The Appeal CommissionThe Workers Compensation Act of Manitoba

Preamble

An Appeal Panel hearing was held on April 4, 2003, at the request of the claimant. The Panel discussed the appeal on the same date.

Issue

Whether or not responsibility should be accepted for massage therapy treatment.

Decision

That responsibility should not be accepted for massage therapy treatment.

Decision: Unanimous

Background

In July 2000, the claimant filed an application for compensation benefits with the Workers Compensation Board (WCB) for carpal tunnel syndrome (CTS) which she related to her employment activities as an administrative secretary. Following a review of the claimant's job description, the medical information on file and after consulting with the WCB's healthcare branch, the claim for CTS was accepted by the WCB.

In November 2000, the attending physician prescribed massage therapy due to soreness in the claimant's shoulder, arm and neck. A WCB medical advisor was asked to review the recommendation. He questioned the helpfulness of this treatment in terms of treating carpal tunnel syndrome and noted that the claimant's upper limb problems were not related to the compensable injury. Following this consultation, the claimant was advised that the WCB would not approve payment for her therapy.

On November 25, 2002, a WCB adjudicator wrote and advised the claimant of that decision:

"Your employer has requested WCB advise in writing whether we would pay for massage therapy treatment. I have again reviewed your claim in consultation with our health care advisor, and at this time WCB will not accept responsibility for massage therapy.

The WCB can, at its discretion, pay for other treatment modalities. If the treatment is time limited and demonstrates ongoing improvement, payment for other treatment modalities may be accepted. However, if the treatment requested appears to be maintenance care, this will not be accepted by the WCB."

In an appeal submission dated January 20, 2003, the claimant indicated that massage therapy enabled her to continue working. "Otherwise, the pain is so intense I'm not able to fulfill my work tasks/obligations. I have previously tried physiotherapy, reflexology and have not had success with the pain management, like these treatments. Health office is aware and supports this treatment…".

In a decision dated February 7, 2003, Review Office denied acceptance for the prescribed massage therapy treatment based on Section 27(1) of The Workers Compensation Act (the Act). Review Office noted that the WCB generally did not fund massage therapy treatment and in particular, was not aware of massage therapy ever being accepted for treatment related to a CTS condition.

Review Office was of the opinion that massage therapy would only provide very transient relief and would not cure or relieve these symptoms associated with this medical condition on a long term basis. Since the provision of medical aid such as massage therapy was discretionary, it was the opinion of Review Office that financial responsibility should not be accepted for this form of treatment in relation to this medical condition. On February 27, 2003, the claimant appealed Review Office's decision and an oral hearing was arranged.

On March 26, 2003, the claimant submitted additional material from her osteopathic remedial massage therapist who treated her on 14 different occasions between December 04, 2000 and December 18, 2002. The therapist's report documents treatment for a number of areas of the claimant's body including her head, right and left wrist, neck, shoulders, right arm, left and right hips and left ankle. The therapist went on to recommend that the claimant undergo a series of five treatments in a compressed time frame followed by a maintenance program.

The claimant ably presented her argument on April 4, 2003. She spoke favorably of the nature of treatment she received to her shoulders, wrists, arms and neck and described it as a preventive measure.

Reasons

The Panel's decision on this matter is guided by s. 27(1) of the Act which provides that "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."

The Board policy on medical aid (44.120.10) elaborates on this objective. Section 2 (b) specifically identifies massage therapy as treatment which may be approved provided that its use "will aid in the recovery of an injured worker or minimize the impact of the injury."

In considering the application of the policy to the current claim, it is important to focus upon two important realities. The first is that the compensable injury is related to carpal tunnel syndrome. While the claimant undoubtedly has experienced pain in her upper body apart from her wrists and hands, it has not been established that these symptoms are causally related to the diagnosed compensable injury. Indeed, the WCB medical advisor specifically found that they were not. While the treatment may well be providing relief for a number of the claimant's symptoms, many of the symptoms being treated are not causally related to the claimant's compensable injury. The WCB is not obliged to approve treatment for symptoms which are not causally related to the compensable injury.

The second reality relates to the nature of the treatment itself which can best be characterized as being of a maintenance or preventive nature. The claimant has not lost time from work as a result of her injury which is described as mild bilateral CTS. While the treatment may act to relieve some of the symptoms of CTS, there is no credible medical evidence to suggest that the massage therapy is curing the compensable injury or in the words of the policy aiding in "the claimant's permanent recovery".

The Panel does not mean to minimize the nature of the claimant's discomfort. We accept that the pain she experiences is real and that some of it is related to her compensable injury. However, she is able to work and there is nothing to suggest the treatment provided offers any form of permanent relief. The legislative mandate of the WCB does not extend to the provision of maintenance treatment in the current circumstances.

For these reasons, the Panel finds that responsibility should not be accepted for massage therapy treatment

Panel Members

B. Williams, Presiding Officer
A. Finkel, Commissioner
M. Day, Commissioner

Recording Secretary, B. Miller

B. Williams - Presiding Officer
(on behalf of the panel)

Signed at Winnipeg this 1st day of May, 2003