Decision #31/08 - Type: Workers Compensation

Preamble

In 1997, the worker sustained an injury to his left knee, for which he received benefits from the Workers Compensation Board (“WCB”). In 2007, he underwent knee replacement surgery, and for the initial period following the surgery, physiotherapy was approved. In November 2007, the WCB refused to authorize further physiotherapy treatments for the left knee. The worker appealed the WCB decision.

A file review was held on February 14, 2008 at the worker’s request.

Issue

Whether or not responsibility should be accepted for further physiotherapy treatment.

Decision

That responsibility should not be accepted for further physiotherapy treatment.

Decision: Unanimous

Background

On March 5, 1997, the worker injured his left knee in a work related accident. The claim for compensation was accepted by the WCB and the worker was paid various types of benefits.

Recent medical information showed that the worker underwent a total left knee replacement on July 6, 2007. He was then referred for physiotherapy treatment by the treating physician and was initially assessed by a physiotherapist on July 19, 2007. On July 24, 2007, the worker’s WCB case manager authorized the physiotherapy treatment.

On August 29, 2007, the treating physiotherapist asked the WCB to authorize 10 additional treatments for the worker aimed at general conditioning and strengthening to prepare the worker for duties that included stairs and walking. On September 10, 2007, the case manager authorized the extension for 10 additional physiotherapy treatments.

In a medical note dated October 2, 2007, the treating physician wrote: “Should continue physiotherapy for the L knee until January 2008.” In a doctor’s progress report of the same date, the treating physician noted that the worker still complained of pain in his left knee on and off. Objective findings included slight effusion. He stated that the worker should continue physiotherapy until his appointment with the treating surgeon on January 8, 2008.

On October 18, 2007, the physiotherapist submitted a second application for additional treatment stating that the worker continued to complain of pain with steps, partial squat, occasionally when walking and that the pain was described as ‘catching’. No specific treatment plan or anticipated treatment timeline was provided.

In a letter to the physiotherapist dated November 10, 2007, it was indicated that the WCB was not approving the request for an extension of physiotherapy treatment on the grounds that it was four months post-surgery and that in-clinic treatment was not likely to be any more effective than a comprehensive home program. The worker disagreed with the decision and the case was referred to the Review Office for consideration. The worker argued that his treating physicians advised him that his recovery period would be approximately one year and that they recommended that he continue with physiotherapy until January 2008.

On December 5, 2007, Review Office determined that no responsibility should be accepted for further physiotherapy treatment. Review Office placed weight to the following factors when making its decision:

  • the worker had received 22 physiotherapy treatments. The treating physician provided no rationale for his opinion that the worker would require a total of six months of physiotherapy.
  • it may be true that the worker’s recovery period would be approximately one year, however, this did not necessarily mean that the worker would require physiotherapy for the full recovery period.
  • it accepted the opinion of the WCB physiotherapy consultant that in-clinic treatment would not likely be more effective than a comprehensive home program.
  • the time that has passed since surgery, the treatment rendered and the fact that the worker was provided with a home program supported that further physiotherapy treatment was not warranted.

    • On December 10, 2007, the worker appealed Review Office’s decision to the Appeal Commission and a file review was requested.

Reasons

Worker’s submission:

The worker relies on his treating physician’s note of October 2, 2007 which recommends continuing physiotherapy on the left knee until January 2008. The worker notes that with his earlier partial knee replacement surgery in 1997, his physiotherapy treatments lasted much longer. His latest surgery was much more extensive yet continuing physiotherapy has not been authorized. Since November 15, 2007, the worker has been attending the physiotherapist’s gym at his own cost of $30 per month. The worker states that physiotherapy, in addition to gym use, is very helpful and requests that physiotherapy be continued until July, 2008, which is one year post-surgery.

Applicable Legislation:

When a worker suffers personal injury by accident arising out of and in the course of employment, compensation is payable to the worker pursuant to subsection 4(1) of The Worker’s Compensation Act (the “Act”). Medical aid payments for expenses such as physiotherapy treatments are payable in accordance with subsection 27(1) of the Act. The WCB makes these payments where it determines that the medical aid is necessary to cure and provide relief from an injury resulting from an accident. In making such a determination, the nature of the injury, the treatment provided and the worker’s response to the treatment may be considered.

Analysis:

The worker underwent a total left knee replacement on July 10, 2007. Following the surgery, the worker commenced physiotherapy treatments on July 19, 2007 and the WCB accepted responsibility for these treatments. In total, the worker attended at 12 physiotherapy sessions between July 19 and August 27, 2007. In September, 2007, a further 10 sessions of physiotherapy were approved by the WCB, based on the treating physiotherapist’s recommended treatment plan of a further 5 weeks of twice weekly physiotherapy sessions for: “general conditioning and strengthening to prepare client for duties that include stairs and walking.”

The worker has requested that the WCB accept continuing responsibility for further physiotherapy treatment. The panel has determined on a balance of probabilities that further physiotherapy treatment is not necessary. In coming to this decision, we rely on the following evidence:

  • The initial physiotherapy referral form signed by the treating physician on July 4, 2007 requests treatment for strengthening, endurance, home exercise, patient education and pain management. The estimated duration of treatment was for 4 to 8 weeks.
  • Physiotherapy was commenced and the worker was provided with a home program.
  • On August 29, 2007, after 12 sessions, the treating physiotherapist submitted an application for additional treatment which sets out a specific treatment plan which is to take place over a defined period of time.
  • On September 10, 2007, an extension of 10 treatments was authorized.
  • The second application for additional treatment submitted by the treating physiotherapist on October 18, 2007 does not put forward a specific treatment plan or timeline and appears to be based primarily on the worker’s complaints of pain only.
  • Although the treating physician provided a note recommending that physiotherapy continue until January 2008, the note does not include any rationale as to why continuing physiotherapy might be required.
  • No physicians other than the treating physician recommend continuing physiotherapy.

In the opinion of the panel, continuing physiotherapy sessions are not necessary to cure and provide relief from the worker’s knee surgery. The initial referral form to physiotherapy requests types of treatments which should either have already been met during the previous 22 sessions of physiotherapy or which could be met through adherence to a home program.

We therefore find that responsibility for further physiotherapy treatment should not be accepted.

The appeal is dismissed.

Panel Members

L. Choy, Presiding Officer
B. Simoneau, Commissioner
M. Day, Commissioner

Recording Secretary, B. Kosc

L. Choy - Presiding Officer

Signed at Winnipeg this 19th day of February, 2008

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