The Appeal CommissionThe Workers Compensation Act of Manitoba

Preamble

A non-oral file review was scheduled to take place on February 9, 2005 with respect to an appeal submission from a worker advisor, acting on behalf of the worker. The Panel met to discuss the case on March 2 and 3, 2005.

Issue

Whether or not the worker is entitled to wage loss benefits to attend the appointment with his plastic surgeon on April 20, 2004.

Decision

That the worker is not entitled to wage loss benefits to attend the appointment with his plastic surgeon on April 20, 2004.

Decision: Unanimous

Background

In August 1994, the worker submitted a claim to the Workers Compensation Board (WCB) for difficulties he was experiencing with both hands due to the nature of his employment activities as a hoe ram operator. The claim was accepted by the WCB and benefits were paid accordingly. The worker also has a 1983 back claim with the WCB.

A memo on file confirms that on March 10, 2004, the worker contacted the WCB regarding payment of time loss for an appointment with a plastic surgeon. The worker was advised by a WCB case management representative that time loss would not be covered as he had already seen a plastic surgeon and it was felt that a second opinion was not required.

On July 14, 2004, a discussion took place between the worker and a WCB case management representative concerning the topic of wage loss benefits in connection with an April 20, 2004 medical appointment. In a decision letter dated July 16, 2004, Rehabilitation & Compensation Services advised the worker of the following:

"With regards to your request for entitlement to time loss and travel expenses for your April 20, 2004 (sic), with Dr. [plastic surgeon] and April 21, 2004, with Dr. [neurosurgeon] you were advised time loss was only being provided for your back appointment with Dr. [neurosurgeon]. Travel arrangements were going to be set up for you to fly in and out the same day so your time loss from work would be minimized. It was also explained at that time we had received Dr. [original plastic surgeon's] report and it was felt a second opinion was not necessary to further manage your claim. It was indicated that you could still attend your appointment with Dr. [plastic surgeon] if you wished to do so but time loss would not be provided for the extended period of the April 20, 2004, appointment."

On August 19, 2004, a worker advisor wrote to Review Office and appealed the above decision. The worker advisor contended that the worker's time loss to attend the medical appointment with the plastic surgeon would not have arisen had it not been for the workplace injury.

In a decision letter dated October 4, 2004 Review Office refused to authorize payment of time loss for the April 20, 2004 appointment. Review Office held that the worker was not eligible because he had attained the age of 65 and that payment was not permitted under The Workers Compensation Act (the Act).

On October 7, 2004, the Appeal Commission received an application to appeal Review Office's decision of October 4, 2004 from the worker advisor and a non-oral file review was held on February 9, 2005.

Reasons

The issue before us was whether the worker is entitled to wage loss benefits to attend the appointment with his plastic surgeon on April 20, 2004. We have found that the worker is not entitled to receive wage loss benefits for the date of this appointment.

We note that the worker was seeing this physician because he wanted a second opinion regarding treatment for his carpal tunnel syndrome. It was noted that the worker had already seen a plastic surgeon who recommended no further surgery. We also note that on March 20, 2004, approximately one month prior to the appointment, the WCB advised the worker that it would not reimburse him for time loss from work for this appointment as they did not require a second opinion.

The WCB has authority to refuse to pay for medical treatments that are considered unnecessary. Subsection 27(1) of the Act provides that the WCB may provide a worker with such medical aid as it considers necessary to cure and provide relief from an injury. As well, the WCB's Board of Directors have made Policy 44.120.10 dealing with medical aid. Section 3(a)(i) provides, in part, that the WCB will reimburse a worker's actual reasonable expenses related to traveling to medical appointments including wage loss. We find that it was reasonable for the WCB to refuse to pay the worker for time missed from work to attend the appointment. The appointment was not necessary for management of the worker's claim and was not authorized by the WCB. The facts of this case, as outlined above, do not warrant the payment of wages in this instance.

The worker's appeal is dismissed.

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 18th day of March, 2005