Board Affirms Open Medicals Ruling

Last week, the Appeals Board released an opinion affirming a trial court’s decision to order an employer to authorize a visit to the designated doctor under an open medical benefits provision of a compensation order.

The self-represented employee prevailed—but the opinion offers valuable guidance for what an employer can do to put its best case forward in similar situations going forward.

Facts

In Lee v. Federal Express Corp., the employee reported injuries to her neck and low back after handling a box while working. FedEx accepted the claim and authorized medical treatment with Dr. Frederick Wolf.

Dr. Wolf treated Lee conservatively until concluding that no objective findings supported the need for continued medical treatment made reasonably necessary by the work accident. In January 2020, he placed her at maximum medical improvement, released her without restrictions, and concluded that no additional medical treatment was necessary for her work-related injuries. 

After a compensation hearing, the trial court found the injury compensable but didn’t award temporary or permanent disability benefits. The December 2021 compensation order did state that Lee was entitled to future medical treatment made reasonably necessary by the work accident with her treating physician.

When Lee tried to return to the doctor, FedEx didn’t authorize it. So in January 2022, she filed a motion seeking additional medical benefits. The trial court granted her motion, and FedEx appealed.

The Opinion

The Board reminded that FedEx didn’t dispute compensability. Although Lee didn’t offer expert medical proof of her need for additional medical care, the trial court had previously awarded her future medical benefits with Dr. Wolf, which order wasn’t appealed. Further, Lee testified that her pain continued despite being placed at maximum medical improvement in January 2020.

FedEx relied on a letter it sent to Dr. Wolf after Lee sought additional treatment. The letter asked him to give his opinion, within a reasonable degree of medical certainty, as to whether Lee required any additional medical treatment for her work injury.

The Board noted, “The request for Dr. Wolf’s opinion, however, was necessarily based on the information Dr. Wolf had available to him two years prior to Employee’s current request for treatment and prior to the trial court’s judgment awarding future medical benefits.”

Dr. Wolf responded that he didn’t think she required further medical treatment for her work-related injury, and he saw nothing in the diagnostic testing related to her work injury. He wrote, “I have nothing further to offer her. That said, I have not refused to see her.”

The Board reasoned, “As the trial court emphasized, Dr. Wolf’s February 2022 opinion was based on diagnostic testing and information dating back two years. Given the circumstances presented, including the trial court’s final compensation order issued in December 2021 authorizing future medical treatment with Dr. Wolf, Employee’s continued symptoms and complaints of pain, the fact that Employee has not seen Dr. Wolf since January 2020, and his reliance upon diagnostic testing performed two years ago, we cannot conclude the trial court erred in ordering Employer to authorize a current evaluation by Dr. Wolf pursuant to the terms of its prior judgment.”

But the Board cautioned in a footnote that its ruling should be interpreted as follows:

“We do not intend to suggest, however, that an employee’s right to future medical benefits has no limits. Even in circumstances where a court-approved settlement or judgment establishes an employee’s entitlement to future medical benefits, if an employer produces credible expert proof that the employee’s current request for treatment is not causally related to the work accident or is not reasonably necessary as a result of the accident, the burden of proof is on the employee to come forward with sufficient evidence supporting his or her claim for additional benefits.”

This opinion is only the second time that the Board has considered a post-judgment dispute since the Reform Act took effect. The other case, which came down last year, was Walls v. United Technologies Corp. It involved open medicals under a settlement agreement and whether proposed treatment was reasonably necessary.

By Jane Salem

Courtesy of The Tennessee Court of Workers' Compensation Claims

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