Oct. 3, 2012
In a recently decided workers' compensation case, the Tennessee Supreme Court ruled that an employee must exhaust the benefit review conference process before filing a lawsuit in court (Chapman v. DaVita, Inc., Tennessee Supreme Court Sept. 21, 2012). The Supreme Court's opinion provides a useful reminder of the administrative procedures that must be followed before filing a lawsuit seeking a determination as to workers' compensation benefits.
On June 3, 2010, Lacey Chapman, an employee of DaVita, Inc., fell and injured her elbow as she entered DaVita's building. Her lawyer filed a request for assistance with the Tennessee Department of Labor (TDOL) on Sept. 21, 2010. Chapman's lawyer wrote to the TDOL on Jan. 28, 2011, to inquire about the status of the claim. On March 17, 2011, after waiting approximately six months on the TDOL to act, Chapman filed a workers' compensation complaint against DaVita in Marshall County Circuit Court.
DaVita filed a motion to dismiss, claiming that the Court did not have jurisdiction to hear the case because Chapman failed to exhaust the benefit review conference process before filing suit. Chapman argued that her administrative remedies were exhausted because of the long interaction with the TDOL. The trial judge did not dismiss the complaint and denied DaVita's request for an interlocutory appeal. Tennessee's Supreme Court granted DaVita's application for extraordinary appeal.
The issue addressed by the Tennessee Supreme Court was whether a trial court has jurisdiction to hear a workers' compensation case in which the plaintiff employee requested TDOL assistance, TDOL did not act, and the plaintiff filed suit without exhausting the benefit review conference process.
The Supreme Court analyzed Tennessee's Workers' Compensation Law and found clear legislative intent that the administrative process cannot be circumvented and must be exhausted before a lawsuit is filed. It relied principally on language found in section 50-6-203 of the Workers' Compensation statute. Section 50-6-203(a) provides that "[n]o claim for compensation under this chapter shall be filed . . . until the parties have exhausted the benefit review conference process provided by the division of workers' compensation." In addition, section 50-6-203(b) provides that either party may file a civil action in the event "the parties are unable to reach an agreement at the benefit review conference...or the benefit review process is otherwise exhausted pursuant to rules promulgated by the commissioner." The Court noted that the rules provide only five ways in which the benefit review conference is "otherwise exhausted" before its completion, including:
- Issuance of a Benefit Review Report which indicates an Order Denying Benefits based upon non-compensability of the claim has been issued by a Workers' Compensation Specialist . . . ;
- Reaching a mediated settlement, as evidenced by a signed document executed by the proper parties and the Workers' Compensation Specialist;
- Issuance of an impasse report signed and dated by a Workers' Compensation Specialist;
- Conducting and completing mediation by a private Rule 31 mediator, provided that the Department has failed to conduct a benefit review conference within 60 days of receiving such a request, pursuant to Tenn. Code Ann. § 50-6-239(c);
- Issuance of a written waiver signed by the Director of the Benefit Review Program or the Director's designee.
The Supreme Court concluded that a trial court does not obtain jurisdiction over a workers' compensation case until the benefit review conference process has been exhausted. In other words, because Chapman had not exhausted her administrative remedies before filing the lawsuit, the trial court did not have jurisdiction. The Court reversed the judgment of the trial court and dismissed Chapman's complaint.
Notably, the Court declared its dissatisfaction with the TDOL's unreasonably dilatory response to Chapman's request for assistance and warned that its decision should not be construed to condone the TDOL's unreasonable delays in handling claims. The Court identified several alternatives, other than filing suit, to prompt TDOL to act, including additional contact with the specialist, contact with the Administration of the Division of Workers' Compensation, or, as a last resort, filing a mandamus action.
Before filing a lawsuit seeking a determination as to workers' compensation benefits, make sure that the parties have participated in the benefit review conference process and either: (1) failed to reach an agreement, or (2) otherwise exhausted the benefit review process by one of the five ways promulgated by the commissioner. In the event the TDOL fails to handle a claim without unreasonable delay, the Court has recommended a recourse, including legal action, that is designed to prompt timely claims handling by the TDOL.
1 In accordance with the Workers' Compensation statute, a party may request the assistance of a workers' compensation specialist to determine if temporary disability or medical benefits are appropriate. A specialist assigned to the case obtains relevant medical records and other information and, thereafter, independently determines whether temporary disability or medical benefits are appropriate. Tenn. Code Ann. § 50-6-238(a)(5)-(6). Upon determining that such benefits are appropriate, the specialist may order that an employer or workers' compensation insurer begin, continue, or recommence the benefits. Tenn. Code Ann. § 50-6-238(a)(2)-(3).