Brown v. Transamerica IMS

407 S.E.2d 430, 200 Ga. App. 272, 1991 Ga. App. LEXIS 966
CourtCourt of Appeals of Georgia
DecidedJune 19, 1991
DocketA91A0102, A91A0103
StatusPublished
Cited by7 cases

This text of 407 S.E.2d 430 (Brown v. Transamerica IMS) is published on Counsel Stack Legal Research, covering Court of Appeals of Georgia primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Brown v. Transamerica IMS, 407 S.E.2d 430, 200 Ga. App. 272, 1991 Ga. App. LEXIS 966 (Ga. Ct. App. 1991).

Opinion

Sognier, Chief Judge.

Harry Brown was an employee of Transamerica IMS when he sustained a work-related injury to his back. During the course of his treatment with his employer-approved physician, Dr. Brian Bothe, Brown began to experience depression as a result of his injury, and Dr. Bothe referred him to Dr. Michael McGarry, a psychologist. Brown did not like Dr. McGarry and requested that Dr. Bothe refer him to Dr. Robert George, a psychologist who was treating Brown’s mother in law. Dr. Bothe agreed to refer Brown to Dr. George on August 1, 1988. On August 31,1988, Dr. Bothe told Brown not to see Dr. George and asked him either to return to Dr. McGarry or to accept a referral to another psychologist. Transamerica IMS and its insurer (hereinafter referred to collectively as “Transamerica”) paid the fees for Brown’s visits to Dr. George through August 31, 1988, but filed a “Notice to Controvert Payment of Compensation” as to Dr. George’s *273 fees after that date.

The administrative law judge found that Transamerica was not liable for the unpaid medical bills of Dr. George on the alternative bases that the referral by Dr. Bothe to Dr. George was not valid because it originated with Brown or, if originally valid, the referral was revoked by Dr. Bothe no later than August 31, 1988. The ALJ rejected Transamerica’s argument that psychological treatment was not reasonable and necessary. The State Board of Workers’ Compensation adopted the findings and conclusions of the ALJ. The Superior Court of Fulton County rejected the ALJ’s reasoning that a referral is rendered invalid because it originates with an employee. The superior court agreed with the ALJ that the employer-selected physician has the authority to revoke a referral, but held that the revocation must be based upon the sound and reasonable discretion of the employer-selected physician. Based on the absence of any evidence indicating the reason behind Dr. Bothe’s revocation of his referral of Brown to Dr. George, the superior court reversed the award and remanded it to the Board for the purpose of determining why Dr. Bothe revoked his referral of Brown to Dr. George. We granted the applications for discretionary review filed by Brown and Transamerica.

1. In Case No. A91A0102, Brown contends the superior court erred by finding that an employer-selected physician has the authority to revoke a referral of the employee to another physician after the employee has begun treatment with that physician. OCGA § 34-9-201 provides that “(c) [a]n employee may accept the services of a physician selected by the employer from the panel [of physicians in OCGA § 34-9-201 (b)] or may select another physician from the panel. . . . The physician selected under this subsection may arrange for any consultation, referral, and extraordinary or other specialized medical services as the nature of the injury shall require. The employer shall not be responsible for the charges for medical services furnished or ordered by any physician or other person selected by the employee in disregard of this subsection, (d) Upon the request of an employee or an employer, the board may order a change of physician or treatment as provided under Code Section 34-9-200.” OCGA § 34-9-200 (b) provides that “[u]pon the request of an employee or an employer, the board may in its judgment, after giving notice in writing of the request to all interested parties and allowing any interested party ten days from the date of said notice to file in writing its objections to the request, order a change of physician or treatment and designate other treatment or another physician.”

In Holcombe v. Brown Transport Corp., 253 Ga. 719 (324 SE2d 446) (1985), when injured employee Holcombe moved out of the state, his employer-selected physician, Dr. Grady, provided him with authorization to obtain physical therapy and referred him to a Dr. *274 Boehm in Tennessee. Holcombe then sought approval from his employer to obtain not only physical therapy but also other treatment, including biofeedback and group therapy, from a second Tennessee physician, Dr. McAllister. The employer acknowledged the validity of Dr. Grady’s referral for physical therapy and paid for Dr. McAllister’s physical therapy treatment, but refused to pay for the “unauthorized” biofeedback and group therapy treatment. The Supreme Court granted the writ of certiorari to this court’s opinion in Brown Transport Corp. v. Holcombe, 171 Ga. App. 532 (320 SE2d 552) (1984) to consider the “statutory remedy for the claimant in the situation wherein the employer contends that certain treatment, for which compensation is being sought, is unauthorized.” Holcombe, supra at 720. The Supreme Court reviewed OCGA § 34-9-201 (c) and noted that “[o]n its face, it might be assumed that this statute provides that the selected physician [from the panel in OCGA § 34-9-201 (b)] can make arrangements — for any consultation, referral, and extraordinary or other specialized medical services as the nature of the injury shall require — which will be automatically binding on both parties.” The Supreme Court, however, rejected that interpretation, holding that the “change of physician” provisions in OCGA § 34-9-201 (d) and OCGA § 34-9-200 (b) (miscited in Holcombe as OCGA § 34-9-200 (d)) “govern in circumstances such as in the present case, i.e., where there is a dispute as to whether the physician and/or the treatment is being changed.” Holcombe, supra at 720. The Supreme Court noted that while in some respects these two parallel statutory provisions are “merely permissive,” in that parties often handle changes in physicians and/or treatment between themselves without recourse to the Board, the statutory provisions “are mandatory, at least for the protection of the parties’ interests,” so that where the parties fail to have a change ordered they run the risk of “possibly suffer [ing] the consequences of having a claim subsequently denied (or upheld).” Holcombe, supra at 721. “The legislative intent to have the board resolve [disputes as to whether the physician and/or treatment may be changed] by its hearing and ordering powers can be seen from the fact that virtually every aspect of compensation under OCGA §§ 34-9-200 and 34-9-201 is to be effected pursuant to the board’s judgment and order. Specifically, OCGA § 34-9-200 (a) makes the decision concerning what treatment . . . the employee is entitled [to be] a decision for the board.” Id.

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Bluebook (online)
407 S.E.2d 430, 200 Ga. App. 272, 1991 Ga. App. LEXIS 966, Counsel Stack Legal Research, https://law.counselstack.com/opinion/brown-v-transamerica-ims-gactapp-1991.