Tennessee § 50-6-204 - Medical treatment, attendance and hospitalization — Release of medical records — Reports — Disputes — Reimbursement or payment of expenses — Burial expenses — Physical examinations — Pain management — Impairment ratings.

§ 50-6-204. Medical treatment, attendance and hospitalization — Release of medical records — Reports — Disputes — Reimbursement or payment of expenses — Burial expenses — Physical examinations — Pain management — Impairment ratings.

The employer or the employer's agent shall furnish, free of charge to the employee, such medical and surgical treatment, medicine, medical and surgical supplies, crutches, artificial members, and other reasonable and necessary apparatus, including prescription eyeglasses and eye wear, such nursing services or psychological services as ordered by the attending physician and hospitalization, including such dental work made reasonably necessary by accident as defined in this chapter. No medical provider shall charge more than ten dollars ($10.00) for the first twenty (20) pages or less, and twenty-five cents (25¢) per page for each page after the first twenty (20) pages, for any medical reports, medical records or documents pertaining to medical treatment or hospitalization of the employee that are furnished pursuant to this subsection (a). It is the intent of the general assembly that the administration of the workers' compensation system proceed in a timely manner and that the parties and the bureau have reasonable access to the employee's medical records and medical providers that are pertinent to and necessary for the efficient resolution of the employee's workers' compensation claim in a timely manner. To that end, employers or case managers may communicate with the employee's authorized treating physician, orally or in writing, and each medical provider shall be required to release the records of any employee treated for a work-related injury to both the employer and the employee within thirty (30) days after admission or treatment. There shall be no implied covenant of confidentiality with respect to those records, which will include all written memoranda or visual or recorded materials, e-mails and any written materials provided to the employee's authorized treating physician, by case managers, employers, insurance companies, or their attorneys or received from the employee's authorized treating physician. For purposes of subdivision (a)(2), “employer” means the employer, the employer's attorney, the employer’s insurance carrier or third party administrator, a case manager as authorized by § 50-6-123, or any utilization review agent as authorized by § 50-6-124 during the employee’s treatment for the claimed workers’ compensation injury. If the bureau becomes involved in the appeal of a utilization review issue, then the bureau is authorized to communicate with the medical provider involved in the dispute, either orally or in writing, to permit the timely resolution of the issue and shall notify the employee, employer, and any attorney representing the employee or employer that they may review or copy the documents and responses. Each party requesting copies of records shall pay a fee authorized by subdivision (a)(1)(B) prior to the bureau providing the requested copies. No relevant information developed in connection with authorized medical treatment or an examination provided pursuant to this section for which compensation is sought by the employee shall be considered a privileged communication, and no medical provider shall incur any liability as a result of providing medical information, records, opinions, or reports as described in subdivision (a)(2)(C); provided, that the medical provider complies with subdivision (a)(2)(C). The injured employee shall accept the medical benefits afforded under this section; provided that in any case when the employee has suffered an injury and expressed a need for medical care, the employer shall designate a group of three (3) or more independent reputable physicians, surgeons, chiropractors or specialty practice groups if available in the injured employee's community or, if not so available, in accordance with subdivision (a)(3)(B), from which the injured employee shall select one (1) to be the treating physician. When necessary, the treating physician selected in accordance with this subdivision (a)(3)(A) shall make referrals to a specialist physician, surgeon, or chiropractor and immediately notify the employer. The employer shall be deemed to have accepted the referral, unless the employer, within three (3) business days, provides the employee a panel of three (3) or more independent reputable physicians, surgeons, chiropractors or specialty practice groups. In this case, the employee may choose a specialist physician, surgeon, chiropractor or specialty practice group to provide treatment only from the panel provided by the employer. The liability of the employer for the services provided to the employee shall be limited to the maximum allowable fees that are established in the applicable medical fee schedule adopted pursuant to this section. The bureau shall have authority to waive subdivision (a)(3)(A)(iii) when necessary to provide treatment for an injured employee. If three (3) or more independent reputable physicians, surgeons, chiropractors, or specialty practice groups not associated in practice together are not available in the employee's community, the employer shall provide a list of three (3) independent reputable physicians, surgeons, chiropractors, or specialty practice groups not associated in practice together that are within a one-hundred-twenty-five-mile radius of the employee's community of residence. For purposes of this subdivision (a)(3)(B), “not associated in practice together” means at least one (1) physician, surgeon, chiropractor, or specialty practice group is not associated in practice with another physician, surgeon, chiropractor, or specialty practice group that is on the list or panel provided to an employee pursuant to this section. When the treating physician or chiropractor refers the injured employee, the employee shall be entitled to have a second opinion on the issue of surgery and diagnosis from a physician or chiropractor from a panel of two (2) physicians practicing in the same specialty as the physician who recommended the surgery. In cases where the employer has provided a panel of specialists pursuant to subdivision (a)(3)(A)(i) of this section, the employee may choose one (1) of the two (2) remaining specialists to provide a second opinion on the issue of surgery and diagnosis. The employee's decision to obtain a second opinion shall not alter the previous selection of the treating physician or chiropractor. The employer shall provide the applicable panel of physicians or chiropractors to the employee in writing on a form prescribed by the bureau, and the employee shall select a physician or chiropractor from the panel, sign and date the completed form, and return the form to the employer. The employer shall provide a copy of the completed form to the employee and shall maintain a copy of the completed form in the records of the employer and shall produce a copy of the completed form upon request by the bureau. In any case when the employee has been presented the physician selection form but has failed to sign the completed form and return it to the employer, the employee's receipt of treatment from any physician provided in the panel after the date the panel was provided shall constitute acceptance of the panel and selection of the physician from whom the employee received treatment as the treating physician, specialist physician, chiropractor or surgeon. In all cases where the treating physician has referred the employee to a specialist physician, surgeon, chiropractor or specialty practice group, the specialist physician, surgeon, or chiropractor to which the employee has been referred, or selected by the employee from a panel provided by the employer, shall become the treating physician until treatment by the specialist physician, surgeon, or chiropractor concludes and the employee has been referred back to the treating physician selected by the employee from the initial panel provided by the employer under subdivision (a)(3)(A). In all cases when an employee changes the employee's community of residence after selection of a physician under this subdivision (a)(3), the employer shall provide the employee, upon written request, a new panel of reputable physicians, surgeons, chiropractors or specialty practice groups, as provided in subdivision (a)(3)(A), from which the injured employee shall select one (1) to be the treating physician. If any physician, surgeon, chiropractor or specialty practice group included on a panel provided to an employee under this subsection declines to accept the employee as a patient for the purpose of providing treatment to the employee for his workers' compensation injury, the employee may either select a physician from the remaining physicians, surgeons or chiropractors included on the initial panel provided to the employee pursuant to subdivision (a)(3)(A) or request that the employer provide an additional choice of a physician, surgeon, chiropractor or specialty practice group to replace the physician, surgeon or chiropractor who refused to accept the injured employee as a patient for the purpose of treating the employee's workers' compensation injury. Any treatment recommended by a physician or chiropractor selected pursuant to this subdivision (a)(3) or by referral, if applicable, shall be presumed to be medically necessary for treatment of the injured employee. Following the adoption of treatment guidelines pursuant to § 50-6-124, the presumption of medical necessity for treatment recommended by a physician or chiropractor selected pursuant to this subsection or by referral, if applicable, shall be rebuttable only by clear and convincing evidence demonstrating that the recommended treatment substantially deviates from, or presents an unreasonable interpretation of, the treatment guidelines. [Deleted by 2013 amendment, effective July 1, 2014.] [Deleted by 2013 amendment, effective July 1, 2014.] When an injured worker is required by the worker's employer to travel to an authorized medical provider or facility located outside a radius of fifteen (15) miles from the insured worker's residence or workplace, then, upon request, the employee shall be reimbursed for reasonable travel expenses. The injured employee's travel reimbursement shall be calculated based on a per mile reimbursement rate, as defined in subdivision (a)(6)(B), times the total round trip mileage as measured from the employee's residence or workplace to the location of the medical provider's facility. The definition of community as contemplated by this subdivision (a)(6)(A) shall apply only for the purposes of this section. The per mile reimbursement rate for the injured employee shall be no less than the mileage allowance authorized for state employees who have been authorized to use personally owned vehicles in the performance of their duties. This minimum per mile reimbursement rate shall be based on the last published comprehensive travel regulations promulgated by the department of finance and administration. Where the nature of the injury or occupational disease, as defined in § 50-6-102, is such that it does not disable the employee but reasonably requires medical, surgical, psychological or dental treatment or care, medicine, surgery, dental and psychological treatment, medicine, medical and surgical supplies, crutches, artificial members, and other apparatus shall be furnished by the employer. [Deleted by 2013 amendment, effective July 1, 2014.] In case death results from the injury or occupational disease, as defined in § 50-6-102, the employer shall, in addition to the medical services, etc., referred to in subsections (a) and (b), pay the burial expenses of the deceased employee, not exceeding ten thousand dollars ($10,000). If the deceased employee leaves no dependents entitled to compensation under this chapter, the employer shall pay to the employee's estate the additional benefits provided in § 50-6-209(b)(2) and (3), and shall also be liable for the medical and hospital services and burial expenses provided for in this section. The injured employee must submit to examination by the employer's physician at all reasonable times if requested to do so by the employer, but the employee shall have the right to have the employee's own physician present at the examination, in which case the employee shall be liable to the employee's physician for that physician's services. Any medical report submitted to the employer based upon the examination, or a true copy of the report, shall be furnished by the employer to the employee upon request; provided, that the employer may, in the employer's discretion, furnish the report to the attorney for the employee or to a member of the employee's family. [Deleted by 2013 amendment, effective July 1, 2014.] The employer shall pay for the services of the physician making the examination at the instance of the employer. When a dispute as to the degree of medical impairment exists, either party may request an independent medical examiner from the administrator's registry. If the parties are unable to mutually agree on the selection of an independent medical examiner from the administrator's registry, it shall be the responsibility of the employer to provide a written request to the administrator for assignment of an independent medical examiner with a copy of the notice provided to the other party. Upon receipt of the written request, the administrator shall provide the names of three (3) independent medical examiners chosen at random from the registry. No physician may serve as an independent medical examiner in a case and serve on any panel of providers selected under this section for the employer involved in such case. The administrator shall immediately notify the parties by facsimile or e-mail when the list of independent medical examiners has been assigned to a matter, but in any event the notification shall be made within five (5) business days of the date of the request. The employer may strike one (1) name from the list, with the rejection made and communicated to the other party by facsimile or e-mail no later than the third business day after the date on which notification of the list is provided. The employee shall select a physician to perform the independent medical examination from the remaining physicians on the list. All costs and fees for an independent medical examination and report made pursuant to this subdivision (d)(5) shall be paid by the employer. The written opinion as to the permanent impairment rating given by the independent medical examiner pursuant to this subdivision (d)(5) shall be presumed to be the accurate impairment rating; provided, however, that this presumption may be rebutted by clear and convincing evidence to the contrary. The administrator shall establish by rule, in accordance with the Uniform Administrative Procedures Act, compiled in title 4, chapter 5, an independent medical examiners registry. The administrator shall establish qualifications for the independent medical examiners, including continuing education and peer review requirements, with the advice of the Tennessee Medical Association and the advisory council on workers' compensation, established by § 50-6-121. The rules established shall include, but not be limited to, qualifications and procedures for submission of an application for inclusion on the registry, procedures for the review and maintenance of the registry, and procedures for assignment that ensures that the composition of the panels is random. Whenever the nature of the injury is such that specialized medical attention is required or indicated and the specialized medical attention is not available in the community in which the injured employee resides, the injured employee can be required to go, at the request of and at the expense of the employer, to the nearest location at which the specialized medical attention is available. If the injured employee refuses to comply with any reasonable request for examination or to accept the medical or specialized medical services that the employer is required to furnish under this chapter, the injured employee's right to compensation shall be suspended and no compensation shall be due and payable while the injured employee continues to refuse. For accidents or injuries occurring on or after July 1, 2005, in case of a dispute as to the injury, other than disputes as to the degree of medical impairment, the court may, at the instance of either party or on its own motion, appoint a neutral physician of good standing and ability to make an examination of the injured person and report the physician's findings to the court, the expense of which examination shall be borne equally by the parties. In all death claims where the cause of death is obscure or is disputed, any interested party may require an autopsy, the cost of which is to be borne by the party demanding the autopsy. Any physician whose services are furnished or paid for by the employer and who treats or makes or is present at any examination of an injured employee may be required to testify as to any knowledge acquired by the physician in the course of the treatment or examination as the treatment or examination relates to the injury or disability arising therefrom. If an emergency, or on account of the employer's failure or refusal to provide the medical care and services required by this law, the injured employee or the injured employee's dependents may provide the medical care and services, and the cost of the medical care and services, not exceeding three hundred dollars ($300), shall be borne by the employer; provided, that the pecuniary liability of the employer shall be limited to the charges for the service that prevail in the community where the services are rendered. If an employer does not provide medical care and treatment, medical services or medical benefits, or both, that an employee contends should be provided as a result of a judgment or decree entered by a workers' compensation judge following a workers' compensation trial or as a result of a workers' compensation settlement agreement, either the employee or the employer, or the attorney for the employee or employer, shall request the assistance of a workers' compensation mediator to determine whether such medical care and treatment, medical services or medical benefits, or both, are appropriate by filing a petition for benefit determination and participating in alternative dispute resolution as provided in § 50-6-236. If the parties do not resolve the dispute by agreement, either party may file a request for a hearing and submit the dispute to a workers' compensation judge for resolution after the workers' compensation mediator has issued a dispute certification notice in accordance with § 50-6-236. A workers' compensation judge shall have the authority to determine whether it is appropriate to order the employer or the employer's insurer to provide specific medical care and treatment, medical services or medical benefits, or both, to the employee pursuant to a judgment or decree entered by a judge following a workers' compensation trial or pursuant to a workers' compensation settlement agreement approved by a workers' compensation judge pursuant to § 50-6-240. The workers' compensation judge's authority shall include, but is not limited to, the authority to order specific medical care and treatment, medical services or medical benefits, or both. The authority of a workers' compensation judge to order the provision of benefits under this section shall include authority to order specific medical care and treatment, medical services or medical benefits, or both for all settlements approved by the department, the bureau, the commissioner, the commissioner's designee or a workers' compensation specialist, even if the settlement was approved under prior law. All psychological or psychiatric services available under subdivisions (a)(1) and (b)(1) shall be rendered only by psychologists or psychiatrists and shall be limited to those ordered upon the referral of physicians authorized under subdivision (a)(3). The administrator, in consultation with the medical care and cost containment committee and the advisory council on workers' compensation, is authorized to establish by rule, in accordance with the Uniform Administrative Procedures Act, a comprehensive medical fee schedule and a related system that includes, but is not limited to, procedures for review of charges, enforcement procedures and appeal hearings to implement the fee schedule. In developing the rules, the administrator shall strive to assure the delivery of quality medical care in workers' compensation cases and access by injured workers to primary and specialist care while controlling prices and system costs. The medical care fee schedule shall be comprehensive in scope and shall address fees of physicians and surgeons, hospitals, prescription drugs, and ancillary services provided by other health care facilities and providers. The administrator may consider any and all reimbursement systems and methodologies in developing the fee schedule, except that, in no event shall the fee schedule set forth differing rates for reimbursement or conversion factors for reimbursement of physical or occupational therapy services based or dependent on whether the services are performed in independently-owned facilities or physician-affiliated facilities, and shall not otherwise consider the physician ownership in the facility providing services. However, differing reimbursement rates may be implemented by the administrator upon the department's presentation of state data demonstrating there is a need for differing reimbursement rates for physical/occupational therapy services and upon the department's holding a public hearing on the issue. The administrator is authorized to retain experts to assist in the development of the fee schedule and related system in accordance with the contracting rules of the department of finance and administration. The administrator, in consultation with the medical care and cost containment committee and the advisory council on workers' compensation, shall review the fee schedules adopted pursuant to this section on an annual basis and when appropriate the administrator shall revise the fee schedules as necessary. It is the intent of the general assembly that this annual review consider, among other factors, the medical consumer price index. The comprehensive medical fee schedule adopted pursuant to this subsection (i) is not intended to prohibit an employer, trust or pool, or insurer from negotiating lower fees in its own medical fee agreements. If a treating physician determines that pain is persisting for an injured or disabled employee beyond an expected period for healing, the treating physician may either prescribe, if the physician is a qualified physician as defined in subdivision (j)(2)(B), or refer, such injured or disabled employee for pain management encompassing pharmacological, nonpharmacological and other approaches to manage chronic pain. In the event that a treating physician refers an injured or disabled employee for pain management, the employee is entitled to a panel of qualified physicians as provided in subdivision (a)(3) except that, in light of the variation in availability of qualified pain management resources across the state, if the office of each qualified physician listed on the panel is located not more than one hundred seventy-five (175) miles from the injured or disabled employee's residence or place of employment, then the community requirement of subdivision (a)(3) shall not apply for the purposes of pain management. For purposes of the panel required by subdivision (j)(2)(A), “qualified physician” means a physician who has met the requirements set forth in the Chronic Pain Guidelines of the State of Tennessee, Department of Health, definition of “Pain Management Specialist.” The injured or disabled employee is not entitled to a second opinion on the issue of impairment, diagnosis or prescribed treatment relating to pain management. However, on no more than one (1) occasion, if the injured or disabled employee submits a request in writing to the employer stating that the prescribed pain management fails to meet medically accepted standards, then the employer shall initiate and participate in utilization review as provided in this chapter for the limited purpose of determining whether the prescribed pain management meets medically accepted standards. As a condition of receiving pain management that requires prescribing Schedule II, III, or IV controlled substances, the injured or disabled employee may sign a formal written agreement with the physician prescribing the Schedule II, III, or IV controlled substances acknowledging the conditions under which the injured or disabled employee may continue to be prescribed Schedule II, III, or IV controlled substances and agreeing to comply with such conditions. If the injured or disabled employee violates any of the conditions of the agreement on more than one (1) occasion, then: The employee's right to pain management through the prescription of Schedule II, III, or IV controlled substances under this chapter shall be terminated and the injured or disabled employee shall no longer be entitled under this chapter to the prescription of such substances for the management of pain; For injuries occurring on or after July 1, 2012, the violation shall be deemed to be misconduct connected with the employee's employment for purposes of § 50-6-207(3); and For injuries occurring on or after July 1, 2012, in the event such violation occurs prior to a finding that the injured or disabled employee is totally disabled as provided in § 50-6-207(4), through either a judgment or decree entered by a court following a workers' compensation trial or a settlement agreement approved pursuant to § 50-6-206 [See the Compiler's Notes], the incapacity to work due to lack of pain management shall not be considered when determining whether the injured employee is entitled to permanent total disability benefits as provided in § 50-6-207(4). A physician may disclose the employee's violation of the formal written agreement on the physician's own initiative. Upon request of the employer, a physician shall disclose the employee's violation of the formal written agreement as provided in this section. The formal written agreement shall include a notice to the employee in capitalized, conspicuous lettering on the face of the agreement the consequences for violating the terms of the agreement as provided for in this subsection (j). If an employer terminates an injured or disabled employee's right under this chapter to pain management through the prescription of Schedule II, III, or IV controlled substances pursuant to alleged violations of the formal agreement as provided in subdivision (j)(4)(B), then the employee may file a petition for benefit determination. If an employer or insurer alleges that an injured or disabled employee is not entitled to reconsideration under § 50-6-207(3) or permanent total disability benefits as provided in § 50-6-207(4) because of the employee’s alleged violations of the formal agreement as provided in subdivision (j)(4)(B), then a court shall also determine whether such violations occurred. Prescribing one (1) or more Schedule II, III, or IV controlled substances for pain management treatment of an injured or disabled employee for a period of time exceeding ninety (90) days from the initial prescription of any such controlled substances is considered to be medical care services for the purposes of utilization review as provided in this chapter. The department is authorized to impose a fee for the administration of an appeal process for utilization review under this subdivision (j)(5) and subdivision (j)(3). All permanent impairment ratings shall be assigned by the treating physician or chiropractor. The treating physician or chiropractor shall utilize the applicable edition of the AMA guides as established by this chapter. The medical advisory committee shall, within six (6) months of the release of a new edition, conduct an evaluation of the new edition, report the committee's findings to the administrator and recommend to the administrator whether the new edition should be designated for application to this chapter. The administrator shall report the committee's findings and recommendation to the general assembly. The AMA guides, as defined in § 50-6-102, shall remain in effect until a new edition is designated by the general assembly. No impairment rating, whether contained in a medical record, medical report, including a medical report pursuant to § 50-6-235(c), deposition, or oral expert opinion testimony shall be accepted during alternative dispute resolution proceedings or be admissible into evidence at the trial of a workers' compensation claim unless the impairment rating is based on the applicable edition of the AMA guides or, in cases not covered by the AMA guides, an impairment rating by any appropriate method used and accepted by the medical community. The treating physician or chiropractor shall assign impairment ratings as a percentage of the body as a whole and shall not consider complaints of pain in calculating the degree of impairment, notwithstanding allowances for pain provided by the applicable edition of the AMA guides as established by this chapter. The treating physician or chiropractor shall evaluate the employee for purposes of assigning an impairment rating and the employee shall attend the evaluation. An employee who fails to attend a scheduled evaluation without justifiable cause shall be subject to sanctions up to and including dismissal of the employee's claim for workers' compensation benefits. Scheduling of the evaluation shall occur within time limits and according to procedures promulgated by the administrator by rule. The treating physician or chiropractor shall complete the evaluation and submit an impairment rating report, on a form prescribed by the administrator, within time limits imposed by the administrator through the promulgation of rules. The treating physician's or chiropractor's written opinion of the injured employee's permanent impairment rating shall be presumed to be the accurate impairment rating. This presumption shall be rebuttable by the presentation of contrary evidence that satisfies a preponderance of the evidence standard. Acts 1919, ch. 123, § 25; Shan. Supp., § 3608a174; Code 1932, § 6875; Acts 1941, ch. 90, § 3; 1943, ch. 117, § 1; 1949, ch. 227, § 2; C. Supp. 1950, § 6875; Acts 1953, ch. 111, § 1; 1957, ch. 234, § 1; 1959, ch. 62, § 1; 1959, ch. 172, § 1; 1963, ch. 362, § 3; 1967, ch. 313, § 3; 1971, ch. 134, § 3; 1973, ch. 379, § 4; 1977, ch. 417, § 1; 1978, ch. 521, § 1; impl. am. Acts 1980, ch. 534, § 1; Acts 1980, ch. 650, § 1; T.C.A. (orig. ed.), § 50-1004; Acts 1983, ch. 194, § 1; 1983, ch. 215, § 1; 1983, ch. 276, § 1; 1984, ch. 782, § 1; 1985, ch. 393, § 3; 1986, ch. 792, § 1; 1986, ch. 809, § 1; 1988, ch. 525, § 3; 1989, ch. 210, § 1; 1989, ch. 446, § 1; 1991, ch. 255, § 1; 1996, ch. 790, § 1; 1997, ch. 198, § 1; 1997, ch. 259, § 1; 1997, ch. 533, § 2; 1998, ch. 1024, §§ 21, 22; 1999, ch. 225, § 1; 1999, ch. 294, §§ 2-5; 1999, ch. 520, § 41; 2000, ch. 990, §§ 1, 3; 2001, ch. 192, §§ 9, 10; 2001, ch. 246, § 1; 2003, ch. 359, § 2; 2004, ch. 433, § 1; 2004, ch. 962, §§ 1, 2, 5, 13, 24, 46; 2005, ch. 7, § 1; 2005, ch. 107, §§ 1, 2; 2005, ch. 188, § 1; 2006, ch. 902, § 1; 2007, ch. 300, § 1; 2007, ch. 522, § 1; 2007, ch. 543, § 1; 2008, ch. 835, § 1; 2008, ch. 1025, § 2; 2009, ch. 486, § 1; 2010, ch. 792, § 1; 2010, ch. 858, § 1; 2011, ch. 416, § 7; 2012, ch. 1100, § 3; 2013, ch. 282, §§ 1, 3; 2013, ch. 289, §§ 35-43; 2014, ch. 903, § 5; 2015, ch. 341, §§ 5, 15; 2017, ch. 380, §§ 2, 3. Code Commission Notes. The former last two sentences of subdivision (d)(6), concerning requiring the rules to take effect July 1, 2005, with the authority to use public necessity rules or emergency rules if necessary, were deleted as obsolete by the code commission in 2008. Former subdivisions (i)(3)-(5), concerning the deadlines for filing proposed rules, commenting on the proposed rules, recommendations for appropriate legislation, holding public hearings and the effective date of the rules, were deleted as obsolete by the code commission in 2008. Compiler's Notes. Acts 2000, ch. 990, § 3 provided that the provisions of the act shall not apply to workers' compensation self-insurer pools established pursuant to § 50-6-405(c)(1) . Acts 2004, ch. 433, § 1 provided that the provisions of subdivision (a)(4)(B) shall be repealed on June 30, 2005. Acts 2005, ch. 107, § 1 repealed the provisions of ch. 433, effective May 4, 2005. Acts 2004, ch. 962, § 42 provided that: The general assembly recognizes that significant cost savings will result from the implementation of this bill. It is in the best interest of the citizens of Tennessee that the cost savings be passed to the entities that have paid faithfully workers' compensation premiums in order to ensure the economic well-being of their employees. It is the intent and purpose of the general assembly that workers' compensation premiums be adjusted downward within fifteen (15) months of July 1, 2004 to reflect the cost savings resulting from the provisions of the act. If a workers' compensation policy is subject to renewal during the fifteen (15) month period, adjustments to the policy may be made at that time. It is the intent of the general assembly that the savings of the act shall routinely be reflected in future filings through the advisory prospective loss cost filing system, pursuant to §§ 56-5-106(b) and 50-6-402. Nothing in this section shall be construed as amending or affecting the procedures for filing and approval of rates set forth in title 56, chapter 5. Acts 2004, ch. 962, § 51 provided, in part, that §§ 5 and 13 of the act shall apply to accidents or injuries occurring on or after July 1, 2004. Acts 2004, ch. 962, § 51 provided, in part, that § 24 of the act shall apply to accidents or injuries occurring on or after July 1, 2005. Acts 2010, ch. 792, § 3 provided that the act, which deleted subdivisions (i)(4)(B)-(D), effective January 1, 2011, shall only apply to workers' compensation medical provider payments made, and an EOR or EOP issued, on or after January 1, 2011. Acts 2011, ch. 416, § 10 provided that §§ 3-9 of the act, which amended §§ 50-6-102(12) , 50-6-204(a)(1) and (2), 50-6-206(a)(2) and (b) and 50-6-301 , shall apply to injuries occurring on or after June 6, 2011. Acts 2012, ch. 1100, § 5 provided that the act, which added subsection (j), shall apply to pain management, including the prescription of Schedule II, III, or IV controlled substances, prescribed on or after July 1, 2012. Acts 2013, ch. 289, § 103 provided that the act, which amended this section, shall be known and may be cited as the “Workers' Compensation Reform Act of 2013.” Acts 2013, ch. 289, § 46, effective July 1, 2014, amends § 50-6-206 , referred to in this section, by deleting it in its entirety. However, pursuant to § 50-6-101 , as amended by Acts 2013, ch. 289, § 3, effective July 1, 2014, all claims having a date of injury prior to July 1, 2014, shall be governed by prior law. Thus, § 50-6-206 remains in effect as to injuries occurring prior to July 1, 2014. Acts 2017, ch. 380, § 4 provided that the act, which amended this section, shall apply to injuries occurring on or after May 18, 2017. Amendments. The 2013 amendment by ch. 282, effective July 1, 2014, substituted “administrator” or “administrator’s” for “commissioner” or “commissioner’s” throughout (d)(5) and (d)(6); and in (j)(4)(E)(i), substituted “may file a petition for benefit determination.” for “may either file a:” at the end of the introductory paragraph, and deleted (a) and (b) which read: “(a) Request for assistance pursuant to § 50-6-238 , if the benefit review conference requirement has not been exhausted, and a workers’ compensation specialist shall determine whether such violations occurred; or “(b) Petition in a court of proper jurisdiction as provided in § 50-6-225 , if the benefit review conference requirement has been exhausted, for a determination of whether such violations occurred.” The 2013 amendment by ch. 289, effective July 1, 2014, deleted (a)(4), (a)(5), (b)(2), and (d)(3), which read: “(a)(4)(A) The injured employee shall accept the medical benefits afforded under this section; provided, that, except as provided in subdivision (a)(4)(B) or (a)(4)(C), the employer shall designate a group of three (3) or more reputable physicians or surgeons not associated together in practice, if available in that community, from which the injured employee shall have the privilege of selecting the operating surgeon and the attending physician; and provided, further, that the liability of the employer for the services rendered the employee shall be limited to the charges that are established in the applicable medical fee schedule adopted pursuant to this section.“(B) If the injury is a back injury, then the group of three (3) or more physicians or surgeons required to be designated pursuant to subdivision (a)(4)(A) shall be expanded to four (4), one (1) of whom must be a doctor of chiropractic; provided, that no more than twelve (12) visits to the doctor of chiropractic shall be approved per back injury, except upon the approval of the employer. The provisions of this subdivision (a)(4)(B) shall not apply to state or local government employees and shall not apply to workers' compensation self-insurer pools established pursuant to § 50-6-405(c)(1) .“(C) If the injury or illness requires the treatment of a physician or surgeon who practices orthopedic or neuroscience medicine, then the employer may appoint a panel of physicians or surgeons practicing orthopedic or neuroscience medicine required to be designated pursuant to subdivision (a)(4)(A) consisting of five (5) physicians, with no more than four (4) physicians affiliated in practice.“(D) In circumstances where an employee is offered a treating panel as described in subdivision (a)(4)(C), the injured employee shall be entitled to have a second opinion on the issue of surgery, impairment, and a diagnosis from that same panel of physicians selected by the employer.“(E) The employer shall provide the applicable panel of physicians to the employee in writing on a form prescribed by the division, and the employee shall document in writing the physician the employee has selected and the employee shall sign and date the prescribed form. The employer shall provide a copy of the completed form to the employee and shall maintain a copy of the completed form in the records of the employer and shall produce a copy of the completed form upon request by the division.“(a)(5) All cases of dispute as to the value of the services shall be determined by the tribunal having jurisdiction of the claim of the injured employee for compensation. The tribunal may also deny payment of physicians' fees and hospital charges for failure to submit the reports as required in this section.“(b)(2) In addition to any attorney fees provided for pursuant to § 50-6-226 , a court may award attorney fees and reasonable costs to include reasonable and necessary court reporter expenses and expert witness fees for depositions and trials incurred when the employer fails to furnish appropriate medical, surgical and dental treatment or care, medicine, medical and surgical supplies, crutches, artificial members and other apparatus to an employee provided for pursuant to a settlement or judgment under this chapter.“(d)(3)(A) To provide uniformity and fairness for all parties in determining the degree of anatomical impairment sustained by the employee, a physician, chiropractor or medical practitioner who is permitted to give expert testimony in a Tennessee court of law and who has provided medical treatment to an employee or who has examined or evaluated an employee seeking workers' compensation benefits shall utilize the applicable edition of the AMA Guides as established in § 50-6-102 or, in cases not covered by the AMA Guides, an impairment rating by any appropriate method used and accepted by the medical community.“(B) No anatomical impairment or impairment rating, whether contained in a medical record, medical report, including a medical report pursuant to § 50-6-235(c) , deposition or oral expert opinion testimony shall be accepted during a benefit review conference or be admissible into evidence at the trial of a workers' compensation matter unless the impairment is based on the applicable edition of the AMA Guides or, in cases not covered by the AMA Guides, an impairment rating by any appropriate method used and accepted by the medical community.“(C) In the event of a release of a new edition of the American Medical Association Guides to the Evaluation of Permanent Impairment, American Medical Association, other than the edition designated in § 50-6-102(2) , the commissioner shall, within six (6) months of the release of the new edition, conduct an evaluation of the new edition and report the commissioner's findings and recommendations to the general assembly. The AMA guides, as defined in § 50-6-102 , shall remain in effect until a new edition is designated by the general assembly.”; in (a)(2), rewrote (A) which read: “It is the intent of the general assembly that the administration of the workers' compensation system proceed in a timely manner and that the parties and the department have reasonable access to the employee's medical records and medical providers that are pertinent to and necessary for the swift resolution of the employee's workers' compensation claim. Notwithstanding any law to the contrary, there shall be no implied covenant of confidentiality, prohibition against ex parte communications or privacy of medical records in the custody of authorized treating physicians with respect to case managers, employers, or insurance companies, or their attorneys, if these persons comply with subdivision (a)(2)(C); provided, however, that the employee, or the employee's attorney, shall be provided copies, no later than ten (10) days in advance of a deposition of the authorized treating physician taken for any purpose or the appearance of the authorized treating physician for testimony, of any and all written memorandum or visual or recorded materials, including e-mails or other written materials:“(i) Provided to the employee's authorized treating physician by case managers, employers, insurance companies, or their attorneys; or“(ii) Received from the employee's authorized treating physician.”, and substituted “subdivision (a)(2)” for “subdivision (a)(2)(C)” in (B); rewrote (a)(2)(C) which read: “To facilitate the timely resolution of workers' compensation claims and to facilitate the use of the benefit review process established by this chapter, there shall be reasonable access to any employee's medical information only by compliance with the following:“(i) An employee claiming workers' compensation benefits shall provide the employer or the division of workers' compensation with a signed, written medical authorization form as prescribed by the commissioner; provided, the form shall:“(a ) Be addressed to a specific medical provider authorized by the employer pursuant to this section;“(b ) Permit the release of information through communication, either orally or in writing, as authorized under this subdivision (a)(2)(C); and“(c ) Plainly state in capitalized lettering on the face of the document the following language:“THIS MEDICAL AUTHORIZATION FORM ONLY PERMITS THE EMPLOYER OR THE DIVISION OF WORKERS' COMPENSATION TO OBTAIN MEDICAL INFORMATION THROUGH ORAL OR WRITTEN COMMUNICATION, INCLUDING, BUT NOT LIMITED TO, CHARTS, FILES, RECORDS, AND REPORTS IN THE POSSESSION OF A MEDICAL PROVIDER AUTHORIZED BY THE EMPLOYER PURSUANT TO T.C.A. § 50-6-204 AND A MEDICAL PROVIDER THAT IS REIMBURSED BY THE EMPLOYER FOR THE EMPLOYEE'S TREATMENT;“(ii) An employee claiming workers' compensation benefits, or the employee's attorney, shall be entitled to obtain medical information, records, opinions, or reports from, or communicate in writing or in person with, any medical provider who has treated or provided medical care to the employee; provided, that the employee executes and provides the medical provider with a properly completed form as described in subdivision (a)(2)(C)(i).“(iii) Any medical provider authorized by the employer pursuant to this section and who has treated or provided medical care to an employee claiming workers' compensation benefits is permitted to communicate, orally or in writing, with the employer, or the employer's attorney, and shall honor any request by the employer for medical information, medical records, professional opinions, or medical reports pertaining to the claimed workers' compensation injury. Oral communication may be utilized, and includes, but is not limited to, a telephone conversation or an in-person meeting.“(iv) If an employee or employer files a request for assistance with the department, requesting the department to make a determination as to whether the claim is compensable or concerning an issue related to medical benefits or temporary disability benefits, the department may request, orally or in writing, medical information, records, opinions, or reports from the medical provider; provided, that:“(a ) Any response by the medical provider to the department's request shall be in writing; and“(b ) If the department receives documents or written responses to any request for information pursuant to this subdivision (a)(2)(C)(iv), then the department shall notify the employee, the employer and any attorney representing the employee or employer within fourteen (14) days of receipt of the document or written response that such persons may review or copy the documents or responses; provided, that the requesting party shall pay the copying fee authorized by subdivision (a)(1)(B) prior to the department providing the requested copies; and“(v) If the department becomes involved in the appeal of a utilization review issue, then the department is authorized to communicate with the medical provider involved in the dispute either orally or in writing to permit the timely resolution of the issue and shall notify the employee, employer or any attorney representing the employee or employer that they may review or copy the documents or responses; provided, that the requesting party shall pay the copying fee authorized by subdivision (a)(1)(B) prior to the department providing the requested copies.”; rewrote (a)(3) which read: “Whenever it appears that the amount of medical benefits to which the employee may be entitled under this section will exceed the amount of five thousand dollars ($5,000), the insurer shall file written notice with the division of workers' compensation, which shall, upon receipt of the notice, notify the employer that the claim for medical benefits for the employee will exceed five thousand dollars ($5,000).”; rewrote (g)(2) which read: “(A) If an employer denies it is required to provide or refuses to provide medical care and treatment, medical services or medical benefits, or both, that an employee contends should be provided as a result of a judgment or decree entered by a court following a workers' compensation trial or as a result of a workers' compensation settlement agreement approved by a court or by the commissioner or the commissioner's designee pursuant to § 50-6-206 , either the employee or the employer, or the attorney for the employee or employer, may request the assistance of a workers' compensation specialist to determine whether such medical care and treatment, medical services or medical benefits, or both, are appropriate by filing with the division a form prescribed for that purpose by the commissioner.“(B) A workers' compensation specialist shall have the authority to determine whether it is appropriate to order the employer or the employer's insurer to provide specific medical care and treatment, medical services or medical benefits, or both, to the employee pursuant to a judgment or decree entered by a court following a workers' compensation trial or pursuant to a workers' compensation settlement agreement approved by a court or by the commissioner or the commissioner's designee pursuant to § 50-6-206 . The specialist's authority shall include, but is not limited to, the authority to order specific medical care and treatment, medical services or medical benefits, or both, and any authority granted to a specialist by § 50-6-238(a)(3) . The specialist's authority shall also include any authority granted to a court by subdivision (b)(2), to award attorney fees and reasonable costs that include reasonable and necessary court reporter expenses and expert witness fees for depositions.“(C) Upon receipt of the request for assistance, the specialist shall review the available information and then, after such review, enter an order, on a form prescribed by the commissioner, in accord with the following:“(i) If the employer, or the employer's insurer, agrees it will provide medical care and treatment, medical services or medical benefits, or both, requested by the employee, the specialist shall issue an agreed order specifying the medical care and treatment to be provided by the employer and if the employer fails to comply with the agreed order, the specialist shall enter an order directing the employer or the employer's insurer to provide specific medical care and treatment; and“(ii) If the employer does not agree to provide the medical care and treatment at issue, the specialist shall enter an order as to whether the employer shall provide medical care and treatment, medical services or medical benefits, or both, to the employee, and if so, the specific medical care and treatment, medical services or medical benefits, or both, that shall be provided to the employee.“(D) If either the employee or the employer disagrees with the order entered by the specialist pursuant to subdivision (g)(2)(C)(ii), the following shall apply:“(i) If the request for assistance involved a request for medical care or treatment pursuant to a court judgment or decree following a trial of the underlying workers' compensation claim, then either the employer or the employee may appeal the specialist's order to the original court that issued the judgment or decree. The parties shall attach a copy of the specialist's order to any request for review that is filed in the original court; however, any review by the original court shall be de novo; and“(ii) If the request for assistance involved a request for medical care and treatment pursuant to a settlement approved by a court of competent jurisdiction or by the commissioner or the commissioner's designee pursuant to § 50-6-206, and either the employee or the employer disagrees with the order of the specialist, the aggrieved party may request administrative review pursuant to § 50-6-238(d) and all provisions of § 50-6-238(d) shall apply to the request. If administrative review is not requested, the order of the specialist shall be considered a final order for administrative purposes. If administrative review is requested, the order of the administrator or administrator's designee shall be considered a final order for administrative purposes, if not otherwise stated in the order.”; and added (k). The 2014 amendment, in (a)(3)(C), as that subdivision was amended by Acts 2013, ch. 289, substituted “from a panel of two (2) physicians practicing in the same specialty as the physician who recommended the surgery” for “specified in the initial panel of physicians provided by the employer pursuant to subdivision (a)(3)(A)” at the end of the first sentence, and added the present second sentence. The 2015 amendment substituted “bureau” for “division” throughout and rewrote (j)(2)(B) which read: “(B) For the purposes of the panel required by subdivision (j)(2)(A), “qualified physician” means an individual licensed to practice medicine or osteopathy in this state and:“(i) Board certified in anesthesiology, neurological surgery, orthopedic surgery, radiology or physical medicine and rehabilitation through the:“(a) American Board of Medical Specialties (ABMS);“(b) American Osteopathic Association (AOA); or“(c) Another organization authorized by the administrator; “(ii) Board certified by an organization listed in subdivision (j)(2)(B)(i)(a)-(c) in a specialty other than a specialty listed in subdivision (j)(2)(B)(i) and who has completed an ABMS or AOA subspecialty board in pain medicine, or completed an Accreditation Council for Graduate Medical Education (ACGMA) accredited pain fellowship; or “(iii) Serving as a clinical instructor in pain management at an accredited Tennessee medical training program.” The 2017 amendment, in (a)(3)(B), substituted “chiropractors, or specialty” for “chiropractors or specialty” two times; inserted “not associated in practice together” following the first occurrence of “groups”, substituted “groups not associated in practice together that are” for “groups,”, substituted “one-hundred-twenty-five-mile radius of the employee’s community of residence” for “one hundred (100) mile radius of the employee’s community”, and added the last sentence; and, at the end of the first sentence of (c), substituted “ten thousand dollars ($10,000)” for “seven thousand five hundred dollars ($7,500)”. Effective Dates. Acts 2013, ch. 282, § 10. July 1, 2014. Acts 2013, ch. 289, § 106. July 1, 2014; provided, that, for purposes of promulgating rules and regulations, making appointments and making necessary provisions for the implementation of the act, the act shall take effect April 29, 2013. Acts 2014, ch. 903, § 14. July 1, 2014. Acts 2015, ch. 341, § 19. May 4, 2015. Acts 2017, ch. 380, § 4. May 18, 2017. Cross-References. Deponents exempt from subpoena to trial but subject to subpoena to deposition, § 24-9-101 . Depositions by physicians, § 50-6-235 . Discontinuance or change in temporary disability benefits by employer, resumption or increase of benefits, § 50-6-234 . Period and maximum amount of compensation, § 50-6-205 . Workers' Compensation Appeals Board Decisions. The employee alleged she suffered injuries to her back, including a lumbar disc herniation, while working in the course and scope of her employment. Following a compensation hearing, the trial court concluded the employee had proven she suffered a work-related lumbar strain, but had not met her burden of proving by a preponderance of the evidence that the lumbar disc herniation arose primarily out of and in the course and scope of her employment. As a result, the employer was responsible only for ongoing reasonable and necessary medical care for her work-related lumbar strain. The employee argued the trial court incorrectly evaluated the expert medical proof, failed to consider the circumstances of the examinations conducted by each expert, and failed to consider the relative qualifications of the experts. She further argued the trial court unfairly discounted a neurosurgeon's causation opinion because he relied on her account of what caused her symptoms and considered whether it was a “reasonable” explanation. The Workers’ Compensation Appeal Board held that the trial court did not abuse its discretion in weighing the expert testimony, especially considering the presumption of correctness attributable to the authorized panel physician's causation opinion. Hollis v. Komyo America, 2019 TN Wrk Comp App Bd LEXIS 4. In a second interlocutory appeal, the employer challenges the trial court's denial of its request to compel the employee to submit to a second independent medical examination by a physician of the employer's choosing due to the fact that the physician who conducted the first independent medical examination is planning to retire. The trial court did not err in concluding that the employer's request was unreasonable and premature and denying the employer's motion. First, the employer had already received an examination by a physician of its choice and second, the physician indicated his intent to retire, but he may decide to continue to practice. McLaurin v. AT&T Services, LLC, 2019 TN Wrk Comp App Bd LEXIS 6. An employee petitioned the trial court to compel the employer to authorize certain medical treatment as recommended by a treating physician. The employer, citing a utilization review denial, declined to authorize the treatment. Following an expedited hearing, the trial court issued an order compelling the employer to authorize the requested treatment. The employer has appealed. The board initially noted that there is a presumption that such treatment is medically necessary. Since the employer's utilization review report, the assistant medical director’s letter agreeing with that report, and the medical director’s affidavit were never properly introduced as evidence at the expedited hearing, the employee's acknowledgments regarding the utilization review denial and the assistant medical director's agreement with it, standing alone, did not rebut the presumption of medical necessity. The trial court’s order compelling the employer to authorize the requested treatment was affirmed. Bauknecht v. Five Star Quality Care, Inc., 2019 TN Wrk Comp App Bd LEXIS 21. An employee, a picker at the employer's warehouse facility, injured his foot when a box fell on it while at work. He was provided a panel of physicians and was later referred to a specialist by the physician he chose from the panel. The employee did not attend his appointment with the specialist because he felt the location was too far from his home. Instead, he obtained unauthorized treatment from a different specialist and filed a petition seeking medical benefits in the form of a panel of specialists or authorization to treat with his own specialist. While a specialist’s location 25 miles from the employee's home may have been inconvenient to the employee, the inconvenience was not sufficient to place the specialist outside the employee's community for the purpose of serving as his authorized physician. The statutory scheme contemplates direct referrals to specialists and provides employers the option of accepting the referral or, instead, providing a panel of specialists. The statutes are silent as to whether an employee can demand a second panel after the employer accepts the referral from the first panel physician. The referral statute also does not impose specific criteria on the treating physician's selection of a specialist. Here, the treating physician’s rationale for referring the employee to the specialist and the employer's acceptance of the referral did not violate the statute. However, the trial court's ordering a panel of specialists, based on what it referred to as the employer's violation of the "spirit" of the referral statute, rather than the actual statutory language itself, was inappropriate and not within its authority. In short, after an initial panel of physicians is offered and an authorized physician is selected, that physician has the discretion to make a referral to a specialist. If the employer does not want to accept that referral, it can offer the employee a panel of specialists. However, there is nothing in the statutes that compels an employer to offer a panel of specialists any time there is a direct referral. Stated differently, there is no authority that enables an employee to negate an employer's statutory ability to accept a direct referral by insisting on a panel of specialists in every case. Rhodes v. Amazon.com, LLC, 2019 TN Wrk Comp App Bd LEXIS 24. An employee alleged he suffered injuries when a large airplane tire rolled off a cart and struck him. In addition to physical injuries to his left shoulder and neck, the employee asserted he suffered depression due to his injuries and the loss of his job. He requested a panel of specialists after receiving a referral for a psychological evaluation from his authorized pain management physician. The employer declined to provide a panel of psychologists. The trial court ordered the employer to provide a panel of specialists in response to a pain management specialist's referral for psychological evaluation and treatment. An authorized physician had referred the employee to the pain management specialist, who provided authorized pain management treatment. The pain management specialist, an authorized physician, made a referral to a psychologist. That referral was presumed medically necessary for treatment of the employee and the employer offered no evidence that the employee did not suffer from symptoms of depression due to his loss of function. Moreover, the employer offered no expert medical testimony to refute the pain management specialist’s opinion that the employee needed treatment for his depression. In conclusion, the evidence supported the trial court's order for a panel of specialists, but the order was modified to limit it to a panel of psychologists, as recommended by the pain management specialist. Montgomery v. Mitchell Industrial Tire Co., Inc., 2019 TN Wrk Comp App Bd LEXIS 32. An employee alleged he sustained head and neck injuries in the course and scope of his work handling livestock. He received authorized medical treatment and was ultimately referred to a neurologist who provided an opinion in a deposition as to the degree of permanent impairment the employee sustained as a result of the work accident. The employer filed a motion to exclude portions of the doctor's testimony concerning the employee's permanent impairment rating, asserting the testimony did not comply with the requirements of Rules 702 and 703 of the Tennessee Rules of Evidence. The trial court properly concluded the doctor's opinions were admissible and denied the employer's motion. Considering the totality of the doctor’s testimony, the preponderance of the evidence supported the trial court's determination that she applied the methodology contemplated by the AMA Guides and that her inability to recollect the details of her impairment assessments for the employee's alleged traumatic brain injury and cervical injury during her deposition did not indicate such a lack of trustworthiness as to render her opinions inadmissible. Ailshie v. TN Farm Bureau Federation, 2019 TN Wrk Comp App Bd LEXIS 55. An employer filed a motion to compel the employee to submit to an examination by the employer's physician. The employee agreed to the requested examination, but asserted that his statutory right to have his own physician present permitted his physician's observing the examination via videoconference. The trial court properly granted the employer's motion to compel the employee to attend the examination but determined the statute giving the employee the right to have his own physician present contemplated only the physician's physical presence at the examination. The statute does not contemplate allowing an employee's physician to be "present" at an employer's examination via videoconference. Williams v. CoreCivic, 2019 TN Wrk Comp App Bd LEXIS 56. An employer asserted the trial court erred, in part, in conditioning a medical examination requested by the employer on its being live-streamed to or video-conferenced with the employee's personal physician. There are no statutes, rules, or regulations providing for the video-conferencing of a medical examination. There are no rules or regulations explaining the manner in which such video-conferencing would be arranged, conducted, or secured. There are no rules or regulations governing who bears the expense of arranging and conducting such a video-conference. Consequently, with no statutes, rules, or regulations in place governing this practice, the board declined to create a "right" to insist on the video-conferencing or live-streaming of a medical examination. The creation of such a right, if deemed appropriate, is a function historically reserved for the legislature. Caldwell v. Federal Mogul Motorsports Corp., 2019 TN Wrk Comp App Bd LEXIS 59. After an employee experienced a work-related injury and underwent surgery, the parties reached a court-approved settlement of the employee's claim that identified the physician who was to provide future medical care. The employee subsequently requested additional medical care, but the designated physician, as well as multiple other physicians, refused to see her, indicating no additional medical care was necessary. Following a hearing to address the employee's request for additional medical care, the trial court denied the request, concluding the employee failed to establish she was in need of additional medical treatment for her work-related injuries. The employee filed a notice of appeal but failed to identify any issues for our review, failed to file a transcript of the hearing or a joint statement of the evidence, and failed to file a brief supporting her appeal. The Board affirmed the trial court's order denying the employee's request for additional medical treatment and certified the order as final. Tate v. BWay Corporation, 2019 TN Wrk Comp App Bd LEXIS 81. An employee sustained injuries after being struck on the head by a metal bar while loading a trailer in the course of his employment. The claim was accepted as compensable. On appeal, the employee asserted that the trial court erred in denying his request for medical transportation services. The trial court concluded that the employee was not entitled to those services because he failed to show they were reasonably necessary as a result of his work-related injury. It did, however, determine that the employee was entitled to reimbursement of reasonable travel expenses. The employee argued that he was restricted from driving by a medical provider, was wheelchair bound, and had no one that was willing or able to constantly take off work to drive him. However, the employee provided nothing beyond his own statements to support his assertion that he was unable to drive or is restricted from driving as a result of his work injury. Nothing in the record supported a finding that medical transportation services were reasonably necessary as a result of the employee's work injury. The employee's unsworn emails and statements to that effect were not evidence. There was no merit in the employee's assertion that he was entitled to medical transportation services. Washington v. UPS Ground Freight, Inc., 2020 TN Wrk Comp App Bd LEXIS 14. An employee alleged she suffered an aggravation of a preexisting mental condition as a result of medication she was taking to treat a compensable work-related physical injury. The employer denied that a compensable aggravation occurred and refused to authorize a referral to a psychiatrist made by the employee's authorized physician. The trial court, in part, ordered the employer to authorize the psychiatrist referral. On appeal, the employer disputed the employee's assertion that she suffered a new work-related mental injury or aggravation of a pre-existing mental condition. The employer did not dispute that the employee suffered from the symptoms she alleged, but it contended her condition was pre-existing and was caused by events in her personal life rather than the medication prescribed for her work-related injury. In contrast, the employee maintained that her underlying mental condition was aggravated by her use of Lyrica, resulting in a compensable aggravation of her pre-existing condition. An authorized physician referred the employee for a psychiatric evaluation that he believed was necessary as a result of the employee’s Lyrica use. Thus, the burden of proof was on the employer to show that the referral was not medically appropriate as a result of the compensable physical injury. However, the employer offered no opinion other than its own that the need for the psychiatric referral was unrelated to the employee's work. The employer's interpretation of the employee's prior treatment records and its belief regarding the cause of her current mental complaints, absent supporting expert medical proof, were not sufficient to overcome the trial court's determination of the appropriateness of the referral for psychiatric evaluation and treatment. Mollica v. EHHI Holdings, Inc., 2020 TN Wrk Comp App Bd LEXIS 22. An employee sustained a work-related injury to her right ring finger and developed complications in her hand. She was subsequently diagnosed with complex regional pain syndrome in her right upper extremity. After she reached maximum medical improvement, her authorized treating physician assigned a permanent medical impairment rating. The employer then retained a physician to review medical records and express an opinion regarding the employee's permanent medical impairment. Because the opinions of the two rating physicians differed, the employer requested an impairment evaluation through the Bureau of Workers' Compensation's Medical Impairment Rating Registry ("MIRR"). The employee moved to quash the employer's request for an MIRR evaluation, contending that a medical records review was an insufficient basis to support the existence of a dispute concerning the medical impairment rating. The trial court denied the employee's motion and the employee appealed. We affirm the trial court's order and remand the case. The Board affirmed the trial court’s order, concluding the trial court did not err in analyzing the issue. Nothing in the statute or regulations prevented either party from obtaining a second opinion on the issue of permanent medical impairment. Likewise, nothing in the statute or regulations prohibited either party from seeking that opinion based on a review of medical records. Either party can then seek an MIRR evaluation if a dispute as to the degree of permanent medical impairment exists. Gray v. Conagra Foods Packaged Foods Co., Inc., 2020 TN Wrk Comp App Bd LEXIS 24. An employee alleged she suffered injuries as a result of physical altercations occurring at work. Following the initial expedited hearing, the employer was ordered to provide psychiatric treatment recommended by the authorized physician and to pay additional temporary disability benefits. That order was appealed, and we affirmed. After the employer provided a panel of psychiatrists whose practices were not located in the employee's community of residence, the employee declined to choose a physician from the panel and requested that the court order the employer to either provide a panel of psychiatrists within her community or appoint as the authorized provider the psychiatrist the employee had retained to provide an evaluation. Following a hearing, the trial court concluded the panel offered by the employer was invalid and mandated that the employer authorize the psychiatrist selected by the employee as the treating psychiatrist. considered. According to the employer, since it was undisputed that the psychiatrist was not an authorized treating physician, “the inquiry as to the trial court's error should end here per the requirements of TCA § 50-6-204(h) . The trial court did not address these requirements in its order. In general, the Board refrains from addressing the applicability or effect of a statute relied upon by a party in the trial court in circumstances where the trial court has not first addressed the issue. Thus, the Board vacated the trial court's designation of the psychiatrist as the authorized treating psychiatrist and remanded the case for the trial court to address the applicability and impact, if any, of TCA § 50-6-204(h) on the court's analysis of these issues. Gautreaux v. Hermitage Hall, 2020 TN Wrk Comp App Bd LEXIS 44. Following a court-approved settlement of an employee's claim for workers' compensation benefits, the employee sought additional medical treatment for lumbar complaints that he contended should be provided as a result of the settlement agreement. The employer declined to authorize the treatment, and the employee filed a petition for benefits seeking additional medical care. Following a hearing, the trial court concluded that the parties' settlement agreement did not exclude future medical care for any of the employee's work injuries and ordered the employer to provide future medical treatment for the employee's low back complaints. The employer appealed. TCA § 50-6-240(d) mandates that settlement agreements “compromising and settling the issue of future medical benefits” include a provision confirming that the employee has been informed of the potential consequences of the settlement, if any, with respect to Medicare and TennCare benefits and liabilities. Here, the parties' settlement agreement did not include such a provision, and neither the parties nor the trial court addressed the applicability of this statutory language to the parties' settlement agreement. Thus, the trial court’s order was vacated and the case was remanded for the trial court’s consideration of the applicability of TCA § 50-6-240(d) to the parties’ settlement agreement and the impact on this case, if any, of the absence of the statutory language from that agreement. Lane v. Securemedy, Inc., 2020 TN Wrk Comp App Bd LEXIS 48.