By Kaitlynn Lehman, 2L, Court intern, Belmont College of Law, Nashville

Writing to you “From the Bench,” my name is Kaitlynn Lehman, and I’ve just finished my first year of law school at Belmont University. The Tennessee Bureau of Workers’ Compensation has taken me under its wing as an intern to show me the ins and outs of the practice of law beyond the classroom.

What you’re about to read is a recap of the second-ever oral argument to take place at the Bureau’s Educational Conference, the decision, and its ramifications.

Oral arguments aren’t for the faint of heart.

Each side is granted a limited amount of time to argue their position and answer questions about why the trial court ruled correctly or incorrectly. If the advocates are fortunate, they’ll face a “hot bench”—appellate judges who will pepper them with questions.

What? Losing track of where you are in your prepared speech and being asked questions you might not know the answer to doesn’t sound fun? I’d be highly inclined to agree with you, but I loved watching it happen from the safety and comfort of the sidelines.

On June 13, the Appeals Board conducted a live oral argument during the Bureau’s annual Educational Conference in the case of Theralease Ridley v. Mature Care of Standifer Place, LLC. As expected, the Board didn’t hold back, firing off tough questions for both sides.

The Board delved deeply into the intricate aspects of the case, focusing on whether the employee’s condition was primarily caused by the incident, whether there was an aggravation, and whether the aggravation was compensable. They also probed the employee’s testimony, and the reliability of Dr. Donald Langenbeck’s and Dr. Stephen Dreskin’s opinions.

The employee, a nursing assistant, sustained a lower-back injury while moving a patient at work. Her authorized physician, Dr. Langenbeck, initially diagnosed her injury as work-related and provided treatment. However, after further testing, Dr. Langenbeck changed his opinion multiple times. The employee then sought an independent medical examination with Dr. Dreskin, whose opinion was that her condition was more than 50% caused by the work injury.

Additionally, the employee had moved and requested a panel of physicians at her new location.

The trial court ruled in favor of the employee, finding that Dr. Langenbeck’s testimony and opinions were inconsistent and unreliable. The trial court also awarded her a new panel of physicians specializing in pain management, as Dr. Dreskin recommended.

The issue for the Appeals Board was whether the trial court erred in these decisions. Spoiler alert: not only did the Board partially overrule the trial court’s decision, but it also found that it had abused its discretion in its ruling.

During the oral argument, each side was given 25 minutes to plead its case and answer questions. Connor Sestak, representing the employer, presented his case first.

Right off the bat, the Board asked about Dr. Langenbeck’s testimony and use of the word “aggravation.” Sestak responded that the mere mention of an “aggravation” doesn’t automatically “end… the ball game” and validate the claim as compensable. He clarified that proof of actual aggravation is needed and that neither doctor reported any advancement of the employee’s preexisting condition, anatomic change, or testimony outside of the employee’s testimony that the pain was disabling. 

When the Board then asked whether the combination of the employee’s testimony and Dr. Langenbeck’s lifting restrictions were enough to establish a compensable aggravation, Sestak responded with a direct quote from the Board’s decision in Barnes v. Jack Cooper Transport. That opinion stated that lay testimony by the employee about pain is “not enough to support an order for medical benefits in the absence of corroborating expert medical proof.”

Sestak also touched on Dr. Langenbeck’s opinions, explaining that although they seemed inconsistent, they were logical, as they followed the medical timeline based on the facts he was given. Sestak took it further during his rebuttal to point out that, in contrast, Dr. Dreskin had only seen the employee once, almost 2.5 years after the work injury.

This sounds completely reasonable, right? Well, if you thought the employer’s attorney made a strong case, just wait until you hear the employee’s side.

When Michael Wagner, representing the employee, stood before the Board, he wasted no time diving right into the facts. He detailed the injury and his client’s pain, advocating for her by highlighting that at one point, Dr. Langenbeck had considered her injury to be acute-on-chronic, aggravating a preexisting condition. Wagner pointed out that her pain was what “any reasonable person would call disabling,” to the extent that she could no longer stand or walk.

He further described Dr. Langenbeck’s attitude as dismissive, stating that his testimony essentially conveyed that when the “conservative treatments” ceased to be effective and she showed no improvement, her injury was deemed no longer work-related. Wagner criticized Dr. Langenbeck by telling the Board that when the doctor “couldn’t cure, … he just said, ‘I quit.’”

Wagner effectively capitalized on the trial court’s opinion that Dr. Langenbeck was inconsistent and unreliable, describing him as “all over the board” and “like Jello … very difficult to hold in your hands.”

Was there perhaps stifled laughter? Of course not… lawyers, physicians, claims professionals, and Bureau employees don’t laugh. Much.

Wagner’s sense of humor didn’t slow him down, however. He didn’t miss a beat when the Board pressed him on whether Dr. Langenbeck’s opinion of temporary aggravation matched the legal definition of a compensable injury.

Wagner cited case law and clarified that an aggravation didn’t need to be permanent to grant medical benefits. He further pointed out that disability benefits were “not at issue in this case…because this was only an expedited hearing for medical benefits.”

When time was called, both attorneys were thanked, and Court was adjourned.

The Opinion Reverses in Part and Modifies in Part

The Appeals Board issued a decision on July 9 and overturned the trial court’s findings that the employee’s expert rebutted Dr. Langenbeck’s causation opinion. However, they affirmed the order for the employer to provide a new panel of physicians in the new locale (not specifically pain management providers) and remanded the case.

The opinion highlighted that Dr. Dreskin’s medical report was written after a “single evaluation that occurred over two years after the work incident and nearly eighteen months after active treatment had ended.” They also pointed out that Dr. Dreskin never provided any sworn testimony and was never cross-examined.

Further, the Board agreed with the employer that Dr. Langenbeck had explained why his causation opinion changed over time and how further testing influenced his evolving perspective. In contrast, Dr. Dreskin didn’t explain why the employee’s injuries were primarily caused by the work incident.

The Board additionally noted that the trial court didn’t analyze the qualifications or experience of each physician or of the relationship of each physician to the employee in determining that Dr. Dreskin’s causation opinion was more persuasive.

As for the employee’s questioning Dr. Langenbeck’s understanding of the meaning of “aggravation,” the Board reminded that “medical professionals often use the terms ‘exacerbation’ and ‘aggravation’ interchangeably,” and “there is nothing in the statute indicating that the general assembly relied on the definitions of the terms ‘aggravation’ and ‘exacerbation’ as discussed [in the AMA Guides].”

The Board’s decision is significant because it emphasizes the importance of expert testimony and opinions in determining the appropriateness of benefits and further medical treatment at the interlocutory stage. At that point, doctors’ opinions are often conveyed solely by medical records or causation letters, before depositions have occurred. The opinion suggests to practitioners that in future cases when the experts disagree, the safe choice is to depose them.

That idea comes with some baggage, though. It costs more and takes more time. It also conflicts with the idea of an “expedited” hearing necessary to resolve issues of medical treatment and/or temporary disability benefits.

Moreover, it’s noteworthy that the Board found that the trial court’s ruling was an abuse of discretion. Why? Because it doesn’t happen often. When the Board makes this kind of ruling, it’s saying that the trial court failed to apply the correct legal standard. Ouch.

Still here?

That’s because you found yourself thoroughly immersed in the world of workers’ compensation law, just like I did this summer.

There’s so much more to workers’ comp than a straightforward yes or no decision on awarding benefits. For employees, businesses, and, insurance companies, the stakes can be undeniably high.

The Ridley case is just one of thousands illustrating how this field demands precision, nuance, and a deep understanding of the law.