In this workers' compensation case, employee Yalonda Woods sought authorization for total left-knee arthroplasty surgery recommended by her authorized treating physician after a March 2025 work injury that caused a meniscus tear and aggravated osteoarthritis. The employer and carrier denied the request following two utilization reviews, which concluded the procedure was not medically necessary due to insufficient documentation of osteoarthritis severity, weight-loss efforts, gait issues, or a physical therapy trial. The court held that Woods was likely to prevail at a compensation hearing on the medical necessity of the surgery and ordered the employer to authorize it. The core reasoning was that the treating physician's opinion carries a statutory presumption of necessity, which the utilization review physician and Bureau Medical Director did not rebut, particularly where the employer failed to supply complete records and the court performed an independent de novo review crediting updated imaging, post-therapy symptoms, functional capacity findings, and the physician's clinical judgment.
In this workers' compensation case, employee Deborah Smith brought a petition against employer Ballad Health concerning unresolved medical benefits. The matter came before the court on an agreed motion for voluntary dismissal after the parties resolved the open medical issues between them. Ms. Smith retains the right to ongoing medical benefits under the terms of a prior settlement agreement. The court dismissed the petition and taxed the $150 filing fee to the employer.
Spencer King, an employee of Rentokil North America, Inc., sought temporary partial disability benefits after injuring his leg at work on April 5, 2023, undergoing two surgeries, and receiving temporary total disability benefits during his initial recovery period. After the first surgery, Rentokil offered a light-duty position consistent with medical restrictions, but King refused it and moved to North Carolina for personal and family reasons; following a second surgery and the end of long-term disability payments, he requested additional benefits for the period from December 17, 2025, until he found suitable work in February 2026. Rentokil opposed the claim, arguing it could have accommodated the restrictions. The court denied the request for temporary partial disability benefits after an expedited hearing, holding that King failed to show he was likely to prevail on the merits because his unemployment resulted from personal circumstances rather than his work-related restrictions.
In this workers' compensation case, employee Travis Gray requested an order replacing Dr. Jody Helms on a neurosurgeon panel offered by employer Leclerc Foods USA Incorporated or authorizing treatment at the Shepherd Center or Vanderbilt following a disputed work injury. After an expedited hearing, the Tennessee Court of Workers' Compensation Claims denied the request. The court found that under Tennessee Code Annotated Section 50-6-204(a)(3)(A)(i), the employer selects the physicians for the panel, and Gray's objections to Dr. Helms were personal rather than based on qualifications, making success on the merits unlikely. The court further noted that no physician had directly referred Gray to the requested facilities.
This case involved a workers' compensation claim by Taylor Gockenbach, a nurse technician, against her employer University Health Systems for medical and temporary disability benefits related to a right shoulder labral tear. Gockenbach alleged the injury resulted from cumulative trauma due to repetitive lifting and patient handling during her shifts, while the employer contended that notice of the injury was untimely. The court determined that Gockenbach was likely to prevail on her claim for medical benefits because she provided notice within 15 days of learning from her doctor on April 25 that she had suffered a work-related cumulative injury, satisfying the statutory requirement, but denied temporary disability benefits after August 8 because the employer could have accommodated her work restrictions. The reasoning centered on expert medical evidence confirming the injury as cumulative rather than acute, the timing of the diagnosis establishing when the employee reasonably should have known of the injury, and the availability of light-duty accommodations.
Danny Floria, an employee of Demcor, Inc., filed a claim for workers' compensation benefits after injuring his arm during an incident at a food truck on the employer's premises while on lunch break. Floria lunged in a joking manner toward coworkers, struck one, and fell, later describing the event differently to the employer before admitting to participating in horseplay. Demcor denied the claim, arguing the injury did not arise primarily out of and in the course and scope of employment due to the horseplay. Following an expedited hearing, the Tennessee Court of Workers' Compensation Claims found Floria unlikely to prevail on the merits, as the voluntary horseplay lacked a rational connection to his job duties and was not incidental to employment under Tennessee law.