The Appeal CommissionThe Workers Compensation Act of Manitoba

Preamble

A non-oral file review was held on October 20, 2004, at the worker's request.

Issue

Whether or not financial responsibility should be accepted for the purchase of the Syncro hearing aid.

Decision

That financial responsibility should not be accepted for the purchase of the Syncro hearing aid.

Decision: Unanimous

Background

In November 2003, the worker filed a claim with the Workers Compensation Board (WCB) for noise induced hearing loss.

On March 2, 2004, the WCB accepted responsibility for the hearing loss claim and the worker was awarded a 4% permanent partial impairment award for his hearing loss impairment. The WCB also advised the worker that the WCB would provide full coverage of all hearing aids purchased from the WCB's "Approved Product List".

In a letter to the WCB dated June 15, 2004, the worker's treating clinical audiologist stated the following:

"Mr. [the worker] has unsuccessfully undergone a trial period with Widex Senso Diva canal hearing aids. As I believe this was the best technology on the approved list, I am now recommending the new Oticon Syncro canal hearing aids, which are not yet on the approved list…".

On June 24, 2004, the WCB advised the claimant that the Oticon Syncro hearing aids were currently priced above the limit of WCB coverage and therefore the WCB was unable to grant coverage for this type of hearing aid. On July 7, 2004, the worker appealed this decision to Review Office.

In a decision to the worker dated August 5, 2004, Review Office stated that the WCB had the right to impose limits or standards of reasonableness when dealing with medical aid expenditures. In this particular case, the WCB set a limit on the amount that the WCB would pay for the cost of hearing aids and that the worker requested a hearing aid that exceeded this limit (i.e. the Syncro hearing aid). Review Office noted that the Adapto model was on the WCB's approved List and that this hearing aid would also meet the worker's needs. Based on this rationale, Review Office determined that financial responsibility should not be accepted for the Syncro hearing aid. On August 2004, the worker appealed Review Office's decision and a non-oral file review was arranged.

Reasons

The issue before us was whether financial responsibility should be accepted for the purchase of a specific hearing aid, a Syncro model. For the worker's appeal to be successful we must find that it is appropriate to authorize the purchase of a hearing aid that is not on the WCB Pre-authorized Product List. We did not find this to be an appropriate case to authorize purchase of a hearing aid which is not on the approved product list.

Subsection 27(1) of The Workers Compensation Act (the Act) provides the WCB with authority to provide injured workers with medical aid necessary to cure and provide relief from a workplace injury. This authority extends to the purchase of hearing aids in cases of hearing loss.

The Board of Directors of the WCB has made a policy regarding Hearing Loss claims (Policy #44.20.50.20). Paragraph 7 of this policy provides that when a claim for hearing loss is accepted and a specialist recommends the use of a hearing aid(s), a worker shall be entitled to a suitable hearing aid(s) of a reasonable cost as approved by the WCB.

The WCB has established a Pre-authorized Products List. The WCB will approve the purchase of suitable hearing aids which are included on this list. The list is quite extensive and has been updated recently.

We have been asked by the worker to approve the purchase of a hearing aid which is not on the WCB's current list of approved hearing devices. We have considered the worker's written submission and other information on his claim file and do not approve the purchase of the Syncro hearing aid as requested by the worker.

We agree with the decision of the WCB Review Office to not approve the purchase of the requested hearing aid. While we note that the worker's audiologist has recommended this specific product, a representative of the manufacturer of this product has advised the WCB that there is another hearing aid on the list, an Adapto model, that will provide similar benefits. Given there is a hearing aid on the list that would appear to be suitable, we are not prepared to approve the purchase of the requested hearing aid. We do not consider this to be an appropriate case to authorize purchase of a hearing aid which is not on the list.

It appears that the worker has not tried using the Adapto hearing aid suggested by the manufacturer and cannot attest to its suitability.

The worker's appeal is denied.

Panel Members

A. Scramstad, Presiding Officer
A. Finkel, Commissioner
M. Day, Commissioner

Recording Secretary, B. Miller

A. Scramstad - Presiding Officer
(on behalf of the panel)

Signed at Winnipeg this 3rd day of November, 2004