The Appeal CommissionThe Workers Compensation Act of Manitoba

Applicable Legislation and Policy

The Appeal Commission and its panels are bound by The Workers Compensation Act, (the "Act"), Regulations and policies of the WCB's Board of Directors.

Under subsection 4(1) of the Act, where a worker suffers personal injury by accident arising out of and in the course of employment, compensation shall be paid to the worker by the WCB.

Subsection 27(1) provides that medical aid will be paid by the WCB for so long as is necessary to cure and provide relief from the injury. Medical aid payments for expenses such as chiropractic and physiotherapy treatments are payable in accordance with this subsection which states the following:

Provision of Medical Aid

27(1) 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.

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 treatment may be considered.

In addition, subsection 27(10) states the following:

Medical Aid to be Under Supervision of Board

27(10) Medical aid furnished or provided under any of the preceding subsections of this section shall, at all times, be subject to the supervision and control of the Board; and the Board may contract with health care providers, hospitals or other health care facilities for any medical aid required, and agree on a scale of fees or remuneration for any such medical aid.

In this particular matter, WCB Policy 44.120.10, Medical Aid, is applicable and states that its purpose is as follows:

The Medical Aid Policy presents a comprehensive and co-ordinated approach to delivery of medical-aid services to injured workers. 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.

In addition, the WCB Chiropractic Management Guideline provides the following with respect treatment duration:

The WCB generally does not approve a course of manipulation in the presence of complicating factors beyond ten weeks. Where active rehabilitation is employed, the WCB generally does not approve the total duration of chiropractic care beyond fourteen weeks. The WCB expects that the duration of ancillary therapies (where employed) should not exceed the maximum duration specified for manipulation.

In exceptional circumstances (including the presence of complicating factors not specified in the guidelines), the WCB may approve treatment duration exceeding those guidelines. Under such circumstances, practitioners must request preauthorization no later than two weeks prior to the maximum treatment duration specified in the guidelines.

The Worker's Position

The worker disagreed with the Review Office determination. He felt that due to the nature of the injuries sustained, further treatments were necessary.

The Employer's Position

The employer did not participate in the appeal.

Analysis

The issue before the panel is whether or not the worker is entitled to chiropractic treatment beyond March 27, 2012.

The applicable WCB guideline directs a maximum of fourteen (14) weeks of treatment for complicated cases involving multiple injuries and loss of range of motion. In order for treatment to be extended beyond fourteen (14) weeks, there needs to be evidence of prolonged and significant improvement or a stabilization of the injury to support or warrant the required exceptional circumstances in order to extend the care. As noted above, the worker has received twenty-one (21) weeks of chiropractic care, which is seven (7) weeks beyond the maximum duration as discussed in the applicable guideline.

The panel notes that the WCB chiropractic advisor reviewed the chiropractic treatment provided to the worker, as evidenced in his file memo dated March 27, 2012. The panel accepts his conclusions and finds that the worker has reached the maximum medical benefits from the chiropractic treatments and is currently completing additional therapy with a physiotherapist and therefore there is no need for concurrent medical care. The panel finds no reason in the circumstances of this case to depart from the guidelines. The panel has determined that further chiropractic treatment is not necessary to cure and provide relief from the worker's compensable injuries. In any event, the panel is of the view that the present matter is not one where there are any exceptional circumstances which would warrant further extension of treatment duration.

In view of the evidence, the panel accepts and adopts the determination of Review Office and finds that chiropractic treatment beyond March 27, 2012, was not necessary to cure and provide relief from the worker's compensable injuries. We therefore find that responsibility for chiropractic treatment beyond March 27, 2012, should not be accepted.