How to Close Future Medical Benefits

By Judge Dale Tipps, Murfreesboro

[Blog administrator’s note: We published this previously but removed it when we realized the newest templates weren’t posted on the Court’s website. The templates have now been added.]

If you can remember all the way back to June, you may recall attending an interesting session titled, “TODAY in Tennessee – The Workers’ Compensation Review,” where a panel of attorneys had a spirited discussion with the attendees (as usual) about issues in closed medicals settlements. I noticed that many attorneys focused on whether closing future medicals would be in the employee’s best interest in various circumstances.

Why is this blog-worthy? Because “best interest” is not the legal standard. Judges Addington and Marion addressed this during their online continuing legal education presentation a while ago, but it bears repeating. “Best interest” is what the Court must find to approve a disputed settlement under Tennessee Code Annotated section 50-6-240(e).

Closed medicals in a standard settlement, on the other hand, fall under the general requirement of section 50-6-240(a) that the settlement must provide “substantially, the benefits provided by the chapter.” As I often explain to self-represented workers, this means that the Court must determine that the amount being paid is reasonably equal to the value of lifetime medical treatment for their particular injury.

In an effort to help keep “best interest” from clouding the issue, the Court has removed that phrase from our settlement templates for cases with closed future medicals. You can find the revised templates here; scroll to the middle of the page to “Downloadable Templates.” They are:

Settlement Agreement with Closed medical Expenses-Compensation Period Has Not Expired. Revised 12/9/24.
Order Approving Settlement Agreement. Revised 12/9/24.
Settlement Agreement-Closure of Medical Benefits after Prior Settlement. Revised 12/9/24.
Settlement Agreement with Closed Medical Expenses, Compensation Period has Expired and Employee has Returned to Work. Revised 12/9/24.

Please begin using them right away, but we’ll give everyone a little time before we start requiring their use.

But wait. How can one determine that the amount being paid is reasonably equal to the value of lifetime medical treatment?

I’m glad you asked. As always, we must rely on medical opinions about the likelihood or potential cost of future care. Many cases are fairly straightforward, and a C-30A with a checked “no” box is often enough. However, the Court will sometimes also ask to see the most recent medical records, as we have often seen C-30A forms signed by the same doctor whose last office note recommends additional treatment. In some cases, a cost projection prepared by a qualified, independent individual is helpful, especially if the Court can see the medical recommendations on which it is based.

We’re not just pedantically construing the statute as an exercise. Careful adherence to the standard can make a real difference in the lives of injured employees.

For example, one judge recently heard a settlement where the parties wanted to close meds on a cervical fusion. The judge found the supporting documents insufficient to show the employee would receive substantially the benefits to which she is entitled. The judge pointed out the records did not mention anticipated treatment specifically related to hardware present in the employee’s cervical spine. So the employer sent the employee back to the authorized doctor, who discovered a failed fusion and ordered a revision fusion surgery. Had the settlement been approved on the first try, the employee would have either been stuck with medical bills far greater than the amount offered to close medicals or she might have been unable to get the treatment she needed.

This is why it’s important for you to approach these settlements with the correct standard in mind. Unfortunately, no single, one-size-fits-all path exists to getting your closed medical settlement approved. Each case is often intensely fact-specific, and the Court takes seriously the statutory requirements for approval.

You can improve the likelihood of success by making sure you’re using the correct standard, anticipating the Court’s questions, and providing the most reliable medical information available.