Decision #55/14 - Type: Workers Compensation
Preamble
The worker is appealing the decision made by the Workers Compensation Board ("WCB") that he is not entitled to the costs of multi-site physiotherapy treatment in relation to his compensable injury. A hearing was held on March 20, 2014 to consider the matter.Issue
Whether or not the worker is entitled to funding for multi-site physiotherapy treatment.Decision
That the worker is entitled to funding for multi-site physiotherapy treatment.Decision: Unanimous
Background
In July 2013, the worker filed a claim with the WCB for gradual pain in his shoulders, back and hips which he attributed to the added job task of removing and replacing new fare boxes.
On July 18, 2013, the worker was seen by a physician and was diagnosed with a repetitive strain injury to both shoulders, the low back and hips. The worker was then referred to a physiotherapist who diagnosed him with neck, shoulders and a mid-back musculoskeletal strain, bursitis of the hips and a second degree gluteal medius strain.
On August 6, 2013, the worker's claim file was reviewed by a WCB physiotherapy consultant based on a request from the treating physiotherapist who requested 14 multi-site treatments. The WCB physiotherapy consultant stated:
The mechanism of injury and reported pain complaints suggest a neck and upper back strain. The physio reported hip pain is due to bursitis and therefore not likely related to the CI (compensable injury). Multi-site visits not warranted. Minimal objective findings to support double appointment times.
By letter dated August 11, 2013, the treating physiotherapist was advised that the WCB would not authorize 14 multi-site treatments based on the opinion outlined by the WCB physiotherapy consultant.
On August 12, 2013, a WCB case manager noted to the file that the treating physiotherapist called to advise that she had been booking the worker into a time period of four slots, as opposed to one treatment to the upper back, neck and shoulders and one to the low back and hips.
On August 13, 2013, the WCB physiotherapy consultant stated:
The mechanism of injury is lifting fare boxes... this is new part of his job that was changed. He was mainly washing [vehicles] before. The accepted compensable diagnosis on file is a neck and upper back strain. Double appointment times are not necessary, the neck and upper back are related, and therefore, there are no two distinct areas of injury.
On August 15, 2013, the worker appealed the August 11, 2013 decision to Review Office. The worker expressed the view that the WCB should cover multi-site physiotherapy treatments for his hips as well as his neck and back as all three areas were injured from his job tasks of moving fare boxes on and off buses. He said he injured his hips from stepping off buses while carrying heavy boxes full of money.
Review Office considered the worker's appeal as well as submissions made by the accident employer's representative and the worker's union representative.
On October 1, 2013 Review Office determined that the worker was not entitled to funding of multi-site physiotherapy treatment based on the nature and extent of the worker's compensable injuries and in keeping with the WCB's regular practices.
Review Office stated that the nature of the worker's complaints were consistent with generalized and broad musculoskeletal "strains" associated with an increase in physical activity. Review Office accepted that the worker's job changed and it was a departure from his normal physical demands. However, Review Office found there was an insufficient degree to his injuries that would warrant an inordinate level of care from a physiotherapist.
On October 2, 2013, the worker appealed Review Office's decision to the Appeal Commission and a hearing took place on March 20, 2014.
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 was assisted by a union representative at the hearing. It was submitted that on the day of the accident, the worker reported an injury to his hip, back, and shoulders and this report was consistent with the first doctor's diagnosis dated the next day, July 18, 2013. The First Doctors Report indicated a repetitive strain injury to the shoulders, lower back and hips. The worker could not understand why the WCB would not approve physiotherapy treatment for the worker's lower back and hips when these multiple body parts were stated to be areas which were hurt from the beginning. It was submitted that the worker ought to be entitled to the treatment he needed to recover fully from his injury.
Employer's submission:
The employer was represented by its workers compensation coordinator. It was submitted that the minimal objective physical findings did not support the multi-site treatment requested by the attending physiotherapist. While for argument's sake, the employer conceded that the compensable injury entailed some involvement of the hip, the employer noted that the worker did not miss any time from work as a result of his injuries and in fact continued performing his regular duties until July 28, 2013. This spoke to the minor nature of the injuries sustained by the worker. With this in mind, the employer questioned the need not only for multi-site treatments but also the extent of treatment. The worker received 18 physiotherapy treatments during the period July 17 to November 1, 2013 and a request for further treatments was denied. In view of same, the panel was called upon to confirm the decision of the WCB.
Analysis:
The issue before the panel is whether or not the worker is entitled to funding for multi-site physiotherapy treatment. In order for the worker's appeal on this issue to succeed, the panel must be satisfied that multi-site physiotherapy treatment is necessary to cure and provide relief from the injury resulting from an accident. We are able to make this finding.
At the hearing, the worker described the mechanism by which he was injured. When removing and replacing fare boxes, the worker would lift the fare box by crouching with his back straight then pull it straight up and out. The fare boxes were heavy, weighing up to approximately 40 pounds. The worker then stepped off the bus while carrying the fare box. He felt that doing this repeatedly was what contributed to the problems with his hip. The worker would then turn the box 180 degrees to empty out the change. The fare box would be replaced on the bus, and the worker would then move on to the next bus.
The panel accepts that these job duties were physically demanding on the hips and low back. We accept that as a result of these job duties, the worker suffered not only pain in his neck and shoulders, but also a mid-back musculoskeletal strain, aggravation of bursitis in the hips and a gluteal medius strain, as assessed by the physiotherapist on July 20, 2013. The reported histories given by the worker and the medical reports all support that the hips and lower back were part of the compensable injury.
In the panel's opinion, physiotherapy directed at the hips and lower back was appropriate treatment for the worker's injury. This would be separate from the physiotherapy the worker received which was targeted at his neck and shoulders. The worker's evidence at the hearing was that when he went to physiotherapy for multi-site treatment, he would be there for approximately two hours, rather than the usual one hour. His physiotherapist advised him that he had to be booked for two separate appointments as she could not treat him fully for both his neck/shoulder and lower back/hips in one hour. The treatment for the two areas differed and he would be given separate exercises and stretches for each body part.
Based on the foregoing, the panel finds that the worker is entitled to funding for multi-site physiotherapy treatment. The worker's appeal is allowed.
Panel Members
L. Choy, Presiding OfficerA. Finkel, Commissioner
M. Kernaghan, Commissioner
Recording Secretary, B. Kosc
L. Choy - Presiding Officer
Signed at Winnipeg this 7th day of May, 2014