Decision #104/14 - Type: Workers Compensation
Preamble
The worker is appealing the decision made by the Workers Compensation Board ("WCB") that he was not entitled to financial coverage for the rental of a scooter during personal travel. A file review was held on June 26, 2014 to consider the matter.Issue
Whether or not the worker is entitled to financial coverage for the rental of a scooter during personal travel.Decision
That the worker is not entitled to financial coverage for the rental of a scooter during personal travel.Decision: Unanimous
Background
The worker has an accepted claim with the WCB for a left knee injury that occurred at work on November 15, 1979.
On October 23, 2013, the worker contacted the WCB to advise that he was going away on vacation for two weeks in January 2014 and questioned whether the WCB would pay for a scooter rental. On the same day, a WCB case manager advised the worker that he was unable to authorize the costs of the scooter based on WCB policy.
In February 2014, the worker submitted receipts to the WCB for scooter rentals on January 13, 14 and 21 while on vacation. By letter dated February 10, 2014, the WCB case manager confirmed to the worker that the WCB was unable to reimburse him for the scooter rental while away on vacation. The worker disagreed with this finding and an appeal was filed with Review Office.
On April 7, 2014, Review Office determined that there was no coverage for the rental of the scooter during personal travel. Review Office referred to WCB policy and stated that the worker's need to travel was a personal choice, not found to be necessary or required for his day to day living needs in relation to his compensable left knee injury. This circumstance fell outside the scope of the Act and Board policies. On April 10, 2014, 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 the Act. As the worker's accident occurred in 1979, his claim is governed by the provisions of the Act which were in place at that time.
According to the terms of the 1979 Act, compensation for certain non-wage loss expenses are payable under subsection 24(1) which provides as follows:
24(1) In addition to the other compensation provided by this Part, the board may provide for the injured workman such medical, surgical, and hospital treatment, transportation, nursing, medicines, crutches, and apparatus, including artificial member, as it may deem reasonably necessary at the time of the injury, and thereafter during the disability, to cure and relieve from the effects of the injury; and the board may adopt rules and regulations with respect to furnishing medical aid to injured workmen entitled thereto, and for the payment thereof.
WCB Policy 44.120.10, Medical Aid, presents a comprehensive and coordinated approach to the 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.
WCB Policy 44.120.30 Support for Daily Living, provides guidance regarding the WCB's approach to supporting workers' participation in daily workplace and personal activities after an accident. The Policy states: "The purpose is to assist, and to allow, workers to be as independent as possible. This policy recognizes that after an injury, workers can experience additional costs to obtain assistance in performing the day to day tasks of living and may also require additional devices or products."
Worker’s Position
The worker was self-represented in the appeal. His Appeal of Claims Decision form stated:
RO (Review Office) has stated that this 73 year old worker has been provided by WCB with a personal electric scooter to minimize effects of a work accident. Travel to any attraction that requires some walking is rare for this person and mobility aids are required. Travel may be years apart for simple reasons of the cost. I believe injured workers should not allow a work injury to control ones life and if a scooter or any other mobility assist opens up personal travel to the various attractions in a park then it can be as if the work injury never happened.
Analysis
In order to find that the worker is entitled to financial coverage for the rental of a scooter during personal travel, the panel must find that the Act or WCB Policy provides authority for this type of compensation to be paid to the worker. We are not able to make that finding.
The panel considered WCB Policy 44.120.10, Medical Aid, but we find that it is not applicable. This policy deals only with the delivery of medical-aid services to injured workers and we find that personal travel cannot be considered to be related to the provision of medical aid. The worker has already been provided with the use of a motorized scooter under this policy.
The panel next considered WCB Policy 44.120.30, Support for Daily Living. Section A.3 of the Support for Daily Living Policy addresses activities for daily living and states: "The WCB consider activities for daily living as actions, services or products that assist a worker to perform basic personal tasks or to live independently." The panel views the policy as being primarily directed at ensuring that injured workers receive assistance with respect to basic personal tasks to help them function on a day to day basis. We feel that personal vacation travel falls outside of the scope of what is typically considered to be basic personal tasks or daily living.
The panel also gave consideration to Section B of the Support for Daily Living Policy which makes provision for exceptional cases, as follows:
B. Eligibility
1. Method
In each case, the WCB examines all the evidence about the worker's injury in order to determine whether the worker, in the WCB's opinion, reasonably needs the support, service or product.
2. Exceptional cases:
Where unique circumstances arise, the worker may be eligible for additional or alternative support services or products as authorized by a WCB Director in accordance with the financial authority levels established by the WCB.
In the panel's opinion, the facts in this appeal do not constitute an exceptional case. The worker seeks coverage of additional costs incurred while on vacation. We do not feel that the exception contained in the policy was intended to cover additional costs related to personal travel, which is entirely elective and discretionary. We find that these additional costs for renting a motorized scooter are not exceptional or unique such as to trigger the extraordinary payment contemplated by Section B of the Support for Daily Living Policy.
The panel therefore finds that the worker is not entitled to financial coverage for the rental of a scooter during personal travel. The worker's appeal is dismissed.
Panel Members
L. Choy, Presiding OfficerA. Finkel, Commissioner
P. Walker, Commissioner
Recording Secretary, B. Kosc
L. Choy - Presiding Officer
Signed at Winnipeg this 13th day of August, 2014