Tennessee Supreme Court Rules Driver Eligible for Knee Replacement Surgery Despite Arthritis

It’s a question that has long puzzled workers’ compensation insurers across the nation: When does an injury qualify as an aggravation of a pre-existing condition, and when does it become compensable, potentially leading to costly surgeries and extended medical care?

Recently, the Tennessee Supreme Court addressed this issue, ruling that a truck driver was entitled to knee-replacement surgery following a minor accident, despite having pre-existing arthritis in both knees. This decision overturned the Tennessee Workers’ Compensation Appeals Board and reinstated a lower court’s award for medical coverage and disability benefits for the driver.

The justices clarified that under workers’ compensation law, an aggravation injury does not necessitate proof of a permanent change or worsening of the condition to be compensable. Instead, it is sufficient for an employee to demonstrate, with reasonable medical certainty, that the aggravation injury primarily arose out of and occurred during the course of employment. Justice Mary Wagner noted in the Dec. 22 opinion in Jo Carol Edwards v. Peoplease that the employee must prove that the aggravation contributed at least 50% to the disablement or need for medical treatment.

The case began in 2020 when Edwards’ truck suffered a tire blowout, causing her to crash into a bridge. Her knees struck a panel beneath the dashboard, but she did not report pain or stiffness until a month later. Under Tennessee workers’ compensation law, the employer is required to provide a list of three treating physicians, from which the employee can choose one. Edwards selected an orthopedic surgeon who concluded that her arthritis was not caused by the accident. However, a second doctor identified a fracture in her left knee, attributing it to the truck accident.

Dr. Timothy Sweo, the second physician, recommended total knee replacement for her left knee, which she underwent a few months later. During a Court of Workers’ Compensation Claims hearing, judges observed Edwards limping and using a cane, finding her testimony credible. Dr. Sweo testified that both knees required replacement and that the accident was likely responsible for more than 51% of the injuries.

The compensation court determined that the first treating physician, Dr. Jason Hutchinson, misinterpreted Tennessee workers’ compensation law by concluding that the exacerbation of an existing condition was not compensable. Consequently, the court ordered Peoplease to cover the costs of Edwards’ left knee replacement, authorize the right knee replacement, pay for past and ongoing temporary total disability benefits, and reimburse her for mileage.

Peoplease appealed the decision, leading the Workers’ Compensation Appeals Board to reverse the lower court’s ruling, denying most benefits for Edwards and remanding the case for further action. On remand, additional doctors conducted independent medical examinations (IMEs) and disagreed on the extent of the injuries caused by the accident.

In the final appeal, the state Supreme Court overruled the Appeals Board, agreeing with the Trial Court that Edwards had met her burden of proving permanent total disability. The doctor from the second IME was particularly persuasive, noting that Edwards had no prior history of limited range of motion or knee pain before the accident.

“We conclude that the evidence does not preponderate against the finding of the Trial Court that Ms. Edwards is permanently and totally disabled,” the justices stated. They reinstated the Trial Court’s determination on this matter.

The full 18-page opinion can be viewed here.

Topics
Personal Auto
Tennessee

It’s a question that has long puzzled workers’ compensation insurers across the nation: When does an injury qualify as an aggravation of a pre-existing condition, and when does it become compensable, potentially leading to costly surgeries and extended medical care?

Recently, the Tennessee Supreme Court addressed this issue, ruling that a truck driver was entitled to knee-replacement surgery following a minor accident, despite having pre-existing arthritis in both knees. This decision overturned the Tennessee Workers’ Compensation Appeals Board and reinstated a lower court’s award for medical coverage and disability benefits for the driver.

The justices clarified that under workers’ compensation law, an aggravation injury does not necessitate proof of a permanent change or worsening of the condition to be compensable. Instead, it is sufficient for an employee to demonstrate, with reasonable medical certainty, that the aggravation injury primarily arose out of and occurred during the course of employment. Justice Mary Wagner noted in the Dec. 22 opinion in Jo Carol Edwards v. Peoplease that the employee must prove that the aggravation contributed at least 50% to the disablement or need for medical treatment.

The case began in 2020 when Edwards’ truck suffered a tire blowout, causing her to crash into a bridge. Her knees struck a panel beneath the dashboard, but she did not report pain or stiffness until a month later. Under Tennessee workers’ compensation law, the employer is required to provide a list of three treating physicians, from which the employee can choose one. Edwards selected an orthopedic surgeon who concluded that her arthritis was not caused by the accident. However, a second doctor identified a fracture in her left knee, attributing it to the truck accident.

Dr. Timothy Sweo, the second physician, recommended total knee replacement for her left knee, which she underwent a few months later. During a Court of Workers’ Compensation Claims hearing, judges observed Edwards limping and using a cane, finding her testimony credible. Dr. Sweo testified that both knees required replacement and that the accident was likely responsible for more than 51% of the injuries.

The compensation court determined that the first treating physician, Dr. Jason Hutchinson, misinterpreted Tennessee workers’ compensation law by concluding that the exacerbation of an existing condition was not compensable. Consequently, the court ordered Peoplease to cover the costs of Edwards’ left knee replacement, authorize the right knee replacement, pay for past and ongoing temporary total disability benefits, and reimburse her for mileage.

Peoplease appealed the decision, leading the Workers’ Compensation Appeals Board to reverse the lower court’s ruling, denying most benefits for Edwards and remanding the case for further action. On remand, additional doctors conducted independent medical examinations (IMEs) and disagreed on the extent of the injuries caused by the accident.

In the final appeal, the state Supreme Court overruled the Appeals Board, agreeing with the Trial Court that Edwards had met her burden of proving permanent total disability. The doctor from the second IME was particularly persuasive, noting that Edwards had no prior history of limited range of motion or knee pain before the accident.

“We conclude that the evidence does not preponderate against the finding of the Trial Court that Ms. Edwards is permanently and totally disabled,” the justices stated. They reinstated the Trial Court’s determination on this matter.

The full 18-page opinion can be viewed here.

Topics
Personal Auto
Tennessee