Decision #103/03 - Type: Workers Compensation

Preamble

An Appeal Panel hearing was held on July 23, 2003, at the claimant's request. The Panel discussed this appeal on July 23, 2003 and again on September 9, 2003.

Issue

Whether or not the worker is entitled to mileage expenses to attend chiropractic appointments in Lorette.

Decision

That the worker is not entitled to mileage expenses to attend chiropractic appointments in Lorette.

Decision: Unanimous

Background

In December 2002, the claimant telephoned the call centre at the Workers Compensation Board (WCB) to report an injury to her neck, shoulders and ribs which occurred at work on November 29, 2002 during the course of her employment as a healthcare aid. The diagnosis rendered by a chiropractor with respect to this claim was an acute cervicothoracic sprain/strain type injury. The claim was accepted by the WCB and benefits were paid accordingly.

On January 15, 2003, a WCB medical aid assessor advised the claimant that her request for reimbursement of travel expenses to attend chiropractic treatments in Lorette had been denied. It was determined that the mileage to these appointments did not qualify under the Workers Compensation Travel Policy. "The travel policy states that mileage is paid for travel incurred over and above normal travel to work, to the nearest medical facility." This decision was appealed by the claimant on January 26, 2003. The claimant contended that the chiropractor in Lorette offered her the "activator method" of treatment which helped her immensely.

On February 28, 2003, Review Office confirmed that the mileage to attend a chiropractor in Lorette, Manitoba was not a WCB responsibility. Review Office noted that when the WCB medical aid assessor advised the claimant that "mileage to these appointments does not qualify under the Workers Compensation Travel Policy", this decision was based on the fact that there was chiropractic treatment available in Beausejour. Review Office indicated that it was the opinion of a WCB chiropractic consultant that this method of treatment had not been proven to be a better treatment option. Review Office indicated that the claimant made a personal choice to attend chiropractic treatment in Lorette and there was no evidence to indicate that this special treatment was required as a direct result of the compensable injury. On April 30, 2003, the claimant appealed Review Office's decision and an oral hearing was arranged.

Following the hearing and discussion of the case, the Appeal Panel requested further details from the WCB's chiropractic consultant as to what advice he had provided to the Review Officer with respect to the "activator method" of treatment. A response was received from the chiropractic consultant dated August 13, 2003 and was forwarded to the interested parties for comment. On September 9, 2003, the Panel met further to discuss the case and considered a submission by the claimant dated August 21, 2003.

Reasons

This case involves a healthcare worker, who injured her neck, shoulder and ribs as a result of a workplace injury. As noted above, her claim for compensation was accepted and she did receive benefits, both for loss of earnings and medical aid.

The only issue before the Appeal Panel was whether or not the claimant is entitled to be reimbursed for the cost of travel incurred to receive treatment from her chosen chiropractor. Pursuant to board policy, the Review Office upheld an earlier decision not to pay these travel costs. She appealed that decision to the Appeal Commission.

For her appeal to be successful, the Panel would have to determine that the claimant was compelled to travel as equivalent treatment was not available in her home community. We were not able to make that determination.

In coming to our decision, we conducted a thorough review of the claim file and held a hearing at which we heard testimony from the claimant. Subsequent to the hearing, we sought further information from a chiropractic advisor to the board.

The claimant chose to attend a chiropractor in a community at some distance from her home. She did so because this chiropractor used a particular method of treatment.

Under Board Policy No. 44.120.10, the board will pay reasonable expenses for travel to medical treatment, which are in excess of costs normally incurred by the worker travelling to and from work. Board practice is that, where treatment is available in a worker's home community, no expenses will be paid, should the worker choose to seek alternate treatment.

She chose to attend a chiropractor who uses the "activator method" of treatment. It is her belief that this is an advanced and superior method of chiropractic treatment, in contrast to the more common "manual adjustment" method. This may be, although it is open to debate among chiropractors. Nonetheless, there is no evidence that the chiropractic treatment available in her hometown would not have been as effective.

She argued that by not paying her travel costs, she was being denied the right to attend the practitioner of her choice. We do not agree with this contention. She has exercised her right to attend the chiropractor of her choice.

However, it is our conclusion that it was not medically necessary to do so, as equivalent treatment is available in her hometown. Thus, we don't find this to be a "reasonable" expense as set out in policy.

Accordingly, the appeal is dismissed.

Panel Members

T. Sargeant, Presiding Officer
A. Finkel, Commissioner
M. Day, Commissioner

Recording Secretary, B. Miller

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

Signed at Winnipeg this 29th day of September, 2003

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