Case Name: ITT-CONTINENTAL BAKING COMPANY et al. v. POWELL
Court: Court of Appeals of Georgia
Jurisdiction: Georgia
Decision Date: 1987-03-20
Citations: 182 Ga. App. 533
Docket Number: 73492
Parties: ITT-CONTINENTAL BAKING COMPANY et al. v. POWELL.
Judges: Birdsong, C. J., and Deen, P. J., concur. Sognier, and Pope, JJ., concur in the judgment only. Carley, J., concurs in Divisions 1 and 2.and dissents as to Division 3. McMurray, P. J., Banke, P. J., and Benham, J., dissent.
Reporter: Georgia Appeals Reports
Volume: 182
Pages: 533–539

Head Matter:
73492.
ITT-CONTINENTAL BAKING COMPANY et al. v. POWELL.
(356 SE2d 267)

Opinion:
Beasley, Judge.
We granted ITT's application for discretionary review of the trial court's affirmance of a workers' compensation award to claimant Powell.
Claimant's duties required prolonged standing on a concrete floor. Because of swelling and pain in his feet, claimant consulted a podiatrist not on the employer's list of approved physicians. When the problems worsened claimant left his employment on June 9, 1984, and had surgery on June 19. He returned to work in September, having filed a claim for medical insurance, but then at the end of November he notified ITT that he wished to file a workers' compensation claim.
ITT filed a WC-1 form (Employer's first report of injury) with the Board on December 21. It contained a notice to controvert which recited that "Mr. Powell's present disability is the result of a congenial [sic] defect and is unrelated to his employment with Continental Baking."
The ALJ found: Shortly after he began work as an oven operator with ITT, claimant noticed his feet were gradually getting worse. His supervisor noticed he was limping with increased frequency. Claimant told his supervisor that his feet had bothered him for a long time but he had begun to limp after starting work. The supervisor told claimant to see a doctor. Subsequently claimant told his supervisor that prolonged standing on concrete caused his feet to swell and he was to have surgery on June 9, 1984. When claimant returned to work on September 8, he changed jobs to dough mixing at a higher wage and regular hours. After his discharge on March 24, 1985, claimant related he had problems with his feet in that he was unable to bend his toes and thus perform any work requiring him to bend or squat.
Claimant's podiatrist found multiple medical problems with his feet. The podiatrist's opinion was that claimant's conditions were preexisting and became worse with time, and that prolonged weight bearing on concrete surfaces hastened the onset of pain. A doctor for ITT testified that it was not clear whether claimant's employment caused the foot pain but it did not cause his foot deformity. The doctor questioned the use of surgery rather than conservative methods and stated he did not think there was any clearcut medical opinion as to whether a short history of working on concrete floors would justify foot surgery or workers' compensation coverage.
Based on these facts, the ALJ found claimant sustained a compensable injury on June 9 and that he underwent a further change of condition from ability to work to total disability on March 24, 1985. Claimant was awarded medical benefits for the services of his podiatrist as well as income benefits from June 9 to September 8, 1984, and from March 24, 1985, until terminated by law. The full board adopted the ALJ's findings and added that "claimant's inability to secure suitable employment after March 24, 1985, was caused by his compensable injury."
ITT posits three grounds for its position that the superior court erred in affirming the award: 1) claimant's condition did not arise out of and in the course of his employment and thus he did not suffer a compensable injury; 2) claimant used a physician not on the panel, relieving ITT of responsibility for medical expenses; 3) claimant was not entitled to disability benefits after his termination because there was no evidence that he was unable to secure employment due to his alleged foot condition.
1. Discretionary review was not granted to reexamine the any evidence rule or the principle that an employer takes his employee as it finds him and assumes the risk of a diseased condition aggravated by injury. Colonial Stores v. Hambrick, 176 Ga. App. 544, 545 (3) (336 SE2d 617) (1985). Since there was some evidence that claimant's preexisting condition was aggravated by his job, the award of income benefits from June 9 to September 8, 1984, will not be disturbed. Home Indem. v. Brown, 141 Ga. App. 563, 566 (2) (234 SE2d 97) (1977); Home Ins. Co. v. McEachin, 151 Ga. App. 567 (260 SE2d 560) (1979).
2. The medical expenses are not ITT's responsibility. Claimant made no effort to select from the panel of physicians but chose his doctor and used his services before the filing by employer of a notice to controvert. State of Ga. v. Tungler, 181 Ga. App. 21 (351 SE2d 248) (1986) is controlling. Accord Ledbetter v. Pine Knoll Nursing Home, 180 Ga. App. 654, 656 (2) (350 SE2d 299) (1986).
Initially, claimant argued that since the employer ITT controverted the claim it could not restrict his choice of physicians under Boaz v. K-Mart Corp., 254 Ga. 707 (334 SE2d 167) (1985). Tungler distinguished Boaz on the fact that in Tungler, notice to controvert was given after the employee's choice of physicians. Of course, if within 21 days after knowledge of the injury the employer files a notice to controvert the claim, then from that point forth the employee may select any physician he chooses and the employer need give no further notice that it will not pay medical expenses.
By supplemental brief, claimant changed tack, pointing out that the employer failed to file a notice to controvert within 21 days of notice of the accident. From that premise it is argued that the employer should not be allowed to question claimant's selection of a physician. This argument overlooks that the primary effect of the notice to controvert is on the payment of income benefits.
A distinction must be recognized between income benefits and medical expenses. Income benefits are to be paid automatically once the employer is notified of the injury, unless the employer in return informs the employee by means of a notice to controvert that in its view the injury is not compensable as not arising out of and in the course of the employment, etc. OCGA § 34-9-221.
Employer-liable medical expenses, on the other hand, initiate with the services of a physician selected from the approved list (except when justified otherwise) as required by OCGA § 34-9-201 (c). When the expenses arise from treatment by one not on the approved list, nothing would trigger a decision to pay these expenses or controvert liability for them until the employer is informed of their incurrence.
This fundamental difference between the two types of claims and how they mature is illustrated by a typical example. An employee is injured on the job and notifies the employer who, since the injury is job-related, begins to pay income benefits while the employee is absent from work. OCGA § 34-9-221. Sometime later the employee is operated on by a physician not on the list. The employer still continues to pay disability income benefits. The employee then seeks payment of his medical expenses from the employer. At this point, the employer would inform the employee of its refusal to pay such medical benefits, on the ground that it is not responsible for them because the expenses did not originate with a listed physician (OCGA § 34-9-201 (c)). This would not affect the employer's continuance, or refusal to continue, the payment of income benefits.
Rule 221 (d) of the Workers' Compensation Board provides: "To controvert in whole or in part the right to income benefits or other compensation, use Forms WC1 or WC3." Even if an employer is required to notify the board of its refusal to pay medical expenses, it is not a statutory requirement as the statutory scheme regarding time constraints for a "notice to controvert" — the 21-day period after knowledge of the injury of OCGA § 34-9-221 (d) and the "within 60 days of the due date of the first payment of compensation" of OCGA § 34-9-221 (h) — relates solely to income benefits. As we have endeavored to illustrate, an employer cannot be expected to refuse to pay an unapproved medical expense until a request for payment is made. This event may occur a considerable time later than 21 days after knowledge of the injury or 60 days of the first payment due date; it varies from case to case. Only from the time it learns that payment is sought would the employer have any obligation to respond.
Based on claimant's actions here, the employer had no reason to assume that claimant was seeking workers' compensation medical benefits. Its failure to file a notice to controvert earlier does not preclude it from denying responsibility for medical services from a physi cian not on the posted panel. The Board erred in awarding medical expenses.
3. The composite finding of the ALJ and the Board was that claimant was unable to perform any job requiring him to bend or squat and that his inability to secure suitable employment after March 24, 1985, was caused by his compensable injury.
The claimant was not discharged for any reason relating to his injury. In fact, claimant stated that he was terminated because one of his foremen said he was drunk. He denied being intoxicated.
"It is well settled that where an employee returns to work following a disabling injury and is then discharged for a cause unrelated to the injury, he is entitled to receive benefits for loss of earning capacity if he is unable to find other employment because of his disability." Gilmer v. Atlanta Housing Auth., 170 Ga. App. 326, 327 (316 SE2d 535) (1984). Where an employee seeks resumption of his disability income benefits following his job termination "the only relevant 'change of condition' is a change in the employee's 'wage-earning capacity,' not in his physical condition . . . The requisite economic change in condition exists when the employee is able to demonstrate that, as a proximate result of his previous work-related injury, he is unable to secure suitable employment elsewhere." Ga. Power Co. v. Brown, 169 Ga. App. 45, 48-49 (311 SE2d 236) (1983). Accord J & M Transp. Co. v. Crowe, 173 Ga. App. 13, 14 (1) (325 SE2d 412) (1984). The claimant has the burden of establishing this. Hartford Accident &c. Co. v. Bristol, 242 Ga. 287, 288 (248 SE2d 661) (1978).
The Board made a conclusionary finding that claimant's inability to find suitable employment was caused by his injury. No facts sustain that conclusion and it must be reversed. There is no showing that claimant was in any way unable to find suitable work, that work was unavailable, or that he made any effort to discover the status of the job market.
Judgment affirmed in part and reversed in part.
Birdsong, C. J., and Deen, P. J., concur. Sognier, and Pope, JJ., concur in the judgment only. Carley, J., concurs in Divisions 1 and 2.and dissents as to Division 3. McMurray, P. J., Banke, P. J., and Benham, J., dissent.