FILED
Jun 30, 2026
11:52 AM(CT)
TENNESSEE COURT OF
WORKERS' COMPENSATION
CLAIMS
TENNESSEE BUREAU OF WORKERS’ COMPENSATION
IN THE COURT OF WORKERS’ COMPENSATION CLAIMS
AT NASHVILLE
AMEL HANA, Docket No. 2023-06-7146
Employee,
v.
ROSS STORES, INC., State File No. 37372
Employer,
and
ARCH INDEMNITY INS. CO., Judge Joshua D. Baker
Carrier.
COMPENSATION ORDER
At a June 16, 2026 compensation hearing, Ms. Hana requested permanent
partial disability, temporary disability, and future medical benefits. Because she
retained 2% permanent impairment and returned to work for Ross, the Court grants
an original award of permanent partial disability but denies increased benefits. Since she was not out of work long enough for temporary total disability, and Ross offered
work within her restrictions, she is not entitled to temporary total or temporary
partial disability benefits. However, she is entitled to future medical benefits.
Claim History
On May 15, 2023, shelving fell on Ms. Hana’s neck and upper back. Ross
authorized treatment, and she returned to restricted duty seven days later.
Ms. Hana worked light duty for nearly three months, from May 23 until
August 11. Her restrictions included “no lifting greater than 25 pounds” and
instructions to “limit continuous bending[,] stooping[,] and twisting.” According to
Ms. Hana’s testimony, she earned very little while on restrictions. This was because
her manager sent her home when she complained of pain or refused to do tasks she
said the doctor had forbidden, like moving her hands up and down and twisting.
1
On August 11, Dr. Christopher Kauffman released her to full duty. After
reviewing MRIs of her lumbar and thoracic spine, he noted no acute injuries in those
areas, observing only age-related degenerative changes. But an MRI of her cervical
spine had shown a work-related disc herniation.
So, Ms. Hana saw Dr. Tarek Elalayli, who believed she had a work-related
neck strain and had reached maximum recovery on March 14, 2024, with 2%
impairment. He placed no permanent restrictions and noted she “underwent a
cervical ESI without improvement,” but that the work injury showed “no indication
for surgery” or further treatment.
When Ms. Hana challenged Dr. Kauffman about releasing her when she was
still in pain, he referred her to Dr. Jeffrey Hazlewood. After examining her, Dr.
Hazlewood completed a C-32 form stating she was at maximum recovery for workrelated strains and contusions to her back and neck. He found she had no permanent
impairment or need for work restrictions, and he also recommended no additional
treatment.
Findings of Fact and Conclusions of Law
Ms. Hana has the burden of proving every element of her claim by a
preponderance of the evidence. Tenn. Code Ann. § 50-6-239(c)(6) (2025).
Permanent Partial Disability
Dr. Elalayli’s 2% rating is the sole expert proof that Ms. Hana has a permanent
impairment, as Dr. Hazlewood believed she had none. While Ms. Hana disagreed,
she offered no contrary proof. So, the Court finds she has 2% impairment, and her
original award of permanent partial disability benefits is $1,513.35 (2% of 450
weeks, or nine weeks, multiplied by the minimum compensation rate of $168.15).
Id. § 50-6-207(3)(A).1
If an employee has not returned to work at equal or greater wages by the end
of the initial compensation period, she may be entitled to increased benefits. Id. §
50-6-207(3)(B).
1
The wage statement listed Ms. Hana’s weekly compensation rate as $167.62.
2
Here, Ms. Hana acknowledged she returned to work and offered no proof she
is earning less than she was before her accident. Thus, the Court denies increased
benefits.
Temporary Disability Benefits
Under Workers’ Compensation Law, two types of temporary disability
benefits compensate an employee who is disabled from working by a work injury—
temporary total disability and temporary partial disability.
Temporary total disability applies when an employee is taken off work due to
a work injury. Jones v. Crencor Leasing and Sales, 2015 TN Wrk. Comp. App. Bd.
LEXIS 48, at *7 (Dec. 11, 2015). However, under section 50-6-205(a), “No
compensation shall be allowed for the first seven (7) days of disability resulting from the injury, excluding the day of injury[.]” Because she returned to work within seven days of her injury, Ms. Hana is not entitled to temporary total disability.
Temporary partial disability applies when an employee is not totally disabled
from work but is restricted due to a work injury. Jones, 2015 TN Wrk. Comp. App.
Bd. LEXIS 48 at *7. When the treating physician has restricted an employee’s work
before maximum recovery and the employer cannot accommodate those restrictions
for a sufficient number of hours or pay, the injured worker may be eligible for
temporary partial disability. Id. at *8.
Here, Ms. Hana testified that she could not work without pain, implying that
the doctor’s restrictions were insufficient, not that Ross failed to accommodate them. At most, she said light duty required twisting or bending that the doctor prohibited. However, documentary evidence showed the doctor simply limited certain
continuous movements. Due to insufficient proof that Ross failed to accommodate
her restrictions, Ms. Hana is not entitled to temporary partial disability benefits.
It is ORDERED as follows:
1. Ross shall pay Ms. Hana permanent partial disability benefits of $1,513.35.
2. Increased permanent partial disability under section 50-6-207(B) is denied.
3. Ms. Hana’s claim for temporary disability benefits is denied.
4. Ross shall furnish reasonable, necessary, and work-related future medical
3
benefits with Ms. Hana’s authorized treating physicians under section 50-6-204.
5. The Court taxes the $150.00 filing fee to Ross, to be paid to the Court Clerk
under Tennessee Compilation Rules and Regulations 0800-02-21-.06 (2026)
within five business days, and for which execution might issue.
6. Ross shall file a Statistical Data Form (SD-2) with the Court Clerk within ten
days of the date this order becomes final.
7. Unless appealed, this order becomes final 30 days after entry.
ENTERED June 30, 2026.
JUDGE JOSHUA D. BAKER
Court of Workers’ Compensation Claims
APPENDIX
Exhibits:
1. Wage Statement
2. Form C-32 of Dr. Tarek Elalayli, with attachments
3. Form C-32 of Dr. Jeffery Hazlewood, with attachments
4. Choice of Physicians forms
5. Dr. Christopher Kauffman’s restrictions for Ms. Hana dated June 23, 2024
6. Medical record from Dr. Christopher Kauffman dated June 23, 2024, and
titled “Patient Care Summary”
4
CERTIFICATE OF SERVICE
I certify that a copy of this order was sent as shown on June 30, 2026.
Name Email Service sent to:
Amel Hana, X
Employee
Gabi Jackson, X gjackson@manierherod.com
Heather Douglas hdouglas@manierherod.com
Employer’s Attorneys
PENNY SHRUM, COURT CLERK
wc.courtclerk@tn.gov
5
Right to Appeal:
If you disagree with the Court’s Order, you may appeal to the Workers’ Compensation
Appeals Board. To do so, you must:
1. Complete the enclosed form entitled “Notice of Appeal” and file it with the Clerk of the
Court of Workers’ Compensation Claims before the expiration of the deadline.
¾ If the order being appealed is “expedited” (also called “interlocutory”), or if the
order does not dispose of the case in its entirety, the notice of appeal must be filed
within seven (7) business days of the date the order was filed.
¾ If the order being appealed is a “Compensation Order,” or if it resolves all issues
in the case, the notice of appeal must be filed within thirty (30) calendar days of
the date the Compensation Order was filed.
When filing the Notice of Appeal, you must serve a copy on the opposing party (or attorney,
if represented).
2. You must pay, via check, money order, or credit card, a $75.00 filing fee within ten calendar
days after filing the Notice of Appeal. Payments can be made in-person at any Bureau office
or by U.S. mail, hand-delivery, or other delivery service. In the alternative, you may file an
Affidavit of Indigency (form available on the Bureau’s website or any Bureau office)
seeking a waiver of the filing fee. You must file the fully-completed Affidavit of Indigency
within ten calendar days of filing the Notice of Appeal. Failure to timely pay the filing
fee or file the Affidavit of Indigency will result in dismissal of your appeal.
3. You are responsible for ensuring a complete record is presented on appeal. If no court
reporter was present at the hearing, you may request from the Court Clerk the audio
recording of the hearing for a $25.00 fee. If you choose to submit a transcript as part of your
appeal, which the Appeals Board has emphasized is important for a meaningful review of
the case, a licensed court reporter must prepare the transcript, and you must file it with the
Court Clerk. The Court Clerk will prepare the record for submission to the Appeals Board,
and you will receive notice once it has been submitted. For deadlines related to the filing of
transcripts, statements of the evidence, and briefs on appeal, see the applicable rules on the
Bureau’s website at https://www.tn.gov/wcappealsboard. (Click the “Read Rules” button.)
4. After the Workers’ Compensation Judge approves the record and the Court Clerk transmits
it to the Appeals Board, a docketing notice will be sent to the parties.
If neither party timely files an appeal with the Appeals Board, the Court Order
becomes enforceable. See Tenn. Code Ann. § 50-6-239(d)(3) (expedited/interlocutory
orders) and Tenn. Code Ann. § 50-6-239(c)(7) (compensation orders).
For self-represented litigants: Help from an Ombudsman is available at 800-332-2667.
NOTICE OF APPEAL
Tennessee Bureau of Workers’ Compensation
www.tn.gov/workforce/injuries-at-work/
wc.courtclerk@tn.gov -800-332-2667
Docket No.: ________________________
State File No.: ______________________
Date of Injury: _____________________
Employee
v.
Employer
Notice is given that ____________________________________________________________________
[List name(s) of all appealing party(ies). Use separate sheet if necessary.]
appeals the following order(s) of the Tennessee Court of Workers’ Compensation Claims to the Workers’ Compensation Appeals Board;ĐŚĞĐŬŽŶĞŽƌŵŽƌĞĂƉƉůŝĐĂďůĞďŽdžĞƐĂŶĚŝŶĐůƵĚĞƚŚĞĚĂƚĞĨŝůĞͲ ƐƚĂŵƉĞĚŽŶƚŚĞĨŝƌƐƚƉĂŐĞŽĨƚŚĞŽƌĚĞƌ;ƐͿďĞŝŶŐĂƉƉĞĂůĞĚͿ͗
ප Expedited Hearing Order filed on _______________ ප Motion Order filed on ___________________ ප Compensation Order filed on__________________ ප Other Order filed on_____________________ issued by Judge _________________________________________________________________________.
Statement of the Issues on Appeal
Provide a short and plain statement of the issues on appeal or basis for relief on appeal: ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________
Parties
Appellant(s) (Requesting Party): _________________________________________ ܆Employer ܆Employee Address: ________________________________________________________ Phone: ___________________ Email: __________________________________________________________
Attorney’s Name: ______________________________________________ BPR#: _______________________ Attorney’s Email: ______________________________________________ Phone: _______________________ Attorney’s Address: _________________________________________________________________________
* Attach an additional sheet for each additional Appellant *
LB-1099 rev. 01/20 Page 1 of 2 RDA 11082 Employee Name: _______________________________________ Docket No.: _____________________ Date of Inj.: _______________
Appellee(s) (Opposing Party): ___________________________________________ ܆Employer ܆Employee Appellee’s Address: ______________________________________________ Phone: ____________________ Email: _________________________________________________________
Attorney’s Name: _____________________________________________ BPR#: ________________________ Attorney’s Email: _____________________________________________ Phone: _______________________ Attorney’s Address: _________________________________________________________________________
* Attach an additional sheet for each additional Appellee *
CERTIFICATE OF SERVICE
I, _____________________________________________________________, certify that I have forwarded a true and exact copy of this Notice of Appeal by First Class mail, postage prepaid, or in any manner as described in Tennessee Compilation Rules & Regulations, Chapter 0800-02-21, to all parties and/or their attorneys in this case on this the __________ day of ___________________________________, 20 ____.
[Signature of appellant or attorney for appellant]
LB-1099 rev. 01/20 Page 2 of 2 RDA 11082