Stephen Jablonski v. Swift Transportation Co. of Arizona, LLC

Summary

In this expedited hearing order, the Tennessee Court of Workers’ Compensation Claims held that the employee was likely entitled to a panel of joint-reconstruction orthopedic surgeons after his authorized treating physician referred him for evaluation of possible knee-replacement surgery. The court ordered Swift Transportation to provide a compliant panel and referred the employer and its carrier to the Bureau’s Compliance Unit for possible penalties.

Holdings

1. When an authorized treating physician determines that a work-injury condition requires evaluation or treatment beyond the physician's expertise and refers the employee to a particular specialty, the employer must either authorize that referral or provide a panel of providers qualified to perform the designated specialty; a panel of general physicians in the same broad field is insufficient.
2. The employee's entitlement to a specialist referral is not contingent on the treating physician first ordering the surgery that the specialist may ultimately recommend.
3. Swift violated its referral obligations by failing to authorize the referral for approximately ten months and by offering a panel that did not contain appropriately qualified joint-reconstruction orthopedic surgeons.

Questions Presented

1. Whether the authorized treating physician's referral to a joint-reconstruction orthopedic surgeon required Swift to authorize the referral or provide a panel of three or more joint-reconstruction orthopedic surgeons.
2. Whether the referral issue was ripe even though the treating physician had not ordered knee-replacement surgery.
3. Whether Swift's panel of general orthopedists complied with Tennessee's workers' compensation referral statute and medical-provider-panel rule.
4. Whether Swift and its carrier should be referred to the Bureau's Compliance Unit for assessment of a penalty.

Disposition

other