Opinion

Smith, Michael v. Sun Products Corporation

  • 2015 TN WC 103
Court
Tennessee Court of Workers' Compensation Claims
Filed
Aug 24, 2015
Status
Published
On the bench
Allen Phillips
Cited by
0 cases
Authority
More cited than 12.4%

The opinion

FILED

August 24, 2015

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WORKERS ' C0:\1PE~SATIO~

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Time: 1:31 P:\·:1

IN THE COURT OF WORKERS' COMPENSATION CLAIMS

AT JACKSON

Michael Smith, ) Docket No.: 2014-07-0029

Employee, )

v. ) State File No.: 78307-2014

)

Sun Products Corporation, )

Employer, ) Date of Injury: July 28, 2014

and )

)

Zurich American Ins. Co., )

Insurance Carrier. ) Judge: Allen Phillips

)

EXPEDITED HEARING ORDER GRANTING MEDICAL BENEFITS AND

DENYING TEMPORARY DISABILITY BENEFITS

THIS CAUSE came to be heard before the undersigned Workers' Compensation

Judge on July 21,2015, upon the Request for Expedited Hearing filed by Mr. Smith, the

Employee, on May 28, 2015, pursuant to Tennessee Code Annotated section 50-6-239

(2014) to determine if the Employer, Sun Products Corporation (Sun) is obligated to

provide medical and/or temporary disability benefits. Considering the positions of the

parties, the applicable law, and all of the evidence submitted, the Court concludes that

Mr. Smith is entitled to some of the requested benefits.

ANALYSIS

Issues

1. Whether Mr. Smith sustained an injury arising out of and in the course and

scope of his employment with Sun;

2. Whether Mr. Smith provided proper notice of his alleged injury to Sun;

3. Whether Mr. Smith is entitled to medical benefits, specifically a panel of

l

physicians or payment of medical bills, for an alleged carpal tunnel injury;

and

4. Whether Mr. Smith is entitled to temporary disability benefits.

Evidence Submitted

The Court admitted into evidence the exhibits below:

1. Wage Statement (AWW: $590.84/ CR: $393.91)

2. Medical Records:

o Family Medical Clinic (Dr. James Naifeh);

o EMG Clinics of Tennessee;

o American Esoteric Laboratories; and

o Veteran's Administration Medical Center

3. Associate Incident Statement (three handwritten pages by Mr. Smith); and

4. Associate Incident Statement (dated September 29, 2014).

The Court designated the following as the technical record:

• Petition for Benefit Determination (PBD), February 23, 2015;

• Dispute Certification Notice (DCN), March 27, 2015; and

• Request for Expedited Hearing, May 28, 2015.

The Court did not consider attachments to the above filings unless admitted into

evidence during the Expedited Hearing. The Court considered factual statements in the

above filings or any attachments to them as allegations unless established by the

evidence.

The following witnesses provided in-person testimony:

• Mr. Smith, and

• Ms. Gail Henderson.

History of Claim

Mr. Smith is a forty-four year-old resident of Dyer County, Tennessee. He worked

for Sun as a process operator for approximately three years beginning on March 10, 2011.

In the past, Mr. Smith served in the United States Army for three years and in the

Tennessee Army National Guard for "six or seven years."

Mr. Smith's job as a process operator required him to use rubber mallets and other

tools, including a "jack hammer-like tool," to remove spilled material from the floor and

2

to dislodge soap powder from the sides of tanks. 1 He testified his job involved repetitive

motion and other actions that caused "a lot of shock to my hands." Mr. Smith recalled an

incident that occurred "sometime in the first year" of his employment where he noticed

"tingling in the elbows and wrists" while swinging a hammer to dislodge impacted

powder. Mr. Smith testified his "lead man," Thomas Mcintosh, was present at the time of

the incident. Mr. Mcintosh purportedly called Mr. Smith a "whiner" and "different

names," and "made fun of [Mr. Smith] for not being able to do his job." Mr. Smith and

Mr. Mcintosh did not talk any more about any injury. Sometime later, Mr. Smith noted a

"knot" near his elbow. He mentioned this knot to Dr. Naifeh, whom he was seeing for

other issues. Dr. Naifeh provided a tennis elbow strap, and Mr. Smith continued to work.

On May 2, 2011, Mr. Smith saw a rheumatologist at the VA Clinic, who

diagnosed right-elbow bursitis. In the history, the provider noted Mr. Smith rested his

elbow on a "hard surface" when driving. (Ex. 2 at 36.) The provider advised him to

"avoid trauma to the bursa." !d. On May 11, 2011, Mr. Smith returned with a history of

treating in 2010 for "fibromyalgia." (Ex. 2 at 35.) He again complained of elbow pain, a

nodule on the elbow, and that "his hands [were] falling asleep when driving." He related

that, "[t]his has been going on for years." !d. The provider diagnosed elbow bursitis,

carpal tunnel syndrome, and fibromyalgia.

Mr. Smith returned to the VA Clinic on August 12, 2011, and the provider again

diagnosed him with elbow bursitis. There is no mention of carpal tunnel. (Ex. 2 at 32.) By

history, he had noted swelling in his elbow for "5 months," but it had "decreased w/in

past 2 months." He specifically denied trauma. /d. at 31. On August 15, 2011, the VA

Clinic fitted him with elbow cushions. /d. at 30. Mr. Smith wore the elbow cushions to

work, and discussed them with Curtis Fowlkes, his lead person at the time. According to

Mr. Smith, Mr. Fowlkes related that he "had had the same problem and that it took some

time to heal."

Mr. Smith continued to perform the same job duties until March 2014. He testified

he tried "on several occasions to apply for different jobs in the plant," and he told Mr.

Fowlkes that he did not believe he could perform the physical requirements of his job.

Mr. Smith left Sun in March 2014 due to "anxiety" and "widespread body pain."

He offered into evidence an undated "Associate Incident Report," which he presented to

Sun before leaving. In the report, he detailed in his own handwriting what he described as

"being a victim of a hostile work environment and a target of bullying on several

occasions." (Ex. 3.) He noted his supervisors told him he was "incapable" of performing

his job, and used other harsh and condescending language towards him. The actions were

"too numerous to list on [the] form," but "the results of the actions have taken its toll on

[his] mind and body." He noted anxiety, suicidal ideations, and "constant body aches and

1

Sun is a manufacturer of detergent powder.

3

pains." His mental issues were of such severity that he "admitted himself' to the VA

Medical Center in Memphis. !d.

Mr. Smith has not worked since March 24, 2014. The VA hospitalized Mr. Smith

for post-traumatic stress disorder (PTSD) for an undefined period between March 24,

2014, and the alleged injury date of July 28, 2014. The VA records admitted into

evidence do not include any documentation of this hospitalization, but instead are limited

to the treatment for the previously di cussed elbow condition in 2011. 2

Mr. Smith introduced certain medical records of Dr. Naifeh beginning in January

2014. The records are handwritten and largely illegible. However, Dr. Naifeh noted

complaints of anxiety, PTSD and fibromyalgia in various notes between January 2014

and July 2014. On July 17, 2014, Dr. Naifeh recommended an EMG/NCS test. EMG

Clinics of Tennessee conducted the test on July 29, 2014, and it revealed moderately

severe bilateral carpal tunnel syndrome. Mr. Smith testified the date of the EMG is when

he first learned of the carpal tunnel diagnosis. 3

Following the EMG, Mr. Smith advised "Brian,"4 the safety supervisor, of the test

results. Brian told Mr. Smith to "come by" Sun and complete another incident report. Mr.

Smith did so, and Brian advised him to "put the date of the day we found out" about the

carpal tunnel as the date of injury. Mr. Smith's wife completed the form, but did not fill

in the injury date. Mr. Smith returned the form, "a couple of days later" but heard

"nothing" from Sun regarding the report. Someone noted in the lower-right comer of the

docum~nt that it was "dropped off at plant 9/29114." (Ex. 4.)

In the report, Mr. Smith's wife wrote:

On July 28th I was diagnosed w/ bilateral carpal tunnel and nerve

damage. Doctor stated could be a direct of repeatedly being required to beat

on surge bins with mallet. Pain started approx. 1 yr. after hire date. I

attempted on several occasions to see doctors about this and was

misdiagnosed until the above date.

!d. On cross-examination, Mr. Smith admitted he understood that company policy

required reporting injuries when they happened. He further admitted to immediately

reporting suffering a prior workers' compensation claim involving a foreign body in his

eye. In the instant case, Mr. Smith stated he reported his carpal tunnel on July 28, 2014,

after the EMG. He also stated he spoke with "his lead," referring to Mr. Fowlkes, in 2011

2

Mr. Smith's counsel stated at the hearing that the VA records were extremely voluminous, over 1,200 pages in

their entirety, and that she had condensed those offered as evidence to records bearing on the issues presented.

3

Mr. Smith recalled the date of the EMG as being, incorrectly, July 28, 20 14; hence, the stated date of injury in the

PBD. The one-day discrepancy is immaterial to determination of the issues in this expedited hearing.

4

"Brian" was later identified as Brian Foster.

4

regarding his upper-extremity problems, although he described the problem as tennis

elbow because such was his diagnosis at the time. He was not aware in 2011 that the pain

his elbow pain was work-related, but thought fibromyalgia could be causing the pain. He

denied that a reference in the VA records to problems that had been "going on for years"

referred to his elbow pain. He also denied that any activities outside of work required

repetitive use of his arms. He made repeated attempts to contact the carrier regarding the

status ofhis carpal tunnel claim.

Ms. Gail Henderson testified for Sun. She worked for Sun as the HR and Safety

Manager. Prior to that time, Brian Mason was "over workers' compensation."

Ms. Henderson recalled "several conversations" with Mr. Smith regarding his

carpal tunnel injury. Though she could not remember "exactly" when the conversations

took place, she "would lean more toward July, August" 2014. She advised Mr. Smith to

follow up with Mr. Mason. Mr. Smith contacted her because the carrier had not called

him, and she followed up with the carrier. Ms. Henderson testified she questioned the

"timing" of Ms. Smith's carpal tunnel claim, but did not elaborate further. She further

stated that Sun hopes to "leave his position open" to see if he might be able to return to

work.

Mr. Smith filed a PBD on February 23, 2015, seeking medical and temporary

disability benefits. The parties did not resolve the disputed issues through mediation and

the Mediation Specialist filed the DCN on March 27, 2015.

Mr. Smith's Contentions

Mr. Smith contends he remains an employee of Sun, but has not worked since

March 2014 because ofPTSD. He began experiencing problems with his hands as early

as 2011, "a few months after he began work at Sun." In July 2014, he saw Dr. Naifeh,

who ordered testing for CTS. After testing positive, he reported his injury to Sun. He has

received no further treatment for his carpal tunnel condition since seeing Dr. Naifeh.

Mr. Smith argues that Ms. Henderson testified she actually knew he was

"complaining of carpal tunnel syndrome" in July 2014, and thus had actual notice of his

injury. No one rebutted Mr. Smith's testimony that he reported the injury to Mr. Foster.

Ms. Henderson testified he told her of his claim. In Hollingsworth v. S & W Pallet, 74

S.W.3d 347 (Tenn. 2009), the Court found that "verbally" reporting an injury provided

sufficient notice.

Mr. Smith has no medical proof because Sun has not provided a panel. Citing Ball

v. Regions Financial Corp., No. W2013-02454-SC-R3-WC, 2014 Tenn. LEXIS 705

(Tenn. Workers' Comp. Panel Oct. 2, 2014), Mr. Smith argues that the "nature and extent

of an employee's injury and the issue of medical causation usually come to light in the

5

course of treatment." Even though he has no medical proof of causation, there is still no

proof relating his carpal tunnel syndrome to any other "intervening" cause.

Mr. Smith is in no condition to work and the carpal tunnel contributes to that

inability to work. Therefore, Sun owes him temporary disability benefits.

Sun's Contentions

Sun contends that Mr. Smith failed to provide notice of his alleged injury until

September 29, 2014, more than thirty days after the alleged injury date of July 28, 2014.

Thus, Mr. Smith's claim fails because he failed to give Sun notice of the injury within

thirty days of when he knew, or should have known, that he sustained an injury arising

out of and in the course and scope of his employment. Ms. Henderson testified she did

not receive the "form," referring to the Associate Incident Report, until September 2014.

Sun also contends that there is inadequate proof of causation. Mr. Smith cannot

show his injury arose primarily out of the employment because he cannot show by a

preponderance of the evidence that the carpal tunnel syndrome is 50% or more related to

his work at Sun, considering all causes. The VA records indicate that the "problems"

have been "going on for years." The burden of proving causation falls on Mr. Smith.

Finally, Sun contends Mr. Smith is not entitled to temporary disability benefits

because he cannot show, by expert medical proof, either a causal relationship between his

inability to work or the period of disability.

Findings of Fact and Conclusions of Law

Standard Applied

The Workers' Compensation Law shall not be remedially or liberally construed in

favor of either party but shall be construed fairly, impartially and in accordance with

basic principles of statutory construction favoring neither the employee nor employer.

Tenn. Code Ann. § 50-6-116 (2014). An employee need not prove every element of his or

her claim by a preponderance of the evidence in order to obtain relief at an expedited

hearing. McCord v. Advantage Human Resourcing, No. 2014-06-0063, 2015 TN Wrk.

Comp. App. Bd. LEXIS 6, at *7-8, 9 (Tenn. Workers' Comp. App. Bd. Mar. 27, 2015).

At an expedited hearing, an employee has the burden to come forward with sufficient

evidence from which the trial court can determine that the employee is likely to prevail at

a hearing on the merits. !d.

6

Factual Findings

Mr. Smith reported a carpal tunnel injury to Sun on July 29, 2014, following an

EMG study. Sun had knowledge of the alleged injury as of that date, or shortly thereafter.

Sun has provided neither a panel nor medical treatment to Mr. Smith, and he has received

all medical treatment to date from providers he sought on his own. There has yet to be a

definitive opinion as to the cause of his carpal tunnel condition from any provider. Mr.

Smith has not shown a causal relation between his inability to work and his carpal tunnel

condition.

Application ofLaw to Facts

Because the issue of proper notice is outcome determinative of the other issues,

the Court will address it first.

Mr. Smith gave proper notice of his alleged carpal tunnel injury.

Tennessee Code Annotated section 50-6-201(a)(l) provides that an injured

employee "shall, immediately upon the occurrence of an injury, or as soon thereafter as

practicable, give or cause to be given to the employer who has no actual notice, written

notice of the injury ... within thirty (30) days after the occurrence of the accident." The

notice should reasonably convey the idea that the employee has suffered an injury arising

out of and in the course of his employment. Masters v. Industrial Garments Mfg. Co.,

Inc., 595 S.W.2d 811, 816 (Tenn. 1980). 5 The reason for the notice requirement is to

allow the employer an opportunity to investigate the alleged injury while evidence is

available and to provide timely medical care to the employee. !d. at 815.

In this case, the pertinent language of the statute states that an employee must

provide written notice, "as soon as practicable" to an employer "who has no actual

notice" of an alleged injury. See Tenn. Code Ann. § 50-6-201(a)(1) (2014)(emphasis

added). The Court finds Sun had actual notice of an alleged injury on the date Mr. Smith

underwent the EMG study. As pointed out by counsel, his testimony that he told Mr.

Brian Foster of the diagnosis the day of the EMG is unrebutted. Sun submitted no

evidence to assail Mr. Smith's credibility on this point. Likewise, Ms. Henderson testified

candidly and corroborated that Sun had actual notice before September 2014 that Mr.

Smith claimed he had carpal tunnel. As such, the fact that Sun's received the incident

report more than thirty days after the alleged injury date is immaterial.

5

"Reliance on precedent from the Tennessee Supreme Court is appropriate unless it is evident that the Supreme

Court's decision or rationale relied on a remedial interpretation of pre-July I, 2014 statutes, that it relied on specific

statutory language no longer contained in the Workers' Compensation Law, and/or that it relied on an analysis that

has since been addressed by the general assembly through statutory amendments." McCord v. Advantage Human

Resourcing, No. 2014-06-0063,2015 TN Wrk. Comp. App. Bd. LEXIS 6, at *13 (Tenn. Workers' Comp. App. Bd.

Mar. 27, 20 15).

7

Tennessee Code Annotated subsection 50-6-201(b)(1) (2014) provides that the

employee shall provide notice within thirty days of when he "knows or reasonably should

know" that he has suffered a work-related injury. Here, Mr. Smith "knew" of his carpal

tunnel condition when the EMG test results were conveyed to him on July 29, 2014. He

then reported the injury to Sun that same day.

In this case, Sun points out that Mr. Smith complained of problems as early as

2011. However, the Court finds that any prior problems with his arms were not in the

nature of carpal tunnel, or at least not definitively diagnosed carpal tunnel. Sun correctly

points out that the VA records indicate, on May 2, 2011, that Mr. Smith had "problems,"

which had "been going on for years." (Ex. 2 at 35.) Even if this record refers to carpal

tunnel, which is less than clear, the statute provides that Mr. Smith must either have

known, or reasonably should have known, the condition was work-related. The only

discussions of activities in the 2011 medical records pertain to the positioning of his arm

while driving.

Of course, Tennessee law has long held that a gradually-occurring injury continues

with every day that the employee continues to work. Barker v. Home-Crest Corp., 805

S.W.2d 373, 376 (Tenn. 1991). Thus, even if Mr. Smith "knew" of his arms hurting on

the job in 2011, he was not required to report the injury at that time as his injury

"continued" every day he worked at Sun.

Likewise, the condition did nqt render Mr. Smith unable to work in 2011. See

Tenn. Code Ann. § 50-6-201(b)(2) (2014)(an employee is not required to give notice of

an injury until being rendered unable to work because of an injury he relates to his job).

He worked for almost three more years, and the record is devoid of evidence that he

attributed the carpal tunnel condition to his work in 2011; to the contrary, he thought he

injured his elbow. It matters not whether he delayed advising Sun of his symptoms in the

past; it matters that he reported it when he became aware of the diagnosis.

Proof of injury.

The notice provisions of the statute do not require an employee to present medical

proof of an injury before an employer is required to provide medical benefits. Rather, the

statute contemplates that an employer will provide medical care upon receipt of notice of

the injury, and then, during the course of treatment and examination, the panel doctor will

render an opinion on causation. See Tenn. Code Ann. § 50-6-102(13) (2014). Otherwise,

an employee would be forced to seek medical care on his own to begin a claim, which the

statute does not contemplate. Further, it is not required that Mr. Smith prove causation

simply to report an injury. As he argues, Tennessee law is clear that "the nature and

extent of an employee's injuries, and the issue of medical causation, usually come to light

in the course of treatment of the employee's injuries." Ball v. Regions Financial Corp.,

No. W2013-02454-SC-R3-WC, 2014 Tenn. LEXIS 705, at *15 (Tenn. Workers' Comp.

8

Panel Oct. 2, 2014) (citing Quaker Oats v. Smith, 574 S.W.2d 45,48 (Tenn. 1978)).

Therefore, at this stage of the case, Mr. Smith is not required to establish through

expert medical proof that his injury arose primarily out of the employment. He is, as

stated previously, required to come forward with sufficient evidence from which the

Court might find he is likely to prevail at a hearing on the merits. This Court so finds.

However, this finding neither prevents Sun from producing countervailing evidence nor

obviates Mr. Smith's burden of establishing his injury under the proper evidentiary

standard at a full hearing. See McCord v. Advantage Human Resourcing, No. 2014-06-

0063, 2015 TN Wrk. Comp. App. Bd. LEXIS 6, at *4 (Tenn. Work. Comp. App. Bd.

Mar. 27, 2015); cf McCall v. Nat!. Health Corp., 100 S.W.3d 209, 214 (Tenn. 2003).

Medical benefits.

Having found sufficient evidence that Mr. Boyd is likely to prevail on the merits

regarding causation, the Court also finds that Sun must provide further evaluation of his

carpal tunnel condition. Tennessee Code Annotated section 50-6-204(a)(l)(a) (2014)

requires an employer to "furnish, free of charge to the employee, such medical and

surgical treatment ... made reasonably necessary by accident." The first requirement of

furnishing medical treatment made necessary by accident is the provision of a panel of

physicians by the employer. Tenn. Code Ann. § 50-6-204(3)(A)(i) (2014). The Court

orders the provision of a panel to determine a complete and accurate diagnosis of Mr.

Smith's condition and its cause.

Mr. Smith provided no evidence of any outstanding medical bills, and the Court

cannot order payment for any charges incurred to date by Mr. Smith.

Temporary disability benefits.

Temporary total disability (TTD) is payable to an injured employee who is totally

disabled to work by his injury and while he is recovering as far as the nature of the injury

permits. Cleek v. Wal-Mart Stores, Inc., 19 S.W.3d 770, 776 (Tenn. 2000). Under

Tennessee law, to establish entitlement to temporary total benefits, the employee must

show he was (1) totally disabled to work by a compensable injury; (2) that there was a

causal connection between the injury and his inability to work; and (3) the duration of

that period of disability. !d. When an employee demonstrates the ability to return to work

or attains maximum medical improvement, then TTD benefits are terminated. Simpson v.

Satterfield, 564 S.W.2d 953, 955 (Tenn. 1978).

Temporary partial disability (TPD) refers to the time during which the injured

employee is able to resume some gainful employment but has not yet reached maximum

recovery. Williams v. Saturn Corp., No. M2004-01215-WC-R3-CV, 2005 Tenn. LEXIS

1032, *6 (Tenn. Workers' Comp. Panel Nov. 15, 2005). As with TTD, there must be

9

adequate proof of a causal connection between the injury and disability for an award of

TPD.

To date, there is no medical opinion that Mr. Smith's carpal tunnel injury disabled

him from working. Though he argues he is unable to work, his lay testimony, without

corroborative expert testimony, does not constitute adequate evidence of medical

causation. Scott v. Integrity Staffing Solutions, No. 2015-01-0055, TN Wrk. Comp. App.

Bd. LEXIS _ , at *6 (Tenn. Workers' Comp. App. Bd. Aug. 18, 2015). Therefore, at

this time, Mr. Smith has not established entitlement to temporary benefits.

Mr. Smith has come forward with sufficient evidence from which this Court

concludes that he is likely to prevail at a hearing on the merits on the issue regarding the

provision of a panel, but has not come forward with sufficient evidence for the other

requested benefits.

IT IS, THEREFORE, ORDERED as follows :

1. Sun, or its workers' compensation carrier, shall provide Mr. Smith with medical

treatment for his injuries as required by Tennessee Code Annotated section 50-6-

204 (2014), to be initiated by providing Mr. Smith with a panel of physicians as

required for evaluation of the carpal tunnel condition and opining as to its causal

relationship to his work at Sun. Mr. Smith or the medical providers shall furnish

medical bills for this evaluation and/or treatment to Sun or its workers'

compensation carrier.

2. Mr. Smith's claim against Sun and its workers' compensation carrier for the

requested temporary disability benefits is denied.

3. This matter is set for an Initial (Scheduling) Hearing on December 9, 2015, at 10

a.m.

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) (2014). The Insurer or Self-Insured

Employer 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.

10

5. For questions regarding compliance, please contact the Workers' Compensation

Compliance Unit via email WCCompliance.Program@tn.go or by calling (615)

253-1471 or (615) 532-1309.

ENTERED this the 24th day of August, 2015.

Judge Allen Phil ps

Court of Workers' Com pen

Initial Hearing:

An Initial (Scheduling) Hearing has been set with Judge Allen Phillips, Court of

Workers' Compensation Claims. You must call 731-422-5263 or toll free at 855-543-

5038 to participate in the Initial Hearing.

Please Note: You must call in on the scheduled date/time to

participate. Failure to call in may result in a determination of the issues without

your further participation. All conferences are set using Central Time (CT).

Right to Appeal:

Tennessee Law allows any party who disagrees with this Expedited Hearing Order

to appeal the decision to the Workers' Compensation Appeals Board. To file a Notice of

Appeal, you must:

1. Complete the enclosed form entitled: "Expedited Hearing Notice of Appeal."

2. File the completed form with the Court Clerk within seven business days of the

date the Workers' Compensation Judge entered the Expedited Hearing Order.

3. Serve a copy of the Expedited Hearing Notice of Appeal upon the opposing party.

4. The appealing party is responsible for payment of a filing fee in the amount of

$75.00. Within ten calendar days after the filing of a notice of appeal, payment

must be received by check, money order, or credit card payment. Payments can be

made in person at any Bureau office or by United States mail, hand-delivery, or

other delivery service. In the alternative, the appealing party may file an Affidavit

of Indigency, on a form prescribed by the Bureau, seeking a waiver of the filing

fee. The Affidavit of Indigency may be filed contemporaneously with the Notice

of Appeal or must be filed within ten calendar days thereafter. The Appeals Board

will consider the Affidavit of Indigency and issue an Order granting or denying

11

the request for a waiver of the filing fee as soon thereafter as is

practicable. Failure to timely pay the filing fee or file the Affidavit of

Indigency in accordance with this section shall result in dismissal of the

appeal.

5. The parties, having the responsibility of ensuring a complete record on appeal,

may request, from the Court Clerk, the audio recording of the hearing for the

purpose of having a transcript prepared by a licensed court reporter and filing it

with the Court Clerk within ten calendar days of the filing of the Expedited

Hearing Notice of Appeal. Alternatively, the parties may file a joint statement of

the evidence within ten calendar days of the filing of the Expedited Hearing

Notice of Appeal. The statement of the evidence must convey a complete and

accurate account of what transpired in the Court of Workers' Compensation

Claims and must be approved by the workers' compensation judge before the

record is submitted to the Clerk of the Appeals Board.

6. If the appellant elects to file a position statement in support of the interlocutory

appeal, the appealing party shall file such position statement with the Court Clerk

within three business days of the filing of the Expedited Hearing Notice of Appeal,

specifying the issues presented for review and including any argument in support

thereof. If the appellee elects to file a response in opposition to the interlocutory

appeal, appellee shall do so within three business days of the filing of the

appellant's position statement.

CERTIFICATE OF SERVICE

I hereby certify that a true and correct copy of the Expedited Hearing Order

Granting Medical Benefits and Denying Temporary Disability Benefits was sent to the

following recipients by the following methods of service on this the 24th day of August,

2015.

Name Certified Via Via Service sent to:

Mail Fax Email

Marianna Williams X molly@ashleyamold.com

Nicole Grida X nicole.grida@zurichna.com

~ ~Uk-- '

Pen~~m, Clerk of Court

Court of ..Workers' Compensation Claims

WC.CourtClerk@tn.gov

12

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