The opinion
FILED
Dec 23, 2025
12:03 PM(CT)
TENNESSEE COURT OF
WORKERS' COMPENSATION
CLAIMS
TENNESSEE BUREAU OF WORKERS’ COMPENSATION
IN THE COURT OF WORKERS’ COMPENSATION CLAIMS
AT NASHVILLE
CANDICE CLENDENING, ) Docket No. 2025-60-5156
Employee, )
v. )
NASHVILLE READY MIX, ) State File No. 88744-2024
Employer, )
And )
BITUMINOUS CASUALTY CORP., ) Judge Joshua D. Baker
Carrier. )
EXPEDITED HEARING ORDER GRANTING BENEFITS
At a December 16, 2025 expedited hearing, Ms. Clendening requested a panel of
psychiatrists for treatment of a mental injury caused by a rollover crash in a cement mixer.
Because she is likely to prove a compensable mental injury at trial, the Court holds she is
entitled to a panel of psychiatrists for treatment.
Claim History
On December 14, 2024, Ms. Clendening was driving a cement-mixer truck downhill
when her brakes failed. As her truck accelerated from gravity’s pull, she saw a stop sign
and cross-traffic but could not stop or even slow her vehicle. It gained speed, went through
the stop sign without hitting another vehicle, but then hit a ditch and rolled onto its left
side, trapping her. She recalled fearing that the vehicle would catch fire at any moment,
until finally, firefighters arrived and removed the windshield to pull her out.
Physically, she reported pain radiating from her neck into her left arm with
numbness and tingling, especially in her left hand. She selected orthopedic surgeon Dr.
Keith Douglas from a panel, and he began treating her left arm a couple of weeks after her
accident.
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Two months later, Dr. Douglas directly referred Ms. Clendening to psychiatrist Dr.
Keith Caruso to “address her anxiety and sleep issues” and “determine if mental health
issues are related to the accident.”
Dr. Caruso evaluated Ms. Clendening and diagnosed post-traumatic stress disorder
and major depressive disorder caused by the work accident. He recommended “medication
management by a psychiatrist” and psychotherapy. He also restricted her from driving
cement trucks “until she is able to tolerate doing so without exacerbation of her symptoms,
which may present as flashbacks, panic attacks, severe anxiety and crying spells.” He stated
his treatment recommendations were reasonable and necessary to treat her work injury and
noted, “Ms. Clendening ha[s] never been in psychotherapy or psychiatric treatment
previously.” However, Dr. Caruso specifically stated in his report that he would not treat
Ms. Clendening.
After Dr. Douglas referred her for psychiatric treatment, Ms. Clendening testified
she did not return to Dr. Douglas for treatment of her physical injuries. On June 6, after
missing two appointments, Dr. Douglas released Ms. Clendening from care and wrote,
“The patient was placed at maximum medical improvement due to her repeated missed
appointments and failure to attend today’s scheduled visit.”
Meanwhile, Nashville Ready Mix declined to authorize psychiatric treatment or
offer a panel of psychiatrists, claiming Dr. Douglas disagreed with Dr. Caruso and was not
recommending any psychiatric treatment.
Ms. Clendening’s counsel sent Dr. Douglas a questionnaire, and he responded yes
to the question, “[D]o you defer to Dr. Caruso’s expertise in mental health disorders in
regard to diagnoses, causation, and medical necessity of treatment for Ms. Clendening’s
mental health disorders and recommended treatment?”
A month later, Dr. Douglas addressed medical causation of Ms. Clendening’s
mental injury. He reported Ms. Clendening “present[ed] for follow-up care related to her
left hand.” However, the record noted no treatment plan or orthopedic treatment, nor did it
reference any examination or interview of Ms. Clendening. Rather, the doctor simply
wrote:
There was prior concern regarding whether [Ms. Clendening’s] underlying
psychological and psychiatric conditions were related to her injury or
preexisting. It is my opinion that greater than fifty percent of her psychiatric
and psychological conditions were preexisting and therefore not work-
related.
Ms. Clendening testified she did not attend the appointment with Dr. Douglas as
reported in her medical record. She said she had no preexisting mental-health condition
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and had never attributed her mental-health symptoms to anything other than her work
accident.
A business day or two before the hearing, Nashville Ready Mix filed a referral order
from Dr. Douglas to psychologist Dr. Megan Avery in Memphis. It read, “Referrals:
Psychiatry. Consult” with “Dr. Megan Avery.” The parties agreed at the hearing that Dr.
Avery is a psychologist, not a psychiatrist, and that she practices in Memphis, more than
200 miles from Ms. Clendening.
At trial, the parties agreed Dr. Douglas is an authorized physician and that Ms.
Clendening suffered a work-related mental-health condition.
However, Nashville Ready Mix argued Ms. Clendening is not entitled to a panel of
psychiatrists because Dr. Douglas, as the claim’s “gatekeeper,” has not referred her for
psychiatric treatment. Instead, she must accept authorized treatment from psychologist Dr.
Avery based on Dr. Douglas’s most recent referral for a “consult.”
For her part, Ms. Clendening contended the “consult” referral to a psychologist
represents no guarantee of treatment, as it is identical to her referral to Dr. Caruso, which
yielded no treatment. Moreover, Dr. Avery, as a psychologist, cannot decide medical
causation or permanency. Cigna Prop. and Cas. Ins. Co. v. Sneed, 772 S.W.2d 422 (Tenn.
1989). Nor can Dr. Avery prescribe and manage medication that Dr. Caruso, a psychiatrist,
said she needs.
She declined the consult referral to Dr. Avery and urged the Court to accept Dr.
Caruso’s opinion over Dr. Douglas’s and order a panel of psychiatrists for treatment. She
argued that Dr. Douglas’s causation opinion is not credible. Most notably, he lacks
psychiatric expertise. But also, he incorrectly attributed her condition to a preexisting
mental illness though none exists. Further, he did not interview or examine her to evaluate
her mental health, as she was not present at the appointment. Instead, he documented that
she was present when she was not.
Findings of Fact and Conclusions of Law
Ms. Clendening must prove she is likely to prevail at a final hearing on her requested
benefits. Tenn. Code Ann. § 50-6-239(d)(1) (2025). She requested a panel of psychiatrists
for treatment. The Court holds Nashville Ready Mix must provide her a panel.
Like Ms. Clendening’s cement truck, her claim’s process functioned well until it
faltered. Dr. Douglas appropriately referred Ms. Clendening to a specialist for a causation
evaluation under subdivision 50-6-204(a)(3)(A)(ii). Nashville Ready Mix appropriately
authorized that referral.
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However, the Court disagrees with Nashville Ready Mix that an order for
psychiatric treatment from an authorized physician under Tennessee Code Annotated
section 50-6-204 is necessary for a panel of psychiatrists under these circumstances.
Following that argument to its logical conclusion, Dr. Douglas would not be gatekeeper:
he would be sole and final arbiter—the claim’s captor rather than its safeguard.
Instead, the Court reads the terms of subdivision (a)(3)(A)(ii) as representing
guardrails for an accepted claim instead of grounds for denial. By relying on Dr. Douglas’s
opinion to deny psychiatric treatment instead of accepting Dr. Caruso’s opinion, Nashville
Ready Mix denied the compensability of Ms. Clendening’s claim for a mental injury,
derailing her authorized treatment.
Put simply, whether Dr. Douglas referred Ms. Clendening for consultation or for
treatment, and whether he agrees with the specialist is immaterial, where Dr. Caruso, as
the authorized referral specialist, determined medical causation and recommended
treatment.
In other words, when faced with Dr. Caruso’s opinion, Nashville Ready Mix had
two choices in an accepted claim: authorize treatment with Dr. Caruso, if he were willing
to treat Ms. Clendening; or offer her a panel of psychiatrists. It did neither, harnessing Dr.
Douglas’s alternative opinion instead to foreclose and prevent psychiatric treatment.
Consequently, the Court must weigh the doctors’ opinions to determine if Ms.
Clendening is likely to prevail at trial by proving she suffered a mental injury that requires
psychiatric treatment.
With conflicting medical opinions, the Court “must obviously choose which view
to believe. In doing so, [the trial judge] 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.” Orman v. Williams Sonoma, Inc., 803 S.W.2d 672, 676 (Tenn. 1991).
When one of those experts is an authorized treating physician, that expert’s opinion
has a presumption of correctness on the issue of causation. Tenn. Code Ann. § 50-6-
102(12)(E). Further, “any treatment recommended by a physician or chiropractor selected
[under] subdivision (a)(3) or by referral, if applicable, shall be presumed to be medically
necessary for treatment of the injured employee.” Id. § 50-6-204(a)(3)(H) (emphasis
added).
Considering the first factor, Dr. Caruso’s qualifications as a psychiatrist
significantly outweigh Dr. Douglas’s qualifications in diagnosing and treating psychiatric
conditions.
4
Next, the circumstances of the doctors’ evaluations also favor Dr. Caruso, as he
thoroughly interviewed and examined Ms. Clendening and issued a lengthy and detailed
report. Conversely, Dr. Douglas never examined Ms. Clendening for a mental health
condition. While identifying her as present when she was absent from an examination could
have resulted from an auto-populated template, it is still a mistake that casts doubt on the
reliability of his opinion.
About the information available to the experts, this factor also favors Dr. Caruso
because he thoroughly interviewed and examined Ms. Clendening to obtain relevant and
necessary information. By contrast, Dr. Douglas only had information about Ms.
Clendening’s physical injury. Further, his opinion lacked a factual foundation, as he
incorrectly attributed her symptoms to a preexisting condition that did not exist.
In Workers’ Compensation Law, a mental injury is defined as “a loss of mental
faculties or a mental or behavioral disorder, arising primarily out of a compensable physical
injury or an identifiable work[-]related event resulting in a sudden or unusual stimulus[.]”
Nickerson v. Knox Cnty., No. E2020-01286-SC-R3-WC, 2021 Tenn. LEXIS 24 (Tenn.
Workers’ Comp. Panel June 8, 2021).
Although Ms. Clendening suffered a relatively minor physical injury compared to
what could have happened, she described the stuff of nightmares: losing brakes downhill
headed into cross-traffic, becoming trapped after a rollover crash, and fearing explosion at
any moment. The Court reasonably assumes that she felt sudden and overwhelming fear
for her life and for the lives and safety of others.
Considering the definition of a mental injury and the relevant factors for weighing
the doctors’ opinions, Dr. Caruso’s opinion is more reliable, credible, and persuasive, and
it overcomes by a preponderance of evidence the presumption of correctness afforded to
Dr. Douglas, Ms. Clendening’s authorized orthopedist.
For these reasons, the Court holds Ms. Clendening is likely to prevail at a final
hearing in proving she is entitled to a panel of psychiatrists for the treatment Dr. Caruso
has recommended for her work-related mental injury.
IT IS ORDERED:
1. Nashville Ready Mix shall offer a panel of psychiatrists for treatment.
2. A status hearing is set for Tuesday, March 10, 2026, at 10:30 a.m. Central Time.
The parties must call 615-741-2113 or 855-874-0474 to participate.
5
3. Unless an 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).
ENTERED December 23, 2025.
________________________________________
JUDGE JOSHUA D. BAKER
Court of Workers’ Compensation Claims
Appendix
Exhibits
1. Medical records filed by Candice Clendening
2. Medical records filed by Nashville Ready Mix
3. Rule 72 declaration of Candice Clendening
4. First Report of Injury forms
5. Referral to Dr. Megan Avery signed by Dr. Douglas and dated December 12, 2025
CERTIFICATE OF SERVICE
I certify that a copy of this Order was sent as indicated on December 23, 2025.
Name Certified Regular Email Sent to
Mail mail
Nadine Martin, X nadine@reasonoverlaw.com
Employee’s attorney
Chris Brown, X Chris.brown@leitnerfirm.com
Employer’s attorney
_______________________________________
PENNY SHRUM
Clerk, Court of Workers’ Compensation Claims
WC.CourtClerk@tn.gov
6
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 *
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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]
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