Decision #90/10 - Type: Workers Compensation
Preamble
This appeal deals with a decision made by Review Office of the Workers Compensation Board ("WCB") which determined that the worker was not entitled to replacement of his hearing aids in accordance with the WCB's Medical Aid policy. The worker disagreed with the decision and an appeal was filed with the Appeal Commission. A file review was held on September 20, 2010 to consider the matter.Issue
Whether or not the worker is entitled to replacement of his hearing aids at this time.Decision
That the WCB should provide one replacement hearing aid.Decision: Unanimous
Background
The worker filed a claim with the WCB for noise induced hearing loss. In 1990, his claim for compensation was accepted and the WCB paid for the costs associated with two hearing aids. In 2007, the worker was provided with two new digital hearing aids.
On November 18, 2009, the worker contacted the WCB to advise that he dropped one of his hearing aids on the floor and accidentally stepped on it and it broke. He was unable to locate his other hearing aid. The worker asked the WCB to have his hearing aids replaced.
On November 23, 2009, a WCB adjudicator advised the worker that the WCB only covered hearing aid repairs in relation to normal use and that it would not replace hearing aids that had been broken, damaged or lost. On January 27, 2010, the worker appealed the decision to Review Office.
On January 28, 2010, Review Office determined that coverage for the replacement of the worker's bilateral hearing aids would not be covered by the WCB in accordance with WCB Policy 44.120.10, Medical Aid. On March 30, 2010, the worker appealed Review Office's decision to the Appeal Commission and a file review was arranged.
Reasons
Applicable Policy and Legislation
The worker is seeking the replacement of his hearing aids. The Workers Compensation Act (the Act) provides that the WCB may make any purchases that it considers necessary to cure and provide relief from an injury.
In accordance with the Act, the WCB Board of Directors established WCB Policy No. 44.120.10, Medical Aid. This policy deals with the provision of medical aid services to workers. The panel is bound by the wording of this policy in making its decision.
Worker's Position
In his appeal form dated March 30, 2010, the worker advises that hearing aids are necessary for hearing the telephone, the door bell, fire alarms, conversation and driving.
In a conversation with a WCB staff member on April 12, 2010, the worker explained that his hearing aid fell out of his ear and that he accidentally stepped on it while looking for it. He indicated that he felt the WCB should replace the hearing aid. In his submission to Review Office the worker indicated that the WCB should cover the costs because he lost his hearing while working.
Analysis
The issue before the panel is whether the worker is entitled to replacement of his hearing aids. The evidence on file is that the worker misplaced one hearing aid and was unable to find it. He later broke his other hearing aid. The worker's evidence is that he requires a hearing aid for safety reasons, namely for driving and to hear telephones, doorbells and fire alarms.
The request is for replacement of two hearing aids. Regarding the broken hearing aid, the panel finds that the WCB should replace this device. While the WCB is not generally responsible for replacing a lost or broken prosthesis, Section 2(a) of the Medical Aid Policy provides that:
2.a. Medically Prescribed Treatments and Prosthetic Devices
ii.) The WCB may provide a backup device when it believes the loss of, or damage to, the original prosthesis would prevent a worker from functioning well in his or her employment, or interfere in his or her activities of daily living by reducing mobility, creating a safety hazard, or by preventing him or her from performing basic activities (eating, dressing, etc.). [emphasis added]
The panel finds that the worker requires a hearing aid for his own safety. The policy provides the discretion to authorize the replacement of the hearing aid for safety reasons. The panel authorizes the replacement of the hearing aid that was accidentally broken.
The panel finds that the worker is not entitled to have the misplaced hearing aid replaced. WCB has no responsibility for replacing this hearing aid. It is only the damage to the second hearing aid that justifies the safety concern.
The worker's appeal is allowed in part.
Panel Members
A. Scramstad, Presiding OfficerA. Finkel, Commissioner
P. Walker, Commissioner
Recording Secretary, B. Kosc
A. Scramstad - Presiding Officer
Signed at Winnipeg this 27th day of September, 2010