Autozone, Inc. et. Al. v. MESA

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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?

Summary:

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.

 

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