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A state court decided that a settlement agreement resolving a worker’s comp claim did not require an employer to pay for surgery that was recommended years after the work injury.

The reason: The worker did not prove that the work-related injury created the need for the surgery.

In October of 2019, Albert Worrell injured his shoulder while he was moving bleachers as an employee of the Obion County School District.

An examining physician determined that Worrell had a rotator cuff tear. The physician performed surgery in December of 2019, after which he found that Worrell had reached maximum medical improvement.

Work Injury Leads to Settlement

In June of 2021, Worrell and the county entered into a settlement agreement that resolved his claim for workers’ compensation benefits.

Pursuant to the agreement, the county agreed to pay for further future medical expenses – but only if they were “directly related” to the work injury.

In June of 2022, after experiencing shoulder pain, Worrell returned to the physician who performed his surgery. That physician referred Worrell to another doctor, who recommended that Worrell undergo shoulder replacement surgery. The latter doctor said Worrell’s rotator cuff was “extremely thin” and that Worrell had “end-stage arthritis with loose bodies in each joint.”

Initially, a medical director for the state’s workers’ compensation bureau approved the recommendation.

Employer Fights Claim for Coverage for Surgery

But the county fought that recommendation, and it asked a court to find that Worrell’s need for a shoulder replacement did not derive from his work-related injury.

A court hearing was held in February of 2023. At the hearing, the only medical proof that Worrell offered to support his case was the first physician’s deposition testimony. In that testimony, the physician said that when he first examined Worrell after his injury, he found pre-existing rotator cuff tears and arthritis. In other words, the shoulder was compromised before he got hurt at work.

The physician also testified that he was unable to say for sure that the work injury and initial surgery were a greater than 50% cause of the need for more treatment. He also said the underlying problems with Worrell’s shoulder were severe.

Based on this evidence, the court decided that Worrell was not entitled to receive shoulder replacement surgery under the workers’ compensation agreement.

After an appeals board affirmed, Worrell filed an appeal.

Employee Presents Constitutional Allegations

In his appeal, Worrell presented constitutional challenges to two relevant state statutory provisions: one that instructs courts to construe the state’s workers’ compensation law fairly and constructively, and another that defines an injury as one that was caused more than 50% by employment.

The state law also says that the term injury does not include the aggravation of a preexisting disease, condition or ailment unless the aggravation arose primarily out of and in the course and scope of employment.

Worrell argued that the challenged provisions violated his substantive due process rights. He also said the law’s definition of injury violated his equal protection rights and that both challenged provisions violated an open court clause under state constitutional law.

The court rejected Worrell’s due process challenges on the basis that the two challenged provisions survived rational basis review.

The provision relating to construction ensures that employees and employers are treated equally, it said, and the definition of injury was reasonably related to the purpose of reducing workers’ compensation premiums for employers.

No Equal Protection Violation

The court also rejected Worrell’s assertion that the law’s definition of injury violated his equal protection rights.

Worrell said the definition wrongfully distinguished between workers who have preexisting asymptomatic degenerative conditions and those who do not.

But the definition establishes a single causation standard for all employees, the court said.

The court also rejected Worrell’s allegation that the definition violated equal protection rights by disproportionately burdening employees with preexisting conditions – who are mostly older. There was no evidence of discriminatory intent in enacting the legislation, it said, and the definition survived rational basis review.

Finally, the court rejected Worrell’s challenge to a state constitutional provision that entitles injured people to remedies under the law.

Worrell v. Obion County School Dist., No. W2023-01082-SC-R3-WC, 2024 Tenn. LEXIS 288 (Tenn. 7/19/24).