Summary
The Tennessee Workers' Compensation Appeals Board held that an employee was not entitled to additional temporary disability benefits based solely on a later physician's recommendation for further surgery after an authorized physician had determined maximum medical improvement. The Board affirmed the order requiring the employer to provide agreed-upon medical treatment, reversed the award of additional temporary disability benefits, and remanded for further proceedings.
Topics
Practice areas
Questions Presented
- Whether an employee may receive additional temporary disability benefits after an authorized treating physician has placed the employee at maximum medical improvement based solely on circumstantial evidence, including a later recommendation for additional surgery.
- Whether the trial court properly ordered the employer to provide additional medical treatment that the employer had agreed to authorize.
Holdings
- An employee seeking additional temporary disability benefits after an authorized physician has determined that the employee reached maximum medical improvement must present medical evidence from the original authorized physician or another medical expert stating that the prior maximum-medical-improvement determination was premature or should be retracted. The need for additional treatment or a recommendation for additional surgery, standing alone, is insufficient.
- The order requiring the employer to provide additional medical treatment made reasonably necessary by the compensable injury was affirmed to the extent the employer had agreed to provide that treatment.
Key quotations
“In sum, the critical question in the present case is whether an award of additional temporary disability benefits after an authorized physician’s MMI determination can be based on purely circumstantial evidence. We conclude it cannot.” (5)
“Instead, to support an award of additional temporary disability benefits after an authorized physician’s MMI determination, the employee must present evidence from either the original authorized physician or another medical expert stating that the previous MMI determination was premature and/or should be retracted.” (5)
Factual background
Jayne-Anne Patrick injured her left knee at work when she slipped on a wet floor while restocking a beer cooler. Her workers' compensation claim was accepted, she underwent surgery to repair a torn medial meniscus, and her authorized treating physician placed her at maximum medical improvement with no work restrictions. After continued symptoms, another physician recommended revision knee arthroscopy, and Patrick sought additional temporary disability benefits; the employer disputed entitlement based on the prior maximum-medical-improvement determination.
Procedural history
Patrick sustained a compensable workplace knee injury, underwent surgery, and was placed at maximum medical improvement by the authorized treating physician. After another physician recommended additional surgery, Patrick sought an expedited hearing for additional temporary disability benefits and medical treatment. The trial court ordered the employer to provide additional treatment and awarded temporary disability benefits beginning when the additional surgery was recommended. The Appeals Board affirmed the medical-treatment order to the extent the employer had agreed to provide it, reversed the award of additional temporary disability benefits, and remanded.
Remand instructions
Remand for further proceedings after affirming the medical-treatment order to the extent the employer agreed to provide additional treatment and reversing the award of additional temporary disability benefits. The Board did not decide entitlement to post-surgery temporary disability benefits.