Kirk, Regina v. Amazon.com, Inc. , 2015 TN WC 78 ( 2015 )


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  •                COURT OF WORKERS' COMPENSATION CLAIMS
    AT CHATTANOOGA
    EMPLOYEE: Regina Kirk                              DOCKET#: 2015-01-0036
    EMPLOYER: Amazon.com, Inc.                         STATE FILE#: 79228-2014
    CARRIER: Sedgwick CMS, Inc.                        DATE OF INJURY: Sept. 24,2014
    EXPEDITED HEARING ORDER DENYING MEDICAL AND TEMPORARY
    DISABILITY BENEFITS
    THIS CAUSE came before the undersigned Workers' Compensation Judge upon
    the Request for Expedited Hearing filed by Regina Kirk, the employee, on May 4, 2015.
    The Court conducted an in-person Expedited Hearing on June 15, 2015.
    Considering the positions of the parties, the applicable law, and all testimony and
    documentary evidence admitted at the Expedited Hearing, the Court finds that Ms. Kirk
    is not entitled to the interlocutory relief she requested because she did not submit
    sufficient medical expert opinion to establish that, at a hearing on the merits, she would
    likely prevail in establishing that her injury arose primarily out of and in the course and
    scope of employment.
    ANALYSIS
    Issues
    ( 1) Whether Ms. Kirk sustained an injury that arose primarily out of and in the
    course and scope of employment with Amazon. com, Inc. (Amazon).
    (2) Whether Ms. Kirk is entitled to Medical and Temporary Disability Benefits.
    Evidence Submitted
    Only Ms. Kirk testified at the Expedited Hearing. Excluding Exhibit 16, which
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    the Court admitted for identification purposes only and did not consider in its decision,
    the Court admitted the following exhibits into evidence at the Expedited Hearing:
    • Exhibit !-Affidavit of Regina Kirk;
    • Exhibit 2-Records of AmCare;
    • Exhibit 3-Records of Workforce Corporate Health/Dr. Jayant Eldurkar;
    • Exhibit 4-Records of Center for Sports Medicine & Orthopaedics/Dr.
    Jason Robertson (the records in this exhibit were filed with the Dispute
    Certification Notice);
    • Exhibit 5-Records of Center for Sports Medicine & Orthopaedics/Dr.
    Jason Robertson (the records in this exhibit were obtained pursuant to
    subpoena and filed by permission granted in the Court's order of May 26,
    2015);
    • Exhibit 6-First Report of Injury;
    • Exhibit 7-Associate First Report of Injury;
    • Exhibit 8-Notice of Denial of Claim for Compensation;
    • Exhibit 9-Wage Statement;
    • Exhibit 10-Agreement Between Employer/Employee Choice of Physician
    form;
    • Exhibit 11-Authorization for Initial Medical Evaluation;
    • Exhibit 12-Retum to Work Order dated February 19, 2015;
    • Exhibit 13-Clinical Visit Summary from Center for Sports Medicine &
    Orthopaedics dated February 19, 2015 (page 2);
    • Exhibit 14--Clinical Visit Summary from Center for Sports Medicine &
    Orthopaedics dated February 19, 2015 (page 1);
    • Exhibit 15-Physical/Occupational Therapy Order dated February 19,
    2015;
    • Exhibit 16-Damages/Benefits Due Chart prepared by Ms. Kirk's attorney
    (Marked for Identification Purposes only).
    The parties stipulated that "the eligibility for any award of past due temporary
    total disability benefits, if applicable, should commence February 19, 2015, due to the
    Employee being placed on restricted duty, which the Employer was unable to
    accommodate." See Agreed Stipulation filed June 19, 2015.
    The Court designated the following as the technical record in this claim:
    •   Petition for Benefit Determination filed February 19, 2015;
    •   Dispute Certification Notice filed April 7, 2015;
    •   Request for Expedited Hearing filed May 4, 2015;
    •   Ms. Kirk's Motion to Continue Expedited Hearing filed May 5, 2015;
    •   Amazon's Response to Motion to Continue filed May 6, 2015;
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    •   Amazon's Response to Ms. Kirk's Request for Benefits filed May 11,
    2015;
    •   Ms. Kirk's Motion to Strike Motion to Continue filed May 21, 2015;
    •   Order for Additional Time filed May 26, 20 15;
    •   Order for Evidentiary Hearing filed May 26, 2015; and
    •   Agreed Stipulation filed June 19, 2015.
    The Court did not consider attachments to the above filings unless admitted into evidence
    at the Expedited Hearing.
    History of Claim
    A First Report of Injury prepared by Amazon documents that, on September 24,
    2014, Ms. Kirk, a packer, reported a "left shoulder strain" and that she "developed
    gradual pain while packing." (Ex. 6). An Associate First Report of Injury, completed the
    date of injury, recorded that Ms. Kirk's "shoulder popped while getting item to placing
    [sic] in box, as day went on it feels like a pull to left arm above neck." (Ex. 7).
    For a short period after her injury, Ms. Kirk received ice, bio-freeze, and non-
    prescription medication at AmCare, an in-house clinic at Amazon. (Ex. 1, p. 1; Ex. 2).
    When Ms. Kirk's left-shoulder pain did not subside, she asked to see a doctor. Amazon
    offered Ms. Kirk a panel, from which she selected Dr. Jayant Eldurkar. (Ex. 10).
    Dr. Eldurkar examined Ms. Kirk on October 6, 2014. (Ex. 3, p. 2). He noted that
    Ms. Kirk reported left-shoulder pain "from reaching across and lifting at heights." (Ex. 3,
    p. 2). Dr. Eldurkar also noted that "no particular incident occurred." (Ex. 3. P. 2). Dr.
    Eldurkar diagnosed a "[l]eft rhomboid sprain/strain" and returned Ms. Kirk to work
    without restrictions. (Ex. 3, pp. 2-3). After the visit, Dr. Eldurkar completed an Amazon
    form on which he wrote that Ms. Kirk sought treatment for a left "upper back spasm."
    (Ex. 3, p. 5). He communicated his opinion on causation by marking a box on the form
    designated "Not Work-Related." (Ex. 3, p. 5). On October 17, 2014, Amazon denied the
    compensability of Ms. Kirk's claim on the ground there was "[n]o medical evidence of
    work-related injury." (Ex. 8).
    Ms. Kirk's left-shoulder pain worsened as she continued to work. On February
    19, 2015, she sought care on her own from Dr. Jason Robertson, an orthopedic surgeon
    (Ex. 4, p. 2). Dr. Robertson recorded that Ms. Kirk told him that her left-shoulder pain
    began September 23, 2014, when "she was reaching for something on a shelf when her
    left shoulder popped." (Ex. 4. p. 2).
    Dr. Robertson examined Ms. Kirk's left shoulder and ordered x-rays. (Ex. 4, p. 3).
    He interpreted a left-shoulder x-ray "to show a type III acromion and mild glenohumeral
    degenerative joint disease." (Ex. 4, p. 3). Dr. Robertson diagnosed a "left shoulder
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    subacromial impingement" and restricted Ms. Kirk from lifting over ten (10) pounds with
    her left upper extremity. (Ex. 4, p. 3). Dr. Robertson completed forms that indicated
    differing opinions as to whether Ms. Kirk's left shoulder injury was work-related. (Ex. 4,
    p. 9; Ex. 5, pp. 5, 12-13, 19).
    Ms. Kirk has not worked since February 19, 2015. The parties stipulated that Ms.
    Kirk's absence from work is due to the fact that Amazon was unable to accommodate the
    left- shoulder restrictions placed by Dr. Robertson. See Agreed Stipulation filed June 19,
    20 15. Amazon has not paid temporary disability benefits and, other than providing the
    one (I)-time visit to Dr. Eldurkar, has not paid medical benefits.
    Ms. Kirk's Contentions
    Ms. Kirk claims that she injured her left-shoulder when she reached for an item
    from a high shelf in the course and scope of her employment. She contends that she is
    entitled to temporary partial disability benefits because she has not worked since
    February 19, 2015, due to Amazon's inability to accommodate the left-shoulder
    restrictions placed by Dr. Robertson. She also requests that Amazon be required to pay
    for Dr. Robertson's treatment.
    Amazon's Contentions
    Amazon contends that Ms. Kirk has not established by medical expert opinion that
    her left-shoulder injury arose primarily out of and in the course and scope of
    employment. It claims that Dr. Eldurkar clearly and unequivocally opined that Ms.
    Kirk's left-shoulder injury is not work-related. Amazon argues that Dr. Eldurkar is Ms.
    Kirk's authorized treating physician and, as such, his causation opinion is entitled to a
    presumption of correctness.
    Amazon also contends that Dr. Robertson gave differing opinions regarding the
    causation of Ms. Kirk's left shoulder condition. It contends that the equivocal nature of
    Dr. Robertson's opinion does not rebut the presumption of correctness afforded Dr.
    Eldurkar's opinion that Ms. Kirk's left-shoulder injury is not work-related.
    Findings of Fact and Conclusions of Law
    Standard Applied
    "The Workers' Compensation Law shall not be remedially or liberally construed
    in favor of either party but shall be construed fairly, impartially, and in accordance with
    basic principles of statutory construction ... favoring neither the employee nor employer."
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    Tenn. Code Ann. § 50-6-116 (2014). At an expedited hearing, an employee need not
    prove every element of his or her claim by a preponderance of the evidence in order to be
    eligible for benefits. McCord v. Advantage Human Resourcing, No. 2014-06-0063, TN
    Wrk Comp App Bd LEXIS 6 at *7-8, 9 (Tenn. Work. Comp. App. Bd. March 27, 2015);
    cf McCall v. Nat'! Health Corp., 100 S.W.3d, 209, 214 (Tenn~ 2003). Instead, an
    employee must come forward with sufficient evidence from which the trial judge could
    conclude that the employee is likely to prevail at a hearing on the merits. !d.
    Factual Findings
    Upon consideration of the testimony of Ms. Kirk in open court, the exhibits
    introduced by the parties, the argument of counsel for the parties, and the record in this
    claim, the Court makes the following factual fmdings in the Expedited Hearing
    conducted June 15, 2015:
    •   On September 24, 2014, Ms. Kirk worked as a packer, a position that
    required her to retrieve items from shelves, pack them in boxes, and then
    place them on a conveyer belt for shipment;
    •   On September 24, 2014, Ms. Kirk felt a pop accompanied by pain in her
    left shoulder when reaching to retrieve an item from a high shelf to pack it
    in a box for shipping;
    •   Ms. Kirk reported her injury on September 24, 2014;
    •   Amazon referred Ms. Kirk to Dr. Eldurkar, who saw her on October 6,
    2014, and released her to return to work without restrictions;
    •   Beginning February 19, 2015, Dr. Robertson placed restrictions on Ms.
    Kirk's use of her left upper extremity; and
    •   Ms. Kirk has not worked from February 19, 2015, to the present because
    Amazon could not accommodate the restrictions placed by Dr. Robertson
    on the use of her left upper extremity.
    Application ofLaw to Facts
    Statutory Authority Governing the Court's Determination of Causation After July 1, 2014
    Prior to July 1, 2014, an injured worker could establish the causation, or work-
    relatedness, of a claim by credible lay testimony supported by equivocal medical expert
    opinion, such as an opinion that an incident at work "could be" the cause of an injury.
    See Williams v. UPS, 
    328 S.W.3d 497
    , 504 (Tenn. 2010); Tindall v. Waring Park Asso.,
    
    725 S.W.2d 935
    , 937 (Tenn. 1987). For injuries or conditions arising on and after July
    1, 2014, the Tennessee Workers' Compensation Law imposes a different evidentiary
    standard for proving causation.
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    The reforms to the Tennessee Workers' Compensation Law, which became law
    July 1, 2014, define a compensable injury as one that "arises primarily out of and in the
    course and scope of employment." Tenn. Code Ann. § 50-6-102(13) (2014).
    Subparagraph (B) to Tennessee Code Annotated section 50-6-102(13) (2014) expands the
    above definition by providing that "[a]n injury 'arises primarily out of and in the course
    and scope of employment' only if it has been shown by a preponderance of the evidence
    that the employment contributed more than fifty percent (50%) in causing the injury,
    considering all causes." Tennessee Code Annotated section 50-6-102(13)(C) (2014)
    requires that entitlement to workers' compensation benefits be "shown to a reasonable
    degree of medical certainty." According to Tennessee Code Annotated section 50-6-
    102(13)(D) (2014), a physician giving a causation opinion must state the opinion without
    consideration of speculation or possibility, but based on a conclusion that the work "more
    likely than not considering all causes" caused the injury forming the basis of the claim.
    In McCord v. Advantage Human 
    Resourcing, supra
    , the Tennessee Workers'
    Compensation Appeals Board held that, at an Expedited Hearing, the injured worker need
    not prove every element of his or her claim by a preponderance of the evidence.
    McCord, 2015 TN Wrk Comp App Bd LEXIS 6 at *7-8. See also Tenn. Code Ann.§ 50-
    6-239(d)(l). Accordingly, the Court can award benefits in an expedited hearing if the
    injured worker comes forward with sufficient evidence from which the Court can
    determine that he or she is likely to prevail at a hearing on the merits. McCord, at *7-8,
    9.
    Interplay Between Lay Testimony and Expert Medical Opinion on Causation after July 1,
    2014
    The Supreme Court has long held in workers' compensation cases that an injured
    employee may establish causation of his or her injury by a combination of medical expert
    and lay opinion. See, e. g., White v. Werthan Indus., 
    824 S.W.2d 158
    (Tenn. 1992);
    Smith v. Empire Pencil Co., 781 S.W.2d (Tenn. 1989). In fact, the Supreme Court in
    Thomas v. Aetna Life & Cas. Co., 
    812 S.W.2d 278
    , 283 (Tenn. 1991), held that "[w]hile
    causation and permanency of an injury must be proved by expert medical testimony, such
    testimony must be considered in conjunction with the lay testimony of the employee as to
    how the injury occurred and the employee's subsequent condition." !d.
    The 2013 reforms to the Workers' Compensation Law added the word "primarily"
    to the definition of a work-related injury and specified the standard under which medical
    experts are to render causation opinions. However, the legislature did not enact language
    that diminished the role of credible lay testimony in the determination of whether a
    claimed injury is compensable. In McCord, the Workers' Compensation Appeals Board
    held that reliance on precedent from the Tennessee Supreme Court that predates the 2013
    reforms to the Law is proper "unless it is evident that the Supreme Court's decision or
    rationale relied on a remedial interpretation of the pre-July 1, 2014 statutes, that it relied
    6
    on specific statutory language no longer contained in the Workers' Compensation Law,
    and/or that it relied on an analysis that has since been addressed by the general assembly
    through statutory amendments." 2015 TN Wrk Comp Bd LEXIS 6 at *19, n.4.
    Accordingly, the Court finds that the case authority set forth above, as it relates to the
    interplay between lay and expert medical opinion, remains good law. !d.
    Assessment ofLay Testimony
    At the expedited hearing, Ms. Kirk testified clearly and unwaveringly that she
    felt a pop in her left shoulder, accompanied by pain, when she reached to retrieve Item 12
    from Row F in her assigned area at Amazon. She testified that Row F was the highest
    shelf and that Item 12 was the item farthest from where she stood.
    The only evidence introduced by Amazon to rebut Ms. Kirk's testimony was the
    First Report of Injury. The First Report indicates that Ms. Kirk reported her injury on the
    date it occurred and the unidentified preparer of the First Report wrote that Ms. Kirk's
    pain developed gradually while she was packing. (Ex. 6). Amazon did not call the
    preparer of the First Report as a witness so that the Court could scrutinize under oath the
    relative reliability of the information that the preparer included in the First Report.
    Ms. Kirk introduced an Associate First Report of Injury that she signed on the date
    of injury. (Ex. 7). This document indicates, consistent with her in-person testimony, that
    Ms. Kirk's left shoulder popped when she reached for an item to pack it in a box. (Ex.
    7). Ms. Kirk also introduced a document prepared by Sean Jones, the AmCare employee
    who treated Ms. Kirk at Amazon, which recorded the following description of Ms. Kirk's
    injury: "pain in left shoulder when reaching high or across the body." (Ex. 11).
    The Court finds that the Associate First Report and Mr. Jones's notation
    corroborates Ms. Kirk's in-person testimony as to the mechanism of her left shoulder
    injury. On the basis of the totality of the evidence introduced at the expedited hearing,
    the Court finds that Ms. Kirk felt a pop in her left shoulder that was accompanied by pain
    when, while working at Amazon, she reached above her head to retrieve an item to pack
    in a box.
    Assessment ofMedical Expert Opinion
    The Court now addresses the expert medical opinions on causation introduced at
    the expedited hearing. The parties introduced both opinions by pre-printed forms
    completed and signed by the physicians. Neither physician rendered his opinion under
    oath, nor did the physicians give their opinions in consideration of the specific language
    in section 50-6-102(13) (2014) defining work-relatedness.
    Amazon relies on Dr. Eldurkar's opinion that Ms. Kirk's injury is not work-
    related. It argues that, pursuant to Tennessee Code Annotated section 50-6-102(13 )(E),
    7
    Dr. Eldurkar's opm10n is afforded a presumption of correctness because Ms. Kirk
    selected him from its panel.
    Dr. Eldurkar saw Ms. Kirk on a single occasion, following which he diagnosed her
    with a strained left upper back muscle. (Ex. 3, pp. 2-3). Ms. Kirk testified that she told
    Dr. Eldurkar she injured her left shoulder while reaching to retrieve an item from a high
    shelf. Dr. Eldurkar stated in his report that "[n]o particular incident occurred, but she
    states [her left shoulder pain occurred] from reaching across and lifting at heights." (Ex.
    3, p. 2). Dr. Eldurkar rendered his opinion without the benefit of diagnostic testing. (Ex.
    3, p. 2). Likewise, he provided no explanation of the facts upon which he based his
    opinion. (Ex. 3).
    The Court first considers whether Dr. Eldurkar is entitled to the presumption of
    correctness afforded by Tennessee Code Annotated section 50-6-1 02(E) (20 14 ). The
    statutory language establishes two (2) qualifying factors for the presumption: (1) whether
    the physician in question is a "treating physician;" and (2) whether the physician in
    question was "selected by the employee from the employer's designated panel." The
    Court questions whether Dr. Eldurkar's opinion qualifies for the benefit of the statutory
    presumption because he saw Ms. Kirk only once and did not treat her.
    In Orman v. Williams Sonoma, Inc., 
    803 S.W.2d 672
    , 677 (Tenn. 1991), the
    Supreme Court held that "[i]t seems reasonable that the physicians having greater contact
    with the Plaintiff would have the advantage and opportunity to provide a more in-depth
    opinion, if not a more accurate one." Dr. Eldurkar saw Ms. Kirk only once, ordered no
    diagnostic testing, and offered no treatment. In light of the above authority, the Court
    finds that, because he did not treat Ms. Kirk, Dr. Eldurkar's opinion is not entitled to the
    statutory presumption.
    There is no appellate guidance on the issue of the application of the statutory
    presumption in section 50-6-102(13)(E). However, the Court has considered the
    possibility that an appellate body might find that the statutory presumption applies to Dr.
    Eldurkar's opinion. Even if that is the case, the Court finds that Dr. Eldurkar's limited
    contact with Ms. Kirk reduces the evidentiary impact of the presumption.
    The Court assigns little weight to the opinion of Dr. Eldurkar because he
    considered that Ms. Kirk's injury was gradual in nature, when, according to Ms. Kirk's
    testimony, she told him that her injury occurred at a specific time and as she performed a
    specific physical activity. The Court also questions the appropriateness of Dr. Eldurkar
    making an opinion as to the work-relatedness of Ms. Kirk's injury without at least
    viewing x-rays. Dr. Robertson's records indicate that the x-rays he ordered revealed
    important findings regarding the condition of Ms. Kirk's left shoulder. Based on the
    above-stated reasons, the Court finds that Dr. Eldurkar's opinion on causation does not
    assist the Court.
    8
    Ms. Kirk relies on the opinion of Dr. Robertson, an orthopedic surgeon whom she
    saw four (4) times for treatment of her left shoulder injury. The records introduced at the
    Expedited Hearing indicate that Dr. Robertson gave differing opinions on the work-
    relatedness of Ms. Kirk's injury. On February 23, 2015, four (4) days after he examined
    Ms. Kirk, Dr. Robertson signed an Amazon form that requested his causation opinion.
    (Ex. 4, p. 9; Ex. 5, p. 19). On this form, Dr. Robertson appears to have initially marked a
    box designated "Not Work-Related." (Ex. 4, p. 9; Ex. 5, p. 19). A hand-written "X"
    appears over the "Not Work-Related" box and a hand-written circle encloses the box on
    the form designated "Work-Related." (Ex. 4, p. 9; Ex. 5, p. 19). Dr. Robertson wrote his
    signature and the notation "3/12/15" across the top of the section ofthe form containing
    the above-described boxes. (Ex. 4, p. 9; Ex. 5, p. 19).
    Exhibit 5 also contains a form entitled "Attending Physician's Statement of Work
    Capacity and Impairment" that bears Dr. Robertson's signature dated March 12, 2015,
    the same date on which he apparently revised the Amazon form to indicate the opinion
    that Ms. Kirk's injury was work-related. (Ex. 5, pp. 12-13). On this form, Dr. Robertson
    marked a box designated "Unknown" in response to an inquiry as to whether Ms. Kirk's
    condition is "due to injury or illness arising out of the patient's employment." (Ex. 5, p.
    13).
    Finally, Exhibit 5 contains an Amazon form that Dr. Robertson signed March 27,
    2015. This form indicates that Dr. Robertson marked the box designated "Work-Related"
    and hand-wrote above it "overuse injury from overhead activity." (Ex. 5, p. 5). The
    Court finds that the evidence introduced at the Expedited Hearing casts uncertainty upon
    Dr. Robertson's causation opinion. The forms on which Dr. Robertson's opinions are
    stated do not provide an explanation for why his opinions differ. For that reason, Dr.
    Roberson's opinions do not assist the Court.
    Decision
    The Court finds that the statutory authority discussed above requires that Ms. Kirk
    prove by a combination of credible lay testimony and expert medical opinion that she will
    likely prevail at a hearing on the merits that her left-shoulder injury is work-related. The
    Court finds that Ms. Kirk's testimony as to the mechanism of her injury is credible.
    However, for the reasons discussed above, the expert medical opinion introduced at the
    Expedited Hearing does not assist the Court. While Dr. Robertson is in a better position
    than Dr. Eldurkar to render an opinion on causation, he gives differing opinions on the
    issue.
    Tennessee Rule of Evidence 702 defines the role of expert opinion in the litigation
    process as "evidence that assists the trier of fact in understanding the evidence or
    determining a fact in issue." In this claim, neither party asked the physician on whose
    opinion they relied to give an opinion under the evidentiary standard set forth in the
    statutory language. The Court generally observes that the introduction of expert medical
    9
    opinion by means of a doctor's response to inquiries on a pre-printed form is perilous to
    the party introducing it. A form limits the ability of the physician to explain the manner
    in which he or she arrived at the stated opinion and rarely provides sufficient space to
    indicate the underlying facts presented to the physician for consideration. The Court finds
    that neither physician's opinion, as introduced here, assisted the Court.
    Accordingly, this Court finds that Ms. Kirk has failed to come forward with
    sufficient expert medical opinion showing that, at a hearing on the merits, she will likely
    prevail on the issue that her injury arose primarily out of and in the course and scope of
    employment. For that reason, the Court, at this time, denies Ms. Kirk's request for
    medical and temporary disability benefits.
    IT IS, THEREFORE, ORDERED as follows:
    1. Ms. Kirk's claim for an interlocutory order for medical and temporary disability
    benefits is denied at this time.
    2. This matter is set for Initial Hearing on August 31, 2015, at 10:30 a.m. Eastern
    Time.
    Initial Hearing:
    An Initial Hearing has been set with Judge Thomas Wyatt, Court of Workers'
    Compensation Claims, on August 31, 2015, at 10:30 a.m. Eastern Time. You must call
    615-741-2051 or toll free at 855-747-1721 to participate in the Initial Hearing. Please
    Note: You must call in on the scheduled date and time to participate. Failure to call in
    may result in a determination of the issues without your further participation. All
    conferences are set using Eastern Time (ET).
    ISSUED AND FILED WITH THE COURT OF WORKERS' COMPENSATION
    CLAIMS ON THE 7TH DAY OF JULY, 2015.
    Judge Thomas Wya
    Tennessee Court of Workers'
    Compensation Claims
    1301 Riverfront Parkway, Suite 202
    Chattanooga, TN 37402
    10
    Right to Appeal:
    Tennessee Law allows any party who disagrees with this Expedited Hearing Order to
    appeal the decision to the Workers' Compensation Appeals Board. To file a Notice of
    Appeal, you must:
    1. Complete the enclosed form entitled: "Expedited Hearing Notice of Appeal."
    2. File the completed form with the Court Clerk within seven (7) business days of the
    date the Expedited Hearing Order was entered by the Workers' Compensation
    Judge.
    3. Serve a copy of the Request for Appeal upon the opposing party.
    4. The appealing party is responsible for payment of a filing fee in the amount of
    $75.00. Within ten (1 0) calendar days after the filing of a notice of appeal,
    payment must be received by check, money order, or credit card
    payment. Payments can be made in person at any Bureau office or by United
    States mail, hand-delivery, or other delivery service. In the alternative, the
    appealing party may file an Affidavit of Indigency, on a form prescribed by the
    Bureau, seeking a waiver of the filing fee. The Affidavit of Indigency may be
    filed contemporaneously with the Notice of Appeal or must be filed within ten
    (1 0) calendar days thereafter. The Appeals Board will consider the Affidavit of
    Indigency and issue an Order granting or denying the request for a waiver of the
    filing fee as soon thereafter as is practicable. Failure to timely pay the filing fee
    or file the Affidavit of Indigency in accordance with this section shall result in
    dismissal of the appeal.
    5. The parties, having the responsibility of ensuring a complete record on appeal,
    may request from the Court Clerk the audio recording of the hearing for the
    purpose of having a transcript prepared by a licensed court reporter and filing it
    with the Court Clerk within ten (10) calendar days of the filing of the Expedited
    Hearing Notice of Appeal. Alternatively, the parties may file a statement of the
    evidence within ten (10) calendar days of the filing of the Expedited Hearing
    Notice of Appeal. The Judge must approve the statement of the evidence before
    the Clerk of Court shall submit the record to the Clerk of the Appeals Board.
    6. If the appellant elects to file a position statement in support of the interlocutory
    appeal, the appealing party shall file such position statement with the Court Clerk
    within three (3) business days of the filing of the Expedited Hearing Notice of
    11