Decision #67/09 - Type: Workers Compensation
Preamble
The worker filed a claim with the Workers Compensation Board (“WCB”) for a work related accident that occurred on November 28, 2007 when she slipped on ice while employed as a healthcare aid. The claim for compensation was accepted and physiotherapy treatments were authorized. The worker is presently appealing the decision made by Review Office dated September 18, 2008 which stated that further physiotherapy treatment was not a WCB responsibility. The worker disagreed and an application to appeal was filed with the Appeal Commission. A file review was held on May 13, 2009 to consider the matter.Issue
Whether or not further physiotherapy treatment should be authorized.Decision
That further physiotherapy treatment should be authorized.Decision: Unanimous
Background
The worker reported to the WCB that she slipped on ice on November 28, 2007 and landed onto her left side and back. On December 5, 2007, the worker advised her WCB adjudicator that she jarred her entire body from the fall and that she had pain in her low back, hips, knees and the top of her head was very sore. She reported that she bruised both knees and her left big toe.
Medical reports indicated that the worker attended for medical treatment on December 3, 2007 with subjective complaints of headaches and muscle stiffness of the back and legs. The diagnosis given was a muscle strain to the neck, back and knee. Also noted on the report was that the worker had a hip replacement two years previously.
On December 4, 2007, the worker attended physiotherapy treatment. The therapist’s diagnosis of the worker’s condition was exacerbation of chronic low back pain. The therapist noted that the worker was currently performing her regular job duties which did not involve much physical work.
The claim for compensation was accepted based on the diagnosis of a muscle strain to the neck, back and knees and on December 7, 2007, the WCB authorized the worker’s physiotherapy treatment.
On January 14, 2008, the worker advised the WCB that she was having ongoing headaches and weakness in her left hip especially when walking stairs. She had left knee trouble that she did not have before. The worker indicated that she had arthritis in her right knee but both knees were bruised from the fall. She stated that her client care had changed and that she now had to pull to assist her new client up and that she found this difficult. On January 28, 2008, the worker indicated that her physiotherapist would be requesting an extension of physiotherapy treatment and that she still had pain in her left hip and left knee and that her low back discomfort was still there but was much better.
On February 12, 2008, the WCB authorized an extension of 8 physiotherapy treatments and suggested self-management with a home-based program.
In a progress report dated March 2, 2009, the treating physician reported that the worker was still having lots of pain in her left hip and that she needed to have more physiotherapy.
On March 20, 2008, the physiotherapist submitted an application for additional funding for physiotherapy treatment. The worker’s subjective complaints were intermittent left buttock and left knee pain. On April 3, 2008, the WCB wrote to the physiotherapist to advise that the extension request was denied on the basis that a home program and/or self pain management techniques should suffice.
The worker had an MRI of the left knee taken on April 16, 2008. The results of the examination showed degenerative changes affecting the patellofemoral and medial femorotibial compartments and degenerative fraying of the medial meniscus. A definite tear was not identified.
On April 22, 2008, the treating physician noted that the worker still had tenderness in her left hip and medial side of her knee. He requested that the WCB approve a few more physiotherapy treatments.
A WCB physiotherapy consultant reviewed the file on April 30, 2008 and approved four additional physiotherapy treatments based on the results of the MRI examination and the fact that the worker fell onto her knees at the time of her compensable injury.
On June 26, 2008, the physiotherapist reported that the worker complained of persistent left gluteal pain and left knee and low back pain on occasion. As it was indicated that the worker continued to benefit from treatment, an extension was requested for one physiotherapy treatment for the next four weeks.
On July 3, 2008, the WCB advised the physiotherapist in writing that the WCB was unable to approve the extension request as there was no evidence that further in clinic treatment was warranted and that a home program and/or self pain management technique should suffice.
On August 20, 2008, the worker appealed the July 3, 2008 decision to Review Office. The worker indicated that she still had pain in her left hip and knee which became more aggravated at work from lifting clients daily and physiotherapy helped. The worker indicated that her name was placed on a list for a hip replacement and she would be off work for seven months.
In a decision dated September 18, 2008, Review Office indicated that it agreed with the position taken by WCB staff that home exercises and self-management should suffice at this point in time. Review Office noted that it was 10 months post-trauma and there was an expectation that a normal healing process should logically have taken place and that by this point the worker would not be in such an acute phase that she would require specialized therapy. Review Office felt that staying active and mobile and diligently performing the home exercise program would provide therapeutic rehabilitation for the worker’s originally injured parts of her anatomy. On January 31, 2009, the worker appealed Review Office’s decision to the Appeal Commission and a file review was arranged.
On April 13, 2009, the treating physiotherapist made the following comments regarding the worker’s condition:
“…[the worker’s] musculoskeletal system was compromised prior to the fall-she had chronic complaints of back and knee pain, right worse than left, her abdominal strength has been compromised by unrelated surgery and she has had a right THR [total hip replacement]. The fall in Nov. 2007 created a new trauma to a joint that was previously asymptomatic-her left hip and associated soft tissue. The recovery from the trauma is no doubt compromised by the inability of many other joints to accept the added strain of yet another weakened link in the chain and this is likely contributing to her prolonged recovery. But the fact remains that presently her left buttock pain persists (though is reduced) her left hip range and strength are reduced and this does affect her ability to function at home and at work. Physiotherapy treatment once every 1 to 2 weeks does help her manage the demands of her work and home activities.”
Reasons
The issue in this appeal is whether or not further physiotherapy treatment should be authorized.
In the incident report filled out by the worker after the occurrence of the compensable injury, the worker noted that she landed on her left side and back as well as hitting her knees, left big toe and the top of her head. The initial medical report on file from an examination which took place on December 3, 2007, shortly after the accident occurred, indicated that the worker’s areas of injury were her back, neck and legs. A diagnosis was provided of a muscle strain of the neck, back and knee as well as headaches and muscle stiffness in the worker’s back and legs.
On December 4, 2007, the worker had an initial physiotherapy assessment. The report generated from that assessment confirmed the worker’s multiple physical complaints.
Over the following months, the worker received a number of physiotherapy and chiropractic treatments. She continued to report, however, that she had pain remaining in her left hip and knee. The worker’s physiotherapist requested authorization for extensions of treatment on the basis of ongoing left hip complaints and intermittent left knee pain.
On June 26, 2008 the WCB once again received a request for an extension of physiotherapy because the therapist indicated the worker was having persistent left gluteal pain as well as left knee pain.
On July 3, 2008, the WCB determined that it would no longer be approving any further extensions of physiotherapy treatment because it felt there was no evidence that further in-clinic treatment was warranted. The worker was advised that a home program and/or self pain management techniques should suffice.
The worker appealed this decision indicating that she was still in pain with her condition being aggravated by her work, as she was lifting clients daily. She pointed out that the pain was mostly in her left hip and knee and that the physiotherapy, in her view, helped her quite a bit, enabling her to continue working.
Review Office, however, upheld the original adjudicator’s decision that no further physiotherapy treatments were warranted. The basis for the Review Office’s decision was two fold:
1. Review Office agreed with the position taken by WCB staff that home exercises and self management should suffice at this point; and
2. ten months post trauma the Review Office expected that a normal healing process should have taken place such that the worker would not need further therapy.
On April 13, 2009 the worker’s physiotherapist wrote a letter which confirmed that prior to the compensable injury, the worker had not been experiencing pain in her left buttock. The physiotherapist noted that by December 13, 2008, however, the worker’s main concern was persistent left buttock pain. The physiotherapist specifically indicated that the worker was "asymptomatic prior to the accident”. In that same letter the physiotherapist also commented that the fall in November 2007 created a new trauma to a joint that was previously asymptomatic, being the worker’s left hip. The physiotherapist specifically stated that:
“the recovery from the trauma is no doubt compromised by the inability of many other joints to accept the added strain of yet another weakened link in the chain and this is likely contributing to her prolonged recovery. But the fact remains that presently her left buttock pain persists … and this does affect her ability to function at home and at work. Physiotherapy treatment once every one to two weeks does help her manage the demands of her work and home activities”.
In our view, this evidence directly addresses the two points that were relied upon by Review Office as a basis for refusing authorization for any further physiotherapy treatment. That is, the evidence clearly shows both that home exercises and self management are not sufficient at this point in time and that the worker is, in fact, able to benefit from ongoing physiotherapy treatment. This letter also explains why ten months post-trauma, the worker continues to experience symptoms and has not met the expectation of what Review Office describes as “a normal healing process”.
Subsection 27(1) of The Workers Compensation Act ("the Act") provides as follows:
“Provision of medical aid
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 entitled “Medical Aid” states that "the provision of medical aid attempts to minimize the impact of the worker’s injury and to enhance an injured worker’s recovery to the greatest extent possible”.
The worker in this case has expressed a clear desire to return to work as a health care aide, a position which we note involves duties which are frequently of a physically demanding nature.
Based on the totality of the evidence, the panel finds that the worker has had continuous left buttock pain since the compensable injury. We find that this pain is causally related to the injury. The evidence is clear that physiotherapy treatment is beneficial and is, therefore, “necessary to cure and provide relief from an injury resulting from an accident”, within the meaning of section 27(1) of the Act as cited above.
We are satisfied, therefore, that further physiotherapy treatment in respect of the worker’s left buttock pain is warranted at this time and should be approved. The worker’s appeal is accepted.
Panel Members
S. Walsh, Presiding OfficerA. Finkel, Commissioner
P. Walker, Commissioner
Recording Secretary, B. Kosc
S. Walsh - Presiding Officer
Signed at Winnipeg this 29th day of June, 2009