Public Decisions | The Appeal Commission

Decision #89/02 - Type: Workers Compensation

Preamble

A non-oral file review was held on June 27, 2002, at the request of a worker advisor, acting on behalf of the claimant.

Issue

Whether or not responsibility should be accepted for the worker's travel costs to Calgary, including time loss from work and chiropractic costs above those that would normally be paid through the WCB's chiropractic guidelines.

Decision

That responsibility should not be accepted for the worker's travel costs to Calgary, including time loss from work and chiropractic costs above those that would normally be paid through the WCB's chiropractic guidelines.

Decision: Unanimous

Background

On November 22, 2001, the claimant slipped on black ice in a parking lot, causing her to land on her tailbone and striking her head against a parked vehicle. As a result of the incident, the claimant was diagnosed with a contusion of the coccyx and mild cervical nerve root irritation.

In December 13, 2001 telephone conversation with the claimant, a Workers Compensation Board (WCB) adjudicator documented the following information:

the claimant had been in a lot of pain since her fall on November 22nd. Her tailbone and neck were both still sore. The claimant was having some problems with her left eye vision which came on about 4 days after the fall.
with respect to past history, the claimant had a bad injury to her neck and back in 1996. She had problems with her back and hips after that for the longest time. Doctors had diagnosed arthritis in both hips. The claimant advised that she had been seeing a chiropractor in Calgary in October 2000 who did wonders for her. He found that her neck was out of line and therefore she was not sitting right and this was causing her all kinds of problems. The claimant indicated that the treatment she received was referred to as "NUCCA" (National Upper Cervical Chiropractic Association) which was a form of chiropractic treatment. No one else did this kind of treatment. The claimant advised that after going to this chiropractor for treatment, she had been drug-free and pain-free. When she last saw him in October 2001 she was fine and had no problems. Now she is back to square one since her fall.
after her fall, the claimant attended a doctor at the local clinic who prescribed Tylenol 3 with codeine but this did nothing for her. About 4 days later, she followed up with her own doctor and saw him about 3 times since. The claimant indicated that x-rays had been done, which showed no broken bones. She was told by her doctor that she had arthritis in her spine and was prescribed Vioxx. This medication, however, was doing nothing for her.
the claimant was able to work but she wondered if the WCB would pay for her travelling expenses to fly to Calgary as she could not sit in a vehicle for that many hours and drive there. This would be the same for a bus.

On January 3, 2002, a WCB chiropractic advisor reviewed the case. The chiropractic advisor did not recommend that the claimant travel to Calgary for treatment as a chiropractor in the claimant's home region could address her concerns. On January 10, 2001, a second WCB chiropractic advisor also reviewed the case. He commented that chiropractic treatment would be helpful and that the claimant could attend a chiropractor in her area for assessment and treatment.

In letter dated January 15, 2002, primary adjudication confirmed to the claimant that the WCB accepted responsibility for the workplace injury and would be paying for her time missed from work on December 17 and 18, 2001. The WCB would not, however, pay for the claimant to attend a chiropractor in Calgary, Alberta for treatment. Primary adjudication based its decision on the opinions expressed by the two WCB chiropractic advisors. Primary adjudication clarified that the WCB was not responsible for any non medical expenses (i.e. travel expenses, time missed from work that she may incur for treatment in Calgary). On January 9, 2002, the claimant appealed this decision to Review Office.

On May 17, 2002, Review Office determined that responsibility would not be accepted for the claimant's travel costs to Calgary nor any time loss from work associated with such trips nor any costs over and above the rates deemed payable per legislation and policy.

After reviewing all of the evidence, Review Office supported the decision provided by the WCB adjudicator that the claimant's treatment program would be covered at the same rate had she stayed with the treatment offered in her home area. Review Office believed that it was not reasonable to expect the WCB to offer coverage for the claimant leaving the province to seek treatment when it was the opinion of the WCB's chiropractic advisors that chiropractic care for her neck condition was available in her home town area. Board Policy 44.120.10 on Medical Aid, section 3(a)(iii) was quoted in the decision. On May 31, 2002, a worker advisor appealed Review Office's decision and a non-oral file review was arranged.

Reasons

WCB policy 44.120.10 provides in part as follows with respect to expenses:

As the background notes indicate, the claimant has requested that she be allowed to travel to Calgary in order to receive a certain chiropractic procedure called the N.U.C.C.A. Technique, which apparently is not employed by her local treating chiropractor. We accept the WCB's chiropractic consultants' opinions that the claimant's request should be denied because she could receive adequate chiropractic care in her own local community. We therefore find that responsibility should not be accepted for the worker's travel costs to Calgary, as this would not be the most cost-effective alternative in treating her condition. Accordingly, the claimant's appeal is hereby dismissed.

Panel Members

R. W. MacNeil, Presiding Officer
A. Finkel, Commissioner
M. Day, Commissioner

Recording Secretary, B. Miller

R. W. MacNeil - Presiding Officer
(on behalf of the panel)

Signed at Winnipeg this 4th day of July, 2002

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