Margaret Tobitt, an employee of Bridgestone/Firestone, Inc., sustained injuries after being struck by a car while walking through the employer's parking lot. Prior to this incident, she had a pre-existing jaw condition related to temporomandibular joint (TMJ) issues, which were not work-related and had undergone surgery in May 1995, resulting in a significant reduction of her pain. The Circuit Court of Warren County awarded Tobitt fifty percent permanent partial disability benefits, with twenty percent of the award commuted to a lump sum, based on findings that her injuries were causally connected to her employment.
Bridgestone/Firestone appealed, contending that Tobitt failed to prove her injury arose from her employment, that the trial court miscalculated her medical impairment ratings, and that the award was excessive. The Special Workers’ Compensation Appeals Panel initially reversed the trial court's judgment, citing insufficient evidence of causation. However, upon further review, the Supreme Court of Tennessee affirmed the trial court's judgment, finding sufficient evidence establishing a causal link between the injury and the incident. The court also found that the trial court had appropriately handled the impairment ratings and the decision to limit the lump sum commutation to twenty percent. Dissenting opinions were noted, but the majority ruled in favor of upholding the trial court's findings.
Susan Peterson witnessed the employee lying on the pavement after an accident. Paramedic Brian Raymond treated her at the scene, noting she was awake and alert, with complaints of wrist and knee pain, but no mention of head or jaw pain. A cervical collar was applied, but Raymond's report showed no head-related complaints. The employee later expressed head pain multiple times in the emergency room, corroborated by co-worker Elizabeth Maynard. Emergency room records documented treatment for arm and knee pain, without mentioning head pain.
The day after the accident, the employee described severe head pain to a nurse at her workplace and later consulted Dr. Urbanek. Following an x-ray that suggested a jaw fracture, she underwent conservative treatment, and Dr. Urbanek eventually performed surgery to address ongoing pain and jaw issues. Despite negative diagnostic results, he asserted the employee had a fracture from the accident, consistent with her symptoms. Post-surgery, the employee experienced persistent jaw pain and nerve damage, leading to facial drooping and difficulties with basic functions. She was referred to Dr. Samuel McKenna, undergoing additional surgeries in 1996 and 1998, which alleviated some symptoms but did not eliminate her pain.
Dr. McKenna assessed that the employee sustained a jaw joint injury due to a car accident and required a second surgery, confirming a lower jaw fracture. He noted that while a fracture indicates significant trauma, joint injury can occur without one. McKenna issued work restrictions including avoidance of facial trauma and vibrations, and assessed a ten percent whole body impairment for the jaw, excluding facial nerve damage. Dr. Debra Sherman performed two surgeries to aid the employee's eye function and eyebrow position but could not restore involuntary blinking, leading to blurred vision and dryness. She also assessed a ten percent impairment for nerve damage, not accounting for the jaw injury.
Witnesses testified about the negative impact of the injury on the employee's work performance, noting her pre-accident diligence versus post-accident difficulties, including complaints from co-workers about her reduced output. The employee faced limitations in using tools and operating machinery due to pain and had to manage eye care and jaw protection. The trial court determined the injury arose from employment, awarding fifty percent permanent partial disability, with twenty percent paid as a lump sum. However, the Special Workers’ Compensation Appeals Panel reversed this, citing a lack of objective evidence linking the jaw trauma to the accident. The case was then reviewed by a higher court, which would evaluate the evidence against the trial court's findings, emphasizing deference to the trial court's credibility assessments but allowing for independent evaluation of expert testimony based on depositions.
To qualify for workers' compensation benefits, an employee must demonstrate an injury resulting from an accident that arises out of and occurs during employment, as defined by Tenn. Code. Ann. § 50-6-102(12). The term 'arising out of' pertains to the injury's cause, necessitating a clear causal connection between the employment and the injury, as established in Hill v. Eagle Bend Mfg. Inc. and Houser v. Bi-Lo, Inc. Expert medical evidence is typically required to establish causation, supported by lay testimony, but speculative claims are inadmissible.
In evaluating the current case, the central issue is whether the employee's symptoms were a continuation of her pre-existing temporomandibular joint disorder (TMJ) or if the car accident exacerbated this condition. Prior to the accident, the employee had undergone surgery for TMJ and reported a good recovery. Following the November 1995 accident, she experienced immediate and severe headaches, corroborated by her co-worker’s testimony about her complaints in the emergency room.
Despite negative diagnostic tests, Dr. Urbanek, who treated the employee, maintained that she had fractured her jaw in the accident, noting that her symptoms indicated further injury. He eventually performed surgery that resulted in nerve damage, affecting her facial functionality. Dr. McKenna, who conducted subsequent surgeries, confirmed that the car accident caused injury to the jaw joint, supporting Dr. Urbanek’s assertion of a fracture. He acknowledged that while the employee had not fully recuperated from her initial TMJ surgery at the time of the accident, she appeared to be doing well.
The court concludes that the evidence supports the trial court's finding that the car accident aggravated the employee’s pre-existing condition, noting that aggravation is only non-compensable if it leads solely to increased pain. The record contains substantial unrefuted evidence indicating an anatomical change or progression of the condition. Unlike typical workers' compensation cases with conflicting medical opinions, this case lacks any medical testimony disputing causation. Medical testimony indicates that the accident caused trauma requiring treatment, which resulted in damage to the employee’s facial nerves. The court emphasizes the importance of accepting the employee’s uncontradicted testimony about her condition worsening post-accident and corroborating statements from co-workers regarding the nature of her injury. The court affirms the trial court’s finding of causation, ruling that the employee’s injury arose from her employment. Costs of the appeal are assigned to the employer.
