The Appeal CommissionThe Workers Compensation Act of Manitoba

Preamble

The worker is appealing the decision made by the Workers Compensation Board ("WCB") to deny responsibility for additional physiotherapy treatment with respect to her low back condition. A file review was held on February 20, 2014 to consider the matter.

Issue

Whether or not responsibility should be accepted for further physiotherapy treatment.

Decision

That responsibility should be accepted for further physiotherapy treatment.

Decision: Unanimous

Background

On January 4, 2013, the worker filed a claim with the WCB for a pinch she felt in her right low back when sliding a chair with both hands at work on October 24, 2012. A CT of the lumbar spine dated November 20, 2012 identified a suspected right paracentral disc extrusion at L4-5 likely compressing the traversing right L5 nerve root.

In April 2013, the worker's claim for compensation was accepted by the WCB. Between November 2012 and April 2013, the worker had been attending physiotherapy treatments for her low back, for which coverage was retroactively approved.

On May 10, 2013, the treating physiotherapist asked the WCB to authorize an additional six physiotherapy treatments related to the worker's low back.

On May 23, 2013, Compensation Services decided that further physiotherapy treatment would not be approved as 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 September 9, 2013, the worker asked Review Office to overturn the May 23, 2013 decision to deny responsibility for further physiotherapy treatments. The worker's position was that physiotherapy treatment which included traction sessions along with acupuncture treatments were relieving her continued back pain.

In a decision dated October 30, 2013, Review Office determined that there was no entitlement to further physiotherapy treatment. Review Office referred to the treating physician's comments that the worker's condition was gradually improving when seen for follow up visits in November and December 2012 and in January 2013. The physician then cleared the worker for full return to work as of January 3, 2013.

Review Office noted that the WCB does not generally authorize the costs of programs or activities that are required to maintain a state of health or employability after the worker had achieved maximum recovery from the effects of the compensable accident. Review Office felt that the worker had 31 physiotherapy treatments and had returned to work full time to her regular duties in January 3013. Therefore the evidence on file did not support that further in-clinic treatment beyond April 2013 was required. On November 26, 2013, the worker appealed Review Office's decision to the Appeal Commission and a file review was arranged.

Reasons

Applicable Legislation:

The Appeal Commission and its panels are bound by The Workers Compensation Act (the “Act”), regulations and policies of the Board of Directors.

When a worker suffers personal injury by accident arising out of and in the course of employment, compensation is payable to the worker pursuant to subsection 4(1) of the Act. Provision of medical aid services to injured workers is payable in accordance with subsection 27(1) of the Act which provides as follows:

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.

Worker’s submission:

The worker requests coverage for further physiotherapy sessions. Her written material indicates that prior to her injury at work, she never needed to attend physiotherapy. She had tried to go without physiotherapy treatment, but found that she was in a lot of pain so she continued to attend physiotherapy at her own expense. She found that the traction sessions along with acupuncture relieved the pain she had in her back and she therefore requested further coverage for this treatment. Her Appeal of Claims Decision form states: "I am not a rich person therefore I must obtain employment, however, my back is still in pain along with sciatica and my physiotherapy bills are getting to be too much to afford."

Employer's submission:

The employer provided a brief submission which indicated that they were in support of the WCB's decision.

Analysis:

The issue before the panel is whether or not responsibility should be accepted for further physiotherapy treatment. In order for the worker's appeal on this issue to succeed, the panel must be satisfied that further physiotherapy treatment is necessary to cure and provide relief from the injury resulting from an accident. We are able to make this finding.

The worker's compensable injury was an acute L4-5 disc herniation. The worker is only 31 years old and there was no indication on file of a pre-existing condition. The panel is satisfied that any ongoing symptoms of lower back pain and sciatica are attributable to the compensable injury.

The worker's family physician cleared the worker for return to full time work effective January 3, 2013 with the provision that there be: "accommodation for continuing physiotherapy." This indicates that while the worker had experienced some functional recovery from her injury, it was not a full recovery and further medical aid to support a return to the workforce was required.

The May 10, 2013 Application for Additional Treatment submitted by the treating physiotherapist for six additional treatments (1x per week for 6 weeks) referenced continued objective findings of positive Straight Leg Raise test on the right at 60 degrees and L5 myotomal weakness. The rationale for further treatment was stated as: "Benefits from traction/acupuncture. Continue in conjunction with home-based active program."

The panel finds that the requested treatment was focused on the specific injury site associated with the compensable injury and consisted of treatment (traction and acupuncture) which had to be administered in clinic, i.e. it could not be done in a home based program. We therefore approve the specific request for six additional treatments based on the objective medical findings identified in the May 10, 2013 application.

The panel notes that any entitlement to further physiotherapy coverage beyond the six additional treatments will be dependent upon the available medical evidence from the relevant time period.

We therefore find that responsibility should be accepted for further physiotherapy treatment. The worker's appeal is allowed.

Panel Members

L. Choy, Presiding Officer
A. Finkel, Commissioner
P. Walker, Commissioner

Recording Secretary, B. Kosc

L. Choy - Presiding Officer

Signed at Winnipeg this 21st day of March, 2014