Decision #136/12 - Type: Workers Compensation
Preamble
The worker is appealing the decision made by Review Office of the Workers Compensation Board ("WCB") which determined that she was not entitled to further physiotherapy treatments with respect to her low back condition. A file review was held on October 25, 2012 to consider the matter.Issue
Whether or not the worker is entitled to further physiotherapy treatments.Decision
That the worker is not entitled to further physiotherapy treatments.Decision: Unanimous
Background
On September 15, 2011, the worker filed a claim with the WCB for injury to her neck, back and ankle when she tripped over a barricade and fell to the ground. The date of injury was reported as September 8, 2011.
The Employer's Accident Report dated September 14, 2011 stated that the worker stepped over a metal rail and fell on her left knee towards the right. The worker twisted and bruised her right ankle and foot.
The claim for compensation was accepted based on the diagnosis of a soft tissue injury to the neck, back and lower back. Benefits and services were paid to the worker.
On September 16, 2011, the worker was seen by a physiotherapist for an initial assessment. The physiotherapist's diagnosis was a soft tissue strain to the neck, back, low back, hypomobile left sacroiliac, and radicular symptoms right arm and left leg due to nerve root irritation. The physiotherapist anticipated that the worker would need 8 weeks of physiotherapy treatment twice per week.
On September 27, 2011, the WCB authorized physiotherapy treatments up to 14 visits. In October and November 2011, the WCB received updates on the worker's progress with physiotherapy treatment.
In a discharge report dated December 30, 2011, the physiotherapist noted that the worker's intermittent soreness in her left low back to hip was improving and she had increased discomfort in her neck and upper shoulders when she increased her exercise program. Under the heading "Current Objective Findings - Impairments", the physiotherapist reported weak left hip abduction with increased myofascial tension in the piriformis and gluteus. The worker had bilateral shoulder impingement due to upper back posture and tension. The physiotherapist indicated that the worker's recovery was satisfactory and the worker was given a home exercise program, i.e. strengthening, stretching and postural correction.
On February 6, 2012, the treating physiotherapist submitted an Application for Additional Treatment form to the WCB. The physiotherapist indicated that the worker required a further six weeks of treatment once per week as the worker continued to have some mechanical dysfunction affecting her low back and pelvis on the left side.
In Claim Notes dated February 18, 2012, a WCB physiotherapy advisor documented that the worker was five months post injury due to the slip and fall incident. He indicated that there was no evidence that further in-clinic treatment was warranted and that a home program and/or self pain management techniques should suffice. On February 21, 2012, the treating physiotherapist was advised that the WCB would not be authorizing further treatment.
On March 5, 2012, the physiotherapist submitted a second Application for Additional Treatment form to the WCB. The physiotherapist outlined the following complaints: "Aching, soreness, occasional sharp pain from left lower back/buttock into upper thigh - better for about two weeks after last treatment and then worsened again - exercises help some but slowly tightens up again." The physiotherapist reported that the worker was not able to manage as well as hoped on a home program only and that her condition slowly worsened. It was felt that the worker would benefit from further regular therapy to treat myofascial tension and strain.
In Claim Notes dated March 16, 2012, a second WCB physiotherapy advisor stated that:
"In the latest physiotherapy report the physiotherapist opines the lumbar spine ROM [range of motion] is full. No adverse neurological findings are reported. Adherence to an active based home program should be encouraged at this stage. Additional in clinic treatment is not likely to result in long term sustained functional gains."
On May 30, 2012, the worker appealed the WCB's decision to deny further physiotherapy treatment. The worker stated:
"…I have had to continue on with physio treatment and pay the costs out of my own pocket. This is not fair as it was a work related incident. I do have exercises, but I have to continue with physio. When I did not go for physio, I ended up with such pain I could not even sleep properly. My physio now is less frequent, but need to continue, if not the pain gets severe. Please reconsider."
On June 14, 2012, Review Office determined that the worker was not entitled to further physiotherapy treatments for her low back condition. Review Office accepted the opinion outlined by the WCB physiotherapy advisor dated March 16, 2012. Review Office was of the opinion that the worker's continuing physiotherapy sessions were not necessary to cure and provide relief from her low back injury.
Review Office noted that the initial referral form to physiotherapy outlined treatment types that should have been met during the previous sessions of physiotherapy or which could be met through adherence to a home program. On July 20, 2012, the worker appealed Review Office's decision to the Appeal Commission and a file review was arranged.
Reasons
Applicable Legislation and Policy:
The Appeal Commission is bound by The Workers Compensation Act (the "Act"), Regulations and the policies set by the WCB’s Board of Directors.
The Act defines "medical aid" to include treatment or services provided by a health care provider and states that:
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. Authorization of medical aid is subject to the supervision and control of the board as set out in s. 27(10):
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.
These provisions are further elaborated upon in Workers Compensation Board Policy 44.120.10, Medical Aid. The Medical Aid Policy presents a comprehensive and coordinated 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. Physiotherapy treatment is included as one kind of medical aid services provided under the policy.
Worker’s Position:
The worker disagreed with the Review Office’s decision that there is no entitlement to further physiotherapy treatment, stating that she continued to require physiotherapy treatment due to the accident and that she suffers pain if she does not receive physiotherapy treatment.
Employer’s Position:
The employer took no position.
Analysis:
As set out in the Medical Aid Policy, physiotherapy treatments for a compensable injury fall within the category of medical aid. The purpose of providing a worker with medical aid is to attempt to minimize the impact of the worker’s injury and to enhance an injured worker’s recovery to the greatest extent possible, consistent with s. 27(1) of the Act.
In this case, the initial request for authorization of physiotherapy treatments was dealt with by the decision of September 27, 2011 to authorize up to 14 treatments. In early February 2012 and again in early March 2012, the treating physiotherapist requested authorization for an additional six weekly treatments.
The file was twice reviewed by WCB physiotherapy consultants in the time period of February – March 2012. These two consultants, on February 18, 2012 and March 16, 2012, reviewed the reports on file and came to essentially the same conclusion – that there was no further benefit to be gained from continuing with physiotherapy treatment and that the worker would benefit most from an active home-based program.
The worker’s recovery from her workplace injury can only be described as being variable. Her complaints provided to her treating physiotherapist indicate that:
- October 11, 2011: worker was feeling “a lot better” but with increased soreness the last few days.
- November 3, 2011: worker was feeling a little more tension in her lower back and hip area as well as some tension in her neck and upper back.
- December 30, 2011: worker reported only intermittent soreness in her lower back and hip but was experiencing increased discomfort in her neck and upper shoulders.
- February 6, 2012: worker reported her neck was feeling fine and her lower back was better but aggravated with standing.
- March 5, 2012: worker noted aching, soreness and occasional sharp pains in her low back and that she had felt better for about two weeks after last treatment but then worsened, though exercises did help some.
We have reviewed the evidence of the worker’s reports of pain, the clinical objective findings noted in the physiotherapist’s reports and her treating physiotherapist’s recommendation for an additional period of six weeks of once per week treatment. The request for authorization of additional physiotherapy treatments must be balanced against the perspectives of the two WCB physiotherapy consultants who each, independently, reviewed the same information and arrived at the conclusion that there was no further benefit to be obtained from ongoing in clinic physiotherapy treatment. The WCB physiotherapy consultants each noted that a home-based program should be sufficient for the worker and that ongoing treatment was not likely to result in any additional functional gain for this worker.
As set out in the Medical Aid policy, the purpose of medical aid is to enhance the worker’s recovery to the greatest extent possible. In this case, the panel gives greater weight to the evidence of the two WCB physiotherapy consultants and finds, on a balance of probabilities, that this worker’s recovery is not likely to be further enhanced by additional physiotherapy treatment.
We therefore conclude that the worker is not entitled to further physiotherapy treatments.
Panel Members
K. Dyck, Presiding OfficerA. Finkel, Commissioner
P. Walker, Commissioner
Recording Secretary, B. Kosc
K. Dyck - Presiding Officer
Signed at Winnipeg this 6th day of December, 2012