STARWOOD HOTELS & RESORTS et al.
MCFADDEN, P. J., RAY and RICKMAN, JJ.
workers' compensation action, claimant Mariana Marcel
Lopez sought a reinstatement of temporary total disability
benefits from her former employer Starwood Hotels &
Resorts Worldwide, Inc., and its insurance company, American
Zurich Insurance Company c/o Sedgwick CMS (collectively
"Starwood"), alleging that she had suffered a
change in condition for the worse. The administrative law
judge ("ALJ") issued an award granting Lopez
temporary total disability benefits and also concluding that
Starwood's request for a hearing amounted to a controvert
of the claim, entitling Lopez to choose her own treating
physician, with Starwood liable for the payment of all
outstanding and reasonable necessary medical expenses.
Starwood appealed the award to the Appellate Division of the
State Board of Workers' Compensation (the
"Board") and the Board affirmed the award of
temporary total disability benefits. However, the Board
reversed the finding of the ALJ that Lopez was entitled to
choose her own physician and, accordingly, found that
Starwood was not liable for the medical expenses from
appealed the Board's decision reversing the ALJ's
finding that she was entitled to choose her own physician to
the superior court. The superior court affirmed the award of
temporary total disability benefits, but reversed the
Board's finding that because Starwood controverted the
claim, the employee was entitled to treatment from a
physician of her choice with Starwood liable for all
outstanding medical bills. We granted Starwood's
application for discretionary review and, for the following
reasons, we affirm in part and reverse in part.
In reviewing a workers' compensation award, this Court
must construe the evidence in the light most favorable to the
party prevailing before the appellate division. In addition,
the findings of the State Board of Workers' Compensation,
when supported by any evidence, are conclusive and binding,
and neither the superior court nor this Court may substitute
itself as a factfinding body in lieu of the State Board. But
erroneous applications of law to undisputed facts, as well as
decisions based on erroneous theories of law, are subject to
a de novo standard of review.
(Citation and punctuation omitted.) The Medical Center v.
Hernandez, 319 Ga.App. 335-336 (1) (734 S.E.2d 557)
construed, the record shows that Lopez worked as a banquet
server at a hotel owned by Starwood. On July 6, 2014, Lopez
slipped and fell on her elbow. Although Lopez experienced
pain in her elbow, she did not seek immediate medical
attention because she thought the problem would resolve
itself. A few days after the accident, the employee's
supervisor insisted that she see a doctor.
was shown the approved panel of physicians by the director of
Human Resources for Starwood and she initially went to a
medical center where it was confirmed that she suffered a
right elbow fracture. Lopez then followed up with an approved
orthopedic specialist ("the treating physician")
who treated her with painkillers, a sling, and physical
therapy. Lopez's condition improved and in November 2014,
the treating physician authorized her return to full duty
work. Starwood paid Lopez temporary total disability benefits
for the period of July 13, 2014 through November 24, 2014.
Lopez returned to work, the hotel had changed management from
Starwood to Expotel Hospitality Services, LLC. Lopez was
assigned to a different position which required fewer
physical duties. However, Lopez experienced pain in her right
elbow and, in July 2015, stopped working due to the severity
of the pain. While working for Expotel, Lopez began treatment
with two physicians she selected herself without approval
from Starwood or Expotel.
29, 2015, Lopez sought the reinstatement of temporary total
disability benefits from Starwood as a result of her July
2014 injury. Subsequently, in January 2016, Starwood filed a
WC-14 hearing request, seeking a determination as to whether
it was still liable for benefits.
a hearing, the ALJ found that Lopez suffered a change in
condition for the worse and issued an award granting her
total temporary disability benefits. Additionally, the ALJ
concluded that Starwood's WC-14 hearing request amounted
to a controvert of the claim, entitling Lopez to choose her
own treating physician effective the date of the filling of
the hearing request, with Starwood liable for the payment of
all outstanding and reasonably necessary medical expenses.
appealed this award to the Board. The Board agreed with the
ALJ's finding that Lopez experienced a change in
condition for the worse. However, the Board concluded that
the ALJ erred by finding that Starwood's WC-14 request
for an opportunity to prove that it was no longer responsible
for benefits amounted to a controvert of the claim.
Specifically, the Board highlighted that Starwood "did
not controvert medical treatment, nor did it otherwise deny
any request by [Lopez] for additional treatment from an
appealed the Board's award to the superior court. In an
order drafted by Lopez's counsel, the superior court
affirmed the finding of both the ALJ and the Board that Lopez
suffered a change in condition for the worse. The superior
court noted that it was applying a de novo standard of review
to the issue of whether the WC-14 hearing request filed by
Starwood constituted a controvert of Lopez's claim. The
court then reversed the Board's decision, finding that
Starwood did controvert the claim and thus Lopez was entitled
to treatment from a physician of her choice and Starwood was
liable for all outstanding medical bills since the date of
Starwood's filing of the WC-14 hearing request.
several enumerated errors, Starwood contends, inter alia,
that the superior court erred by concluding that Lopez was
entitled to choose her own physician and that Starwood was
liable for all of her outstanding medical bills since the
date of the filing of its WC-14 hearing request.
Specifically, Starwood argues that the superior court was