Worker’s Failure to File Required Physician Certification Defeats Claim for Extraordinary Benefits

Case File

When a Tennessee worker sought extraordinary benefits, his failure to produce the requisite documentation undid his claim.

Case

Burkes v. Sysco Knoxville, LLC, No. E2025-02007-SC-R3-WC (Tenn. 10/22/26)

What Happened?

A worker for a food service company was working when he injured his knee. The parties settled the worker's claim for workers' compensation benefits, but the worker sought additional benefits after the initial benefit period expired. Extraordinary benefits are an enhanced permanent disability award available in limited Tennessee workers' compensation cases when statutory criteria are met and limiting recovery to increased benefits would be inequitable.

The trial court entered a compensation order, determining that the worker was entitled to increased benefits but was not entitled to extraordinary benefits because the worker did not provide the required certification form. On appeal, the Workers' Compensation Appeals Board affirmed.

The worker appealed to the Tennessee Supreme Court.

Rule of Law

In Tennessee, before a court can award extraordinary benefits, the workers' compensation judge must find, based on clear and convincing evidence, that limiting the employee's recovery to increased benefits would be inequitable in light of the totality of the circumstances.

Additionally, the judge must also make specific, documented findings that the following criteria are met:

(1) The employee has been assigned an impairment rating of at least 10% to the body as a whole by the authorized treating physician.

(2) The authorized treating physician has certified on a form provided by the bureau that, due to the permanent restrictions on activity the employee has suffered as a result of the injury, the employee no longer can perform the employee's pre-injury occupation.

(3) The employee is not earning an average weekly wage or salary that is greater than or equal to 70% of the employee's pre-injury AWW or salary.

What the Tennessee Supreme Court Said

The Tennessee Supreme Court affirmed the Appeals Board's judgment and adopted its opinion. According to the court, the worker did not describe how he substantially complied with the requirements of the statute for claiming extraordinary benefits because he did not present the physician certification form.

"Although the statute gives discretion to the trial court whether to award extraordinary benefits if the form is provided (and the other criteria are met), the statute affords no discretion to award benefits when no Physician Certification Form has been filed," the court wrote. "In short, the Physician Certification Form is a statutory requirement, and its absence is fatal to Employee's claim for extraordinary benefits."

Verdict: The Tennessee Supreme Court affirmed the Appeals Board's upholding of the trial court's denial of extraordinary benefits because the worker failed to submit the physician certification form required by statute.

Takeaway

For extraordinary benefits in Tennessee, employees must show that authorized treating physicians have certified on a bureau-provided form that, due to permanent restrictions on activity the employee suffered as a result of the injury, the employee no longer has the ability to perform the employee's pre-injury occupation. The authorized treating physicians' certifications pursuant to this shall have a presumption of correctness that may be overcome by the presentation of contrary clear and convincing evidence

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