Davis v. Aetna Cas. & Sur. Co.
| Decision Date | 01 February 1984 |
| Docket Number | No. 67545,67545 |
| Citation | 314 S.E.2d 913,169 Ga.App. 825 |
| Parties | DAVIS v. AETNA CASUALTY & SURETY COMPANY. |
| Court | Georgia Court of Appeals |
C. Lawrence Jewett, Jr., Atlanta, for appellant.
Gregory T. Presmanes, Atlanta, for appellee.
On August 1, 1979, the appellant, Robin Davis, injured her back and right leg while on the job at a Pic-N-Pay store. She filed a claim for workers' compensation on October 8, 1979, and benefits commenced thereafter. Subsequently, the appellant entered into a settlement agreement with the appellee insurer, and this agreement was approved by the State Board of Workers' Compensation on June 29, 1981.
The settlement agreement in part provides that In December 1981, while in Anchorage, Alaska, the appellant underwent a surgical procedure to her right knee, and she submitted these medical expenses to the appellee insurer. The insurer, however, refused to pay those expenses, on the grounds that the expenses were unreasonable and/or unnecessary and that no justifiable emergency existed to allow treatment by an unauthorized physician.
On February 4, 1983, the appellant commenced this action, alleging, inter alia, breach of contract and tortious breach of contract, and seeking judicial enforcement of the settlement agreement pursuant to OCGA § 34-9-106 (Code Ann. § 114-711). The appellee insurer moved to dismiss the complaint, on the grounds that the Board retained jurisdiction to determine any liability for such medical expenses because the settlement agreement left that matter open and controlled by the pertinent provisions of the Workers' Compensation Act (Act). On May 20, 1983, the trial court dismissed the action for failure to state a claim upon which relief could be granted and because the appellant had not exhausted her administrative remedies, and this appeal followed. Held:
OCGA § 34-9-106 (Code Ann. § 114-711) provides in part that "[a]ny party in interest may file in the superior court of the county in which the injury occurred or, if the injury occurred without this state, in the county in which the original hearing was had, a certified copy of a settlement agreement approved by the board ... whereupon the court shall render judgment in accordance therewith and notify the parties." Such a proceeding in the superior court to enforce an award or an approved settlement is not a separate suit but is merely a continuation of the Board's proceeding. Simpson v. Travelers Ins. Co., 117 Ga.App. 43, 159 S.E.2d 294 (1967); Durham Iron Co. v. Durham, 62 Ga.App. 361, 7 S.E.2d 804 (1940). This section requires neither notice to the employer/insurer nor a hearing in the proceeding to enforce a settlement agreement. Carpenter v. Newcomb Devilbiss Co., 111 Ga.App. 472, 142 S.E.2d 381 (1965). If a hearing is held, however, "[e]vidence of compensability under the Act is irrelevant, and the superior court has no authority to hear and decide any issue of fact respecting the right of the employee to receive compensation for a period prior to termination of the award or approved agreement." Jenkins v. Reliance Ins. Co., 113 Ga.App. 70, 72, 147 S.E.2d 343 (1966).
In this case, the appellant sought judicial enforcement of the settlement agreement, and she asserted medical expenses of $1,948.62 incurred for a surgical procedure on her injured right knee. The appellee contended that this enforcement proceeding was premature because the appellant had not first obtained a determination of liability by the Board; the appellee emphasized as factual issues appropriate for Board resolution matters such as the necessity of the treatment and the question of authorized emergency treatment. Certainly a claimant and an employer/insurer could agree in a settlement that liability for future medical expenses would be determined by the regular policies and procedures of the Act, including the resort to administrative appeals to resolve a disputed claim, and in such a case, without first exhausting those administrative remedies, a claimant's attempt at judicial enforcement of the award under OCGA § 34-9-106 (Code Ann. § 114-711) would be premature. The parties did not make such a general, expansive agreement in this case; the only conditions on compensability of medical expenses imposed by the settlement agreement consisted of the requirements that the expenses be incurred within the specified three-year period and that the treatment be for the work-related injury.
Nevertheless, we must agree with the appellee that in this case the appellant, in order to pursue a judicial enforcement of the settlement agreement, must first seek a Board determination of the insurer's liability for the medical expenses specifically alleged. The appellee insurer denied the appellant's claim that the medical expenses were for treatment of a work-related injury and were incurred within the required time period, and these were disputed facts that pertained to compensability, rather than mere mathematical calculations, and such factual disputes should be resolved by the Board. Cf. Colbert v. Fireman's Fund Ins. Co., 112 Ga.App. 187, 144 S.E.2d 470 (1965); Carpenter v. Newcomb Devilbiss Co., supra. Contrary to the appellee's assertions, however, the only matters that may be addressed by the Board concern whether the expenses were incurred within the three year period and whether they related to the treatment of the compensable work-related injury.
Insofar as the appellant's complaint sought damages for a breach of contract, however, we conclude that the dismissal of the action was improper. The exclusivity of remedies provision contained in OCGA § 34-9-11 (Code Ann. § 114-103) does not make judicial enforcement of an award under OCGA § 34-9-106 (Code Ann. § 114-711) a claimant's only method of forcing a reneging employer or insurer to comply with the compensation award. OCGA § 34-9-11 (Code Ann. § 114-103), of course, provides for the surrender of an injured employee's common law causes of action against an employer in exchange for compensation without proof of negligence; it is designed to expedite compensation and medical treatment, and to protect the employer from double liability. Wright Assocs. v. Rieder, 247 Ga. 496, 277 S.E.2d 41 (1981); Nowell v. Stone Mtn. Scenic R....
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