The opinion
FILED
Oct 15, 2021
11:01 AM(CT)
TENNESSEE COURT OF
WORKERS' COMPENSATION
CLAIMS
TENNESSEE BUREAU OF WORKERS’ COMPENSATION
IN THE COURT OF WORKERS’ COMPENSATION CLAIMS
AT MURFREESBORO
KELLY ROLLINS, ) Docket No. 2021-05-0232
Employee, )
v. )
UNITED PARCEL SERVICE, INC., ) State File No. 94527-2019
Employer, )
And )
LIBERTY MUTUAL, ) Judge Dale Tipps
Carrier. )
COMPENSATION ORDER
The Court held a Status Hearing in this case on October 13, 2021. The parties agreed
that their previously filed stipulations and the compromised disability benefits within their
proposed settlement documents leave no factual issues for resolution. The only issue is
whether Mr. Rollins is entitled to lifetime medical benefits. Therefore, by the parties’
agreement, the Court will decide this matter on the record. For the reasons below, the
Court holds that Mr. Rollins is entitled to permanent disability benefits, temporary
disability benefits, and lifetime medical benefits.
Findings of Fact and Conclusions of Law
Mr. Rollins, as the employee in a workers’ compensation claim, has the burden of
proof on all essential elements of his claim. Scott v. Integrity Staffing Solutions, 2015 TN
Wrk. Comp. App. Bd. LEXIS 24, at *6 (Aug. 18, 2015). At a compensation hearing, he
must show by a preponderance of the evidence that he is entitled to the requested benefits.
Willis v. All Staff, 2015 TN Wrk. Comp. App. Bd. LEXIS 42, at *18 (Nov. 9, 2015).
Stipulations
Mr. Rollins suffered physical injuries in the course and scope of his employment
with UPS when he was involved in an automobile accident on September 10, 2019. He
suffered multiple injuries, including a fractured hip, fractured right patella, fractured left
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scapula, lumbar fractures, right-wrist sprain, and post-traumatic stress disorder. UPS
accepted the claim and provided medical treatment.
UPS also paid temporary total disability benefits at the weekly rate of $1,056.00
through August 27, 2020. Because Mr. Rollins did not reach maximum medical
improvement until September 15, 2020, he is entitled to additional temporary total
disability benefits of $2,866.34.
As a result of his injuries, Mr. Rollins was unable to return to work at UPS, which
made him an offer under its Voluntary Separation Allowance Plan. He accepted the offer,
which resulted in his voluntary retirement in exchange for “specific consideration.”
Mr. Rollins’s weekly compensation rate for permanent disability benefits is
$960.00. His permanent partial disability original award and increased benefits total
$115,000.00. He is not entitled to any additional permanent disability benefits.
UPS agreed to reimburse Mr. Rollins $300.00 for his payment of C-32 Medical
Report fees.
Medical Benefits
The Workers’ Compensation Law is clear on this point: “the employer or the
employer’s agent shall furnish, free of charge to the employee, such medical and surgical
treatment . . . made reasonably necessary by accident[.]” Tenn. Code Ann. § 50-6-
204(a)(1)(A). As the parties have stipulated to the compensability of Mr. Rollins’s injuries,
UPS is responsible for his future medical treatment under this provision. Thus, he is
entitled to continuing medical treatment with Drs. Stephen Engstrom, Robert Boyce,
Donald Lee, Byron Stephens, and Melissa Thorne-Smith.
IT IS, THEREFORE, ORDERED as follows:
1. United Parcel Service, Inc., shall provide Mr. Rollins future medical benefits
under Tennessee Code Annotated section 50-6-204(a)(1)(A). Drs. Stephen
Engstrom, Robert Boyce, Donald Lee, Byron Stephens, and Melissa Thorne-
Smith remain the treating physicians.
2. United Parcel Service, Inc., shall pay Mr. Rollins permanent partial disability
benefits of $115,000.00 in a lump sum.
3. United Parcel Service, Inc., shall pay Mr. Rollins temporary total disability
benefits of $2,866.34 in a lump sum.
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4. United Parcel Service, Inc., shall reimburse Mr. Rollins $300.00 for his C-32
Medical Report fee expenses.
5. The Court further finds Mr. Rollins’s counsel, Terry Fann, provided good and
valuable services to Mr. Rollins in pursuit of his claim and is therefore entitled
to recover a fee of twenty percent of his permanent disability award under
Tennessee Code Annotated section 50-6-226, as well as reimbursement of his
expenses of $1,213.85.
6. United Parcel Service, Inc., shall pay to the Court Clerk the $150.00 filing fee
under Tennessee Compilation Rules and Regulations 0800-02-21-.06 within five
days of entry of this order.
7. United Parcel Service, Inc., shall file an SD-2 with the Court Clerk within five
days of entry of this order.
8. Unless appealed, this order shall become final thirty days after entry.
ENTERED OCTOBER 15, 2021.
_____________________________________
Judge Dale Tipps
Court of Workers’ Compensation Claims
APPENDIX
Technical record:
1. Petition for Benefit Determination
2. Dispute Certification Notice
3. Joint Stipulations
4. Proposed settlement documents
CERTIFICATE OF SERVICE
I certify that a copy of the Compensation Hearing Order was sent as indicated on
October 15, 2021.
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Name Certified Via Service Sent To
Mail Email
Terry Fann, X terryfann@wfptnlaw.com
Employee’s Attorney
David T. Hooper, X dhooper@hooperzinn.com
Employer’s Attorney
_____________________________________
Penny Shrum, Clerk of Court
Court of Workers’ Compensation Claims
WC.CourtClerk@tn.gov
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Compensation Hearing Order Right to Appeal:
If you disagree with this Compensation Hearing Order, you may appeal to the Workers’
Compensation Appeals Board or the Tennessee Supreme Court. To appeal to the Workers’
Compensation Appeals Board, you must:
1. Complete the enclosed form entitled: “Notice of Appeal,” and file the form with the
Clerk of the Court of Workers’ Compensation Claims within thirty calendar days of the
date the compensation hearing order was filed. When filing the Notice of Appeal, you
must serve a copy upon 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 of 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 bear the responsibility of ensuring a complete record on appeal. You may request
from the court clerk the audio recording of the hearing for a $25.00 fee. A licensed court
reporter must prepare a transcript and file it with the court clerk within fifteen calendar
days of the filing the Notice of Appeal. Alternatively, you may file a statement of the
evidence prepared jointly by both parties within fifteen calendar days of the filing of the
Notice of Appeal. The statement of the evidence must convey a complete and accurate
account of the hearing. The Workers’ Compensation Judge must approve the statement
of the evidence before the record is submitted to the Appeals Board. If the Appeals
Board is called upon to review testimony or other proof concerning factual matters, the
absence of a transcript or statement of the evidence can be a significant obstacle to
meaningful appellate review.
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. The appealing
party has fifteen calendar days after the date of that notice to submit a brief to the
Appeals Board. See the Practices and Procedures of the Workers’ Compensation
Appeals Board.
To appeal your case directly to the Tennessee Supreme Court, the Compensation Hearing
Order must be final and you must comply with the Tennessee Rules of Appellate
Procedure. If neither party timely files an appeal with the Appeals Board, the trial court’s
Order will become final by operation of law thirty calendar days after entry. See Tenn.
Code Ann. § 50-6-239(c)(7).
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 (check one or more applicable boxes and include the date file-
stamped on the first page of the order(s) being appealed):
□ Expedited Hearing Order filed on _______________ □ Motion Order filed on ___________________
□ Compensation Order filed on__________________ □ 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]
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