City of Atlanta v. Sebastian

368 Ga.App. 859

891 S.E.2d 66

CITY OF ATLANTA et al. v. SEBASTIAN.

A23A1185

Court of Appeals of Georgia.

July 27, 2023

Marc Eric Sirotkin, Atlanta, Timothy Clark Lemke, for Appellant.

Kyle D. Johnston, for Appellee.

Mercier, Judge.

Following the City of Atlanta's decision to unilaterally suspend his workers’ compensation benefits, Justin Sebastian filed a motion to recommence benefits with the State Board of Workers’ Compensation ("the Board"). The Board found the suspension improper, reinstated Sebastian's benefits, and awarded attorney fees to Sebastian. The City appealed the Board's ruling to the Superior Court of Fulton County, which upheld the decision. We granted the City's application for discretionary review, and for reasons that follow, we affirm.

1. "If any evidence supports the Board's findings, those findings are binding and conclusive, and neither this Court nor the superior court may substitute itself as the fact[-]finding body." Hartford Cas. Ins. Co. v. Hawkins , 353 Ga. App. 681, 685, 839 S.E.2d 230 (2020) (citation and punctuation omitted). Questions of law and the application of law to undisputed facts, however, are reviewed de novo. See id. ; Technical College System of Ga. v. McGruder , 326 Ga. App. 469, 469, 756 S.E.2d 702 (2014).

In this case, the operative facts are not in dispute. Sebastian, a City of Atlanta police officer, suffered work-related injuries during a motor vehicle collision in December 2017. The City commenced payment of workers’ compensation benefits, with Dr. Wing Chang serving as Sebastian's authorized treating physician. Sebastian subsequently requested a change of physician, and he selected Dr. Craig Weil as his authorized treating physician from the panel of physicians posted by the City pursuant to OCGA § 34-9-201 (b) (1).

On April 25, 2019, Weil released Sebastian "to light duty with the following restrictions: ... No field patrol duty. Limited to desk duty or office duty. No restraint situations. No defensive tactic situations." At subsequent visits, Weil treated Sebastian for issues relating to his cervical spine, shoulder, arms, and wrist. Weil diagnosed Sebastian with carpal tunnel syndrome and a possible rotator cuff tear, and he recommended that Sebastian "follow up with a cervical spine doctor." In conjunction with a treatment session on September 8, 2020, Weil found: "Additional medical evaluation is requested for the cervical spine. Dr. Thomas Dopson is recommended."

Sebastian saw Dopson on September 16, 2020. Following that examination, Dopson concluded that Sebastian was at maximum medical improvement and "should be capable of unrestricted employment in regards to his cervical and lumbar spine." In October 2020, Weil completed a "work release" stating that Sebastian had reached maximum medical improvement and was released for "[f]ull duty" with respect to his cervical and lumbar spine injuries. Following a treatment visit on November 17, 2020, however, Weil modified this assessment, ordering that Sebastian be "[r]elease[d] to light duty with the following restrictions: ... No defensive tactic situations." Weil further stated: "The patient is not returning to our office for treatment. The restrictions are set for no defensive tactics and will be determined by the spine specialist he sees through work comp. RECOMMENDATION: Christopher Edwards, M. D."

It does not appear that Sebastian was treated by Edwards. But he returned to Dopson in January and February 2021, after which Dopson concluded that Sebastian could "[r]eturn to [r]egular duty." Citing the February 2021 work release, the City unilaterally suspended Sebastian's workers’ compensation benefits on the following ground: "Employee was able to return to work on 2/3/2021 without restrictions from the authorized treating physician[.]"

Sebastian moved to reinstate his benefits, arguing that because Dopson was not his authorized treating physician, his benefits could not be suspended based on Dopson's work release. The Administrative Law Judge ("ALJ") assigned to the case agreed, found the unilateral suspension improper, reinstated Sebastian's benefits, and ordered the City to pay Sebastian's counsel $2,600 in assessed attorney fees. On further review, the Board's appellate division affirmed the ALJ's decision, and the superior court upheld that finding. This appeal followed. ¹

The primary issue in this case involves the statutory and regulatory circumstances under which an employer may unilaterally suspend an employee's workers’ compensation benefits following a work release. The Workers’ Compensation Act, OCGA § 34-9-1 et seq., "is a humanitarian measure to be construed liberally, and its purpose is to provide compensation for an injured employee in proportion to his loss of future earnings on account of the injury."

Ware County Bd. of Ed. v. Taft , 350 Ga. App. 848, 850, 830 S.E.2d 326 (2019) (citation and punctuation omitted). In analyzing the Act's provisions,

we must presume that the General Assembly meant what it said and said what it meant. To that end, we must afford the statutory text its plain and ordinary meaning, we must view the statutory text in the context in which it appears, and we must read the statutory text in its most natural and reasonable way, as an ordinary speaker of the English language would.

Id. (citation and punctuation omitted). We must also "avoid a construction that makes some language mere surplusage." Roseburg Forest Products Co. v. Barnes , 299 Ga. 167, 169 (1), 787 S.E.2d 232 (2016) (citation and punctuation omitted). These same rules of construction apply to the Board's rules and regulations. See Walker v. Dept. of Transp. , 279 Ga. App. 287, 292 (2) (a), 630 S.E.2d 878 (2006).

The Act requires an employer to pay weekly income benefits to an injured worker who falls within the Act's purview. See OCGA § 34-9-221. Although OCGA § 34-9-221 references suspension of benefits, it is silent as to how such benefits may be suspended following a release to full duty work. See OCGA § 34-9-221 (c). Instead, the mechanism for benefit suspension is contained in Board Rule 221, which provides in pertinent part:

When suspending benefits for release to return to work without restrictions, the employer/insurer shall attach to the Form WC-2 a copy of the supporting medical report from employee's authorized treating physician, who must have examined the employee within sixty days of the effective date of the release.

Bd. Work. Comp. r. 221 (i) (4) (a). The WC-2 form, in turn, requires the employer to provide the date the employee was able to return to work "without restrictions from the authorized treating physician."

Neither the Act nor the Board's rules expressly defines "authorized treating physician." The statutory scheme, however, provides for the appointment of a doctor to manage and oversee an injured worker's medical care. Pursuant to OCGA § 34-9-201 (b), the injured worker may select a physician from the employer's list of physicians. See OCGA § 34-9-201 (b) (1). The selected physician is authorized to refer the worker to a specialist or other doctor for treatment. The statute, however, draws a clear distinction between the "primary authorized treating physician" and a referred or consulting specialist.

As provided in OCGA § 34-9-201 (b) (1) :

The physicians selected under this subsection from the panel may arrange for any consultation, referral, and extraordinary or other specialized medical services as the nature of the injury shall require without prior authorization from the board; provided, however, that any medical practitioner providing services as arranged by a primary authorized treating physician under this subsection shall not be permitted to arrange for any additional referrals.

(Emphasis supplied).

The City concedes on appeal that Dopson was a referred "spine specialist" brought into the case by Weil, "the authorized treating physician for [Sebastian]." Nevertheless, it argues that because Dopson was "undisputedly an authorized treating physician," i.e., a physician permitted to treat Sebastian, Dopson's determination that Sebastian could be released to full duty work without restrictions supported a suspension of benefits. Characterizing Dopson as " ‘employee's authorized treating physician’ for his spine," the City contends that its unilateral suspension was proper under Rule 221 (i) (4) (a).

We disagree. As discussed above, the statutory scheme — as well as the Board's corresponding rules — distinguishes between authorized treating physicians and referred physicians. See OCGA § 34-9-201 (b) (1) ; Bd. Work. Comp. r. 201 (a) (1) (i). The Act makes numerous references to "the authorized treating physician," discussing that physician's centralized role in an injured worker's care. See, e.g., OCGA § 34-9-200 (c) ("As long as an employee is receiving compensation, he or she shall submit himself or herself to examination by the authorized treating physician at reasonable times[.]"); OCGA § 34-9-201 (b) (1) ("primary authorized treating...