 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
Filed Date Stamp Here
Tennessee Bureau of Workers’ Compensation
www.tn.gov/workforce/injuries-at-work
wc.ombudsman@tn.gov
1-800-332-2667
REQUEST FOR BENEFITS FROM THE UNINSURED EMPLOYERS FUND
Eligible employees may use this form to request benefits from the Uninsured Employers Fund (UEF) if
they are injured while working for an employer that failed to provide:
1. Workers’ compensation insurance as required by the TN Workers’ Compensation Law; and,
2. Medical and/or disability benefits as required by the TN Workers’ Compensation Law.
This form MUST be completed and sent via certified mail to the following address:
Tennessee Bureau of Workers’ Compensation
ATTN: UEF Benefit Manager
Uninsured Employers Fund
220 French Landing Drive, Suite 1B
Nashville, TN 37243-1002.
This form MUST be sent within sixty (60) calendar days after the claim is over and MUST include:
1. A court order stating your employer owes you benefits and that you may request UEF benefits;
2. A completed Internal Revenue Service (IRS) Form, W-9 Request for Taxpayer Information and
Certification available at www.irs.gov; and
3. A completed Bureau of Workers’ Compensation Form C31 Medical Waiver and Consent available
on the “Forms” link at www.tn.gov/workerscomp.
I certify that I believe I am eligible for benefits from the UEF; that my employer has not paid all or part of
the benefits I am due; and my employer has not complied with an order issued by the Court of Workers’
Compensation Claims.
I, _______________________________________, request benefits from the Uninsured Employers Fund.
(Print Your Name)
____________________________________________________________________________________________________
Signature Date
Tennessee Law allows the State of Tennessee to recover payments made by the UEF for temporary
disability benefits or medical benefits. An agreement between you and your employer for payment of
benefits must be pre-approved by the UEF before being approved by a workers’ compensation judge.
LB-3284 (NEW 4/19) RDA 10183