FOURTH D I VI SI ON

M C FA DDEN, C. J.

, DOYLE, P. J.

, and COOM ER, J.

N O T IC E : M otions for r e c ons i de r a tion m us t be

ph y sic a l ly r e ce iv ed i n our c le r k ’s offic e w ithin te n

da y s of the da te of de c is ion to be de e m ed tim e ly file d.

http://w w w .ga a ppe a l s .us /r ule s

Febr uar y 18, 2020



# I n th e Co u r t o f

A p p eals o f

G eo r g ia

A1 9 A1 87 8

. T H E HARTFORD CASUALTY INSURANCE

COM PANY et al . v

. HAW KINS.

A1 9 A1 8 7 9 . STATE FARM FIRE AND CASUALTY COM PANY

et al . v . HAW KINS.

C O O M E R , J u d ge.

In t h es e d i s cret i o n a r y a p p eal s

, Aced It G o l f, LLC d / b / a 9 2 T h read s (t h e

“ Em p l o y er”) an d i t s t wo i n s uran ce carri ers

, St at e Farm Fi re & Cas u al t y Co m p an y an d

Th e H art fo rd Cas u al t y In su ran ce Co m p an y (co l l ect iv el y

, “ Ap p el lan t s ”) ap p e a l t h e

o rd er o f t h e s u p eri o r co u rt rev ers i n g t h e d eci s i o n of t he ap p el l at e d i v i si o n o f t h e St at e

Bo ard o f W o rk ers ’ Co m

p en s at io n (t h e “ Bo ard ”), wh i ch d en i ed

, am on g o t h er t h i n g s

,

cl ai m an t Li s a Hawk i n s ’ req u es t fo r a ch an g e of p hy si ci an

. Ap p el l an t s co n ten d t h at

t h e s u p eri o r co u rt erred (1 ) b y fai l i n g t o ap p l y t h e “ an y ev id en ce” s t an dard o f rev i ew

t o t h e Bo ard ’ s fi n d i n g s o f fact t h a t Hawk i n s ’ i n ju ri es h ad res o l ved as o f Au g u s t 1,2 0 1 7 ; (2 ) b y g ran t i n g Hawk in s ’ ch an g e o f ph y s i ci an r e q u e s t d es p i t e t he Bo ard ’ s

fact ual det erm i n at i o n t h at n o ad d i t i on al m ed i cal t reat m en t was req u ired fo r an y wo rk

rel at ed co n d i t i o n; an d (3 ) b y o rd eri n g t h e p ay m en t o f at t o rn ey fees t o H awk i n s

. Fo r

t h e fo l lo wi n g reas o ns , we rev ers e t h e s u p eri o r co urt ’ s o rd er i n i ts en t iret y

.

“ In rev i ewi ng a w o rk ers ’ co m p en s at i o n award

, bo t h t he ap p el l at e co u rt an d t h e

s u p eri o r co u rt m

u s t co n s tru e t h e ev i den ce in t h e l i g h t m o st fav o rab l e t o th e p art y

p rev ai l i n g b efo re t h e [Bo ard ] .” Ra y B el l Co n st r

. Co

. v. Ki n g

, 28 1 Ga. 8 5 3, 8 5 4 (6 4 2

SE2 d 8 4 1 ) (2 0 0 7 ) (ci tat i o n s an d p u n ct u at i o n o m i t ted ). Vi ewed i n t h i s l i gh t

, t h e reco rd

s h o ws t h at on Oct o b er 8

, 2 0 15

, 1 Hawk i n s t ri p p ed b ack w ard s ov er an op en d rawer an d

fel l o n t o t h e fl o or d u ri n g t h e co u rs e o f h er em p l o y m en t wi t h t h e Em

p l o y er, a s m al l

fam i l y -o w n ed bu s i n es s t h at d o es T-s h i rt p ri n t in g an d em b ro i d ery wo rk

. Sh e d i d n ot

i m m ed i at el y s eek m ed i cal t reat m en t

. Aft er Hawk i ns no t i fi ed t he Em p l o y er ab o u t h er

i n ju ri es

, t h e Em

p l o y er au t ho ri zed treat m en t w i t h a p h y s i ci an ch o sen b y Hawk i n s

, El i

A. Fi n k el s tei n

, M .D. at Res u rg en s Ort h o p aed ics

. Th e E m pl o y er d i d n o t h av e a

p ro p erl y co m

p l et ed pan el o f p h y s i ci an s at t he t i m e o f t h e acci d en t

, b ut o n e o f t h e

o wn ers t al k ed wi t h St at e Farm aft er t h e acci d en t an d co m p il ed a p an el of p h y s i ci an s

,

w h i ch i n cl ud ed Dr. Fi n k el s t ei n. Hawk i n s fi rs t s aw Dr. Fi n k el s t ei n o n No v em b e r 6

,

1 At t h i s p o i n t

, St at e Farm s erv ed as th e Em p l o y er’ s wo rk ers ’ co m

p en sat i o n carri er.

22 0 1 5

, wh er e s h e p res en t ed wi t h co m p l ai n t s of n eck

, arm

, sh o ul d er, an d lo wer b ack

p ai n

. Bas ed o n t h e res u lt s o f an M RI, Dr. Fi n k el st ei n o p i ned t h at t h ere w ere “ n o

fi nd i ng s i n t h e cerv i cal s p i n e o t h e r t h an s t rai gh t en in g o f t he l o rd o s i s ,” an d t h at

Hawk i n s ’ s h o u l der “ m ay s h o w s o m e m i l d ev i den ce o f s u b acro m i al b u rs i t i s an d AC

i m p i n g em en t, b u t ot h e r w i s e n o fi n d i n g s.” Dr. Fi n k el s t ei n referred Hawk in s fo r a

co u rs e o f t h erap y

, p res cri b ed Fl ex eri l

, p l aced Hawk i n s on light- duty w o rk res t ri ct i on s

wi t h no u s e o f t h e l e f

t u p per ex t rem i t y

, an d fu rt h er referred Hawk i n s t o An g el o

Di Fel i ce, M .D. t o fo l lo w u p o n h er s h o u ld er p ai n

. Hawk in s fi rs t s aw Dr. Di Fel i ce in

Decem b er 2 01 5

. Al t h o u g h sh o wi n g s o m e im p ro v em en t, Hawk i n s r e p o rt ed p ai n,

n u m b n es s

, an d t in g l i n g do wn h er l eft arm an d h an d. U p o n rev iew o f Hawk i n s ’ M RI

s can

, Dr. Di Fel i ce fo un d n o “ ob v i o u s ” ro t at o r cu ff t ear, bu t p l aced h er o n res t ri ct i on s

“ p er Dr. Fi n k el s t ei n .”

In M arc h 2 0 1 6

, Hawk i n s was ev al uat ed fo r p ai n m an ag em en t by Ed u ard o

Es co rci a, M

. D. Her t reat m en t p lan wi t h Dr. E s co rci a i n cl u d ed b i l at eral cerv i cal

i n ject i o n s an d v ari o u s p ai n m ed i cat i on s

. H awk i n s co n ti n u ed t o wo rk t h ro u gh 2 0 1 6,

b u t s h e fel t t h at h e r wo rk l o ad “ o v erwh el m ed [h er] s h ou l d er” d u ri ng th e b u s y

Ch ri s t m as s eas o n

. At t hi s p o in t , Hawk in s i n fo rm ed t h e Em pl o y er t h at s h e co u l d n o

l o n g er d o a fu l l -t i m e em b ro i d e r y j o b an d n eed ed a l i g h t-d u t y acco m m od at i o n

. In

3Feb ru ary 2 0 1 7

, Hawk i n s u n d e r wen t a s eco n d M RI. On Feb ru ary 1 6

, 2 01 7

, Dr.

Es co rci a reco m

m en d ed l i g h t -d u t y res t ri ct i on s i n cl u d i n g “ [n ] o p u sh i n g/ pu l l i n g

, n o

l i ft i n g

, m i n i m al u p per b o d y u s e fo r 4 t o 6 week s .” Hawk i n s w as t erm i nat ed on M arch

6

, 2 0 1 7. T h e Em

p l o y er ad m i t t ed t h at “ on e o f t h e reas o n s ” fo r Hawk i n s ’ t erm i n at i o n

was t h at s h e w as u nab l e t o p erfo rm h er reg u l ar d u t y jo b an d s h e “ co ul d n ’ t d o as m u ch

o f t h e wo rk as we wo u l d h av e l i k ed .”

On M ay 8, 2 0 1 7

, Hawk i n s u n d er w e nt a f unc tiona l c a

pa c ity e val u at i o n (“ FCE”),

i n wh i ch t h e m ajo ri t y of act iv it i es t es t ed s h owed t h at Hawk in s h ad “ dem o n s t rat ed

ab i l i t i es ” i n t h e l i g ht -d u t y c a t e g o ry

. Th e ev al u at or, h o wev er, op i n ed t hat Hawk i n s

“ g av e a s el f-l i m i t ed effo rt ,” an d t h a t t h e res u l t s o f t h e FCE d i d n o t refl ect h er t ru e

cap ab i l i ti es

. M o reo ver, t h e ev al u at o r s t at ed t hat “ u n les s an ob ject iv e m ed i cal reas o n

ex i s t s t h at wo u l d p recl u de ret u rn -t o -wo rk

, ” Hawk i n s “ sh o u l d b e ret u rn ed t o wo rk .”

On May 1 7

, 20 1 7

, Hawk i n s ret u rn ed t o Dr. Di Fel ice, an d h e no t ed t h at t h e FCE h ad

s o m e “ i n co n s i s t en ci es ” an d t hat Hawk in s was s t i l l s y m p to m at i c an d s u fferi n g fro m

s o m e s h o u l d er d y s fu nct i o n

. As a res ul t

, he ag ai n p l aced h er o n res t ri ct i on s fo r h er l eft

s h o u l d er wi t h n o o verh ead u s e o f t h e left u pp er ex t rem i t y

, an d li ft i n g o f u p t o t w o

p o u n d s b el o w s ho u l d er l ev el

.

4On M ay 2 5

, 2 0 1 7

, at St at e Farm ’ s req ues t

, Hawk i n s u n d erwen t an i n d ep en d en t

m ed i cal ev al uat i o n wi t h P a u l Mefferd

, D.O. at Sp i n e Reh ab i li t at io n Sp eci al i s t s o f

Geo rg i a. Bas ed on a rev i ew o f m ed ical reco rd s an d t es t s

, as wel l as h i s o wn

i n d ep en den t m ed ical ex am i n at io n

, Dr. M efferd o p i ned t h at Hawk i n s was cap ab l e o f

a “ ret urn t o reg u l ar d u t y an d fu l l -t i m e wo rk ” an d t h a t n o f u rt h er m ed i cal t reat m en t

was n eces s ary i n co n nect i o n wi t h t h e Oct o b er 8

, 2 0 1 5 wo rk -rel at ed i n ju ry

. On J u n e

2 8

, 2 01 7

, Dr. Fi n k el s t ei n s aw Hawk i n s an d no t ed t h at al t h o u g h t h e r e was l eft

s h o u ld er d y sfu n ct io n wi t h “ s u b je c t i v e n eu ro p at h i c s y m p t o m s o f t he l eft u p p er

ex t rem i t y ,” h e h ad n o fu rt h er t reat m en t to o ffer an d ad v i s ed Hawk i n s t o co n ti n u e p ai n

t h erap y

. He al s o s t at ed t h a t a n y fi n d i n g o f d i s ab i l i t y wo u l d b e at D r. Di Fel i ce’ s

d i s cret i o n

. On Au g u s t 1

, 2 0 1 7, b as ed u p o n h i s rev i ew o f Hawk in s ’ m ed ical reco rd s

,

h er d ep o s i ti o n tes t im o n y an d s u rv ei l l an ce m at eri al s tak en at t h e req u es t o f t h e

i n s u ran ce co m

p an i es

, Dr. Di Fel i ce o p i n ed t h at Hawk i n s ’ “ co m p l a i n t s o f p ai n an d

d i s ab i l i t y o f h er l eft arm are i n co n s i s t en t wi t h M s

. Hawk i n s ’ ph y s ical act iv i t i es as

d ep ict ed i n t h e v i d e o s u rv ei l l an ce” fo o t ag e t ak en i n J u n e 20 1 7 “ s h owi n g h er u s i n g

h er up p er l eft ex trem it y ,” t h at Hawk i ns h ad reach ed m ax i m u m m ed i cal i m

p ro v em en t

w i t h r eg ard t o t he Oct o b er 8

, 2 0 1 5 wo rk i n ju ry t o h er n eck an d l eft arm

, t h at s h e

wo u l d n eed n o fu rt h er wo rk r e s t r i c t i o n s as a res u l t o f t he in ju ry

, an d t h at n o

5ad d it i o n al m ed i cal t reat m en t t o h er l eft u p p er ex t rem i t y w as req u i red

. St at e Farm

co n tro v ert ed Hawk i n s ’ cl ai m o n Au g u s t 2 5

, 2 0 1 7

, o n t h e g ro u n d t h at n o fu rt h er

m ed i cal care was req u i red

.

On Au g u s t 8

, 2 0 1 7

, H a w k i n s req u es t ed a ch an g e o f ph y s ici an t o Xav i er A.

Du ral d e, M .D. 2 On Oct ob er 1 1

, 2 0 1 7

, Hawk i n s u n d e r w e n t an i n dep en d en t m ed i cal

ex am i n at i o n wi t h Ro b ert Kars ch

, M.D. Dr. Kars h o p in ed t h at n o fu rt h er t reat m en t

was n eed ed fo r Hawk i n s ’ cerv i cal s p i n e. It was h i s i m p res s i o n t h at Hawk i n s ’ “ l eft

s i ded n eck an d t rap ezi u s pai n i s fro m h er p o s t u r i n g fo r h er l eft sh o u l d er p ai n ” an d

wo u l d im p r o v e wi t h fu rt h er t reat m en t

. He n o t ed t h at Hawk i ns co u l d t ry a t o p i cal

NSAID an d PRP i n

ject i on

, an d reco m

m en d ed s urg i cal in t erv en t i o n i f t h e PRP

i n ject i o n d i d n o t p ro v i d e rel i ef. D r

. K a r s ch s t at ed t h at

, ab s en t fu rt h er t reat m en t

,

Hawk i n s was “ [c] ap ab le o f s ed en t ary o r d es k wo rk o n l y

. ”

Ha w k i n s f

i l ed a cl ai m fo r wo rk ers ’ co m p en s at i o n b en efi ts

, p en al t i es

, an d

as s es s ed at t o rn ey ’ s fees ag ai n s t t h e Em p l o y er an d St at e Farm b as ed o n an Oct o b er 8,

2 0 1 5 i n ju ry dat e. Sh e al so s o u g h t b en efi t s ag ai n st t h e Em p l o y er an d Hart fo rd d u e to

t h e fact t hat s h e s u ffered a fi ct io n al n ew acci d en t on M arch 7

, 2 0 1 7

, wh en s h e was

2 Th ere i s n o i n d icat i o n t h at Hawk i n s ev er s o u g h t t reat m en t wi t h Dr. Du ral de.

6t erm i n at ed fro m h er jo b. 3 At t h e h eari n g o n her cl ai m s, Hawk i n s req u es t ed a ch an g e

o f p h y s i ci an t o Dr. Kars ch bas ed o n h i s reco m m en d ed t reat m en t p l an

.

Bas ed o n t h e fo reg o in g

, t h e A d m i n i s t rat i v e Law J u dg e (“ ALJ ”) fo u n d t h at

Hawk i n s s u s t ai n ed an i ni ti al Oct o b er 8

, 2 0 1 5 wo rk -rel at ed i nju ry

, an d t h at b ecau s e

Hawk i n s co n t i n u ed to wo rk ab o v e t h e p res cri b ed l i g h t -d u t y wo rk res t r i c t i o n s

, s h e

s u ffered a n ew acci d en t

, i n t h e fo rm o f ag g rav at i o n o f h er p re-ex i s t i n g co n di t i o n

, o n

M arch 7, 2 0 1 7

, en t i t l i n g h er t o b en efi t s as of t h at d at e.

. Th e ALJ

, h o w ev er, fo u n d

t h at Hawk i n s ’ w o rk -rel at ed i n j u ri es res o l v ed as of Au gu s t 1

, 2 0 1 7

, wh en h er t reat i n g

p h y s i ci an s fo u n d h er cap ab l e o f ret u rn i n g t o reg u l ar-d u ty

, u n res tri ct ed wo rk an d

o p i n ed th at n o fu rt h er m ed i cal t re a tm e nt w a s r e quir e d fo r h er wo rk -rel at ed co n d i t i o n s

.

Th e AL J d i d n o t fi n d Hawk i n s’ t es t i m o n y ab o ut her co n t i n u ed p ai n t o b e cred i b l e

b as ed in part o n h er o wn o b s erv at i o n s d u ri n g t h e d u rat i o n o f t h e fi v e-h o u r h eari n g,

i n wh i ch Hawk i n s “ d i d n o t fi d g et

, g ri m ace o r ex h ib i t an y o t h er b e h a v i o r s wh i ch

wo u l d su g ges t t hat s h e was i n p ai n .” Acco rd i ng l y

, t h e ALJ co ncl u d ed t h at Hawk i n s

3 A fi ct i o n al n ew acci d en t o ccu rs wh en a cl ai m an t i s i n j u red o n t h e jo b an d co n t i n u es

t o p erfo rm h er jo b d u t i es u n ti l s u ch ti m e t h at s h e is fo rced t o c e a s e wo rk b ecau s e o f t h e

g rad u al wo rs en in g o f h er co n di t i o n wh i ch i s at l eas t p art i al l y at t ri b u t ab l e t o h er p h y s i cal

act i v i ty i n co n t i nu i n g t o wo rk s u b s eq u en t t o h er i n j u ry

. ABF F

r e i g h t S ys t em, In c. v.

Pr es ley , 3 3 0 Ga. Ap p. 8 8 5

, 8 8 6 (7 6 9 SE2 d 6 11 ) (2 0 1 5 ). Hart fo rd was t h e i n s u rer fo r t h e

M arch 7 , 2 0 1 7 d at e o f i n

ju ry

.

7was en t i t l ed t o t o t al t em p o rary d i s ab i l it y ben efi t s effect i v e M arch 7

, 2 01 7 t o Au g u s t

1

, 20 1 7

, p ay ab l e b y Hart fo rd

. Th e ALJ d en i ed H awk i n s ’ req u es t s fo r at t o rn ey ’ s fees

an d l at e p ay m en t p en al t i es

, an d fu rt h er den i ed h er r e q u es t fo r a ch an g e i n h er

au t h o ri zed t reat i n g p h y s i ci an an d fo r ad d i t i o nal m ed i cal t reat m en t wi t h reg ard to

ei t h er t h e Oct o b er 8 , 2 01 5 o r M arch 7 , 2 0 17 d at es o f i n j u ry

.

Hawk i n s ap p eal ed t o t h e Bo ard

, arg u i n g i n p ert i n en t p art t h at t h e ALJ (1 ) erred

i n fi n di n g t h at bo t h her Oct o b er 8

, 2 0 1 5 an d M arch 7

, 2 01 7 wo rk in ju ri es res o l v ed as

o f Au g u s t 1

, 2 01 7 ; an d (2 ) erred i n d en y in g h e r req u es t fo r a ch an g e o f p h y s i ci an

u n d er Bo ard Ru l e 2 0 1 (c). T h e Bo ard ad o p t ed th e ALJ ’ s o rd er i n i t s en t i ret y

. Hawk i n s

t h en ap p eal ed t o t he s u p eri o r co u rt

.

Fo l l owi n g a h eari ng

, t h e s u p eri o r co urt rev ers ed t he d eci s i o n s o f t h e Bo ard an d

ALJ

. Sp eci fi cal l y

, t he s u p eri o r co u rt fo un d t h at t h e Em p lo y er an d St at e Farm fai l ed

t o m ai nt ai n a v al i d pan el o f p h y s i ci an s i n v i o l at io n of OCGA § 3 4 -9 -2 0 1 an d Bo ard

Ru l e 2 0 1 at t h e t i m e o f Hawk i n s ’ i n i t i al Oct o b er 8, 2 0 1 5 i nju ry

. Becau se Hawk i n s

ex erci s ed h er ri g h t t o a ch an g e o f p h y s i ci an p ri o r t o St at e Farm co n t ro vert i n g h er

cl ai m

, t h e s u p eri o r co u rt co n cl ud ed t h at Hawk i n s was s t at u t o ri l y en t i tl ed t o a ch an g e

8i n ph y s i ci an

, an d t h e Bo ard ’ s d en i al o f h er req u es t “ co ns t i t u te[d ] l eg al erro r.” 4

M o reo v er, t h e s u peri or co u rt fo u n d t h at beca us e Hawk i n s ’ req u es t fo r a ch an g e o f

p h y s i ci an s h o u l d h av e b een g ran t ed

, “ t h e [Bo ard ] al s o erred i n fi nd i n g [Hawk in s ’ ]

wo rk in ju ri es res o l v ed as o f Au g u s t 1

, 2 0 1 7” b ecau s e Dr. Kars ch as si g n ed co n t i n u ed

wo rk res t ri ct i o n s an d reco m m en d ed ad d i t i o nal treat m en t fo r Hawk in s’ wo rk i n ju ri es

.

Fi n al l y

, t h e su p eri o r co u rt rev ers ed t h e Bo ard ’ s fi nd i ng th at an as s es s m en t o f

at t o rn ey ’ s fee s wa s no t warran t ed b as ed o n i t s fi n di n g t h at St at e Farm “ i l l eg al l y

d e n i e d [Hawk i n s ] her s t at u t o ry ri g h t to a ch an g e o f p hy si ci an b y co n t ro vert i n g al l

m ed i cal t reat m en t a f

te r [ H a w kins] t i m el y as s ert ed t h is ri g h t.” St at e Farm an d Hart fo rd

t h en fi l ed ap p l i cat i on s fo r d i s c ret i o n ary ap p eal

, wh ich we g ran t ed

. Th es e ap p eal s

fo l l o w ed . W e ad d res s b ot h ap p eal s t o g et her.

“ I f a ny ev i d en ce s u p p o rt s t h e [Bo ard ’ s ] fi n d i n g s, t h os e fi n d i n g s a r e binding a nd

co n cl u s i v e, an d n ei t h er t h i s [C] o u rt n o r t h e s up eri o r co urt m ay s u b s t i t u t e it s el f as t h e

fact fi n d i n g b o d y .” Med i ca l Of fi ce M g mt

. v. H a r d ee

, 30 3 G a. Ap p

. 6 0

, 6 7 (2 ) (b ) (6 9 3

SE2 d 1 0 3 ) (2 0 1 0 ) (ci t at i o n an d p u n ct uat i o n o m i t t e d )

. “ Ho wev er, erro n eo u s

ap p li cat io n s o f l aw t o u n di s pu t ed fact s

, a s w e l l a s d eci s i o n s b as ed o n erro n eo u s

4 Al t h o u gh t he s up eri o r co u rt fo u n d t hat Hawk i ns was s t at ut o ri l y en t i t l ed t o a ch an g e

o f p h y s i ci an an d co n t i n u in g m ed i cal t reat m en t

, t h e co u rt ’ s ord er fai l ed t o s peci fy t h e d at e

o f acci d en t an d t h u s , i t i s u n cl ear wh i ch i n s urer wo u l d b e l i ab l e.

9t h eo ri es o f la w

, are su b ject t o t h e d e n o v o s t an d ard o f rev i ew.” M cLen d o n v.

Ad ver t i s i n g Th a t

W o r ks , 2 9 2 Ga. Ap p . 6 7 7, 6 7 7 -6 7 8 (6 65 SE2 d 3 7 0 ) (2 0 0 8).

1

. Ap p el l an t s co n ten d t h at t h e s u p eri o r co u rt erred b y fai l in g t o ap p l y t h e “ an y

ev i d en ce” s t an dard o f rev i ew to t h e Bo ard ’ s fi n d i ng of fact th at Hawk i n s’ i nju ri es h ad

res o l ved as o f Au g us t 1 , 2 0 1 7 . W e ag ree.

Th e reco rd s h o ws t h at Dr. Fi nk el s tei n s aw Hawk i n s o n Ju n e 2 8

, 2 0 1 7

, an d

co n cl u d ed t h at al t h o u gh H awk i n s ex h i b i t ed left sh o ul d er d y sfu n ct i o n an d “ s u b ject i v e

n eu ro p at h i c s y m

p t o m s of t h e l eft u p p er ex t rem i t y, ” h e h ad n o fu rt h er t reat m en t to

o ffer an d ad vi sed Hawk in s t o co n t i nu e p ai n t h erap y

. H e al s o s tat ed t h at an y fi n d i n g

o f d i sab i li t y wo u l d b e at Dr. Di Fel i ce’ s d i s cret i o n

. On Au g u st 1

, 2 0 1 7

, Dr. Di Fel i ce

o p i n ed t h at Hawk in s h ad reach ed m ax i m u m m ed ical i m

pro v em en t wi t h reg ard t o t h e

Oct o b er 8

, 2 0 1 5 wo rk i n

ju ry t o h er n eck an d left arm

, an d t h at s h e w o u l d n e ed n o

fu rt her wo rk res t ri ct i o n s as a res u l t o f t h e i n j u ry

, an d t h at no ad d i t i o n al m ed i cal

t reat m en t t o h e r l eft u p p er ex t rem it y was req u i red

. Th u s

, t h e Bo ard ’ s fi n d i n g

Hawk i n s ’ wo rk -rel at e d in ju ri es h ad res o l v ed as o f A u g u s t 1, 2 01 7

, i s su p po rt ed by

ev i d en ce i n t he reco rd

.

10Th e s u p eri o r co u rt rev ers ed t h e Bo ard ’ s fi nd i n g t h at H aw k i n s ’ wo rk -rel at ed

i n ju ri es had res o l v ed as o f Au g u s t 1

, 2 0 17

, b as ed o n i t s co n cl u s i o n t h at t he Bo ard h ad

erred i n den y in g Hawk i n s ’ r e q u e s t f or a ch an g e i n ph y s i ci an

. Th e s up eri o r co u rt

reas on ed t h at i f t h e Bo ard h ad p r o p e r l y g r a n t ed Hawk in s ’ req u es t fo r a ch an g e o f

p h y s i ci an t o Dr. Kars ch

, i t wo u l d n o t h av e fo u n d t h a t H a wk in s ’ wo rk i n ju ri es

res o l ved as o f Au g u s t 1

, 2 0 1 7

. Ho wev er, a rev i ewi n g s u peri o r co u rt “ i s n o t au t h o ri zed

t o d is reg ard co m

p et en t ev i d en ce t h at i t bel i ev es i s n ot cred ib l e, rewei g h t h e ev i d en ce,

o r res o l v e co nfl ict i n g ev i d en ce, as t h es e p o w ers are res erv ed s o l el y fo r t h e ALJ an d

t h e Bo ard

. ” Au t o z o ne, In c. v. Mes a

, 3 4 2 Ga. A p p

. 7 4 8

, 75 3 (8 0 4 SE2 d 7 3 4 ) (2 0 1 7 )

(fo o t no t e o m i t t ed ). Acco rd i n gl y

, b ecau s e t here was ev id en ce i n t he reco rd t o s u p p o rt

t h e Bo ard ’ s fi n di n g t h at Hawk i n s ’ wo rk -rel at ed i nju ri es h ad res o l v ed as of Au g u s t 1,

2 0 1 7 , t h e s u p eri o r co u rt erred i n rev ers i n g t h e Bo ard ’ s fi n d i n g.

2

. Ap p el l an t s fu rt h er co n t en d t h at t h e s u p eri or co u rt erred wh en i t rev ers ed t h e

Bo ard ’ s d en i al o f Hawk i n s ’ ch an ge of ph y s ici an req u es t d es p it e t h e Bo ard ’ s fact u al

d et erm i n at i o n th at n o ad d i t io nal m ed i cal t reat m en t was req u i red fo r an y wo rk -rel at ed

co n di t i o n . W e ag ree.

OCGA § 3 4

- 9

- 2 0 0 (a) req u i res an em p l o y er t o fu rn i s h t he i n

ju red

em p l o y ee wi th m ed i cal t reat m en t wh ich “ s h a l l b e reas o nab l y req u i red

11an d ap p ear l i k el y t o effect a cu re, g i v e rel i ef, o r res to re t h e em p lo y ee t o

s u i t ab l e em

p l o y m en t ,” an d OCGA § 3 4 -9 -2 0 1 (b ) (1 ) a l l o ws th e

em p l o y er t o s at i sfy t h at req u i rem en t b y p o s t i n g a p an el o f s i x ph y s i ci an s

fro m wh i ch an em

p l o y ee m ay accep t s erv i ces

. An em p l o y ee m ay m ak e

o n e ch an g e f

r o m a p an el p h y s i ci an t o an o th er p an el p h y s i ci an

, an d a

p an el p h y s i ci an m ay refer t h e em p l o y ee t o a no n p an el p hy s i ci an

,

al t h o u g h t h at n o n p an el p h y s i ci an m ay n ot m ak e fu rt h er n on p an el

referral s

. OCGA § 3 4

- 9

- 2 0 1 ( b ) (1 ). A n em p l o y ee m ay al s o as k th e

Bo ard t o ord er a ch an g e o f p h y s i ci an o r t reat m en t, an d i f gran t ed th e

em p l o y er i s l i ab l e fo r t h o s e ex p en s es

. OCGA §§ 3 4 -9 -2 0 0 (b ); 3 4-9 -2 0 1

(e).

“ If t he em

p l o y er fai l s to p ro v i d e an y o f t h e p ro ced u res fo r s el ect i o n o f

p h y s i ci an s as s et fo rt h i n s u b s ect io n (c) o f [OCGA § 3 4 -9 -2 0 1 ]

, an

em p l o y ee m ay s el ect an y p h y s i ci an t o ren d er serv i ce at t h e ex p en s e o f

t h e em pl o y er.” OCGA § 34 -9 -2 0 1 (f). Fu rt h er, i f an em p l o y er t erm i n at es

t h e e m p l o y ee’ s m ed i cal b en efi t s

, th e em p l o y ee i s en t i t l ed t o s ee a n y

d o ct or s h e ch o o ses an d m ak e th e em p l o y er p ay fo r i t i f s he can p ro ve

s h e was s t i l l i n

j u red at t h at t im e as a res ul t o f t h e acci den t

. If an

em p l o y er-ap p ro v ed p h y s i ci an rel eas es an em p lo y ee b ack i n t o th e wo rk

fo rce as cu red

, th e em

p l o y er h as n o t ad eq u at el y m et i ts d u ty o f p ro v i d i n g

t reat m en t t o t h e em

p l o y ee i f th e em

p l o y ee i s ab l e t o p ro v e t h a t [h er]

s u b s eq u en t m ed i cal p ro b l em s were rel at ed t o [h er] wo rk -rel at ed in ju ry

.

La n e v. W

il l i a ms Pl a n t S

vcs

. , 3 3 0 G a. Ap p

. 4 16

, 4 2 1 (2 ) (7 6 6 SE2 d 4 8 2 ) (2 0 1 4 )

(ci t at i o n s an d p u n ct u at i o n o m i t t ed ).

12T h e B oard fo u n d t h at H awk i n s ’ wo rk -rel at ed i n ju ri es h ad res o l v ed as o f

A u g u s t 1

, 20 1 7

, wh i ch p red at ed h er req ues t fo r a ch an g e i n h er t reat i n g p h y s i ci a n

.

Co n s eq u en t l y

, t h e Bo ard d e n i ed Hawk in s ’ req u es t s fo r a ch an g e i n h er au t h o ri zed

t reat i n g p h y s ici an an d fo r ad d i t i o n al m ed i cal t reat m en t fo r ei t h er of h er wo rk -rel at ed

i n ju ri es

. Rel y i ng o n Bo ard Ru l e 2 0 1 (c), th e s u peri o r co u rt rev ers e d t h e Bo ard ’ s

d en ial

, co n cl u d i n g t h at b ecau s e t h e Em p l oy er di d n o t h av e a v al i d p an el o f ph y s i ci an s

at t h e t i m e o f Hawk i n s ’ i n i t i al Oct o b er 8

, 2 0 1 5 i n j u ry

, Hawk i n s au t o m at i cal l y

p o s s es s ed t h e ri g h t t o a u n i l at eral ch an g e o f ph y s i ci an

. Bo ard Ru l e 2 0 1 (c) p ro v i d es

t h at :

[w] h en a cas e h as n o t b een co n t ro v ert ed b u t t h e e m p l o ye r fai l s t o

p ro v i d e an y o f t h e p ro ced u res fo r sel ect i o n o f p h y s i ci an s as s et fo rt h i n

OCGA § 3 4 -9 -2 0 1 (c), t h e em p l o y ee i s au t h o ri zed t o s el ect a p h y s i ci an

wh o i s no t l i s t e d o n t h e em p l o y er’ s po s ted p an el o f p h y s ici an s

. . . .

Aft er n o t i ce h as b een g i v en t o t h e em p l o y er, th at p h y s i ci an s o s el ect ed

b eco m es t h e au t ho ri zed t reat i ng p hy s i ci an

, an d t h e em p l o y ee m ay m ak e

o n e c h a n g e fro m th at p h y s i ci an t o an o th er p h y s i ci an wi t h o u t ap p ro val

o f t h e em p l oy er an d wi t h o u t an o rd er o f t h e Bo ard

.

In MARTA v. Rei d

, 2 8 2 G a. Ap p

. 8 77

, 8 8 3 (3 ) (6 4 0 SE2 d 3 00 ) (2 0 06 ), we h el d

t h at :

13[t ] h e St at e Bo ard o f W o rk ers ’ Co m p e n s a t i on i s an ad m in i s t rat iv e

co m m i s s i o n

, w i th s u ch ju ri s d i ct i o n

, po wers

, an d au t h o ri t y as m ay be

co n ferred u p o n it b y

t h e Gen eral As s em

b l y . Th e Bo ard i s a creat u re o f

t h e s t at u te, an d h as n o i n heren t p o wers an d n o l awfu l ri gh t t o act ex cep t

as d i rect ed b y th e st at u t e. It m ay ex erci s e i t s ru le-m ak in g p o wers u nd er

a n d wi t h in t h e l aw, b u t n o t ou t s i d e o f t he l aw o r i n a m a n n e r

i n co ns is t en t wi t h t he l aw. Al t h o ug h OCGA § 3 4-9 -6 0 g ran t s t o th e

Bo ard t he po wer t o m ak e ru l e s

, n o t in co n si s t en t wi t h t h i s Ti t le, fo r

carry i n g o u t t he p ro v is i o n s o f t hi s Ti tl e, Bo ard ru l es so pro m u l g at ed m ay

n o t en l arg e, r e d u ce, o r o t h erwi s e affect t he s u b s t an t i ve ri gh t s of th e

p art i es

.

(Ci t at i o n an d p u nct u at io n om i t t ed .) “ It i s arg u ab le t h at [Bo ard Ru l e 20 1 (c)] i s i n v al id

b ecau s e i t en l arg es th e s u b s t an t i v e ri g h t s of cl ai m an t s [.] ” W r i gh t v. O ver n i t e Tr a n s

p.

Co ., 2 1 4 Ga. Ap p

. 8 2 2 , 8 2 4 (2 ) (4 4 9 SE2 d 1 67 ) (1 9 9 4).

Ho wev er, p ret erm i t t i n g wh et h er Bo ard Ru le 2 0 1 (c) i s i n v a l i d

, t he s u p eri o r

c o urt erred i n co n cl u di n g t h at Hawk i n s was en t it l ed t o a ch an g e i n p h ys i c i a n

.

Hawk i n s h as t h e b u rd en o f p ro v i n g t h at t h e m ed i c a l s e r vi ces sh e is seek i n g are

d i rect l y rel at ed t o a wo rk -rel at ed i n ju ry . See Smi t h v. Mr

. S

weep er S t o r es

, In c. , 2 4 7

Ga. Ap p . 7 2 6 , 7 2 8 (1 ) (5 4 4 SE2 d 7 5 8 ) (2 0 0 1 ) (“ W h en m ed i cal s erv i ces are s o u g h t

,

t h en t h e cl ai m an t m

u st pro v e t h at t h o s e s erv i ces are d i rect l y rel at ed t o a wo rk -rel at ed

i n ju ry .”). As d i s cu s s ed i n Di v i s i o n 1

, t h e Bo ard fo u n d

, b a s e d o n ev i d en ce i n t h e

14reco rd

, t h at h er wo rk -rel at ed i n j u r i e s h a d res o l v ed as o f Au gu s t 1, 2 0 1 7

. Th u s

, t h e

Bo ard act ed wi t h i n it s d i s cret io n i n d en y i n g Hawk in s ’ req u es t fo r ad d i t i on al m ed i cal

t reat m en t

. See W

i l l i a ms v. W

es t Cen t r al Ga

. Ba nk

, 2 2 5 Ga. Ap p

. 2 3 7

, 2 38 (4 8 3 SE2 d

6 0 7 ) (1 9 9 7 ) (“ Th e [B] o ard h as b ro ad d i s cret i o n u n der t h e s t an d a r d s s e t fo rt h in

OCGA § 3 4 -9 -2 0 0 (a) t o d et erm i n e wh at m ed i cal treat m en t th e em p l oy er an d i n s u rer

wi l l be req u i red t o f

u r n i s h t o an i n

ju red em

p l o y ee.” (ci tat i o n s o m i t t ed )).

Co n s eq u en t l y

, t h e q u es t io n o f wh i ch p ro v id er sh o u l d b e au t h o riz e d f or su ch t reat m en t

i s m o ot

, an d t h e s u p eri o r co urt erred i n co n cl ud i n g t h at Hawk i n s w as en t i t l ed t o a

ch an ge i n h er au t h ori zed t reat i n g p h y s i ci an

.

3

. Ap p el l an t s n ex t co nt en d t h at t h e s u p eri o r co u rt erred i n r ev ers i n g t h e

Bo ard ’ s d en i al o f an award o f at t o rn ey fees t o Hawk i n s . W e ag ree.

Th e B oard fo u n d t hat an as s es s m en t o f at to rn ey fees was n o t warran ted b ecau s e

n ei t h er i n s u rer h ad act ed b as ed o n u n reas o nab l e g ro u n d s

. W h et h er p ro ceed i n g s h av e

b een d efen d ed wi t h o u t reas o n ab l e g ro u n d s “ p res en t s an i ss u e o f fact fo r

d et erm i n at i o n b y t h e Bo ard

, an d wh ere t h ere i s an y ev i den ce t o s u p p o rt t he Bo ard ’ s

award t h e co u rt m

u st affi rm .” Mo t o r Co n vo y, In c. v. Ma d

d ox

, 1 72 G a. Ap p

. 4 3 0

, 4 3 1

(3 2 3 SE2 d 2 3 5 ) (1 9 8 4 ) (ci t at i o n s o m i t ted ). Th e s u p eri o r co u rt rev ers ed t h e Bo ard ’ s

fi nd i ng b as ed o n i t s co n cl u s i o n th at St at e Farm “ i l l eg al l y den i ed [Hawk i n s ] h er

15s t at u to ry

ri g ht t o a ch an g e o f p h y s i ci an b y co n t ro v ert i n g al l m ed i cal t reat m en t aft er

[Hawk i n s ] t i m el y as s ert ed t h i s ri g h t .” As d i s cu ss ed i n Di v i s i o n 2

, t h e s up eri o r co u rt

erred i n co n cl u di n g t h at H awk i ns w as au t o m at i cal l y en t i t l ed t o a ch an g e of p hy s i ci an

.

Th e reco rd s u p p o rt s t h e Bo ard ’ s d et erm i n at i o n t hat n ei t h er i n s u rer act ed bas ed o n

u n reas o nab l e g ro u n d s

. Co n seq u en t l y

, we rev ers e t he s u p eri o r co u rt ’ s award o f

at t o rn ey fees t o Hawk i n s

.

Ju d g men t r ever sed . McFa d

d en , C.J., a n d Do

yl e, P. J., co n cu r

.

16