The opinion
FILED
Feb 08, 2022
12:08 PM(CT)
TENNESSEE COURT OF
WORKERS' COMPENSATION
CLAIMS
TENNESSEE BUREAU OF WORKERS’ COMPENSATION
IN THE COURT OF WORKERS’ COMPENSATION CLAIMS
AT NASHVILLE
CONCEPCION GUATEMALA, ) Docket No. 2019-06-2251
Employee, )
v. ) State File No. 108266-2019
TYSON FOODS, INC., )
Employer. ) Judge Joshua Davis Baker
)
___________________________________________________________________
COMPENSATION ORDER
____________________________________________________________________
In a January 20, 2022 compensation hearing, Mr. Guatemala requested continuing
medical treatment and reimbursement of medical expenses.1 Tyson agreed to provide
continuing reasonable and necessary medical treatment from Dr. Jeffrey Hazlewood, so
this request is granted. However, because Mr. Guatemala submitted no admissible proof
on his claim for reimbursement of past medical expenses, that request is denied.
History of the Case
Mr. Guatemala injured his lower back on August 1, 2019, when a trailer became
unlatched from the truck he drove and hit the back of his cab. Tyson provided immediate
care in its clinic with a registered nurse.
Mr. Guatemala said he asked to see a doctor, but Tyson would not allow it, and he
was told if he went to see a doctor, he would have to pay for it. Afterward, he continued
getting treatment conservative treatment at the infirmary for the next two weeks. At the
last visit, the attending nurse asked why he was there. After this encounter, Mr. Guatemala
sought treatment on his own.
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Mr. Guatemala also requested temporary and permanent disability benefits but withdrew those requests
at the outset of trial.
Mr. Guatemala received treatment through his private health insurer from Drs. Viola
Chen and Jason Jones. He claimed he sought treatment because the nurse told him he did
not need a doctor, and Tyson would not provide one.
Nearly eight months later, with medical bills mounting, Mr. Guatemala asked Tyson
for reimbursement for the care he received from Drs. Chen and Jones. Tyson declined to
reimburse him but provided a Choice of Physicians form. He chose Dr. Tarek Elalayli, an
orthopedic spine surgeon.
Dr. Elalayli examined Mr. Guatemala and diagnosed a lumbar sprain that, in his
opinion, should have resolved. He recommended a home exercise program and pain
management with Dr. Hazlewood.
Dr. Hazlewood provided an injection that Mr. Guatemala said made him feel worse.
This puzzled Dr. Hazlewood, who, after further conservative care, placed Mr. Guatemala
at maximum medical improvement without restrictions or permanent impairment. Dr.
Hazlewood agreed to see Mr. Guatemala as needed, and he eventually returned to Dr.
Hazlewood.
Findings of Fact and Conclusions of Law
Mr. Guatemala bears the burden of proving entitlement to workers’ compensation
benefits by a preponderance of the evidence. Tenn. Code Ann. § 50-6-239(c)(6) (2021);
Panzarella v. Amazon.com, Inc., No. E2017-01135-SC-R3-WC, 2018 Tenn. LEXIS 244,
at *8 (Tenn. Workers’ Comp. Panel May 16, 2018). Mr. Guatemala seeks only two types
of benefits here; one has been provided agreeably, the other denied.
Sometimes even when we go forward, we go forward without progress. That is the
case here. In an expedited hearing order issued previously in this case, Tyson agreed to
allow Mr. Guatemala to continue seeing Dr. Hazlewood but denied his request for payment
of medical bills from unauthorized providers. The Court declined to award payment for
these medical bills because he could not authenticate them. We have now come forward
to the compensation hearing only to arrive at the same spot.
As previously mentioned, Tyson agreed that Mr. Guatemala could continue
receiving reasonable and necessary care from Dr. Hazlewood if he wished. With this issue
decided, only the reimbursement issue remains.
Mr. Guatemala seeks reimbursement for care received through his private insurance
from Drs. Chen and Jones. However, the proof that he sought permission from Tyson for
treatment of his workers’ compensation injury with these doctors before receiving
treatment is limited. The fact that Tyson provided a panel when he requested
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reimbursement for his bills eight months later tends to show he was not denied medical
care.
But even if Tyson initially denied him care, the Court could not award relief because
he offered no proof of his loss. As he did at an expedited hearing, Mr. Guatemala asked to
introduce medical bills, but provided no proof that the bills were for treatment related to
his workers’ compensation injury. An injured worker must authenticate medical bills under
Rule 901 of the Tennessee Rules of Evidence and offer proof that the medical bills are
reasonable, necessary, and causally related to the work accident. Eaves v. Ametek, Inc.,
2018 TN Wrk. Comp. App. Bd. LEXIS 53, at *8-9 (Sept. 14, 2018). Because the bills were
unverified and thus inadmissible, and no proof was in the record that the care he received
was reasonable and necessary for his work injury, the Court denies his request to recoup
those costs.
IT IS ORDERED as follows:
1. Tyson shall continue to provide Mr. Guatemala all medical care made reasonable
and necessary by his work injury with Dr. Jeffrey Hazlewood serving as the
authorized treating physician.
2. Mr. Guatemala’s request for reimbursement of medical expenses is denied for lack
of proof.
3. Costs of $150.00 are assessed against Tyson under Tennessee Compilation Rules
and Regulations 0800-02-21-.07, for which execution might issue as necessary.
4. Tyson shall file a completed Form SD-2 within five days after this order becomes
final.
5. Unless appealed, the order shall become final thirty days after issuance.
ENTERED February 8, 2022.
___________________________________
Joshua Davis Baker, Judge
Court of Workers’ Compensation Claims
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APPENDIX
Exhibits:
1. Form C-32
2. Medical Records
Technical Record:
1. Petition for Benefit Determination
2. Request for Expedited Hearing
3. Petition for Benefit Determination
4. Dispute Certification Notice filed December 2, 2021
5. Dispute Certification Notice filed February 27, 2020
6. Motion for Dismissal
7. Order to Show Cause
8. Request for Expedited Hearing
9. Expedited Hearing Order entered August 31, 2020
10. Scheduling Order entered July 12, 2021
11. Notice of Intent to Use Form C-32
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CERTIFICATE OF SERVICE
I certify that a copy of this Order was sent as indicated on February 8, 2022.
Name Certified Via Via Service sent to:
Mail Fax Email
Concepcion Guatemala, X guatemala121976@gmail.com
Employee
Michael Haynie, X mhaynie@manierherod.com
Employer’s Attorney
____________________________________________
Penny Shrum, Court Clerk
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]
LB-1099 rev. 01/20 Page 2 of 2 RDA 11082
Tennessee Bureau of Workers’ Compensation
220 French Landing Drive, I-B
Nashville, TN 37243-1002
800-332-2667
AFFIDAVIT OF INDIGENCY
I, ________________________________________, having been duly sworn according to law, make oath that
because of my poverty, I am unable to bear the costs of this appeal and request that the filing fee to appeal be
waived. The following facts support my poverty.
1. Full Name: 2. Address:
3. Telephone Number: 4. Date of Birth:
5. Names and Ages of All Dependents:
______________________________________ Relationship:
______________________________________ Relationship:
______________________________________ Relationship:
______________________________________ Relationship:
6. I am employed by:
My employer’s address is:
My employer’s phone number is:
7. My present monthly household income, after federal income and social security taxes are deducted, is:
$ ___________________
8. I receive or expect to receive money from the following sources:
AFDC $ ________ per month beginning
SSI $ ________ per month beginning
Retirement $ ________ per month beginning
Disability $ ________ per month beginning
Unemployment $ ________ per month beginning
Worker’s Comp.$ ________ per month beginning
Other $ ________ per month beginning
LB-1108 (REV 11/15) RDA 11082
9. My expenses are:
Rent/House Payment $ ________ per month Medical/Dental $ ___________ per month
Groceries $ ________ per month Telephone $ per month
Electricity $ ________ per month School Supplies $ per month
Water $ ________ per month Clothing $ per month
Gas $ ________ per month Child Care $ per month
Transportation $ ________ per month Child Support $ per month
Car $_________ per month
Other $ _______ per month (describe: )
10. Assets:
Automobile $ (FMV)
Checking/Savings Acct. $
House $ (FMV)
Other $ Describe:
11. My debts are:
Amount Owed To Whom
I hereby declare under the penalty of perjury that the foregoing answers are true, correct, and complete
and that I am financially unable to pay the costs of this appeal.
_
APPELLANT
Sworn and subscribed before me, a notary public, this
_______ day of , 20_______.
NOTARY PUBLIC
My Commission Expires:
LB-1108 (REV 11/15) RDA 11082