The Appeal CommissionThe Workers Compensation Act of Manitoba

Preamble

The worker is appealing the decision made by the Workers Compensation Board ("WCB") which determined that he is not entitled under The Workers Compensation Act (the "Act") to a Medical Review Panel with respect to his compensation claim stemming from a work-related accident on January 26, 2009. A file review was held on April 24, 2014 to consider the matter.

Issue

Whether or not a Medical Review Panel should be convened pursuant to subsection 67(4) of the Act.

Decision

That a Medical Review Panel should be convened pursuant to subsection 67(4) of the Act.

Decision: Unanimous

Background

The worker sustained physical and psychological injuries stemming from a work-related accident on January 26, 2009. His claim for compensation was accepted and various benefits and services were paid to the worker. As a result of his compensable injuries, the worker has permanent work restrictions regarding his ability to lift, stand, sit, bend and twist his spine.

In June and August 2013, the worker's case was considered by Review Office as the worker disagreed with a number of decisions that were made on his WCB claim. In both decisions, Review Office referred to medical information on file to support the following decisions:

• The worker was not entitled to partial wage loss benefits beyond May 15, 2012;
• The worker was not entitled to opioid medication coverage beyond August 7, 2012;
• There was no entitlement to benefits related to his leave from February 14, 2012 to February 28, 2012;
• There was no entitlement to coverage for massage therapy after November 27, 2009;
• There was no entitlement to an independent living allowance after February 2010; and
• The cost of the snow blower should not be reimbursed by the WCB.

On September 19, 2013, the worker's legal counsel requested the convening of a Medical Review Panel ("MRP") as he argued that there was a difference of medical opinion between the worker's healthcare providers and WCB medical officers with respect to diagnosis, causation, prognosis, treatment and disability, which led to the denial of WCB benefits to the worker. The medical reports referred to by legal counsel were as follows:

• report dated January 19, 2011 by community mental health counsellor
• report dated January 31, 2013 by a physiotherapist
• report dated February 23, 2012 by a psychiatrist
• report dated March 19, 2013 by the family physician
• report dated March 21, 2013 by a physical medicine and rehabilitation specialist
• report dated August 23, 2012 by a massage therapist

On October 4, 2013, the request for an MRP was denied by initial adjudication on the grounds that the requirements of subsection 67(4) and (1) of the Act had not been met. On October 4, 2013, legal counsel for the worker appealed the decision to Review Office.

On December 11, 2013, Review Office upheld the decision that there was no basis to convene an MRP based on its review of the medical reports referred to by legal counsel. On March 19, 2014, the worker's legal counsel appealed the decision to the Appeal Commission and a file review was held on April 24, 2014.

Reasons

 

Panel Members

L. Choy, Presiding Officer
A. Finkel, Commissioner
M. Kernaghan, Commissioner

Recording Secretary, B. Kosc

L. Choy - Presiding Officer

Signed at Winnipeg this 20th day of June, 2014