Decision #118/00 - Type: Workers Compensation
A non-oral file review was held on November 15, 2000, at the request of the claimant.
Whether or not responsibility should be accepted for chiropractic treatment beyond June 2, 2000.
That responsibility should be accepted for chiropractic treatment up to June 24, 2000 inclusive.
During the course of his employment functions on March 27, 2000, the claimant injured his right lower back while lifting parcels at work. On the same day of accident, the claimant attended a local hospital for treatment and was diagnosed with a right lumbar paraspinal spasm.
Subsequent file documentation showed that the claimant was assessed by a chiropractor on March 29, 2000. The diagnosis rendered by the chiropractor was an acute lumbosacral torsion sprain. The recommended course of treatment consisted of chiropractic adjustments 3-5 times per week for two weeks and then 3 times per week for 8 weeks.
The claim for compensation was accepted and the claimant received full wage loss benefits between March 28, 2000 and April 9, 2000 inclusive. The claimant returned to regular full time work duties on April 25, 2000.
On April 18, 2000, Rehabilitation and Compensation Services wrote to the claimant advising that the Workers Compensation Board (WCB) had approved responsibility for chiropractic treatment for a maximum period of 8 weeks or up to May 24, 2000. The adjudicator provided the claimant with details regarding the guidelines used by the WCB in their responsibility to supervise and control medical/chiropractic treatment. The claimant was informed that further chiropractic treatment beyond May 24, 2000, would have to be pre-approved by the WCB.
In a progress report dated May 17, 2000, the attending chiropractor indicated that the claimant's lower back pain "comes and goes" and was unpredictable. It would increase with stooping, twisting and lifting. The chiropractor requested permission to extend chiropractic treatment for an additional four weeks up to June 24, 2000.
On May 31, 2000, a WCB chiropractic advisor wrote to the treating chiropractor to advise that no further responsibility would be accepted for chiropractic treatment after May 24, 2000. It was felt by the chiropractic advisor that there were no exceptional circumstances in the claimant's case that would warrant additional treatment.
On June 9, 2000, the claimant appealed the WCB's decision to terminate chiropractic treatment as of May 24th. The claimant stated that he made a hasty return to work while he was still in severe pain. The chiropractic treatment helped him to cope and readjust to his job but certainly not by May 24th. The claimant indicated that he continued to receive chiropractic care and was completely recovered from his pain by June 2, 2000. Any future visits to the chiropractor starting June 5, 2000, were considered by the claimant to be maintenance care.
In a decision of June 16, 2000, Review Office determined that further responsibility would be accepted for chiropractic treatment up to and including June 2, 2000. Review Office believed that the claimant had achieved maximum improvement by June 2, 2000 and that with home exercises and a home treatment program, he would not require additional chiropractic treatment in relation to his compensable injury up to June 24, 2000, as suggested by the treating chiropractor.
In a further letter dated August 9, 2000, the claimant indicated that he thought that he had completely recovered after his chiropractic treatment on June 2nd but within a few days he felt tremendous pain in his left thigh and right lower side. The claimant advised that he returned to his chiropractor for follow up treatment and was told that the pain in his thigh was still a side effect from his injury. The claimant therefore requested that the WCB approve further chiropractic treatments beyond June 2, 2000.
On August 24, 2000, Review Office advised the claimant to submit an appeal with the Appeal Commission as the Review Office had already dealt with the matter concerning chiropractic treatment. On August 30, 2000, the claimant appealed Review Office's decision and a non-oral file review was held.
The Panel met on November 15, 2000 to conduct a non-oral file review of this appeal. We concluded, unanimously, that responsibility for chiropractic treatment should be accepted up to, and including, June 24, 2000. We found no justification to extend this responsibility beyond that date.
In coming to this decision, the Panel was persuaded by the Chiropractor's Progress Report, dated May 17/00, submitted by the claimant's attending chiropractor. In that report, which was based on his assessment of the claimant on May 15th, the chiropractor noted that progress was "fair" and that he anticipated that the claimant would be partially disabled from regular work until June 24th. He requested approval to continue treatment to that date, beyond the originally-authorized date of May 28th. This request was denied.
We are cognizant that WCB guidelines limit chiropractic treatment, in cases such as this. However, these guidelines allow for an extension where the treating chiropractor feels it is warranted and requests an extension.
By June 2nd, while following the course of treatment prescribed by the chiropractor, the Claimant felt he had recovered to the point he could return to work, which he did on that day. Within a few days, the pain returned. Nonetheless, we were persuaded, on a balance of probabilities, that this cycle of improvements and setbacks in the Claimant's condition in June indicated that the chiropractor's diagnosis of the need for treatment to continue to June 24th was correct.
While we have concluded that extended treatment was warranted during the acute phase of treatment, we do not feel that treatment is warranted beyond that. The guidelines do not support treatment for maintenance purposes; and we find no compelling reason to make an exception.
Therefore, the Appeal is allowed in part: chiropractic treatment for the period from June 3 to June 24, 2000, inclusive, is authorized.
T. Sargeant, Presiding Officer
A. Finkel, Commissioner
L. Butler, Commissioner
Recording Secretary, B. Miller
T. Sargeant - Presiding Officer
(on behalf of the panel)
Signed at Winnipeg this 2nd day of November, 2000