A Tennessee teacher who fell in her classroom is entitled to an 8% impairment rating, and her employer is obligated to cover her unauthorized medical expenses under a workers compensation claim, the state’s Supreme Court ruled.

Suzanne King, a teacher for the Greene County School System at Chuckey Doak Middle School in Afton, Tennessee, suffered injuries to her right knee, hip and back on Sept. 2, 2008, when she tripped over a student’s school books, court records show.

Ms. King returned to work two days after the incident, but she continued to experience pain, records show. Noting the pain one month later, her physician continued conservative treatment, including physical activity and over-the-counter medication.

An MRI was performed on March 10, 2009, and Ms. King was referred to a physical medicine and rehabilitation specialist, according to records. On April 27, 2009, the specialist opined that her injuries were work-related and recommended a sacroiliac joint injection and additional therapy. Ms. King, however, declined the treatment.

Without reviewing her treatment records, an orthopedic surgeon found that Ms. King had a 0% impairment rating and released her to work without restrictions, according to records. Ms. King eventually underwent a sacroiliac joint injection on Oct. 12, 2009.

In a letter dated May 4, 2010, a doctor indicated that Ms. King reached maximum medical improvement and suffered no permanent partial impairment as a result of her 2008 work-related accident, records show. Still in pain, Ms. King asked her case manager to provide the name of a chiropractor, but she was told that the Greene County School System was not required to include chiropractors in its panel.

“Believing she was left without a treating physician, Ms. King sought alternative treatment from … a chiropractor and contacted the Tennessee Department of Labor,” according to records.

In July 2010, an MRI revealed a disc bulge with no evidence of nerve root compression, records show. This led Ms. King’s counsel to request a physician panel for further treatment, but the request was denied. Still, Ms. King was referred to a neurosurgeon.

According to records, Ms. King underwent surgery to remove a disc herniation and, as a result of lingering pain, a second surgery was performed on Jan. 6, 2011.

The neurosurgeon opined that Ms. King reached maximum medical improvement on July 18, 2011, records show. He recommended permanent restrictions against repetitive bending and twisting, in addition to a 20-pound lifting restriction. Ms. King was assigned an 8% impairment rating to her entire body.

Ms. King then filed a workers comp complaint, and a trial was held in Greene County Circuit Court on Feb. 5, 2013, according to records.

Ms. King testified that after the physiatrist said she reached maximum medical improvement, she didn’t have an authorized treating doctor and was offered no additional options. She said she contacted the state’s Department of Labor and saw a chiropractor because she didn’t know what else to do.

She noted that the treatment was paid through her group health insurance, records show.

Greene County Circuit Court assigned an 8% impairment rating to Ms. King’s body as a whole, and indicated that her restrictions shouldn’t affect her ability to work as a teacher or in the educational field, according to records. For that reason, the court set a vocational impairment at 10%, finding that she should receive an award of $23,671.60 for permanent partial impairment benefits.

Greene County Circuit Court also found that unauthorized medical services performed by the neurosurgeon were “reasonable and necessary” to treat Ms. King’s work-related injury, records show.

On appeal, Greene County School System argued that the 8% impairment rating was inconsistent with the injury Ms. King suffered in 2008, and that the trial court erred in obligating the school system to pay for unauthorized medical expenses, according to records.

The Tennessee Supreme Court Special Workers’ Compensation Appeals Panel affirmed Greene County Circuit Court’s decision on Tuesday.

Its ruling states that when an employee receives medical care for a work-related injury that was not authorized by the employer, “the employee must establish the necessity and reasonableness of the charges.”

Ms. King sought additional treatment because of her continued pain, and her insurance provider paid the medical expenses, according to the ruling. Because the “medical expenses were reasonable and necessary,” Greene County School System is responsible for those expenses.