Acevedo, Johnny v. Crown Paving, LLC

TENNESSEE BUREAU OF WORKERS’ COMPENSATION

WORKERS’ COMPENSATION APPEALS BOARD

Johnny Acevedo, Decedent ) Docket No. 2021-06-1453

by April Acevedo, Surviving Spouse )

) State File No. 61125-2021

v. )

)

Crown Paving, LLC, et al. )

)

)

Appeal from the Court of Workers’ ) Heard January 27, 2023

Compensation Claims ) in Nashville, Tennessee

Kenneth W. Switzer, Chief Judge )

Reversed and Remanded

This interlocutory appeal presents a procedural issue of first impression: Can a medical

provider who has provided treatment to an injured worker intervene in an action pending

in the Court of Workers’ Compensation Claims to protect its interest in the payment of

medical bills arising from such treatment? The trial court answered that question in the

affirmative and granted the motion to intervene, and the employer has appealed. Upon

careful consideration of the pertinent statutory provisions, applicable rules, and relevant

precedent, we reverse 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, Nashville, Tennessee, for the employer-appellant, Crown Paving, LLC

Jill Draughon, Nashville, Tennessee, for the appellee, April Acevedo, as Surviving Spouse

of Johnny Acevedo, Decedent

Catheryne L. Grant, Brentwood, Tennessee, for the appellee, HTI Memorial Hospital Corp.

d/b/a Skyline Medical Center

Factual and Procedural Background

Johnny Acevedo (“Employee” or “Decedent”) worked for Crown Paving, LLC

(“Employer”). On July 27, 2021, while working in a hot environment, Employee

collapsed, struck his head on concrete, and was transported to a local hospital, Skyline

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Medical Center (“Skyline”). On August 18, 2021, Employer denied Employee’s claim,

asserting that: (1) Employee suffered a syncopal episode on the date of the accident that

did not arise primarily out of the employment; and (2) his subsequent fall and head injury

were idiopathic in nature. Tragically, Employee passed away on August 26, 2021. The

death certificate listed the “immediate cause” of death as “traumatic subarachnoid

hemorrhage and skull fracture” and noted “accident” as the “manner of death.” It also

listed diabetes mellitus as an “other significant condition[] contributing to death.”

Employee’s surviving spouse, April Acevedo (“Claimant”), filed a petition seeking death

benefits under the Tennessee Workers’ Compensation Law for herself and her minor

dependent.

After Claimant filed the petition for benefits in the Court of Workers’ Compensation

Claims, Skyline filed a motion to intervene in Claimant’s cause of action pursuant to Rule

24 of the Tennessee Rules of Civil Procedure. In support of its motion, Skyline alleged

that, between the date of Employee’s injury and the date of his death, Employee’s medical

expenses while at Skyline Medical Center exceeded $700,000.00. Skyline asserted that, if

the court concludes Employee’s death arose primarily out of and in the course and scope

of his employment, they are entitled to payment of those expenses by Employer or its

workers’ compensation insurer. Moreover, Skyline argued that a permissive intervention

can be granted pursuant to Rule 24.02 if Skyline’s claim and Claimant’s claim “have a

question of law or fact in common.”

In response to Skyline’s motion, Employer presented four arguments. First, it

argued that Claimant and Skyline are “colluding to deter Employer from standing firm on

its denial.” Second, it asserted that allowing intervention is “not judicially efficient.”

Third, Employer argued that Skyline’s interests and Claimant’s interests are “completely

aligned,” making a permissive intervention unnecessary. Finally, Employer asserted that

a medical provider’s interest in seeking the payment of medical expenses does not fall

within the meaning of the word “claim” as that term is used in pertinent workers’

compensation statutes or regulations and, thus, the Court of Workers’ Compensation

Claims cannot exercise jurisdiction over a medical provider’s claim for the payment of

medical expenses.

Upon consideration of the motion and each party’s written arguments, the trial court

entered an order granting Skyline’s request for permissive intervention. In making this

determination, the trial court reasoned that “Skyline’s interests are aligned closely, but are

not identical to, those of the surviving dependents.” The court also concluded that issuing

an order for the payment of medical benefits is within the “fairly broad grant” of statutory

authority given to the Court of Workers’ Compensation Claims as stated in various

provisions of Tennessee’s Workers’ Compensation Law. Employer has appealed.

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Standard of Review

The standard we apply in reviewing a trial court’s decision presumes that the court’s

factual findings are correct unless the preponderance of the evidence is otherwise. See

Tenn. Code Ann. § 50-6-239(c)(7) (2022). Conversely, the interpretation and application

of statutes and regulations are questions of law that are reviewed de novo with no

presumption of correctness afforded the trial court’s conclusions. See Mansell v.

Bridgestone Firestone N. Am. Tire, LLC, 417 S.W.3d 393, 399 (Tenn. 2013).

A trial court’s order granting or denying permissive intervention under Rule 24.02

of the Tennessee Rules of Civil Procedure is generally reviewed under an abuse of

discretion standard. See State v. Brown & Williamson Tobacco Corp., 18 S.W.3d 186, 192

(Tenn. 2000) (“In exercising that discretion, the court must consider whether the

intervention will unduly delay or otherwise prejudice the rights of the original parties.”).

An appellate court may “find an abuse of discretion only if the [trial] court ‘applied

incorrect legal standards, reached an illogical conclusion, based its decision on a clearly

erroneous assessment of the evidence, or employ[ed] reasoning that causes an injustice to

the complaining party.’” Wright ex rel. Wright v. Wright, 337 S.W.3d 166, 176 (Tenn.

2011) (citations omitted). We are also mindful of our obligation to construe the workers’

compensation statutes “fairly, impartially, and in accordance with basic principles of

statutory construction” and in a way that does not favor either the employee or the

employer. Tenn. Code Ann. § 50-6-116 (2022).

Analysis

On appeal Employer has raised two issues: (1) whether medical providers can

intervene and become “formal parties” to workers’ compensation claims; and (2) whether

the trial court abused its discretion in permitting Skyline to intervene. Because subject

matter jurisdiction is a threshold issue, we address it before considering other issues. See

Nickerson v. Knox Cnty. Gov’t, No. 2019-03-0559, 2020 TN Wrk. Comp. App. Bd. LEXIS

18, at *3-4 (Tenn. Workers’ Comp. App. Bd. Apr. 17, 2020).

Subrogation

Initially, we address Skyline’s characterization of its interest as a “subrogation lien.”

Subrogation is defined as “the substitution of another person in place of a creditor, so that

the person in whose favor it is exercised succeeds to the rights of the creditor in relation to

the debt.” Old Republic Life Ins. Co. v. Woody, 652 S.W.3d 418, 427 (Tenn. Ct. App.

2022) (emphasis added). Here, Skyline cannot “step into the shoes of” a creditor because

it already holds the position of creditor with respect to the services it provided to Decedent.

Moreover, there has been no determination regarding whether Decedent’s accident arose

primarily out of and in the course and scope of his employment, nor has there been a

determination that Decedent’s death was caused by a compensable accident. Thus, at this

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interlocutory stage of the case, Skyline cannot assert a legal claim against Employer or its

workers’ compensation insurer because no such claim exists. Further, its claim for the

payment of medical bills, as it currently exists, is not a “subrogation lien” and is not in the

nature of subrogation because Skyline is not in a position to “succeed to the rights of” any

entity. If the trial court were to deem the claim compensable, the entitlement to medical

benefits under Tennessee’s Workers’ Compensation Law, including the payment of

medical bills already incurred, belongs to Decedent and, in turn, his surviving spouse or

estate. It does not belong to Skyline, and nothing in the Workers’ Compensation Law

assigns Skyline as a successor in interest upon Decedent’s death. If, on the other hand, the

trial court were to conclude Decedent’s fall did not arise primarily out of the employment,

Skyline’s claim for the payment of medical bills would appropriately be directed to

Decedent’s estate.

Subject Matter Jurisdiction

Next, we consider whether the Court of Workers’ Compensation Claims has subject

matter jurisdiction over a third party’s interest in securing the payment of medical bills. It

is well-established that workers’ compensation claims are “entirely creatures of statute.”

Gerdau Ameristeel, Inc. v. Ratliff, 368 S.W.3d 503, 506 (Tenn. 2012). Tennessee’s

legislature has “broad discretion . . . to define the claims and to prescribe the procedure for

recovering workers’ compensation benefits.” Id. As expressed in Tennessee Code

Annotated section 50-6-103, the General Assembly created our Workers’ Compensation

Law to ensure that “[e]very employer and employee subject to this chapter shall,

respectively, pay and accept compensation for personal injury or death by accident arising

primarily out of and in the course and scope of employment.” (Emphasis added.)

When the General Assembly passed the 2013 Workers’ Compensation Reform Act

(“Reform Act”), it created the Court of Workers’ Compensation Claims and vested it with

the authority to “hear and determine claims for compensation, . . . and to make orders,

decisions, and determinations.” Tenn. Code Ann. § 50-6-238(a)(3). Moreover, the

legislature directed judges on the Court of Workers’ Compensation Claims to “conduct

hearings in accordance with the Tennessee Rules of Civil Procedure, the Tennessee Rules

of Evidence, and the rules adopted by the bureau [of workers’ compensation].” Id. In

circumstances where the Administrator of the Bureau has adopted a rule that conflicts with

the Tennessee Rules of Civil Procedure or the Tennessee Rules of Evidence, “the rule

adopted by the administrator shall apply.” Tenn. Code Ann. § 50-6-239(c)(1).

Tennessee Code Annotated section 50-6-204 governs an injured worker’s

entitlement to medical benefits under Tennessee’s Workers’ Compensation Law. An

employer is required to furnish, “free of charge to the employee,” all medical treatment

“made reasonably necessary by accident as defined in this chapter.” Tenn. Code Ann. §

50-6-204(a)(1)(A). This section also provides that “[t]he liability of the employer for the

services provided to the employee shall be limited to the maximum allowable fees that are

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established in the applicable medical fee schedule adopted pursuant to this section.” Tenn.

Code Ann. § 50-6-204(a)(3)(A)(iii) (emphasis added). As we have noted previously, an

employer who elects to deny a claim takes the risk that it will be held liable for medical

expenses incurred by the injured worker if the claim is later deemed compensable. See,

e.g., Young v. Young Electric Co., No. 2015-06-0860, 2016 TN Wrk. Comp. App. Bd.

LEXIS 24, at *16 (Tenn. Workers’ Comp. App. Bd. May 25, 2016) (citing GAF Bldg.

Materials v. George, 47 S.W.3d 430, 433 (Tenn. Workers’ Comp. Panel 2001)). Notably,

nothing in Tennessee Code Annotated sections 50-6-103 or -204 speaks to the rights and

obligations of any entity other than employees and employers.

Employer has argued that a medical provider’s entitlement to the payment of

medical expenses incurred by an injured worker is not within the scope of the word “claim”

as that term is defined in the context of Tennessee’s Workers’ Compensation Law.

Although our workers’ compensation statutes do not define the word “claim,” the rules

adopted by the Administrator do. In Tenn. Comp. R. and Regs. 0800-02-21-.02(7), the

word “claim” is defined to mean “[a]n employee’s request for benefits available under the

Workers’ Compensation Law.” Here, there can be no doubt that Claimant’s petition

includes a request for medical expenses incurred by Decedent arising from what Claimant

asserts was a work-related accident. Hence, if the court were to conclude Decedent’s

accident arose primarily out of and in the course and scope of the employment, Claimant’s

“claim” would necessarily include “such medical and surgical treatment . . . and

hospitalization . . . made reasonably necessary by accident as defined in this chapter.”

Tenn. Code Ann. § 50-6-204(a)(1)(A). That does not, however, answer the question

regarding whether the medical provider itself can maintain a claim in the Court of Workers’

Compensation Claims for the payment of medical bills.

Early in the development of Tennessee’s workers’ compensation jurisprudence, the

Tennessee Supreme Court was faced with an issue regarding a physician’s claim for the

payment of medical expenses arising from a work-related injury. In Knox Stove Works v.

Hodge, 289 S.W. 505 (Tenn. 1926), a physician treated an employee of the defendant-

employer following the employee’s work-related injury. Id. at 505. Thereafter, the

physician sued the employer for payment of the medical bill resulting from treatment of

the injured worker, and a justice of the peace entered a judgment for the physician. Id. at

506. 1 The question on appeal was whether the justice of the peace had jurisdiction to

entertain the claim of a physician for medical bills arising from a work-related injury. In

disputing jurisdiction, the employer argued that the claim should have been brought

pursuant to Tennessee’s Workers’ Compensation Law and, therefore, a justice of the peace

was without subject matter jurisdiction to hear the dispute. Id. The applicable workers’

compensation statute contained a provision that stated, “[a]ll cases of dispute as to the value

1

In that suit, the physician asserted he had provided treatment to the injured worker based on a contract

with the employer “by implication,” given that he had provided “first aid and professional services to their

employees off and on for a year.” Id.

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of such [medical] services shall be determined by the tribunal having jurisdiction of the

claim of the injured employee for compensation.” Id.

Nevertheless, the Tennessee Supreme Court rejected the assertion that a court

having jurisdiction of workers’ compensation claims would be the proper forum to hear a

dispute brought by a medical provider for the payment of medical bills arising from a work-

related injury. The Court’s rationale is instructive for purposes of the present case:

If the employee should sue for the value of medical services that he

procured for himself . . ., jurisdiction of such a suit would be in the courts

named [in the Workers’ Compensation Law]. Likewise[,] if the employee

should sue for the failure of the employer to furnish the medical services

required of the employer by [the Workers’ Compensation Law], jurisdiction

of such a suit would be in the courts named in [the Workers’ Compensation

Law]. Both suits would involve, as a matter of fact, compensation to which

the employee might be entitled under the Act. Other similar cases can be

supposed.

The case before us, however, is a suit of a [d]octor for services

rendered under a contract with an employer. There is here no controversy

between employer and employee. [The Workers’ Compensation Law] is one

to provide a system of [Workers’] Compensation, and, according to its

caption, among other things, “to provide methods for insuring and securing

the payment of such compensation.”

The suit here does not rest upon [the Workers’ Compensation Law]

but is based upon a contract, and jurisdiction of such a suit lies in the same

tribunals that have jurisdiction of a suit for . . . any other contract.

Id. at 507 (emphases added). Thus, as the law existed when Hodge was decided, the claim

of a medical provider for the payment of bills arising from an alleged work-related injury

was in the nature of a contract claim and was not properly joined with the employee’s claim

for workers’ compensation benefits. Instead, a cause of action filed pursuant to the

Workers’ Compensation Law was the employee’s claim for any benefits to which the

employee may be entitled under the provisions of that law.

In the present case, neither party has cited, nor have we located, any appellate

decision in Tennessee’s more than 100-year history of workers’ compensation

jurisprudence acknowledging or affirming the right of a medical provider to intervene in a

workers’ compensation suit for purposes of pursuing a judgment for the payment of

medical bills. Instead, both parties have cited Moore v. Town of Collierville, 124 S.W.3d

93 (Tenn. 2004), in support of their respective positions. In Moore, the primary issue was

whether an employee’s health insurer, which had paid certain medical bills allegedly

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arising from a work injury, was entitled to recover those amounts from the employer that

had been adjudged liable for the work injury. Id. at 94-95. 2 On appeal, the “question of

first impression” was whether an employer is liable to a health insurer for reasonable and

necessary medical expenses incurred by an injured worker in circumstances where the

health insurer had not intervened in the workers’ compensation suit. Id. at 97. In its

analysis of this issue, the Tennessee Supreme Court explained that “[w]here an employer

is liable for such medical expenses, the employer must pay the medical providers directly

for the costs of such care, rather than the employee personally.” Id. at 98. However,

“[w]here the employee has personally paid for the disputed medical treatment, . . . the

employer shall reimburse the employee personally.” Id.

The Supreme Court in Moore also addressed what it described as the “difficult

issue” of a health insurer’s entitlement to reimbursement with or without intervention. In

its discussion of this issue, the Court noted that the Workers’ Compensation Law “makes

it crystal clear that the employer is obligated to the employee to pay reasonable and

necessary medical expenses for work-related injuries.” Id. at 99 (emphasis added). The

Court continued: “The workers’ compensation statutes, however, do not provide for or

prohibit employer reimbursement of medical expenses to a third-party health

insurer . . . and they do not address the question of intervention.” Id. Ultimately, the Court

decided that “allowing health insurers to receive reimbursement without formally

intervening in workers’ compensation claims is consistent with the remedial nature of the

workers’ compensation statutes.” 3 Id. Finally, the Court explained that “requiring health

insurers to intervene in workers’ compensation claims to protect their potential

reimbursement interests may have a chilling effect on health insurers’ willingness to pay

claims that could ultimately be deemed ‘work-related’ and thus outside their contractual

obligations.” Id.

We conclude Moore does not answer the question before us. Instead, assuming

arguendo that Moore remains good law despite the Supreme Court’s reliance on a remedial

interpretation of workers’ compensation statutes, its holding, at most, stands for the

proposition that a health insurer that has paid for an injured worker’s treatment need not

intervene in a workers’ compensation suit to seek reimbursement of medical expenses.

2

For purposes of the present case, it is significant to note that it was the employee, not the medical provider

or the health insurer, who asserted a claim for the payment of certain medical bills under Tennessee’s

Workers’ Compensation Law.

3

We have previously concluded that reliance on pre-Reform Act precedent is appropriate “unless it is

evident that the Supreme Court’s decision or rationale relied on a remedial interpretation of pre-July 1,

2014 statutes.” McCord v. Advantage Human Resourcing, No. 2014-06-0063, 2015 TN Wrk. Comp. App.

Bd. LEXIS 6, at *13 n.4 (Tenn. Workers’ Comp. App. Bd. Mar. 27, 2015) (emphasis added). In Moore,

the Supreme Court expressly relied on a remedial interpretation of statutory provisions, which would make

our reliance on such language precarious at best.

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We must also consider the differences between courts that had jurisdiction of

workers’ compensation cases at the time Moore was decided versus courts having such

jurisdiction now. Prior to July 1, 2014, Tennessee’s courts of general jurisdiction,

including circuit and chancery courts, had concurrent jurisdiction over numerous types of

cases, including workers’ compensation cases. See, e.g., In re: D.Y.H., 226 S.W.3d 327

(Tenn. 2007) (identifying Tennessee’s courts of general jurisdiction as “circuit and

chancery courts”). Thus, the same courts exercising jurisdiction over workers’

compensation cases also heard cases involving other legal claims such as contract disputes,

personal injury claims, product liability cases, etc.

In the Reform Act, however, Tennessee’s General Assembly vested jurisdiction

over workers’ compensation cases with dates of injury on or after July 1, 2014, exclusively

in the newly-created Court of Workers’ Compensation Claims, which operates under the

auspices of the Tennessee Bureau of Workers’ Compensation. See Tenn. Code Ann. § 50-

6-237 (“There is created the court of workers’ compensation claims in the bureau of

workers’ compensation, which shall have original and exclusive jurisdiction over all

contested claims for workers’ compensation benefits.”). The court’s purpose is to perform

“the adjudicative function within the bureau of workers’ compensation.” Tenn. Code Ann.

§ 50-6-102(8). Moreover, as noted above, the scope of Tennessee’s Workers’

Compensation Law is legislatively limited to the rights and obligations of employees and

employers. Tenn. Code Ann. § 50-6-103. 4

In short, we conclude that the Court of Workers’ Compensation Claims, and by

extension the Workers’ Compensation Appeals Board, cannot exercise subject matter

jurisdiction over a medical provider’s claim for the payment of a medical bill. 5 It is the

employee, not the medical provider, who can maintain a cause of action in the Court of

Workers’ Compensation Claims for the payment of medical bills arising from work-related

4

One notable exception to this statement is contained in Tennessee Code Annotated section 50-6-208(a)(5),

which sets out the limited circumstances in which Tennessee’s Subsequent Injury and Vocational Recovery

Fund can be added as a party-in-interest in a case pending in the Court of Workers’ Compensation Claims.

5

We do not intend to suggest, however, that the Tennessee Bureau of Workers’ Compensation does not

play a role in addressing the payment of medical bills arising from work-related injuries. Tennessee Code

Annotated section 50-6-125 authorizes the creation of a “Medical Payment Committee” within the Bureau,

which is vested with the authority to “hear disputes on medical bill payments between providers and

insurers.” Tenn. Code Ann. § 50-6-125(a)(1) (2022). Moreover, if the Medical Payment Committee refers

a medical provider or insurer for a penalty assessed under Tennessee Code Annotated section 50-6-118, the

aggrieved party can appeal by seeking a “contested case hearing” under the terms of the Uniform

Administrative Procedures Act (“UAPA”). Further appeal of such a determination is to the Chancery Court

of Davidson County, as specified in Tennessee Code Annotated section 4-5-322(b)(1). At no point in the

processes outlined in sections 50-6-125 and 50-6-118(c) does the Court of Workers’ Compensation Claims

or the Workers’ Compensation Appeals Board have jurisdiction to hear disputes between medical providers

and employers or their insurers over the provider’s claim for payment of outstanding medical bills.

8

injuries. 6 Consequently, we further conclude the trial court abused its discretion in granting

Skyline’s motion to intervene. All other issues raised in this appeal are pretermitted.

Conclusion

For the foregoing reasons, we reverse the trial court’s order allowing Skyline’s

intervention and remand the case. Costs on appeal are taxed to Skyline.

6

Although not raised by any party, we note that Tennessee Code Annotated section 50-6-226(a)(4)

authorizes the Court of Workers’ Compensation Claims to assess whether the “fees of physicians and

charges of hospitals” are “reasonable.” By its express terms, that provision limits the authority of the trial

court to resolving disputes between parties over the reasonableness of such fees. We do not interpret that

language to expand the subject matter jurisdiction of the Court of Workers’ Compensation Claims to the

claims of medical providers asserting entitlement to the payment of medical bills.

9

TENNESSEE BUREAU OF WORKERS’ COMPENSATION

WORKERS’ COMPENSATION APPEALS BOARD

Johnny Acevedo, Decedent ) Docket No. 2021-06-1453

by April Acevedo, Surviving Spouse )

) State File No. 61125-2021

v. )

)

Crown Paving, LLC, et al. )

)

)

Appeal from the Court of Workers’ ) Heard January 27, 2023

Compensation Claims ) in Nashville, Tennessee

Kenneth M. Switzer, Chief Judge )

CERTIFICATE OF SERVICE

I hereby certify that a true and correct copy of the Appeals Board’s decision in the referenced

case was sent to the following recipients by the following methods of service on this the 14th day

of February, 2023.

Name Certified First Class Via Via Sent to:

Mail Mail Fax Email

A. Allen Grant X agrant@eraclides.com

bnorris@eraclides.com

Jill Draughon X jdraughon@hughesandcoleman.com

dforbes@hughesandcoleman.com

Catheryne Grant X catherynelgrant@feeneymurray.com

trp@feeneymurray.com

Kenneth M. Switzer, Chief Judge X Via Electronic Mail

Penny Shrum, Clerk, Court of X penny.patterson-shrum@tn.gov

Workers’ Compensation Claims

Olivia Yearwood

Clerk, Workers’ Compensation Appeals Board

220 French Landing Dr., Ste. 1-B

Nashville, TN 37243

Telephone: 615-253-1606

Electronic Mail: WCAppeals.Clerk@tn.gov