The Appeal CommissionThe Workers Compensation Act of Manitoba

Preamble

An Appeal Panel hearing was held on December 12, 2000, at the request of the claimant. The Panel discussed this appeal on December 12, 2000

Issue

Whether or not responsibility should be accepted for the cost of laser therapy administered between March 22 and April 20, 2000.

Decision

That responsibility should be accepted for provision of physiotherapy services administered commencing March 22, 2000.

Background

In April 1999, the claimant submitted a claim for bilateral carpal tunnel syndrome which she related to her employment activities in a healthcare facility. On May 31, 1999, the claimant was informed that her claim was approved and that the Workers Compensation Board (WCB) would cover any medical expenses related to the carpal tunnel syndrome including purchase of a wrist brace.

In a letter dated June 5, 2000, a sports medicine specialist noted that the claimant specifically requested laser therapy for her chronic wrist problem. In addition, the specialist indicated the following:

"High (sic) advised the patient that laser therapy may or may not be helpful for her wrist. There was certainly no evidence that this would help or cure carpal tunnel syndrome. I advise (sic) to her it would probably not be harmful. The cost of the treatment would not be covered by Manitoba health or WCB as it was of no proven benefit. I advise (sic) the patient that she would be responsible for the cost of the treatment and it would be her choice to pursue it. She been advise (sic) me that she wanted to proceed with a course of laser therapy which was subsequently scheduled.

I subsequently reviewed the patient on two occasions. She stated that her wrist symptoms had improved although there are certainly no objective findings to indicate any changes. She was advised that continuing laser therapy would be her choice and a limit was set to the total number of treatments (12)."

Subsequent file documentation showed that the claimant received laser treatment between March 22 to April 20, 2000. On July 10, 2000, the claimant was advised that the WCB was unable to accept responsibility for the costs associated with the laser therapy treatment. On August 1, 2000, the claimant appealed this decision stating that she was given permission by her adjudicator to go ahead and have the laser therapy.

In a decision dated August 18, 2000, Review Office determined that no financial responsibility could be accepted for the cost of the laser therapy.

Review Office indicated that the adjudicator in question had been asked whether or not he authorized therapy either verbally or in writing. The adjudicator stated he did not at any time authorize the laser therapy as part of the worker's claim. The Review Officer also spoke with a WCB orthopaedic consultant who stated he did not believe the laser treatment would be helpful for the claimant's carpal tunnel condition.

Review Office commented that the doctor who administered the laser therapy had stated in his letter that the therapy would not likely help or cure the carpal tunnel syndrome. He also stated that the claimant was informed that the cost of the therapy would not be covered either by Manitoba Health or by the WCB 'as it was of no proven benefit'. Under these circumstances, Review Office did not believe that the WCB should be responsible for the costs of the unproven medical treatment in relation to the carpal tunnel syndrome. On September 28, 2000, the claimant appealed Review Office's decision and an oral hearing took place on December 12, 2000.

Reasons

The issue in this appeal is whether or not the claimant is entitled to have the WCB pay for laser therapy she received as treatment for her carpal tunnel syndrome.

The relevant subsection of The Workers Compensation Act (the Act) in this appeal is subsection 27(1) which provides for the provision of medical care. Subsection 27(1) states:

Provision of medical aid
27(1) The board may provide a worker with such medical aid as the board considers necessary to cure and provide relief from an injury resulting from an accident.

This issue is also covered by WCB policy #44.120.10, which provides - among other things - that medical-aid services by other than accredited healthcare providers must receive pre-approval by the WCB.

After experiencing pains in her forearms for a number of months, the claimant was diagnosed with carpal tunnel syndrome (CTS) on March 15, 1999. This condition was the result of her work in which she performed repetitive tasks which placed regular strain on her wrists and lower arms. The claim was accepted and she was paid wage loss benefits.

Treatment by way of physiotherapy, exercising, splints, etc. was of some benefit, but fell somewhat short of an improvement sufficient to return to work. In late 1999, she was informed that surgery could be of assistance, most likely allowing her to return to work with no restrictions.

For her own reasons, she did not wish to undergo surgery. She was informed by WCB that, as a result of her refusal to have surgery, her wage loss benefits would terminate on June 23, 2000. At this point, she began to do some personal research into CTS, including the purchase of medical books designed for laypersons. In one such book, she read that a new and sometimes successful treatment for CTS is laser therapy.

To this end, she consulted with a doctor who advised her that this treatment is unproven and not covered by MHSC or the WCB. But, he did say that it might work and, at worst, would do no harm. She chose to go ahead with the treatment, which was administered by a physiotherapist.

She reports that, within about two weeks, her symptoms began to improve. By the end of the 15 treatments, the symptoms had gone and have remained so.

In considering this appeal we considered the evidence in respect of policy #44.120.10, which states that unusual or alternative treatment must be approved in advance by the WCB. The claimant states that she believed she had received such approval from the primary adjudicator, in a telephone call on March 2, 2000. The adjudicator maintains that he gave no such approval. There is no memo on the file indicating that he had done so. We found no reason to doubt the word of the adjudicator.

Nonetheless, we were persuaded by the apparent recovery of the claimant. Given that the injury was accepted as compensable, we are of the view that, since this treatment led to symptomatic recovery, it should be covered by the Board. In coming to this decision, we took the position that, in this case, the claimant should be authorized for further physiotherapy, administered in the form of laser treatment.

We note that the issue we were asked to consider covered the period from March 22, 2000 to April 20, 2000. However, we also note that the invoice on file for the treatment covers a longer period, from March 22 to July 7. This invoice was received after the date on which the initial decision was made by adjudication. We are of the view that all 15 treatments should be covered.

Panel Members

T. Sargeant, Presiding Officer
A. Finkel, Commissioner
B. Leake, Commissioner

Recording Secretary, B. Miller

T. Sargeant - Presiding Officer
(on behalf of the panel)

Signed at Winnipeg this 9th day of January, 2001