ÿWPC' Æ# ä UNï %= 0ûC U:>4xŒÆ›Æa '-w@5 0?u 0D´ÆøƾÆ„ 0JJ 0T” 0^è 0hF 0r® 0|  0†œ 0" 1u² 0d' B‹U>¨U*æU* D3:B)mDC– 0@Ù 0K AOd½³v~pvÓî D+Á$ AOì$ 0D;% D/% B®% AYË% 0F$& A©j&˜HP LaserJet 4 PlusHPPCL5MS,ð,,,,,ð0nLhÎ(ÈhH  Z ‹6Times New Roman RegularX(ÓH=$¡¡Ñ  ÑÒH°ÒÒ°ÒÑTR[  AØ'ÿ Legal[  AØ'ÿ Legal AØ'ÿ Legal AØ'ÿ LegalTÑÔ€XÎ_XXXÔÑ7€¾úXXdðXXdð7Ñ, øð AZ‹"Arial RegularÚƒç"3|x’Level 1Level 2Level 3Level 4Level 5‚Level 1Level 2Level 3Level 4Level 5H ~ îP€PP‚Pƒ„…†‡Ó€(ï(3pX$¤¤Ý ƒH=!ÝÑ  ÑÒH°ÒÒ°ÒÑTR[  AØ'ÿ Legal3Ø' AØ'ÿ Legalÿ3Ø'TÑÔ€XÈ×XXXÔÑ7€u#XXdìdì7ÑÝ  Ýà ` àòòÚ  Ú0Ú  Úóó(#Ã$òòÚ  Ú0Ú  ÚóóƒLevel 1Level 2Level 3Level 4Level 5„Level 1Level 2Level 3Level 4Level 5…Level 1Level 2Level 3Level 4Level 52 ÿÿ0Indent1Ô2ÔÔ3  Ô2" ÿÿ0Indent2à0 àÔ2ÔÔ3  Ô2, ÿÿ0Indent3à0 àà0 àÔ2ÔÔ3  Ô26 ÿÿ0Indent4à0 àà0 àà0 àÔ2ÔÔ3  Ô2@ ÿÿ0Indent5à0 àà0 àà0 àà0 àÔ2ÔÔ3  Ô2J ÿÿ0Indent6à0 àà0 àà0 àà0 àà0 àÔ2ÔÔ3  Ô2T ÿÿ0Indent7à0 àà0 àà0 àà0 àà0 àà0 àÔ2ÔÔ3  Ô2^ ÿÿ0Indent8à0 àà0 àà0 àà0 àà0 àà0 àà0 àÔ2ÔÔ3  Ô ÿÿ?AGMSYaioIndent0I.A.1.a.(1)(a)i)a)P ÿÿ8Mac DefaultMac DefaultÓ ` °šXÓ d< Œ 9p`(&Times New Roman< Œ 9p`(Arial< Œ 9p`(Times$$$$'ÿÿdxd% Line 7 d++++7Border 1dd("ÿÿ$££Ò  ÒÒ  Ò( ±þ$’’ò òFigure€Ú  Ú1Ú  Úó ó-.,Cþÿ << Gÿÿ ³Ý ƒ!ÝÑ  ÑÑ#€d#ÑÔ€'ÔÑ  ÑÒ  ÒÒ H ÒÑ\R AØ'\ÑÔ€(ÔÑ#€d#ÑÝ  ÝÔ€(ÔÓ  ÓÔ YYY ÔFILEDÔ€(XÔÌÌò òNovemberÏ25,Ï1997ÌÌCecilÏCrowson,ÏJr.ÌÔ€(ôÔAppellateÏCourtÏClerkó óPtPtHHÚ(ÿáÿâùFG(üHHØ(d'`Styl{WP}01•ÃÃÃÃÃÃÃÃÃÃÃÃÃÃÃÃÃÃà Ãà Ãà Ãà Ãà ÃÃÃÃÃÃÃÃÃÃÃÐ ÐÐHHÐÐ  ÐÐ2ÐÐÿÿ¸æ$ÿÐÐHHÐÐÐÐÐÐÐÐ  ÐÐ ÐÐ ÐÑÑÑGenevaÑÑ ÑÑ € ÑÑ<Px–ÈÑÒÒÒ443!#4ÒÒ$ *$ÒÒ$*$ÒÒ ÿKK ÒÒ  Geneva ÒÒ  Geneva ÒÓ.,ÓÓÓÓ6ÓÓ ÓßßßßßßßßßßßßßßßßßßÑGenevaÑÑ ÑÒ  ion-F Geneva ÒÒ  ion-F Geneva Ò'ÈÈÈÈdxd-‚ƒCþÿ<< Cÿÿ($$””ò òÚ  Ú1Ú  Úó ó„„'÷ÿ dxdüÿP Pd-¸:Müÿ << deUU(n$––ò ò(Ú  Ú1Ú  Ú)ó ó-.:›&OLE 2.0 Box <=8ÿÿÿÿÿÿÿÿÿÿCÿÿ HKKKKÝ ƒ!ÝÔ . ÔÔ€'ÔÑ  ÑÒ  ÒÒ H ÒÑ\R AØ'\ÑÔ€(ÔÑ#€))Xd#ÑÑ#€))Xd#ÑÝ  Ý›Ñ À ÑÑ X Ñò òÑ  ÑÓ  ÓÞ ÞÌÌÌó óà@ àò òIN€THE€SUPREME€COURT€OF€TENNESSEEÌà@ àSPECIAL€WORKERS'€COMPENSATION€APPEALS€PANEL̜ـÙßR€/0,A1-j|` 81 `€€@ÿRß›à@ àAT€KNOXVILLEó óÌÓ  ÓÌÌÌÌÌÌROBBIN€RODDY,à àà àà àà à)à àRHEA€CHANCERYÌà àà àà àà àà àà à)à àÌà àPlaintiff/Appelleeà àà àà à)à àNO.€03S01„9704„CH„00041Ìà àà àà àà àà àà à)Ìv.à àà àà àà àà àà à)à àHON.€€JEFFREY€F.€STEWART,Ìà àà àà àà àà àà à)à àCHANCELLORÌSPRING€KNITS,€INC.,€and€à àà à)ÌCIGNA€INSURANCE€COMPANY,à à)Ìà àà àà àà àà àà à)Ìà àDefendants/Appellantsà àà à)ÌÌÌÌÌÌÌò òòòFor€the€Appellant:à àà àà àà àFor€the€Appellee:ÌÌó óóóJohn€D.€Barryà àà àà àà àJ.€Arnold€FitzgeraldÌMilligan,€Barry,€Hensley€&€Evansà àà àP.€O.€Box€227,€1470€Market€St.Ì800€First€Tennessee€Buildingà àà àDayton,€TN€37321Ì701€Market€StreetÌChattanooga,€TN€37402ÌÌÌÌÌÌÌÌÌÌÌò òòòÓ  ÓM€E€M€O€R€A€N€D€U€M€€€€O€P€I€N€I€O€Nóóó óÌÌò òòòMembers€of€Panel:ÌÌó óóóChief€Justice€E.€Riley€AndersonÌSenior€Judge€John€K.€ByersÌSpecial€Judge€Roger€E.€ThayerÌÓ  ÓÌÌÌÌÌÌÌÌÌÌÌÌAFFIRMED.à àà àà àà àà àà àBYERS,€Senior€JudgeÌÌÓÓòòò òÓ  ÓOPINIONó óóóÌÓ  Óà àThis€workers'€compensation€appeal€has€been€referred€to€the€SpecialÏWorkers'€Compensation€Appeals€Panel€of€the€Supreme€Court€in€accordance€withÏTenn.€Code€Ann.€ðð€50„6„225(e)(3)€for€hearing€and€reporting€to€the€Supreme€CourtÏof€findings€of€fact€and€conclusions€of€law.€Ìà àThe€employee€alleged€injury€to€her€back€when€she€lifted€a€bolt€of€cloth€atÏwork.€€The€trial€court€found€that€her€back€condition€was€caused€by€a€work€relatedÏaccident€and€awarded€45€percent€permanent€partial€vocational€disability€andÏmedical€expenses,€including€those€of€the€treating€surgeon,€which€wereÏunauthorized.Ìà àWe€affirm€the€judgment€of€the€trial€court.Ìà àOn€Saturday,€August€8,€1992,€the€employee,€Robbin€Roddy,€was€inspectingÏrolls€of€fabric€at€work€when€a€co„worker€brought€her€an€unusually€heavy€roll€to€workÏwith.€€When€she€threw€the€roll€up€in€a€bin,€her€back€ð ðjust€popped.ðð€€She€reported€theÏinjury€to€her€supervisor,€James€Hood,€who€went€with€her€to€the€office€where€theyÏcompleted€an€injury€report.€€Hood€then€sent€her€home.€€Ìà àShe€was€aware€that€the€company€posted€at€the€work€site€a€list€of€threeÏdoctors€from€whom€she€could€choose.€On€the€following€Monday€she€went€to€theÏFamily€Medical€Center,€to€the€office€of€one€of€those€doctors,€Dr.€Richard€R.€Jost,Ïwhere€she€and€her€family€had€been€seen€in€the€past€for€routine€medical€care.€Ìà àIt€is€uncontested€that€the€employee€never€saw€Dr.€Jost€for€examination,Ïevaluation,€treatment€or€assessment€of€disability€for€this€injury.€€For€all€of€herÏtreatment€she€saw€Mr.€Robert€Wayne€Harrison,€a€certified€physicianððs€assistantÏemployed€and€supervised€by€Dr.€Jost.€€The€record€indicates€that€apparently€theÏemployee€was€accustomed€to€referring€to€the€physicianððs€assistant€as€ð ðDr.€Rob.ðð€InÏfact,€the€record€shows€that€counsel€for€the€defendant€occasionally€referred€to€him€asÏð ðDr.€Harrison.ðð€Ìà àWhen€asked€about€his€role€in€the€treatment€of€the€employee,€Mr.€HarrisonÏtestified€that€he€is€ð ðpermitted€to€do€all€aspects€of€medical€care€with€the€exception€ofÏwrite€prescriptions.€€Thatððs€actually€been€changed€by€statute€at€the€present,€but€atÏthe€time€in€question,€I€guess€weððre€dealing€with€a€record€of€1992,€so€at€that€time€theÏstatute€did€not€allow€prescription€writing.ððÌà àMr.€Harrison€first€saw€the€employee€on€August€13,€1995.€€She€gave€him€aÏhistory€of€having€injured€her€back€at€work€for€Spring„Knit€while€lifting€a€heavy€roll€ofÏmaterial.€€She€complained€of€pain€in€the€low€back€area.€€He€testified€that€a€relativelyÏcomplete€orthopaedic€examination€of€the€back€was€done€and€that€it€revealedÏtenderness€over€the€iliosacral€region.€€He€further€stated€that€she€had€relatively€fullÏmotion€although€she€appeared€to€be€in€some€discomfort€with€bending.€€Her€reflexesÏwere€normal€in€both€legs€at€that€time.€€He€instructed€her€ð ðto€remain€off€work,€bedÏrest,€heat,€just€general€conservative€„€„€what€we€would€refer€to€as€conservativeÏmedical€care,€was€given€an€anti„inflammatory€medication.ðð€Ìà àMr.€Harrison€saw€the€employee€again€on€August€17,€1992€and€found€that€sheÏwas€still€complaining€of€marked€pain.€€He€interpreted€an€x„ray€done€at€that€time€asÏrevealing€spina€bifida€occulta€at€L5„S1€with€minimal€disc€space€narrowing€at€L5€andÏno€other€acute€changes.€€When€deposed,€he€explained€that€spina€bifida€occulta€isÏð ða€relatively€minor€congenital€problem€found€in€a€fairly€high€significance€of€normalÏpopulation,€not€felt€in€itself€to€be€clinically€significant.ðð€€He€advised€the€employee€toÏð ðreturn€to€work€[on€August€20th]€with€absolutely€no€lifting.ðð€€She€was€given€painÏmedication€and€Xanax.Ìà àMr.€Harrison€saw€the€employee€on€August€20,€1992€for€follow„up€andÏdetermined€she€was€ð ðsomewhat€better.ðð€€He€told€her€to€continue€the€ð ðno€liftingÏrestrictions€for€seven€days€and€return€to€see€him€in€one€week.Ìà àOn€August€28,€1992€Mr.€Harrison€saw€the€employee€for€follow„up€andÏdetermined€she€continued€to€show€progressive€improvement€but€still€had€some€painÏin€the€lower€back€radiating€into€the€buttocks.€€He€told€her€to€continue€on€light€duty€forÏseven€more€days€and€then€to€return€to€full€duty€without€restrictions.Ìà àMs.€Roddy€testified€at€trial€that€she€was€in€severe€pain€and€unable€to€care€forÏher€own€daily€needs€throughout€this€time,€and€that€her€condition€grew€progressivelyÏworse.€€She€was€never€able€to€tie€her€shoes,€required€help€in€dressing,€could€notÏget€into€her€car€by€herself,€could€not€drive,€and€basically€could€not€function€withoutÏhelp.€€When€she€was€returned€to€work€by€Mr.€Harrison€she€worked€only€four€hours€aÏday.€€She€testified€that€ð ðbecause€I,€I€was€just€working€four€hours€a€day€and€heÏ[James€Hood,€plant€manager]€said€he€needed€more€than€that,€so€he€fired€me.ððÌà àMr.€Hood€testified€that€the€employee€called€in€on€September€9,€1992€to€tellÏhim€that€she€needed€to€go€to€Nashville€on€personal€business€and€he€told€her€toÏcome€in€first€to€do€some€work€in€the€office,€then€go€to€Nashville.€€She€refused.€€HeÍthen€told€her,€ð ðWell,€youððll€just€have€to€do€what€you€have€to€do€and€I€have€to€do€whatÏI€have€to€do.ðð€€He€said€that€he€never€heard€from€her€again€and€then€got€somebody€toÏtake€her€place€and€terminated€her.Ìà àMs.€Roddy€testified€that€after€she€was€fired€she€worked€briefly€opening€bottlesÏat€a€bar€and€then€went€to€Illinois€to€stay€with€her€sister.€€Her€sister€got€her€a€part„timeÏjob€sitting€at€a€table€separating€small€screws€from€nuts€and€bolts.€€€While€in€IllinoisÏshe€continued€to€suffer€severe€back€pain,€she€was€in€the€emergency€room€everyÏnight€getting€a€shot,€she€was€miserable,€and€she€saw€numerous€differentÏemergency€room€doctors,€all€of€whom€told€her€the€same€thing.€€On€ThanksgivingÏday€she€came€back€to€Tennessee.€€€Ìà àOn€November€30,€1992€the€employee€went€back€to€the€Family€MedicalÏCenter€where€she€again€saw€Mr.€Harrison.€€His€notes€indicate€she€told€him€thatÏwhile€she€was€in€Illinois€she€saw€an€orthopedic€surgeon€who€advised€that€she€mayÏhave€a€herniated€disc€and€recommended€a€CT€scan€in€Illinois,€but€she€chose€toÏreturn€to€her€home€in€Tennessee€for€additional€evaluation.€€She€told€Mr.€HarrisonÏthat€her€back€pain€had€worsened€and€his€exam€revealed€that€she€appeared€to€be€inÏsevere€pain.€€He€scheduled€a€CT€scan€for€the€following€morning.€€ÌÓÓà àThe€next€note€in€Mr.€Harrisonððs€record€is€dated€December€7,€1992:ÌÌà8 àð ðPt.€boyfriend€brought€in€2€empty€bottles€(Percodan€&€Xanax€1€mg.)Ïfrom€Dr.€Bennell€Caughran€in€Chattanooga.€€He€stated€that€Dr.ÏCaughran€wanted€family€M.D.€to€write€new€prescriptions€for€bothÏbecause€he€could€not€phone€in€prescriptions,€but€needed€them€written.€ÏDr.€Caughranððs€office€was€contacted€and€he€said€yes€he€wanted€RobÏto€write€the€prescriptions€for€her.ððÌÌÓÓà àThere€is€no€indication€that€the€prescriptions€were€written.Ìà àThat€day€the€employee€went€to€the€emergency€room€and€requested€to€seeÏDr.€€Donathan€Ivey.€€When€asked€at€trial€why€she€went€to€see€Dr.€Ivey,€she€stated:ÌÓÓà8 àð ðWell,€he€was,€he€was€one€of€the€physicians€that€were€on€our,€was€onÏour€list€for€workmenððs€comp€with€Dr.€Jost€and€Dr.€Ivey€and€„€„€I€think€itÏmight€have€been€Dr.€Bacon€or€some€doctor€here€in€Dayton.€€So€I€wentÏto€Ivey€and€he€put€me€in€surgery€the€next€morning.€€He€said€he€didnððtÏsee€how€Iððd€stood€it€this€long.ððÌà àÌÓÓà àDr.€Ivey,€who€is€a€general€surgeon€and€neurosurgeon,€testified€that€theÏemployee€gave€the€following€history€when€he€first€saw€her€on€December€8,€1992:ÌÓÓà8 àð ðShe€œhad€had›€a€CAT€scan€done€in€Rockwood,€Tennessee€and€wasÏtold€that€she€had€a€ruptured€disc.€€And€she€was€examined€by€aÏphysician€in€Chattanooga€and€was€told€that€she€needed€surgery.€€ButÏher€insurance,€according€to€her,€her€insurance€company€refused€toÏreimburse€the€physician€for€the€surgery.€€The€patient€was€admittedÏfrom€the€emergency€room€on€December€the€7th.ððà à€€ÌÌÓÓà àDr.€Ivey€performed€a€lumbar€myelogram€and€an€isoview€CT€scan€andÏdiagnosed€ruptured€lumbar€intervertebral€disc€with€right€sciatica.€€He€performedÏsurgery€on€December€10,€1992€and€at€surgery€a€large,€extruded€intervertebral€discÏwas€removed€at€L„5€on€the€right.€€He€opined€her€condition€was€ð ð€.€.€.€very€severe.€ÏShe€had€an€extruded€disc.€€Now,€an€extruded€disc€is€the€worst€kind.€€Thatððs€whereÏthe€disc€has€literally€exploded.ððÌà àDr.€Ivey€continued€to€follow€the€employee€for€postoperative€care€andÏultimately€assessed€ten€percent€medical€impairment€to€the€body€as€a€whole€basedÏon€the€òòAmerican€Medical€Association€Guides€to€the€Evaluation€of€PermanentÏImpairment,€4th€Ed.óó€€He€gave€her€permanent€restrictions€to€refrain€from€heavy€liftingÏand€advised€her€that€her€symptoms€might€also€be€aggravated€by€bending€andÏstooping.Ìà àThe€trial€judge€found€the€employeeððs€back€condition€to€be€work€related€andÏawarded€the€employee€45€percent€permanent€partial€vocational€disability€to€theÏbody€as€a€whole.€€He€also€ordered€the€employer€to€pay€$10,641.50€in€contestedÏmedical€expenses€for€the€surgery€and€treatment€by€Dr.€Ivey.Ìà àThe€employer€contends€that€the€employee€has€failed€to€prove€that€herÏexploded€disc€was€caused€by€her€work€accident;€that€the€employeeððs€medicalÏexpenses€for€surgery€and€treatment€by€Dr.€Ivey€are€not€compensable€because€theÏemployee€had€already€chosen€Dr.€Jost€as€her€approved€physician;€and€that€theÏaward€of€45€percent€permanent€partial€disability€is€excessive.Ìà àOur€review€of€the€findings€of€fact€made€by€the€trial€court€is€òòde€novoóó€upon€theÏrecord€of€the€trial€court,€accompanied€by€a€presumption€of€the€correctness€of€theÏfinding,€unless€the€preponderance€of€the€evidence€is€otherwise.€€òòTenn.€Code€Ann.€ððóóÏ50„6„225(e)(2).€€òòStone€v.€City€of€McMinnville,€óó896€S.W.2d€584€(Tenn.€1991).€Ìà àThe€employer€contends€the€employee€must€have€had€another€injury€after€herÏwork€related€injury€and€that€the€supposed€later€injury€caused€her€exploded€disc.€ÏFor€evidence,€they€say€that€Mr.€Harrison€never€diagnosed€a€herniated€disc€and€Dr.ÏJostððs€supervisory€review€of€Mr.€Harrisonððs€notes€confirmed€the€absence€of€aÏherniated€disc.€€€€à àÌà àIn€rendering€his€Memorandum€Opinion,€the€trial€judge€specifically€notedÏhaving€ð ðobserved€the€testimony€and€demeanor€of€the€witnesses€who€testified€inÏopen€court.ðð€€Where€the€trial€judge€has€made€a€determination€based€upon€theÏtestimony€of€witnesses€whom€he€has€seen€and€heard,€great€deference€must€beÏgiven€to€that€finding€in€determining€whether€the€evidence€preponderates€against€theÏtrial€judgeððs€determination.€€òòSeeóó€òòHumphrey€v.€David€Witherspoon,€Inc.,€óó734€S.W.2dÏ315€(Tenn.€1987).€€When€an€issue€hinges€on€the€credibility€of€witnesses,€the€trialÏcourt€will€not€be€reversed€unless€there€is€found€in€the€record€clear,€concrete,€andÏconvincing€evidence€other€than€the€oral€testimony€of€witnesses€that€contradicts€theÏtrial€courtððs€findings.€òòGalbreath€v.€Harris,€óó811€S.W.2d€88,€91€(Tenn.€App.€1990),€òòcert.Ïdenied,óó€502€U.€S.€939€(1991).€€Ìà àWhere€the€medical€testimony€is€presented€by€deposition,€this€Court€is€able€toÏmake€its€own€independent€assessment€of€the€medical€proof€to€determine€where€theÏpreponderance€of€the€evidence€lies.€€òòCooper€v.€INA,€óó884€S.W.2d€446€(Tenn.€1994).€ÏThe€medical€evidence€in€this€case€was€submitted€by€the€depositions€of€Dr.€Ivey€andÏDr.€Jost.€€Since€Dr.€Jost€never€saw€the€employee€and€relied€completely€on€theÏrecords€provided€to€him€by€his€physicianððs€assistant,€Mr.€Harrison,€we€find€theÏdeposition€of€Dr.€Ivey€to€be€more€credible.€€€Ìà àThe€employer€has€presented€no€evidence€of€any€alleged€injury€which€mightÏbe€responsible€for€the€employeeððs€exploded€disc.€€It€is€uncontested€that€theÏemployee€did€injure€her€back€at€work,€and€her€testimony€that€there€was€no€otherÏinjury€was€found€to€be€credible€by€the€trial€judge.€€We€defer€to€the€trial€courtððsÏdetermination€that€the€employeeððs€back€condition€is€work€related.Ìà àThe€employer€next€contends€that€the€services€of€Dr.€Ivey€were€not€authorizedÏand€therefore€his€surgery€and€treatment€are€not€compensable.ÌÌà àòòTenn.€Code€Ann.€ððóó€50„6„204(a)(4)€provides:ÌÓÓà8 àð ðThe€injured€employee€shall€accept€the€medical€benefits€affordedÏhereunder;€provided,€that€the€employee€shall€designate€a€group€ofÏthree€(3)€or€more€reputable€physicians€or€surgeons€not€associatedÏtogether€in€practice,€if€available€in€that€community,€from€which€theÏinjured€employee€shall€have€the€privilege€of€selecting€the€operatingÏsurgeon€or€the€attending€physician;€and,€provided€further,€that€theÏliability€of€the€employer€for€such€services€rendered€the€employee€shallÏbe€limited€to€such€charges€as€prevail€for€similar€treatment€in€theÏcommunity€where€the€injured€employee€resides.€€The€above€listing€ofÏphysicians€or€surgeons€may€include€doctors€of€chiropractic€within€theÏscope€of€their€licenses.ððÌÌà àOur€Supreme€Court€has€held€that:ÌÌà8 àð ðWhere€the€employer€fails€to€give€the€employee€the€opportunity€toÏchoose€the€ultimate€treating€physician€from€a€panel€of€at€least€threeÍphysicians,€he€runs€the€risk€of€having€to€pay€the€reasonable€cost€forÏtreatment€of€the€employeeððs€injuries€by€a€physician€of€the€employeeððsÏchoice.€.€.€.€€The€decision€turns€on€the€issue€of€whether,€under€theÏcircumstances,€the€employee€was€justified€in€obtaining€further€medicalÏservices,€without€first€consulting€the€employer€or€its€insurer.ðð€€òòÌÌUnited€States€Fid.€&€Guar.€Co.€v.€Morgan,óó€795€S.W.2d€653€(Tenn.€1990),€òòcitingÏBurlington€Industries,€Inc.€v.€Clark,€óó571€S.W.2d€816€(Tenn.€1978).ÌÌÓÓà àThe€record€in€this€case€reveals€that€when€she€was€first€injured,€the€employeeÏwent€to€the€office€of€one€of€the€doctors€on€the€employerððs€list.€€Although€she€soughtÏtreatment€at€that€office€on€four€occasions,€she€was€never€seen€by€any€physician.€ÏHer€condition€continued€to€worsen.€€The€trial€court€accredited€her€testimony,€whichÏrevealed€that€emergency€doctors€in€Illinois€x„rayed€and€told€her€she€neededÏsurgery.€€She€had€a€CT€scan€in€Rockwood€and€was€told€there€that€she€neededÏsurgery.€€She€was€in€severe€pain€and€sent€her€boyfriend€to€the€office€of€her€treatingÏphysicianððs€assistant€to€get€her€pain€medication€refilled,€but€there€is€no€record€thatÏthe€request€was€honored.€€Mr.€Harrison€testified€that€he€was€not€at€that€timeÏauthorized€to€prescribe€medication.€€The€next€day€the€employee€reported€to€theÏemergency€room€and€requested€to€see€another€doctor€who€was€also€on€the€list€ofÏthe€employerððs€approved€physicians.€€It€is€uncontested€that€the€surgery€andÏtreatment€performed€by€this€physician€was€reasonable€and€necessary.€€Mr.ÏHarrison,€who€is€not€a€surgeon,€would€not€have€been€able€to€perform€the€neededÏsurgery.€€Under€these€circumstances,€we€find€that€the€employee€acted€in€good€faithÏand€was€justified€in€seeking€medical€treatment€on€her€own.€€òòSee€United€StatesÏFidelity€and€Guar.,€supra.€€óóTherefore,€we€affirm€the€trial€courtððs€order€that€theÏemployer€pay€these€medical€costs.Ìà àFinally,€the€employer€says€that€the€trial€courtððs€award€of€45€percentÏpermanent€partial€vocational€disability€is€excessive.€€Ìà àIn€making€determinations,€the€court€shall€consider€all€pertinent€factors,Ïincluding€lay€and€expert€testimony,€employeeððs€age,€education,€skills€and€training,Ïlocal€job€opportunities€and€capacity€to€work€at€types€of€employment€available€inÏclaimantððs€disabled€condition.€òòTenn.€Code€Ann.€ððóó€50„6„241(a)(1).Ìà àThe€employee€is€35€years€old€and€has€a€ninth€grade€education€and€workÏexperience€as€a€bar€maid,€housekeeper€and€factory€employee.€€She€is€permanentlyÏrestricted€from€heavy€lifting€and€continues€to€have€back€pain€and€inability€to€bendÏand€stoop.€€The€preponderance€of€the€evidence€supports€the€trial€courtððs€award€ofÏ45€percent€permanent€partial€disability.Ìà àThe€judgment€of€the€trial€court€is€affirmed€with€costs€assessed€to€theÏappellant.ÌÌÓÓÔ% € Ôà àà àà àà àà àà à___________________________________Ìà àà àà àà àà àà àJohn€K.€Byers,€Senior€JudgeÌÌCONCUR:ÌÌÌÌ________________________________ÌE.€Riley€Anderson,€Chief€JusticeÌÌÌÌ________________________________ÌRoger€E.€Thayer,€Special€Judge€œÇÒ  ÒÒ H Òà à€€€€€€€€€€€€€€€€€IN€THE€SUPREME€COURT€OF€TENNESSEEÌà à€€€€€€€€€€€€€Ìà àà à€à à€€€€€€€€€€€€€AT€KNOXVILLEÌÌÒ Ê ÒÒ H ÒÌÒ S ÒÒ H ÒROBBIN€RODDY,€à àà àà àà à)€€€€RHEA€CHANCERYÌ€€€€€€€€€€€€à àà àà àà àà à)€€€€€No.€€8001Ìà àPlaintiff/Appellee,à àà àà à)à àà àà àà àà à€€€€à àà àà à€€€€€€€Ïà àà àà àà à)à à€à àÌvs.€€à àà àà àà àà àà à)€€€€€Hon.€Jeffrey€F.€Stewart,€€€€€€à àà àà àà àà à€€€€€€€€€€€Ïà àà à)€€€€€ChancellorÌà àà àà àà àà àà à)ÌSPRING€KNITS,€INC.€Andà àà àà à)à àà àà àà àà àCIGNAÏINSURANCE€COMPANY.à àà àà à)à àà àà àà àà àÏà àà àà àà àà àà àà à)à à03S01„9704„CH„00041Ì€€€€€€€€€€€€€Defendants/Appellantsà àà à)à àÌà àà àà àà àà àà àÌà àà àà àà àà àà àÌÌà àà àà àà àJUDGMENT€ORDERÌà àà àà àÌà à€€€€€€€€€€€ÓfæÓÓ ø ÓÓ` Ü…X ì–XÓThis€case€is€before€the€Court€upon€the€entire€record,€including€theÏorder€of€referral€to€the€Special€Workersðð€Compensation€Panel,€and€the€PanelððsÏMemorandum€Opinion€setting€forth€its€findings€of€fact€and€conclusions€of€law,€whichÏare€incorporated€herein€by€reference;Ìà àà àWhereupon,€it€appears€to€the€Court€that€the€Memorandum€Opinion€of€theÏPanel€should€be€accepted€and€approved;€andÌà àà àIt€is,€therefore,€ordered€that€the€Panelððs€findings€of€fact€and€conclusions€ofÏlaw€are€adopted€and€affirmed,€and€the€decision€of€the€Panel€is€made€the€JudgmentÏof€the€Court.€€à àà àÌÒ  ÒÒ H Òà à€€€€€Costs€on€appeal€are€taxed€to€the€appellants,€Spring€Knit,€Inc.€And€CignaÏInsurance€Company€and€surety,€John€D.€Barry,€for€which€execution€may€issue€ifÏnecessary.ÌÌ11/25/97Ì€ÌÌÌÌÌÌÌ