Two utilization reviewers said no. A judge who watched her limp said otherwise

A Tennessee employer used paper reviews to block a worker's knee surgery. A judge sided with the doctor who actually examined her.

On March 13, 2025, Yalonda Woods tore the meniscus in her left knee at work. Her authorized treating physician, Dr. Jonathan Shaver, recommended a total knee replacement. Her employer, Tennova Healthcare Hospice, disagreed. It argued the surgery was not medically necessary and sent the recommendation to utilization review – the process insurers and employers use to vet whether a treatment should be covered.

A review doctor, Dr. Tamara Pylawka, denied the surgery. Imaging, she said, showed only mild osteoarthritis. The Bureau's Medical Director backed her up, citing Woods's weight and the fact that she had not yet tried physical therapy.

So, Woods tried physical therapy. The notes told a different story: daily trouble climbing stairs, swelling, and pain that did not let up despite real effort. When therapy ended with no improvement, Dr. Shaver ordered the surgery again in December 2025. He now had a newer x-ray showing more joint narrowing and degenerative changes consistent with osteoarthritis.

Tennova sent it back to review. Dr. Pylawka denied it a second time, citing missing documentation of how severe the osteoarthritis was. The Medical Director agreed again, faulting the records for not describing weight-loss efforts or physical-exam findings.

This is where the...

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