The opinion
FILED
Oct 01, 2025
08:18 AM(CT)
TENNESSEE COURT OF
WORKERS' COMPENSATION
CLAIMS
TENNESSEE BUREAU OF WORKERS’ COMPENSATION
IN THE COURT OF WORKERS’ COMPENSATION CLAIMS
AT NASHVILLE
William Fults, Docket No. 2025-50-1067
Employee,
v.
Gant Oil Company, Inc.,
Employer, State File No. 13991-2024
and
Federated Mutual Insurance
Company,
Carrier. Judge Kenneth M. Switzer
EXPEDITED HEARING ORDER GRANTING MEDICAL BENEFITS
This case presents “the often daunting challenge of quantifying causation in
circumstances where an employee is alleging a work-related aggravation of a pre-existing
condition.” Edwards v. Peoplease, LLC, 2024 TN Wrk. Comp. App. Bd. LEXIS 23, at
*14, appeal docketed, (July 2, 2024).
William Fults seeks Gant Oil Company’s authorization of a total knee replacement.
His expert, Dr. Robert Landsberg, stated that the need for this surgery primarily relates to
a work accident at Gant, while Dr. Jeffrey Peterson, the authorized physician, disagreed.
After a September 23, 2025 expedited hearing, the Court holds Mr. Fults is likely to prevail
at a hearing on the merits regarding the work-relatedness of his need for surgery and grants
his request.
Claim History
Injury and treatment
Mr. Fults’s petition alleged that he injured his left knee at work on January 24, 2024.
It stated he “was climbing up [a] truck ladder that gave way causing him to fall.” His
declaration added that he fell “from a ladder several feet . . . striking and twisting his left
knee.”
1
A few days later, Mr. Fults saw his primary care physician, Dr. Jimmie Woodlee,
who ordered imaging of the left knee. The February 5 x-rays showed “mild
tricompartmental degeneration” and “moderate joint effusion,” while the February 14 MRI
revealed “[u]ndersurface tearing of the medial meniscal body and posterior horn,” “[s]mall
free edge fraying of the lateral meniscal body,” and “[t]ricompartmental chondromalacia.”
Dr. Woodlee then referred Mr. Fults to Dr. Peterson.
In March, Dr. Peterson reviewed Mr. Fults’s imaging and examined him. The
doctor noted that Mr. Fults reported “a fall off a ladder.” He recommended a left-knee
arthroplasty to repair the torn meniscus.
The carrier did not immediately authorize the procedure, so Mr. Fults returned to
Dr. Peterson in May. He reported worsening pain, so the doctor ordered an updated MRI
of the left knee. The MRI confirmed the meniscal tear and showed “grade 4
chondromalacia of the medial compartment” and “moderate tricompartmental
osteoarthritic changes of the knee.”
Dr. Peterson repeated the surgery recommendation at the next visit in June. Another
MRI taken later that month yielded the same results. The reviewing physician commented,
“These findings have advanced since prior exam.”
Mr. Fults underwent authorized surgery in July, and operative notes recorded that
Dr. Peterson was “pleased” by the results. The notes further stated “[m]eniscal shaving
and partial medial meniscectomy was performed,” and, “[t]he lateral compartment showed
some mild inner border tearing of the lateral meniscus, for which a meniscal shaving was
performed.” Dr. Peterson additionally wrote, “Based on the level of arthritis seen today,
he will likely be a TKA candidate in the future.”
At follow-up visits in September and October, Dr. Peterson recorded “good healing”
but also that Mr. Fults was continuing to have knee pain. As an addendum to the October
visit notes, Dr. Peterson wrote:
I was able to review the patient’s preoperative MRI as well as his
intraoperative surgical details from his right knee arthroscopy. At the time
of his surgery I did make a comment on his face sheet as well as in his
operative report that he does have significant chondromalacia of the medial
compartment as well as patellofemoral joint[,] which would likely
necessitate a total knee arthroplasty in the future. My gut is that he continues
to have pain because of the arthritis and not because of the continued
meniscal pathology. I did inform him that he will likely need to pursue
further treatment for his right knee issues outside of the worker’s
compensation system because his arthritis is a pre-existing issue that was
obviously aggravated by his fall but that his work injury did not cause the
arthritis.
2
(Emphasis added).
At the next visit in November, Dr. Peterson placed Mr. Fults at maximum medical
improvement with no restrictions for the torn meniscus. Dr. Peterson echoed his opinion
about the arthritis from the previous visit, writing that Mr. Fults had continued pain and
swelling in the left knee,” along with “severe arthritis,” which would be treated with Mr.
Fults’s health insurance. He explained:
I do not feel that the arthritis is a direct causal relation with his injury at work.
The meniscus for sure has been problematic for him and that was addressed
with the surgery via worker’s compensation but a total knee replacement at
this point based on his arthritis pattern . . . would be hard for me to document
[or] justify causation from his work injury.
At his attorney’s request, Mr. Fults saw Dr. Robert Landsberg for an independent
medical examination in April 2025. Dr. Landsberg reviewed records and previous
imaging, performed his own imaging, and examined Mr. Fults.
He wrote in his report that Mr. Fults had no complaints or problems with his left
knee until the work accident. Dr. Landsberg recounted that the surgeon “removed articular
cartilage from the medial femoral condyle and remove[d] the portion of the medial
meniscus at the time of surgery.” He continued:
[H]ad it not been for the work injury of [1/24/2024], he would not be having
the problems with his left knee that he is having now. After the work injury,
chondroplasty shaving and torn meniscus with partial meniscectomy, he now
has severe bone-on-bone symptomatic osteoarthritis in the left knee.
Therefore, with a reasonable degree of medical certainty, the work injury of
[1/24/2024] led to the progression of his osteoarthritis leading to the fact
that he needs a total knee replacement now.
(Emphasis added).
Lay testimony
Mr. Fults, age 80, gave a detailed account of how the injury occurred. He explained
that the gas delivery truck he drove is equipped with a long hose through which fuel passes
to the customer’s tank. Mr. Fults had transferred diesel from the truck to the tank and then
needed to close the lid on the top of the tank on the truck. He climbed up the ladder attached
to the delivery truck and near the top, he placed his left foot on a railing when the ladder
gave way, twisting his left knee. He said he was five or six feet above ground. The ladder
broke a mirror on the truck before he struck the ground. He managed to drive the truck
back to Gant and reported the injury.
3
Mr. Fults further testified that before the work injury, he had no problems with his
knee. He experienced no difficulty walking approximately three miles, three times per
week, and five miles once per week for exercise. He had never undergone any type of
treatment for his knee. His son, Christian Fults, confirmed in testimony that his father can
no longer walk for exercise.
Mr. Fults has returned to work, and despite Dr. Peterson placing him under no
restrictions, Gant does not require him to climb ladders anymore. He said that if he were
to try to climb a ladder, he would probably fall. Mr. Fults occasionally still climbs stairs
at work. He wishes to undergo the knee replacement with Dr. Peterson.
Dr. Landsberg’s deposition
Dr. Landsberg was deposed in July and is a Board-certified orthopedic surgeon in
practice since 1975. He operates two days per week, typically on knees, shoulders, hips,
hands, ankles, and wrists.
Dr. Landsberg testified about his meeting with Mr. Fults, saying that Mr. Fults told
him he had no problems before the work accident with his left knee.
The doctor described in detail his understanding of how the accident occurred. Mr.
Fults was climbing up a ladder attached to his truck, with one foot on the railing and the
other on the ladder, when “the ladder started sliding away from the truck” and “started to
move.” He said Mr. Fults hit the truck’s side mirror before landing “forcefully,” and from
the fall his “left knee bent out in a funny direction.” Landsberg Dep. 11:18-12:2.1 Dr.
Landsberg later added that Mr. Fults suffered a “complex injury,” saying: “He twisted, he
fell, he landed on his knee. His knee twisted after he fell. He thinks it bent out to the side
abnormally. And that’s all compatible. Those MRI findings and then eventually
arthroscopic findings were compatible with that injury.” 14:20-25.
Dr. Landsberg discussed the imaging taken shortly after the accident and later. The
February 14, 2024 MRI showed the meniscus tear and “small free edge fraying,” as well
as “mild tricompartmental chondromalacia.” 12:15-17. He added that chondromalacia
refers to the “soft cartilage,” and the x-ray showed mild arthritis. 12:21, 12:24-25. Dr.
Landsberg said the June MRI showed “dry compartmental degenerative changes . . . so a
little bit worse with chondromalacia.” 13:6-8. In addition, it showed “progressive
abnormality.” 17:9.
He then turned to the meniscal repair, during which Dr. Peterson “took away some
of the articular cartilage, the unstable portion of the articular cartilage.” 13:22-24. Dr.
Landsberg explained that the chondromalacia is “graded” or classified using a number
1
Given the complexity of the medical proof in this case, for ease of appellate review, the Court opted to
cite to the doctors’ deposition transcripts.
4
system. Grade one is “softening”; grade two is a “little fissuring”; grade three is “peeling
off a little”; grade 4 is “erosion to the bone.” 14:6-15. At the time of surgery, Mr. Fults
was grade three, so Dr. Peterson “removed some of the joint surface because it was flapping
in the breeze a little bit.” 14:11-14.
Post-surgery, Mr. Fults still reported pain but also experienced new symptoms, such
as his knee buckling or giving way. 16:16. Dr. Landsberg examined him and said that Mr.
Fults could not straighten his left knee. 18:18. He observed that Mr. Fults’s left knee
appeared “bow-legged” compared to the other knee, and he noted thigh atrophy. 18:15-
17, 19:1.
Dr. Landsberg took x-rays, which showed “severe advanced osteoarthritis in the left
knee,” “bone-on-bone rubbing,” and “he’s got no joint space at all.” 19:18-19, 20:1-3. He
said that the work injury led to the torn meniscus as well as damage to the joint surface.
Specifically, “when he tore that meniscus, . . . that injury it [sic] jammed the joint surface.
And from that day on, the torn meniscus and the abnormal articular cartilage just became
more and more frayed. And that all started after the work injury.” 18:2-7. The only option
for Dr. Peterson was to remove the tear and the damaged portions of the surface. 21:8-11.
This left Mr. Fults with “less cushioning,” and he was “less shock absorbent.” 22:4-5.
Dr. Landsberg concluded:
[H]ad it not been for the work injury . . . , he wouldn’t have had the pain and
damage to the joint surface of the meniscus. He wouldn’t have needed the
arthroscopic surgery, and he would not have bone-on-bone arthritis in the left
knee with the cystic changes and the spurs. . . . So had it not been for the
work injury he wouldn’t have had the damage to his joint surface and
meniscus. He wouldn’t have needed the arthroscopic surgery, and that’s why
his arthritis progressed rapidly after the work injury and surgery.
23: 8-20. Dr. Landsberg conceded that other potential treatments were available, but he
said that a total knee replacement was inevitable, and there is “no need to put it off when
you are already 80 years old and you need something done.” 24:16-18.
On cross-examination, Dr. Landsberg agreed that the February 24, 2024 MRI
already showed grade four chondromalacia, but he clarified that the tibial surface did not
show grade four but the femoral surface did. 34:14-20, 35:21-23. He testified that he
looked at imaging from the left and right knees taken in February 2024, which was
incorrect since he later admitted that no x-rays of the right knee were taken at that time
20:4-6, 33:4-7.
Dr. Landsberg said that before the work incident, “[H]e obviously had some pri-
existing [sic] arthritis. He probably had grade three/four chondromalacia pre-existing[.]”
41:15-17. Counsel further asked if Mr. Fults’s activities or work after the accident “caused
5
or contributed to his need for surgery for the meniscus or the ultimate knee replacement
which [sic] you are suggesting.” Dr. Landsberg said:
Once you have damage to the meniscus, say with that injury that he had, as
well as the joint surface , walking, climbing and the more you are up the more
you do, you start, you continue running, jumping, and doing all that, it’s
going to progress more rapidly. So, yeah, everyday he walked on it, probably
got a little worse.
42:13-24.
Dr. Peterson’s deposition
Dr. Peterson was deposed a month later and similarly began with his qualifications.
He has been practicing since 2001 and is a Board-certified orthopedic surgeon. He
performs surgery such as meniscal repairs or knee replacements “pretty much every day.”
Peterson Dep. 6:12.
He testified that the February 14, 2024 MRI clearly showed the torn meniscus as
well as “absolute complete loss of articular cartilage on the distal femur,” which was
preexisting cartilage loss. 10:5-12, 23. When asked on direct examination if he agreed
that Mr. Fults more likely than not would have needed a knee replacement at some point
“based upon a natural progression of the underlying condition,” Dr. Peterson responded,
“Most likely, yeah, with full-thickness loss of cartilage.” 12:11-16.
He added that during surgery he saw grade three to four arthritis in the inside part
of the knee (medial, femur, and tibia). 13:11-13. He wrote immediately after surgery that
Mr. Fults would need a knee replacement in the future. 14:14-17.
Then the following exchange occurred about causation:
Q: [I]n your opinion, to a reasonable degree of medical certainty, was that
level of arthritis that you just described caused by the fall or accident that’s
the subject of this claim or any of the treatment that Dr. Woodlee or you
provided?
A: Absolutely not. . . . I’ve done this for 20 years. The arthritis that this man
had at the time of his index surgery is not correlated at all with a fall from a
ladder. It would never necessitate or never cause that kind of arthritis in that
short of a time course. Absolutely not. Never seen it.
14:22-25, 15:1-3, 15: 7-12.
6
Dr. Peterson said that he disagreed “100 percent” with Dr. Landsberg’s opinion and
identified areas within the report that he disputes. 16:1.
He was critical of Dr. Landsberg’s interpretation of the imaging. Dr. Peterson said
that Dr. Woodlee took “supine” x-rays, meaning Mr. Fults was lying on the x-ray table and
was not “weight-bearing” or standing up. However, Dr. Landsberg took weight-bearing
imaging. 17:11-25, 18:1-5. He agreed this was not an “apples to apples” comparison
because with the supine view, “There’s no weight through the joint.” 18:9-12. He also
said that “projectional changes” can affect the view of an x-ray. 19:9-12.
The questioning below conveys his opinion using the statute’s terminology:
Q: [A]ssuming that the standard for establishing causation is that a physician
must state to a reasonable degree of medical certainty that the condition—in
this situation, a knee replacement—was caused primarily—which in this
circumstance means greater than 50 percent—by the accident or by the
resulting care from that accident, when considering all causes. If that’s the
definition of injury that has to be established, would you be able to say that
his need for a knee replacement was caused primarily by either the accident
or your treatment or Dr. Woodlee’s treatment when considering all causes?
A: Absolutely not.
19:17-25, 20:1-5.
Dr. Peterson explained that the preexisting condition “is the sticking point.” 21:19-
20. He acknowledged that the work injury “aggravated” the preexisting arthritis—“[B]ut
it didn’t cause the arthritis and [did] not necessitate the need for a total knee, from my
perspective.” 22:3-9. Counsel followed up with, “[A]s far as the arthritis, we’re not able
to speak anatomically as to whether that was advanced as a result of the fall?” Dr. Peterson
answered, “Correct.” 22:21-24.
On cross-examination, Dr. Peterson said his understanding of the mechanism of
injury was “he fell off a ladder.” 23:8, 15-16. Dr. Peterson acknowledged that Mr. Fults
did not tell him that he fell approximately six feet or that he was required to climb up onto
a fuel tanker with hoses. 32:10-22. He further said that Mr. Fults’s work accident
“absolutely” aggravated his underlying arthritis. 34:2-8. However, counsel did not ask
about, nor did Dr. Peterson volunteer, a percentage on whether that aggravation primarily
caused the need for a knee replacement.
Findings of Fact and Conclusions of Law
Mr. Fults must show a likelihood of prevailing at a hearing on the merits that he is
entitled to the recommended knee replacement surgery. Tenn. Code Ann. § 50-6-239(d)(1)
7
(2024); McCord v. Advantage Human Resourcing, 2015 TN Wrk. Comp. App. Bd. LEXIS
6, at *7-8, 9 (Mar. 27, 2015).
Under the Worker’s Compensation Law, an injury is “accidental” only if it is caused
by a specific incident, or set of incidents, arising primarily out of and in the course and
scope of employment, and “shall not include the aggravation of a preexisting disease,
condition or ailment unless it can be shown to a reasonable degree of medical certainty
that the aggravation arose primarily out of and in the course and scope of employment.”
Id. § 50-6-102(12)(A) (Emphasis added). Further, an injury causes the need for medical
treatment “only if it has been shown to a reasonable degree of medical certainty that it
contributed more than fifty percent (50%) in causing the . . . need for medical treatment,
considering all causes.” Id. § 50-6-102(12)(C).
The Appeals Board recently instructed that, in circumstances where an employee is
diagnosed with a relevant preexisting condition, a trial court should consider:
(1) whether the employee was symptomatic or asymptomatic prior to the
work accident; (2) whether the employee was experiencing any functional
limitations caused by that preexisting condition prior to the work accident;
and (3) whether the evidence reveals any anatomic change to the body part(s)
in question after the work accident.
Allen v. Deliveries via ISG, LLC, 2025 TN Wrk. Comp. App. Bd. LEXIS 16, at *10 (Apr.
29, 2025) (Internal quotations omitted). A trial court should consider all other relevant
factors in assessing whether a work-related accident has materially advanced, aggravated,
or accelerated a preexisting condition to the point that the need for medical treatment and/or
any resulting disability arises primarily from that work accident. Id.
Longstanding case law holds that when the medical testimony differs, the trial judge
must choose which view to believe. Orman v. Williams Sonoma, Inc., 803 S.W.2d 672,
676 (Tenn. 1991). The trial court “is allowed, among other things, to consider the
qualifications of the experts, the circumstances of their examination, the information
available to them, and the evaluation of the importance of that information by other
experts.” Id.
In addition, Dr. Peterson was not selected from a panel of physicians, but he became
an authorized treating physician from a referral. The rebuttable presumption of correctness
attributable to a causation opinion applies only to opinions expressed by a treating
physician selected from a panel of physicians. Gilbert v. United Parcel Serv., Inc., 2019
TN Wrk. Comp. App. Bd. LEXIS 20, at *13 (June 7, 2019).
Here, both physicians concluded that Mr. Fults’s arthritis preexisted the work
accident. The question is whether the work accident aggravated the preexisting arthritis
and whether Mr. Fults has shown “to a reasonable degree of medical certainty that the
8
aggravation arose primarily out of and in the course and scope of employment.” The Court
finds that he did.
Looking first at the considerations in Allen, Mr. Fults credibly testified that he had
no symptoms in his left knee before the work accident. At age 78, he was able to perform
all job duties, including regularly climbing ladders, with no trouble, and he also walked
approximately 14 miles per week for exercise. His son confirmed this testimony.
As to whether the physicians saw “any anatomic change to the body part(s) in
question after the work accident,” the experts disagreed. When asked if he was unable to
“speak anatomically as to whether [the arthritis] was advanced as a result of the fall, Dr.
Peterson answered, “Correct.” But two other physicians did note anatomical changes.
Specifically, the physician who read the June 2024 MRI noted grade four
chondromalacia and commented, “These findings have advanced since prior exam.” Dr.
Landsberg likewise testified to several anatomical changes that he observed. He compared
the left-knee imaging in February 2024 to the June imaging. The former showed “mild
tricompartmental chondromalacia” and “mild arthritis,” but the latter revealed “dry
compartmental degenerative changes . . . so a little bit worse with chondromalacia.”
Moreover, after the surgery, Dr. Landsberg testified that Mr. Fults by then had “bone-on-
bone arthritis in the left knee with the cystic changes and the spurs.” He also had thigh
atrophy and appeared slightly bow-legged. The Court finds that Mr. Fults underwent
numerous anatomical changes after the work accident, including advancement of the
preexisting arthritis.
Turning now to the Orman factors, the Court first finds that both physicians are
well-qualified to give expert opinions, so this factor favors neither. Dr. Peterson was a
treating physician who saw Mr. Fults six times and performed surgery, directly observing
the condition of the knee, while Dr. Landsberg saw him once for an independent medical
examination. This factor favors Dr. Peterson’s opinion. Further, both physicians
considered the same information: multiple sets of imaging and records from Drs. Woodlee
and Peterson. This factor favors neither.
But the last factor—the evaluation of the importance of that information by other
experts—is significant in this case and the one that tips the scales in Dr. Landsberg’s favor.
Specifically, both doctors’ records contain a history, but their testimony of their
understanding of the mechanism of injury differs dramatically. In Dr. Peterson’s opinion,
Mr. Fults “fell from a truck.” He was unaware of the twisting mechanism, nor did he know
that Mr. Fults fell approximately six feet to the ground and landed forcefully, with his knee
bent in an awkward direction. Dr. Landsberg in contrast knew about those details of the
incident, and he explained that the “twisting” made the injury “complex” and correlated
with the imaging results.
9
As to the imaging, Dr. Peterson testified to the difference between supine and
weight-bearing images and agreed it was not an “apples to apples” comparison. But he did
not fully explain why Dr. Landsberg’s testimony about what the images showed, and the
differences between the two, was wholly unreliable. He also did not point out where
“projection” might have occurred to affect the resulting images.
Moreover, the fact that Dr. Landsberg mistakenly said that images were taken of
both knees in February 2024 does not negate his opinion entirely. The more important
comparison is not between the injured and non-injured knee at any given time, but rather
between images of the left knee only as time passed, which showed an anatomical change
and the rapid progression of the arthritis.
Dr. Landsberg offered a plausible explanation for the need for the knee replacement:
that the shaving of the meniscus and joint surface, while necessary to repair the meniscus,
had the dual and unfortunate effect of also hastening the progression of Mr. Fults’s
preexisting arthritis. Dr. Peterson disagreed with this “100 percent,” but he did not
elaborate on the shaving and the impact it could have had. Instead, he simply testified that
the work injury did not cause the arthritis—a given—and need for a knee replacement.
Importantly. Dr. Peterson never offered an opinion on whether the work injury
“aggravated” Mr. Fults’s preexisting arthritis so that the aggravation was or was not the
“primary cause” of the need for surgery. Stated another way, Dr. Peterson’s opinion is
incomplete, because he never expressed a percentage regarding whether the incident
aggravated the preexisting condition to necessitate the knee replacement.
Dr. Landsberg did—twice. He wrote in his report, “within a reasonable degree of
medical certainty, the work injury of [1/24/2024] led to the progression of his osteoarthritis
leading to the fact that he needs a total knee replacement now.” He also testified, “[H]ad
it not been for the work injury, he wouldn’t have had the damage to his joint surface and
meniscus. He wouldn’t have needed the arthroscopic surgery, and that’s why his arthritis
progressed rapidly after the work injury and surgery.”
Finally, “the Supreme Court has consistently held that an employee’s assessment as
to his or her own physical condition is competent testimony that is not to be disregarded."
Limberakis v. Pro-Tech Sec., Inc., 2017 TN Wrk. Comp. App. Bd. LEXIS 53, at *6 (Sept.
12, 2017). As previously stated, Mr. Fults credibly testified that he had no problems with
the knee until the work accident, but since then he has experienced disabling pain and other
symptoms.
For all these reasons, the Court finds that the January 24, 2024 work incident
aggravated Mr. Fults’s preexisting osteoarthritis, and this aggravation, and treatment of it,
primarily caused his current need for a total knee replacement. The Court holds he is likely
to prevail at a hearing on the merits on this question.
10
IT IS THEREFORE ORDERED:
1. Gant Oil Company shall pay for all future reasonable, necessary, and work-related
treatment for Mr. Fults’s left knee, to include a total knee replacement from Dr.
Jeffrey Peterson, the authorized treating physician.
2. The Court sets a status hearing on January 26, 2026, at 10:00 a.m. Central
Time. You must call 615-532-9552 or 866-943-0025 to participate.
3. Unless an interlocutory appeal is filed, compliance with this order must occur by
seven business days of the date below as required by Tennessee Code Annotated
section 50-6-239(d)(3).
ENTERED October 1, 2025.
________________________________________
JUDGE KENNETH M. SWITZER
Court of Workers’ Compensation Claims
11
Appendix
Exhibits:
1. Declaration of William Fults
2. Stipulations
3. Dr. Landsberg’s deposition
4. Dr. Peterson’s deposition
5. Medical records
6. Declaration of Jayne Plympton
CERTIFICATE OF SERVICE
I certify that a copy of this Order was sent as indicated on October 1, 2025.
Certified Regular
Name Email Sent to
Mail mail
D. Russell Thomas, russthomas@thethomaslawfirm.com
X
employee’s attorney claudia@thethomaslawfirm.com
Carrigan Hicks, Chicks@burrowlee.com
Brett Burrow, X bburrow@burrowlee.com
employer’s attorneys tbtasher@burrowlee.com
_______________________________________
Penny Shrum
Clerk, Court of Workers’ Compensation Claims
WC.CourtClerk@tn.gov
12
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