Court of Appeals of Georgia, A17A1294
Decided: September 8, 2017
Issues: Did the Superior Court misapply the “any evidence” standard when reviewing the Board’s ruling specifically with regard to the weight of medical evidence in the subject claim?
The employer, Autozone, Inc, appealed the judgment of the superior court, which reversed, in part, the State Board’s denial of certain benefits to the claimant. The employer claimed that the superior court misapplied the “any evidence” standard when reviewing the Board’s ruling and erred when finding that the Administrative Law Judge, who initially denied the claimant’s claim, acted “contrary to law.” The Court of Appeals agreed and reversed the superior court’s order.
The Court of Appeals reiterated the facts of the claim viewed in the light most favorable to the employer/appellant, as the party that prevailed before the Board. In that regard, the claimant worked as a delivery driver for the employer. As a result of a work-related car accident in November 2010, she injured her neck and back. Following the accident, the claimant returned to work in a light duty job, in which she performed clerical work because the medications from her work injury made her too dizzy to perform her normal job as a driver. However, the claimant returned to work in her regular position as a driver after she was released to do so by her physician in January 2011.
The claimant continued to treat for her work injuries and underwent a lumbar MRI in February 2011, which one of the claimant’s physicians, Dr. John Rumbaugh, deemed “normal.” Thereafter, a referral physician, Dr. Allen Goodrich, reviewed the same MRI, also found it was normal, concluded that the claimant had reached maximum medical improvement and released her to full duty work. The claimant underwent another lumbar MRI in September 2011, which a third physician, Dr. Amar Rajadhyaksha, concluded was normal and who also placed the claimant at maximum medical improvement, released her to full duty work, and assigned a zero percent impairment rating. In October 2011, the claimant saw Dr. Tamar Ference, who ordered a cervical MRI, which he concluded was normal. He recommended physical therapy and that the claimant not work until her condition improve.
In January 2012, the claimant presented to Dr. Jonathan Hyde, who reviewed the claimant’s prior MRIs and an updated lumbar x-ray, as well as a new EMG/NCV, and opined all were normal. However, following a diagnostic right sacroiliac (“SI”_ joint injection, Dr. Hyde opined the injection was positive for SI dysfunctional pain and recommended a fusion of the claimant’s right SI joint and placed her on no-work status. The claimant declined surgery and continued to work for the employer until March 2012, when she claimed she could not continue working due to back pain. Dr. Hyde assigned light duty restrictions and the claimant began receiving TTD benefits until April 2012.
The claimant saw Dr. Hyde on three more occasions over the next two and a half years for complaints of back pain. In May 2012, Dr. Hyde concluded that the claimant was “fully capable of working within the restrictions given,” but questioned whether she wanted to return to work. He evaluated the claimant again in September 2013 and December 2014, but did not note any changes or make any additional treatment recommendations, other than the SI joint fusion he had previously recommended. At that time, however, the claimant chose to proceed with surgery.
The employer/insurer sent the claimant for an IME with Dr. Peter Millheiser, who concluded that the claimant did not have any evidence of sacroiliac dysfunction or permanent impairment and did not require the recommended fusion, and, in fact, was capable of full duty work and did not need any additional treatment. Thereafter, the employer/insurer refused to authorize the surgery that Dr. Hyde had recommended.
The claimant did not work for two years after she quit her job with the employer. At that time, she became a nanny for a six year old boy, and was working in that position full-time when she saw Dr. Hyde in December 2014 and Dr. Millheiser in April 2015. She was still working in that position when she filed the subject workers’ compensation claim seeking authorization for surgery.
The parties submitted the matter on briefs and documentary evidence. The ALJ denied the claimant’s request for benefits on the basis that surgery was not reasonable or necessary, relying “particularly” on Dr. Millheiser’s finding that the claimant had no SI joint dysfunction in April 2015, and was not swayed by Dr. Hyde’s opinion because Dr. Millheiser’s findings were supported by numerous earlier medical opinions finding no joint dysfunction. The Board adopted the ALJ’s decision, finding the ALJ was in the best position to determine the credibility and weight of the evidence and that the findings of fact were supported by a preponderance of competent and credible evidence, to which the ALJ appropriately applied the law.
The claimant appealed to the superior court, which set aside the Board’s decision and ruled in favor of the claimant. The superior court stated that the record contained “no objective medical evidence” that the proposed surgery was not reasonable and necessary. Moreover, the court explained that Dr. Hyde based his recommendation for surgery on the diagnostic SI injection, whereas Dr. Miller performed “no medical testing of any kind,” and relied only on physical examination. Finally, the superior court found the decision of the ALJ and Board was contrary to the law because O.C.G.A. 34-9-200(a) requires an employer to provide benefits for treatment, but expressed concern that the Board relied on Dr. Millheiser’s opinion to relieve the employer of its “obligation to furnish medical treatment” prescribed by the ATP. As such, the superior court set aside the Board’s decision and remanded the case for further review in keeping with the findings of the superior court.
The employer appealed to the Court of Appeals based on two errors: the superior court’s misapplication of the “any evidence” standard and, second, with regard to substituting its opinion regarding the weight to be assigned the conflicting opinions of Dr. Hyde and Dr. Millheiser.
When the Board’s decision is appealed to the superior court, the Board’s decision is conclusive and may not be set aside unless there was insufficient competent evidence to support the decision, the decision is contrary to law, or another statutory basis exists. The superior court is not authorized to disregard competent evidence it believes is not credible, reweigh the evidence, or resolve conflicting evidence. Because there was substantial evidence in this claim to support the conclusion of the Board that the joint fusion surgery was not reasonable or medically necessary, the Court held that it was “for the ALJ and Board to determine which opinion was more credible and resolve this conflict, not the superior court.” Because the superior court substituted its judgment regarding whether the opinion of Dr. Hyde or Dr. Millheiser should carry more weight, the superior court exceeded its authority, the Court of Appeals reversed the superior court.
CONTENT IS INFORMATION ONLY, NOT ADVICE
Thank you for visiting the web site of Sponsler, Bishop, Koren & Hammer, P.A. ("SBKH"). The information contained on the SBKH Web site is provided for educational and informational purposes only. The contents of this site are not and should not be construed as legal advice. The web site is not an offer to perform services on any matter. This website contains general information from a variety of sources and might not reflect current legal developments, verdicts or settlements. We do not undertake to update material in our web site to reflect subsequent legal or other developments.
NO RELATIONSHIP OR OBLIGATION ARISES FROM USE OF THE SITE
The law differs in every jurisdiction, and you should not rely on any opinion except that of an attorney you have retained, who has a professional duty to advise you after being fully informed of all the pertinent facts, and who is licensed in the applicable state, and is familiar with the applicable law. Internet subscribers and online readers should seek professional counsel about their legal rights and remedies. You should not act or refrain from acting on the basis of any information found this site. Any actions or decisions about your legal rights should be based on the particular facts and circumstances of your situation, and appropriate legal advice from.
SBKH expressly disclaims all liability with respect to actions taken or not taken based upon any information or other contents of this site. Viewing the SBKH site, or communicating with SBKH by Internet e-mail or through this site, does not constitute or create an attorney-client relationship with anyone. The content and features on this site do not create, and are not intended to create, an attorney-client relationship, and shall not be construed as legal advice. This content and features of this web site, including means to submit a question or information, do not constitute an offer to represent you.
CONFIDENTIALITY IS NOT GUARANTEED
Any information sent to Sponsler, Bishop, Koren & Hammer, P.A. via Internet e-mail or through the website is not secure and is done on a non-confidential basis. SBKH respects the privacy of any person who contacts our firm, and we will make reasonable efforts to keep information private, but because of the nature of Internet communications and the absence of an attorney/client relationship, we cannot promise or guarantee confidentiality.
DISCLAIMER - THIS SITE DOES NOT PROVIDE MEDICAL DIAGNOSIS OR ADVICE.
The content provided on this site, such as documents, text, graphics, images, videos, or other materials, are for informational purposes only. The information is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always consult a physician for diagnosis and treatment of any medical condition or for any questions you may have regarding a health concern. Never disregard professional medical advice or delay in seeking it because of something you have read or seen on this site. Links to other sites are provided for information only. Use of trade names is for identification only and does not constitute endorsement by Sponsler, Bishop, Koren & Hammer, P.A.
Thank you for visiting the web site of Sponsler, Bishop, Koren & Hammer, P.A. ("SBKH"). This web site was created by SBKH so that you could learn more about the legal services that we offer and other information related to the law. These contents are for informational purposes only. None of the information at this web site is intended to constitute, nor does it constitute, legal advice, and none of the information necessarily reflects the opinions of SBKH, its attorneys or clients. Please read our Disclaimer, which is incorporated into these Terms, for additional limitations on the use and effect of this web site.
SBKH IS NOT RESPONSIBLE FOR CONTENT
SBKH may periodically change, remove, or add the material in this web site without notice. This material may contain technical or typographical errors. SBKH does not guarantee its accuracy, completeness or suitability. SBKH assumes no liability or responsibility for any errors or omissions in the contents of this web site. Your use of this web site is at your own risk. Under no circumstances shall SBKH or any other party involved in the creation, production or delivery of this web site be liable to you or any other person for any indirect, special, incidental, or consequential damages of any kind arising from your access to, or use of, this web site. IN NO EVENT SHALL SPONSLER, BISHOP, KOREN & HAMMER, P.A. BE LIABLE FOR ANY SPECIAL, INDIRECT OR CONSEQUENTIAL DAMAGES RELATING TO THIS MATERIAL, FOR ANY USE OF THIS WEBSITE, OR FOR ANY OTHER LINKED WEBSITE.
THIRD-PARTY WEB SITES
STATE LAWS VARY
SBKH lawyers are licensed to practice law only within the states of Arizona, Georgia, Mississippi, New York, Illinois, Alabama, Tennessee, Texas, New Jersey, Arizona, Missouri, Kentucky, North Carolina, California, Florida, and Pennsylvania but we affiliate or form relationships with lawyers throughout the United States. SBKH may refer prospective clients to other law firms located throughout the country, who form relationships with SBKH, and are experienced in handling such cases. SBKH may also undertake legal representation in certain cases, and will affiliate with other legal counsel located throughout the country to provide legal representation.
The laws of each State are different. This web site contains information about general or coSBKHon rules that apply in some states. This web site also contains information about verdicts or settlements in past cases. You cannot assume that the same rules apply, or that the same result would occur, in your state or any particular state.
The Statute of Limitations is especially important. Every state has laws called the "statute of limitations" which set a deadline to file a lawsuit. That means that a lawsuit filed too late may be thrown out, regardless of the defendant's fault or the severity of the injuries, Some states have a two-year period for negligence injury claims; the time period in other states may be longer or shorter. Insurance policies, particularly homeowners insurance, may require that suit be filed within one year of a loss. Some states allow claims against government agencies, but require a written notice very soon after the accident, perhaps within three months. Because investigation and research is needed to identify all possible defendants and theories of recovery, if you have an accident or injury, you should consult a lawyer as soon as possible.
LEGAL AND ETHICAL REQUIREMENTS
SBKH has tried to comply with all legal and ethical requirements in compiling this web site. We welcome comments about our compliance with the applicable rules and will update the site as warranted, upon learning of any new or different requirements. We only want to represent clients based on their review of this web site, if it complies with all legal or ethical requirements.
To the extent that the professional responsibility rules of any jurisdiction require us to designate a principal office or an attorney responsible for this web site, Sponsler, Bishop, Koren & Hammer, P.A. designates its office in Tampa, Florida (USA), 100 South Ashley Drive, Suite 2150, Tampa, FL 33602 1600, and attorney Warren K. Sponsler.
GOVERNING LAWS IN CASE OF DISPUTE; JURISDICTION
Copyright ©2014 Sponsler, Bishop, Koren & Hammer, P.A. All rights reserved. All materials presented on this site are copyrighted and owned by Sponsler, Bishop, Koren & Hammer, P.A., unless in the public domain or attributed to another source. Any republication, retransmission, reproduction, downloading, storing or distribution of all or part of any materials found on this site is expressly prohibited.
As you navigate within the Site, SBKH may be collecting and tracking personal information, either by asking you to tell SBKH something about yourself (such as your name, address or email address) or by using data-tracking software that tells us what parts of the Site you have browsed. SBKH may collect other information about you, such as your IP address, geographic information, the type of the web browser and operating system you use, and any other information that your web browsing software or Internet Service Provider automatically provides to our Site. We may be collecting and tracking information about the activities in our Site you engage in to help us know what users are interested in. We may also use "cookies" to keep track of visitors. A cookie is a small file stored on the hard drive of your personal computer. If your web browser allows, you may disable the placement of cookies on your hard drive. Disabling the placement of cookies may prevent you from accessing or using portions of the Site. Except as provided below, the Site does not currently share or sell any other information. Except as provided herein, no personally identifiable information is collected beyond that which is identified in this section of the Site Terms. You agree that we may aggregate any information which we collect or maintain, and that we may use such aggregated information for internal analysis or for marketing purposes. We may disclose aggregate, de-identified data (i.e. stripped of information that identifies you) to third parties in connection with such analysis and/or marketing. By using the Site, you expressly assent to the collection and use of the limited information identified.
We may disclose your information to: (1) comply with applicable laws; (2) respond to governmental inquiries; (3) comply with valid legal process; (4) protect our rights or property; or (5) facilitate your request for a free case evaluation. By registering and using this Site, you acknowledge that the processing of your information for the purposes described above may involve the transfer of such information from within the United State of America (USA) to countries outside the USA whose data protection regulation may not be as stringent as that within the USA×