Decision #19/08 - Type: Workers Compensation
Preamble
This appeal deals with whether or not it was reasonable for the worker to take the whole day off work to attend a medical appointment with his physician on July 4, 2007. Both primary adjudication and Review Office determined that it was reasonable for the worker to only take three hours off work to attend the medical appointment on July 4, 2007, instead of the whole day. The worker disagreed and appealed to the Appeal Commission. A hearing was then held on December 19, 2007.Issue
Whether or not the worker is entitled to wage loss benefits for the full day on July 4, 2007.Decision
That the worker is not entitled to wage loss benefits for the full day on July 4, 2007.Decision: Unanimous
Background
On June 15, 2007, the worker tripped and fell at work and struck both of his knees onto a cement floor. On June 18, 2007, the treating physician diagnosed the worker with contusion to both knees. The worker continued to perform his regular work duties after the accident and only missed time from work to attend medical appointments.
On June 21, 2007, the worker advised a WCB adjudicator that he needed to take the entire day off work on July 4, 2007, to attend a medical appointment with his physician as the doctor may send him for further tests. The adjudicator advised the worker of the WCB’s policy to only authorize a maximum of two hours for an appointment but if he was sent for additional tests, consideration would be given at that time as to whether or not he would be entitled to additional benefits.
The worker attended his physician for treatment on July 4, 2007. The examination revealed that the worker’s left knee condition had resolved and that his right knee was unremarkable except for a severe tender spot over the patella.
On July 23, 2007, the worker advised a different adjudicator that he missed 8 hours of work to attend his medical appointment on July 4, 2007. The worker’s reasons for missing the whole day of work to attend the appointment involved the time it took to leave work, drive to the doctor’s office and sit and wait for the appointment.
In a decision dated July 25, 2007, the worker was advised that the WCB was reimbursing his employer 3 hours of time loss for the July 4, 2007, medical appointment. The adjudicator noted that the WCB confirmed with the physician’s office that the appointment on July 4, 2007, took place at 2:00 p.m. She felt that 3 hours to attend the medical appointment on July 4, 2007, was reasonable. On July 29, 2007, the worker appealed the decision to Review Office.
On September 20, 2007, Review Office determined that the worker was not entitled to wage loss benefits for a full day on July 4, 2007. Review Office stated that the worker’s hours of work on a daily basis began at 8:00 a.m. and ended at 4:00 p.m. His doctor’s appointment on July 4 was at 2:00 p.m. Review Office felt that it should not take the worker more than one hour to leave work and arrive at his appointment on time at 2:00 p.m. There was no evidence to show that the physician had requested the worker go for any tests prior to his appointment on July 4. Review Office did not feel it was necessary for the worker to lose a full eight hours of wages in order to attend the medical appointment at 2:00 p.m. in the afternoon on July 4, 2007. On October 3, 2007, the worker disagreed with Review Office and appealed to the Appeal Commission.
Reasons
Worker’s Position
The worker explained the reasons for his appeal and answered questions posed by the panel.
The worker advised that he first saw his physician on June 18, 2007. At that time his knees were swollen so x-rays could not be taken. The worker explained that he continued to work and the swelling in his knees increased. He noted that July 2 was a holiday and that he took July 3 as a vacation day because he did not want to work and aggravate his knee. He stated that when he saw the physician on July 4, the swelling was down and x-rays were taken. He stated “so that’s basically why I took the day. I didn’t want to go back to work to aggravate it anymore.”
In answer to questions, the worker confirmed that he did not seek WCB wage loss benefits for July 3, 2007. The worker was asked whether his physician told him to take off the time from work. He replied “He said it was up to me. I’m sure if I would have gone back in and asked …he’s going to say, “Okay, take the day off”.
The worker also acknowledged that he did not tell WCB staff that he took off the day because he was concerned with swelling. He said he thought the day had been approved.
The worker disagreed with the case manager’s note of July 23, 2007, which summarized a conversation between the worker and the case manager regarding the appointment.
Employer Position
The employer was represented by its compensation coordinator. The employer’s representative noted that the explanation provided at the hearing by the worker for taking off the full day on July 4, 2007, is not mentioned on the file. He submitted that this is the first time that the worker has indicated that he took off the full day due to swelling.
The employer’s representative noted that the July 4 appointment was scheduled for 2:00 p.m. and not 10:00 a.m. as suggested by the worker to the case manager in July 2007. He noted that the WCB paid the worker for three hours to attend the appointment which included travel time. He submitted that nothing had been presented at the hearing that suggests the allotment of three hours was unreasonable, given the hours of work and the time of the appointment.
Analysis
The issue before the panel was whether there is entitlement to wage loss benefits for a full day on July 4, 2007.
The panel has considered the evidence on file and provided at the hearing and finds that the worker is not entitled to wage loss benefits for the full day on July 4, 2007. The panel notes that the worker’s hours of work are from 8:00 a.m. to 4:00 p.m. and that the appointment with the physician was scheduled for 2:00 p.m. The panel finds that the WCB did not, before July 4, 2007, approve a full day off work for the appointment. The worker was allotted three hours to attend the appointment, including travel time of one hour. The panel finds this to be reasonable in the circumstances.
At the hearing the worker advanced a different explanation for taking off the full day than he had provided to WCB staff. He stated that he took off the full day so that he did not aggravate his knee and to prevent it from swelling so that x-rays could be taken on July 4, 2007. He noted that he had taken July 3, 2007, as a vacation day for the same reason. He did not make a request for payment for July 3, 2007.
The panel notes that file information does not support this explanation. The panel relies upon the file information which was gathered at a time closer to July 4, 2007. The panel also notes that the worker did not have medical authorization for a full day of time loss.
The appeal is denied.
Panel Members
A. Scramstad, Presiding OfficerM. Bencharski, Commissioner
M. Day, Commissioner
Recording Secretary, B. Kosc
A. Scramstad - Presiding Officer
Signed at Winnipeg this 31st day of January, 2008