Deny a worker's comp treatment, lose it later, and you still pay only the fee schedule. That is Tennessee's answer to carriers.
The state's Workers' Compensation Appeals Board certified the ruling as final on August 7, 2026, closing out a fight over how much an employer owes for treatment it once refused.
The case began with a Fresenius Medical Care Holdings, Inc. worker who fell through rotted wood while making a delivery on November 12, 2018, hurting his low back and right knee. The employer accepted the knee injury but pushed back on the back claim, blaming a pre-existing condition.
Then it got costly. A spine surgeon recommended a fusion. The employer ordered a second opinion, and that doctor concluded the need for surgery was not primarily caused by the work injury. The employer denied it. The worker went ahead anyway - surgery, physical therapy and pain management, all unauthorized.
At trial, the court found the back condition was a "permanent worsening" of a pre-existing injury. It awarded permanent partial disability and future medical benefits and ordered the employer to pay the unauthorized bills - but capped that payment at Tennessee's medical fee schedule.
That cap drove the appeal, and it was the only issue the worker raised. He pegged the bills at $562,783.85. The employer put them at $147,979.91.
His argument was straightforward: an employer that denies care and is later found liable should lose the fee-schedule discount and pay the full billed amount. The board disagreed. The statute says an employer's liability "shall be limited to the maximum allowable fees" under the schedule, and a companion rule stops carriers from paying more. Authorized or unauthorized, the board found, the bills are treated the same. Any change is for the legislature.
For carriers, the message is clean. Denying treatment still carries risk - but not the risk of paying above-schedule rates on bills you are later ordered to cover.
The board also eased the worker's fear of being left "holding the bag." Providers generally cannot chase a comp claimant for the balance, it noted, and a separate rule requires employers to fully reimburse workers for out-of-pocket costs on covered care, even above the schedule. That worry, the board said, was speculative and not ripe.
