It is not unusual for Workers’ Compensation Carriers to deny claims based upon an allegation of improper notice. Carla Scruggs v. Amazon.com Services, LLC, et al. (2022) discussed below details that notice is a weak argument for denying a Tennessee Workers’ Compensation claim.
Facts and Background
On April 9, 2021, while performing her duties for Amazon.com Service, LLC (“Employer”), Carla Scruggs (“Employee”) allegedly injured her left knee. Employee did not immediately report the injury to Employer and chose to treat the injury at home. On April 30, Employee slipped in liquid at work and allegedly injured the same knee. Employee then reported both incidents to Employer. Employee was initially treated at Employer’s on-site medical clinic, AmCare. Employee later chose Dr. Frederick Wolf from a selection of physicians provided by Employer. Dr. Wolf noted Employee was experiencing difficulty with her left knee and experiencing symptoms that Employee reported began as a result of the April 9 event. Employer submitted a Notice of Denial regarding the April 9 injury. Dr. Wolf recommended surgery after a lateral meniscus tear was found.
Procedural History
Employee filed a petition for benefit determination as well as two requests for expedited hearing, one for each date of injury. The court consolidated Employee’s two claims and allowed Employer the opportunity to file a motion for summary judgment which was later denied. The trial court also issued an order awarding Employee medical benefits. Employer has appealed both orders.
Analysis
Judge Pele I. Godkin delivered the opinion of the Appeals Board. Employer identified the central issues for review as “(1) whether the trial court erred in finding that Employee is likely to prevail at a hearing on the merits regarding timeliness of notice and/or reasonable excuse for failure to give timely notice; (2) whether the trial court erred in determining Employer was not prejudiced by the late notice of Employee’s April 9, 2021 injury,” ( Scruggs v. Amazon.com Services LLC, et al. , No. 2021-08-0876, 2022).
Tennessee Code Annotated section 50-6-201(a) states that “[e]very injured employee…shall, immediately upon the occurrence of an injury, or as soon thereafter as is reasonable and practicable, give or cause to be given to the employer who has no actual notice, written notice of the injury.” The statute also asserts “[n]o compensation shall be payable…unless the written notice is given to the employer within fifteen (15) days after the occurrence of the accident, unless reasonable excuse for failure to give the notice is made to the satisfaction of the tribunal to which the claim for compensation may be presented.” Tenn. Code Ann. § 50-6-201(a) (2021). The notice requirement is intended to allow the employer the opportunity to investigate the facts and provide treatment for the injured employee in a timely manner. The 2013 Workers’ Compensation Reform Act amended the notice requirement:
No defect or inaccuracy in the notice shall be a bar to compensation, unless the employer can show, to the satisfaction of the workers’ compensation judge before which the matter is pending, that the employer was prejudiced by the failure to give the proper notice, and then only to the extent of the prejudice.
Tenn. Code Ann. § 50-6-201(a)(3). As noted by Judge Godkin, “to prevail on a notice defense, the employer must demonstrate the existence of ‘actual prejudice’ caused by the employee’s giving of late notice,” ( Scruggs v. Amazon.com Services LLC, et al. , No. 2021-08-0876, 2022).
Employer argued that Employee had no reasonable excuse for her failure to provide notice of the event on April 9. Employee testified that she did not provide timely notice of the April 9 event because she assumed the injury was similar to the typical “aches and pains” accumulated throughout a typical workday.
Employee sought medical care after the April 30 incident because the pain differed from her previous symptoms. The trial court concluded that Employee did have a reasonable excuse for her failure to provide timely notice of the April 9 incident. The Appeals Board supports the trial court’s determination.
“The legislature has expressed its intent that a trial court consider the reasons for late notice, consider whether the late notice resulted in prejudice to the employer under the circumstances of that particular case, and fashion an appropriate remedy if one is needed,” ( Scruggs v. Amazon.com Services LLC, et al. , No. 2021-08-0876, 2022). Both the trial court and the Appeals Board found that Employer failed to provide specific evidence that showed the late notice prejudiced its ability to investigate the claims made by Employee. Employer failed to establish legitimate prejudice required by section 50-6-201(a)(3).
It is established that an employee’s burden of proof in an expedited hearing can be considered a lesser evidentiary standard than the burden imposed at trial. The Appeals Board concluded that because Dr. Wolf’s medical records suggested that Employee’s injury arose from a work incident and Dr. Wolf was selected from Employer’s panel, any treatment he recommended was presumed necessary. The burden was on Employer to prove that treatment was not necessary. The Appeals Board finds no error in the trial court’s decision to award medical benefits.
It was concluded that Employer’s appeal was frivolous and had no realistic chance of success. Employee is entitled to recover reasonable attorneys’ fees and costs associated with the frivolous appeal.
If your Workers’ Compensation claim was denied over notice, please contact one of our Tennessee Workers’ Compensation attorneys for a free consultation at (865) 691-2777.