The opinion
FILED
Apr 13, 2026
11:45 AM(CT)
TENNESSEE
WORKERS' COMPENSATION
APPEALS BOARD
TENNESSEE BUREAU OF WORKERS’ COMPENSATION
WORKERS’ COMPENSATION APPEALS BOARD
Billy Brown Docket No. 2023-02-8932
v. State File No. 2355-2024
The Lilly Co. d/b/a
Lilly Environmental, et al.
Appeal from the Court of Workers’
Compensation Claims
Brian K. Addington, Judge
Affirmed and Remanded
The employee in this interlocutory appeal sustained a compensable low back injury. After
a period of authorized medical care, the relationship between the employee and his
authorized physician deteriorated. The employee requested a new panel of orthopedic
physicians and a panel of neurosurgeons pursuant to a purported referral from the treating
physician. The authorized physician then declined to see the employee again. Following
an expedited hearing, the trial court ordered the employer to provide a new panel of
orthopedic specialists for selection of a new treating physician, but it declined to order a
panel of neurosurgeons, finding that no referral was made. The employer has appealed.
Having carefully reviewed the record, we affirm the trial court’s order and remand the case.
Presiding Judge Timothy W. Conner delivered the opinion of the Appeals Board in which
Judge Pele I. Godkin and Judge Meredith B. Weaver joined.
A. Allen Grant and Scott A. Morrell, Nashville, Tennessee, for the employer-appellant,
The Lilly Co. d/b/a Lilly Environmental
Timothy A. Roberto, Knoxville, Tennessee, for the employee-appellee, Billy Brown
Memorandum Opinion 1
On November 17, 2023, Billy Brown (“Employee”) was driving a forklift within
the course and scope of his employment for The Lilly Co. d/b/a Lilly Environmental
1
This decision is being filed pursuant to Tenn. Comp. R. and Regs. 0800-02-22-.03(1) (2023).
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(“Employer”), when the forklift struck an unpainted metal support beam. Employee
reported the incident, and a company manager came to the scene to investigate the damage.
When Employee was sent for a drug test, he purportedly showed the nurse the left side of
his back, which was red and swollen following the incident. However, he told Angie Carr,
a supervisor, that he “was fine” but may be “stoved up.” Employee was apparently
terminated following the incident.
On November 22, Employee told Ms. Carr that he was seeing his primary care
physician due to soreness and numbness from the accident. According to a November 22
report issued by Dr. Rania Al Asmar, Employee complained of right lower back and hip
pain that radiated down his right leg. Dr. Al Asmar ordered an “urgent MRI” of the lumbar
spine due to suspected “intervertebral disc prolapse with impingement.” By November 29,
Employee complained of worsening symptoms that “left me nearly unable to walk or move
around freely.” He allegedly called both Ms. Carr and the company’s safety manager to
report that his doctor had ordered an MRI for early December.
The December 4 MRI report indicated Employee had “[m]ultilevel degenerative
changes” in the lumbar spine “superimposed on epidural lipomatosis.” According to the
radiologist’s assessment, Employee had a “broad-based disc bulge” at every level of the
lumbar spine. Upon review of the MRI findings, Dr. Al Asmar prescribed pain medication
and referred Employee to a neurosurgeon.
After several visits to a walk-in clinic, Employee eventually received authorized
care with an orthopedic specialist, Dr. Richard Duncan. In his March 9, 2024 report, Dr.
Duncan noted Employee’s history of having struck a metal pole while driving a forklift.
Employee complained of left-sided low back pain with radiating numbness and tingling
into the left foot and reported undergoing three weeks of physical therapy that had helped
“a little.” Following his physical examination, Dr. Duncan diagnosed lumbar radicular
pain and thoracic spine pain. He prescribed medications and an injection.
In his March 12 report, Dr. Duncan noted that he had reviewed office notes from
the walk-in clinic as well as the prior x-ray and MRI reports. He commented that
Employee’s scans showed “degenerative changes normal for age” and that he saw no
evidence of a disc herniation. However, Dr. Duncan did see evidence of “L4 nerve root
compression” that was likely a “result of his injury based on his history.” Dr. Duncan
recommended a “L4 selective nerve root injection” and asked that Employee return in five
to six weeks for reevaluation.
Dr. Duncan continued to offer conservative care over the next several months,
including injections, medications, physical therapy, and home exercise. He noted
improvement in Employee’s symptoms, and, on June 11, 2024, he placed Employee at
maximum medical improvement (“MMI”) with a 3% impairment rating. He did not restrict
Employee’s physical activities.
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Employee returned to Dr. Duncan several more times. He received epidural steroid
injections in January and March 2025, which he reported improved his symptoms. Dr.
Duncan did not alter his opinions regarding MMI or permanent impairment. 2 However, in
his April 16, 2025 report, Dr. Duncan suggested the possibility of a repeat MRI, but then
stated, “[W]orkers’ compensation does not want to do that.” He then commented that if
Employee “wants to ask [him] further questions then he can go somewhere else if [he] is
not happy with my opinions or my impairment rating.” He also noted that Employee “may
want to speak with a neurosurgeon.” Finally, Dr. Duncan stated, “I do not have anything
else I can do from a medication or injection standpoint to help him.”
Following the April 2025 visit with Dr. Duncan, Employee asked the trial court to
compel Employer to provide a panel of orthopedic specialists for selection of a new treating
physician, and a panel of neurosurgeons in response to Dr. Duncan’s purported referral.
Employer opposed the requests, arguing that it had provided all appropriate treatment to
date and that Dr. Duncan had not expressed an unwillingness to see Employee again. It
further argued that Dr. Duncan’s comment in his final report did not amount to a “referral.”
Thereafter, Employer acknowledged in a supplemental brief that Dr. Duncan had, in fact,
declined to see Employee again as a patient. However, it maintained that any need for
additional medical treatment was not causally related to the work accident, citing Dr.
Duncan’s September 12, 2025 response to a medical questionnaire in support of its
position.
Following the expedited hearing, the trial court concluded that Employee remained
entitled to reasonable and necessary medical treatment causally related to the work
accident. Citing our opinion in Limberakis v. Pro-Tech Sec., Inc., No. 2016-08-1288, 2017
TN Wrk. Comp. App. Bd. LEXIS 53, at *9-10 (Tenn. Workers’ Comp. App. Bd. Sept. 12,
2017), the trial court ordered Employer to provide a panel of orthopedic specialists for
selection of a new treating physician. However, it declined to order a panel of
neurosurgeons, concluding that Dr. Duncan’s statements did not constitute a referral for
treatment. Employer has appealed.
It is a fundamental tenet of Tennessee workers’ compensation law that an employee
is entitled to medical treatment “made reasonably necessary” by a work-related accident.
Tenn. Code Ann. § 50-6-204(a)(1)(A). Moreover, as we concluded in Limberakis, “unless
a court terminates an employee’s entitlement to medical benefits, or approves a settlement
in which the parties reach a compromise on the issue of future medical benefits, an injured
worker remains entitled to reasonable and necessary medical treatment causally related to
the work injury.” Limberakis, 2017 TN Wrk. Comp. App. Bd. LEXIS 53, at *7. In other
words, an employer cannot unilaterally terminate an employee’s right to future medical
2
During the course of his low back treatment, Employee was also evaluated for right knee symptoms and
eventually underwent a total knee replacement. That course of treatment is not pertinent to the present
appeal.
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benefits. Id. at *6. Despite Employer’s effort to distinguish Limberakis, we conclude the
rationale expressed in that case applies with equal measure here.
In Limberakis, after the treating physician declined to see the employee again, the
employer sent the physician a letter, and the doctor replied that he did not believe the
employee “will require further medical treatment as it directly relates to his work-related
injury.” Id. at *3. Nevertheless, we concluded the employee remained entitled to medical
benefits as provided in subsection 204(a)(1)(A) unless and until those benefits were
terminated by court order. Id. at *10. Here, after Dr. Duncan declined to see Employee
again as a patient, Employer sent Dr. Duncan a medical questionnaire asking whether
Employee needs “any further medical treatment for [Employee’s] lumbar spine that is
primarily related . . . to the work incident.” Dr. Duncan checked the “NO” line but offered
no further comment or explanation. In addition, at the time Dr. Duncan responded to
Employer’s questionnaire in September 2025, he had not seen Employee as a patient in
almost five months. Under these circumstances, the trial court gave little weight to Dr.
Duncan’s response and ordered Employer to provide a new panel for selection of a treating
physician. We agree the preponderance of the evidence supports that order. It will be up
to the selected physician to determine whether Employee needs additional medical
treatment “made reasonably necessary by accident.” Tenn. Code Ann. § 50-6-
204(a)(1)(A).
For the foregoing reasons, we affirm the decision of the trial court and remand the
case. Costs on appeal are taxed to Employer.
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