A Tennessee workers' comp court referred a staffing agency for penalties after it sat on specialist referrals for nearly five months following a crush injury.
In a March 23, 2026 expedited hearing order, Judge Kenneth M. Switzer of the Tennessee Court of Workers' Compensation Claims ruled against Express Employment Professionals and its carrier, AIU Insurance Co. The court ordered Express to provide specialist medical panels, reinstated temporary total disability benefits, authorized attorney's fees, and referred the employer to the state's Compliance Program for penalties.
The case began on October 14, 2025, when Jessie Harris, an anodizing technician placed by Express at a Crescent Brands facility, was pinned against a dye tank by an automated crane that should not have been moving. Harris was intubated and life-flighted to a hospital, where he was treated for polytrauma, respiratory failure, multiple rib fractures, and small bilateral pneumothoraxes.
After his discharge, Express sent Harris to a walk-in clinic, where nurse practitioner Aleaha Carey - working under the supervision of Dr. John Pennington - diagnosed a range of conditions stemming from the crush injury, including traumatic pneumothorax, anxiety with depression, upper-back pain, and migraines. Carey referred Harris to four specialists: an orthopedist, a pulmonologist, a neurologist, and a psychiatrist.
Express honored the orthopedist referral but never provided panels for the other three. It never explained why. Then, on March 3, 2026, Express denied the entire claim.
The employer raised two defenses. First, it argued that Harris's injuries resulted from willful misconduct, claiming he was standing on the wrong side of the crane when the accident happened. The court found that Express could not identify a specific workplace rule that Harris had violated, offered no written policies or safety manuals to support the claim, and could not show that Harris had received actual notice of the alleged rule. The supervisor who instructed Harris to check the tank that day did not testify. The court noted that even if Harris had been negligent or reckless, that alone does not defeat a workers' compensation claim under Tennessee law.
Second, Express argued that THC found in Harris's post-accident drug tests should bar his claim. The employer contended that its membership in the Tennessee Drug-Free Workplace Program entitled it to a statutory presumption that Harris's drug use caused the accident. Under Tennessee law, that presumption is available when an employer has implemented a compliant drug-free workplace program and the employee fails a post-accident drug test. The catch is that the employer must strictly comply with the program's statutory and regulatory requirements – including providing at least one hour of training to all employees.
Harris testified that he could not recall receiving training on the program, could not recall receiving written documentation about it, and was never told that failing a post-accident drug test could affect his workers' compensation eligibility. Express offered no evidence to the contrary. The court also pointed to the Bureau of Workers' Compensation's own disclaimer on the acceptance memo, which stated that it was not certifying the accuracy or completeness of Express's application or its program. Without strict compliance, the presumption did not apply, and the burden fell back on Express to prove that Harris's drug use caused the accident. It could not.
Express also tried to challenge the medical referrals themselves. It relied on a letter from Dr. James Fish, the orthopedist Harris had selected from a panel, in which Dr. Fish stated that the pulmonology, neurology, and psychiatric referrals were neither related to the work injury nor medically necessary. The court gave little weight to that opinion, noting that Dr. Fish is an orthopedic specialist offering views outside his area of expertise, and that Express had not submitted records from follow-up visits showing how Dr. Fish arrived at his conclusions. The court also took issue with the fact that Express asked Dr. Fish to consider a causation treatise that Tennessee workers' compensation law has not adopted, which improperly gave Dr. Fish an incorrect perception of the causation standard in Tennessee.
More fundamentally, the court ruled that once an authorized provider makes a referral, honoring it is a statutorily mandated obligation. An employer cannot use an after-the-fact opinion from a different provider to retroactively justify ignoring referrals it was required to act on within three business days.
The court ordered Express to furnish panels of pulmonologists, neurologists, and psychiatrists. It also ordered Express to reinstate temporary total disability benefits retroactive to March 3, 2026, and to schedule a follow-up appointment with Dr. Fish. The court found that the circumstances support an award of attorney's fees for Express's unreasonable failure to timely initiate medical benefits, and authorized Harris's counsel to file an itemized affidavit – a remedy the court emphasized is available only in extremely limited circumstances at the interlocutory stage. Express was referred for penalties under two subsections of the Tennessee workers' compensation statute for failing to timely furnish both medical treatment and a specialist panel.
