Decision #59/08 - Type: Workers Compensation
Preamble
The worker has a claim with the Workers Compensation Board (“WCB”) for a low back and left shoulder injury that occurred during the course of her employment on May 14, 2007. The claim for compensation was accepted and benefits and services were paid to the worker up until her return to work. Soon afterwards, the worker was prescribed a lumbar support belt and requested reimbursement for the costs associated with the purchase. Initial adjudication and Review Office denied responsibility for the costs of the belt on the grounds that it was unrelated to the compensable injury. The worker disagreed and filed an appeal with the Appeal Commission and a file review was held on March 26, 2008.
Issue
Whether or not responsibility should be accepted for a lumbar support belt.
Decision
That responsibility should not be accepted for a lumbar support belt.
Decision: Unanimous
Background
On May 14, 2007, the worker sustained work related injuries to her low back and left shoulder. The claim for compensation was accepted based on the diagnosis of a low back strain/sprain dysfunction and benefits and services were paid to the worker up until September 5, 2007 when the worker was declared fit to return to her regular work duties.
Following her return to work, the worker attended her physician for treatment with complaints of further pain in her low back and was prescribed a lumbar support belt. The worker then requested reimbursement for the costs of the lumbar support from the WCB.
On October 19, 2007, a WCB adjudicator advised the worker that the WCB was unable to reimburse her for the costs associated with the lumbar support belt based on the following factors:
· The employer confirmed that the worker had been provided with an adjustable air ride seat with an adjustable lumbar support system, tilt steering and an automatic door opener.
· The WCB generally would not provide a lumbar support for this type of diagnosis especially when the worker’s job duties did not involve heavy lifting; and
· The worker’s symptoms related to her work injury had resolved and therefore the need for this type of belt would not be considered necessary in facilitating the worker’s recovery or return to work.
The worker appealed the above decision on October 23, 2007. The worker submitted that without the lumbar support belt, she would be unable to drive. She stated that the constant pounding of the air ride seat and the rough roads produced unbearable pain to the point where pain killers were needed.
In a decision dated November 27, 2007, Review Office confirmed that no responsibility should be accepted for a lumbar support belt. Review Office noted that following the worker’s return to work she attended her physician with complaints of low back pain and that the physician’s report provided minimal clinical findings. It noted that while some discomfort can be expected following a return to work, the file evidence which included the diagnosis of a sprain, the minimal clinical findings provided after the worker’s return to work and the time that had passed and the nature of the worker’s duties (no heavy lifting) supported that the need for a lumbar support belt was not directly related to the May 14, 2007 compensable injury. On January 3, 2008, the worker appealed Review Office’s decision to the Appeal Commission and a file review was arranged.
Reasons
The worker says that she wears the lumbar support belt each time she drives and that it has helped tremendously with the pounding of the air ride seat and the roads.
Whether the WCB is responsible for the cost of the belt is contingent in part upon an interpretation of subsection 27(1) of The Workers Compensation Act (the “Act”) and WCB Policy 44.120.10, both of which address the provision of medical aid by the Board. Subsection 27 (1) provides that:
The board may provide a worker with such medical aid as the board considers necessary to cure and provide relief from an injury resulting from an accident.
WCB Policy 44.120.10 provides, in part, that:
2. Medically Prescribed Treatments, Devices and Their Related Accessories
To minimize the impact of workers’ injuries and to encourage recovery and return to work, the WCB approves the use of many prescribed and recommended treatments and devices, including prescription drugs, over-the-counter medical supplies, braces, prosthetic devices, wheelchairs, dentures, hearing aids, eye glasses, contact lens and other devices.
a. Medically Prescribed Treatments and Prosthetic Devices
i) The WCB will generally pay for medically prescribed treatments (cosmetic, physical or psychological) and standard prostheses when required by reason of a compensable injury, and the treatment or device is likely to improve function or minimize the chance of aggravating the existing injury or of causing a further injury.
These provisions clearly indicate that the provision of medical aid is discretionary and contingent upon being necessary to assist the worker to recover from her compensable injury or to minimize the impact of the compensable injury. Accordingly in order for the worker’s appeal to be successful we must be satisfied that the medical aid being sought in this case is required by reason of a compensable injury. In weighing the evidence, we are unable to find on a balance of probabilities that this is the case.
On May 19, 2007 the worker attended her physician who noted tenderness in the lumbosacral spine and diagnosed an L5 paraspinal sprain. The worker’s incident report made on May 21, 2007, one week following the accident, records the area of injury as being the left lower back. The initial assessment by a physiotherapist on May 22, 2007 recorded objective findings of a stiff and painful left SI (sacroiliac) joint and soreness in the L4-S1 region, left more than right, paraspinals. The patient’s treating physician noted an “improved lower back” on July 9, 2007, and on that same date her physiotherapist stated “lower back resolved”, although the worker continued to experience a painful upper back and shoulder. Again on August 23, 2007 her treating physician reported “almost full recovery of lower back” and recommended a full return to duties on September 5, 2007. Following the worker’s return to work, she began to experience pain in her right lower back. This is first noted in her physiotherapist’s report of September 7, 2007 which references a “recent return to work with painful right lower back” and “pain over R SI to palpation”. By November 30, 2007 her treating physician noted mild radicular symptoms to both feet. A CT scan done on December 19, 2007 shows a normal scan of the lumbosacral spine.
We are satisfied on a balance of probabilities that the weight of the medical evidence reflects that the worker had recovered from the sprain/strain injury to her lower back by the early summer, 2007. The onset of symptoms in the fall of that year following her return to work manifested themselves on the right side of the worker’s body, rather than the left, the original area of injury, and included for the first time radicular pain extending into both feet. While the lumbar support belt may be addressing the workers symptoms that arose following her return to work, we are unable to find that those symptoms relate to the workplace injury that occurred in May 2007.
For these reasons we find that the WCB should not cover the cost of the lumbar support belt. The worker’s appeal is dismissed.
Panel Members
K. Dangerfield, Presiding OfficerA. Finkel, Commissioner
M. Day, Commissioner
Recording Secretary, B. Kosc
K. Dangerfield - Presiding Officer
Signed at Winnipeg this 1st day of May, 2008