Opinion ID: 430490
Heading Depth: 2
Heading Rank: 1

Heading: The Requirement of an Employee Request for Medical Services

Text: 15 Section 7(d) of the Act provides in part that: 16 An employee shall not be entitled to recover any amount expended by him for medical or other treatment or services unless he shall have requested the employer to furnish such treatment or services, or to authorize provision of medical or surgical services by the physician selected by the employee, and the employer shall have refused or neglected to do so, or unless the nature of the injury required such treatment and services and the employer or his superintendent or foreman having knowledge of such injury shall have neglected to provide or authorize the same .... 17 33 U.S.C. Sec. 907(d) (1976); see also 20 C.F.R. Sec. 702.421 (1983). 18 Both the ALJ and the Benefits Review Board found that Mr. Lloyd never requested the employer to furnish or authorize the services provided by Dr. Schuster. However, [w]hen an employee is told by the employer's physician that 'he is recovered from his injury and requires no further treatment, he has, in effect, been refused treatment by the employer,' and is therefore entitled to reimbursement for all necessary treatment subsequently procured on his own initiative. Shahady v. Atlas Tile & Marble Co., 682 F.2d 968, 970 (D.C.Cir.1982) (per curiam) (quoting Atlantic & Gulf Stevedores, Inc. v. Neuman, 440 F.2d 908, 911 (5th Cir.1971)), cert. denied, --- U.S. ----, 103 S.Ct. 786, 74 L.Ed.2d 993 (1983); see also George O. Buckhaults, 2 BEN.REV.BD.SERV. (MB) 277, 279 (Sept. 19, 1975). 19 In the present case, the Board found that Dr. Gordon did refuse to provide further treatment to Mr. Lloyd and that Dr. Gordon was the employer's physician, so that Dr. Gordon's refusal is attributable to the employer. These Board determinations reversed those of the ALJ, who had found that Dr. Gordon did not refuse to provide further treatment and that Dr. Gordon was not the employer's physician. Under the Act, the Board is required to treat the findings of the ALJ as conclusive if they are supported by substantial evidence in the record considered as a whole. 33 U.S.C. Sec. 921(b)(3) (1976); see also 20 C.F.R. Sec. 802.301 (1983). We conclude that the ALJ's findings are supported by substantial evidence and that the Board therefore committed legal error by substituting its own contrary findings. 20
21 We consider first the ALJ's finding that Dr. Gordon did not refuse to provide further treatment to Mr. Lloyd. Dr. Gordon testified that when he released Mr. Lloyd from treatment on January 28, 1976, he remained available to perform any follow-up treatment that Mr. Lloyd should request. Dr. Gordon further testified that he told Mr. Lloyd that he could call and come back if he had any further trouble. It was not until over a year and a half later, on August 22, 1977, that Mr. Lloyd first sought treatment from Dr. Schuster. The record supports the conclusion that Dr. Gordon's prior conduct did not indicate that he would have refused treatment had Mr. Lloyd requested it at that time. In Shahady, in contrast, the claimant testified that he actually did request further treatment from the employer's physician, and that the physician told him that [h]e was fine, there was nothing wrong with [his] leg, and to come back and see him in a year. 682 F.2d at 969. Within a few months of this discharge the claimant independently procured treatment. Id. at 970. In Shahady, therefore, the record clearly established that, at the time when the employee independently procured treatment, he had ample reason to believe that the employer's physician would have refused to provide any treatment. In the present case, however, we conclude that the ALJ's finding that Dr. Gordon did not refuse to provide further treatment to Mr. Lloyd is supported by substantial evidence in the record considered as a whole and is conclusive. 22 The Board's basis for rejecting the ALJ's finding on this point is meritless. The Board concluded that Dr. Gordon's actions were tantamount to a mistaken diagnosis. 4 In James Washington, 3 BEN.REV.BD.SERV. (MB) 474, 479 (May 10, 1976), the Board held that a mistaken diagnosis can be equivalent to a refusal of treatment by the employer. In Washington, the employer's doctors diagnosed the claimant's symptoms as arthritis, while the claimant's own physician correctly diagnosed the condition as two degenerated discs. In the present case, in contrast, the Board admits that Dr. Gordon and Dr. Schuster did not actually diagnose claimant's ailments differently. Each found back pain complicated by accompanying emotional problems. 5 The Board concluded, however, that Dr. Gordon's method of treatment was tantamount to a mistaken diagnosis because it differed considerably from Dr. Schuster's method of treatment, which subsequently was found by an administrative law judge to be reasonable and necessary. 6 23 The Board's conclusion follows from its premises only if there is exactly one right method of treatment. But that, of course, is not the case. Capable doctors can and frequently do disagree about what course of treatment will most benefit the patient. We do not foreclose the possibility that a demonstrably improper method of treatment might constitute a refusal to provide treatment. In the present case, however, the record is devoid of any evidence that Dr. Gordon's method of treatment was medically unacceptable. Indeed, we find no evidence even to indicate that Mr. Lloyd's recovery would have been less successful had he remained under Dr. Gordon's care. 24
25 We next consider the ALJ's alternative finding that Dr. Gordon was not the employer's physician, so that even if Dr. Gordon had refused to provide further treatment, his refusal could not be attributed to the employer. The Board disagreed with the ALJ and found that Dr. Gordon was the employer's physician. 26 We note at the outset that the term employer's physician does not appear in the Act and is not defined in the case law. The constructive refusal doctrine seems to require, however, that in order for a doctor to be an employer's physician, the relationship between the doctor and the employer must be such that it is reasonable to assume that the employer will adopt or has adopted the doctor's medical conclusions. Only in such a case would an employee be justified in concluding from the fact that the doctor tells him that he is recovered and requires no further treatment that the employer will refuse to provide or authorize further treatment if requested. 27 For example, in Atlantic & Gulf Stevedores, Inc. v. Neuman, 440 F.2d 908 (5th Cir.1971), the employer's counsel stated at a hearing before the Deputy Commissioner that the employee was fully recovered and that the employer would contest the need for surgery should it become an issue. When the employee's doctor testified that the employee needed surgery, the employer offered the testimony of two doctors who previously had examined the employee and had reported that he was fit to return to work. Both doctors were of the opinion that surgery was unnecessary. In such circumstances, it was clearly reasonable for the employee to attribute the employer's physicians' conclusions to the employer, and subsequently to obtain further treatment on his own without first requesting the employer's authorization. 28 In the present case, then, we must examine the relationship between Dr. Gordon and the employer to determine whether there was substantial evidence to support the ALJ's determination that Dr. Gordon was not the employer's physician. The Board had two grounds for concluding, contrary to the ALJ, that Dr. Gordon was the employer's physician. The first ground is that Dr. Hyde, a physician at the alleged employer's clinic, referred Mr. Lloyd to Dr. Gordon. There is no indication in the record, however, that the Workmen's Clinic, where Mr. Lloyd initially was taken, actually is the employer's clinic or has any connection with the employer. While it is true that the employer directly referred Mr. Lloyd to Dr. Hyde, who in turn referred him to Dr. Gordon, given that both Dr. Hyde and Dr. Gordon were apparently independent physicians, this chain of events establishes too attenuated a relationship between Dr. Gordon and the employer to make him the employer's physician. 29 The second ground for the Board's conclusion is that the employer called Dr. Gordon as its witness. The mere fact that an employer calls as a witness a doctor who previously treated the employee does not retroactively make the doctor the employer's physician. The record in this case does not disclose any significant ongoing relationship between Dr. Gordon and the employer prior to Mr. Lloyd's decision to obtain treatment from Dr. Schuster. Accordingly, we conclude that the ALJ's finding that Dr. Gordon was not the employer's physician is supported by substantial evidence in the record considered as a whole and is conclusive.
30 We conclude that the ALJ's finding that Dr. Gordon did not refuse to provide further treatment to Mr. Lloyd is supported by substantial evidence. We also agree that, even if Dr. Gordon had refused, he was not the employer's physician and, therefore, his refusal could not be attributed to the employer. Accordingly, we uphold the ALJ's judgment that Mr. Lloyd unjustifiably failed to comply with the requirements of section 7(d) of the Act and section 702.421 of the regulations.