Future Medical Benefits in Tennessee

Written by: Carolina Martin, Esq.

Under Tennessee Workers’ Compensation law, an employee is entitled to lifetime medical treatment made reasonable and necessary by their compensable workplace injuries. This can be a daunting prospect for employers, especially in cases where the injured worker is young and the contemplated period of entitlement to these benefits spans several decades. However, except for cases where the employee was deemed permanently and totally disabled, the statute allows for closure of medical treatment by agreement of the parties if the judge approves it, providing an avenue through which the employer can eliminate the uncertainty of the time and amount of money it will cost them to pay for and monitor future medical treatment.

According to Tenn. Code Ann. §50-6-240(a), it is the judge’s duty “to examine the proposed settlement to determine whether the employee is receiving, substantially, the benefits provided by this chapter” and the Court usually interprets this to mean a determination of whether the settlement amount is sufficient to cover the related medical treatment likely to be necessary over the employee’s lifetime. To aid the Court in making this assessment, the parties are required to include, in the settlement agreement itself, the reason they believe closure of medicals is in the best interest of the employee

Additionally, as part of the settlement documentation, the parties are expected to present evidence supporting their argument. Rule 9 of Court’s Practices and Procedures states: “In cases where the Employee has agreed to close future medical benefits, the parties may attach a written statement from the treating physician stating that no further medical treatment is anticipated, or documentation of the anticipated cost of future medical treatment.”

While this may seem like a suggestion based on the language of the rule, judges routinely refuse to approve settlements for closure of medicals when the supporting evidence is lacking.  Depending on the type of injury, when it is easily apparent that no future treatment will be needed, the Court does not require a separate statement from the treating physician. This usually is true of settlements involving minor injuries or in some amputation cases, where the doctor has indicated in form C-30A of the Tennessee Bureau of Workers’ Compensation or in the medical notes that no future treatment is anticipated.

In other cases, however, additional information or documentation is required for the settlement to be approved. Even if a treating physician indicates that an employee has reached maximum medical improvement and no further medical treatment is necessary, according to prior guidance from the Court, there is no certainty that this will be the case, so the evidence that the settlement amount will be sufficient to cover it is necessary.

Technically, evidence of the cost of future medical treatment can be presented either in the form of a statement from the authorized treating physician setting forth the anticipated treatment and its cost or a professional medical cost projection. Doctors, however, are usually not inclined to provide such statements to avoid issues with their patients in case the amount for actual future treatment differs from the predicted amount. They are also often only able to estimate the cost for their own services and decline to discuss what the cost of treatment provided by others (such as diagnostic testing, medication, facility fees for surgeries, etc.) would be, all of which would have to be considered and included in the total if appropriate.

As a result, the safest bet to ensure approval in these cases is to obtain a medical cost projection from a third party, with a report containing a description of the treatment likely to be needed and its cost, taking into consideration the injury, prior treatment, and the life expectancy of the employee. These are already performed when the circumstances of the settlement require a Medicare Set Aside (MSA), but these can also be done independently of an MSA.

Even when all the required supporting documentation is provided, there is no guarantee that the court will approve closure of medicals. After all, the judges’ duty is to ensure that this type of settlement is in the best interest of the employee. As such, other, more nuanced, factors such as the judge’s perception as to whether the injured worker would be able to competently handle the funds for the purpose intended, are also taken into consideration. But making sure that the amount being offered is sufficient to cover any potential future treatment necessary, wording the terms of the settlement agreement to reflect this and providing as much evidence as possible that the estimated amount is accurate will increase the likelihood that the Court will be satisfied and the settlement will be approved, putting an end to the employer’s uncertainty as to what lifetime medicals will look like in a claim.

Leave a comment