The Appeal CommissionThe Workers Compensation Act of Manitoba

Preamble

The worker is appealing several decisions made by the Workers Compensation Board ("WCB")regarding physiotherapy treatment and the costs associated with a pillow.  A file review was held on May 27, 2015to consider these matters.  

Issue

Whether or not the worker is entitled to further physiotherapy treatment; and

Whether or not responsibility should be accepted for the purchase of a pillow.

Decision

That the worker is entitled to further physiotherapy treatment up to June 3, 2014 inclusive and final; and

That responsibility should not be accepted for the purchase of a pillow.

Decision: Unanimous

Background

The worker injured his right forearm on February 18, 2014 while performing his work-related duties. Following the accident, the worker received physiotherapy, chiropractic treatment and was treated by a general practitioner. He claimed compensation based on the diagnosis of soft tissue strain to the neck and right arm (epicondylitis).

On March 13, 2014, the worker called the WCB to inquire about coverage for a tensor bandage, an ice pack and a pillow. By letter dated March 14, 2014, the WCB advised the worker that the costs of a regular pillow would not be covered, as a pillow was required regardless of a workplace injury.

By letter dated May 23, 2014, the WCB advised the treating physiotherapist that funding for additional physiotherapy would not be authorized. The worker disagreed with the March and May decisions and appealed to Review Office.

Prior to considering the worker's appeal as to whether or not he was entitled to additional funding for physiotherapy treatment, Review Office sought medical advice from a WCB physiotherapy consultant on November 5, 2014. The consultant stated:

Based on the information provided in the submitted physiotherapy reports and the clinical chart notes there is no documented objective evidence of a sustained improvement in function.

Considering all of the above information funding of physiotherapy beyond the initial authorized assessment and 14 subsequent visits is not recommended.

On December 30, 2014, Review Office determined that the worker was not entitled to further physiotherapy treatment or for the costs of a pillow.

On February 9, 2015, the worker appealed Review Office's decisions to the Appeal Commission and a file review was arranged.

Reasons

Legislation and Policy

In considering this appeal, the panel is bound by The Workers Compensation Act (the “Act”), regulations and policies of the Board of Directors.

Under subsection 4(1) of the Act, where a worker suffers personal injury by accident arising out of and in the course of employment, compensation shall be paid to the worker by the WCB. Subsection 27(1) of the Act provides that medical aid will be paid by the WCB for so long as is necessary to cure and provide relief from the injury.

The WCB Policy 44.120.10, Medical Aid, sets out that “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.” To minimize the impact of a worker’s injury and encourage recovery, the WCB may approve the use of prescribed and recommended treatments and devices.

Worker’s Position

The worker’s position is that he required physiotherapy treatment beyond the fourteen treatments authorized by the WCB and noted that such treatment was required to get rid of his pain and keep him working. He noted that physiotherapy “put acupuncture needles in my aching areas, which brought blood to those areas, and aid in the healing process.” Other benefits noted were through moist heat treatment and home stretches.

With respect to the request for purchase of a pillow, the worker’s position is that it would assist him to properly rest his shoulder and neck. He noted that with this injury, he could not comfortably sleep using his existing pillow. The new pillow he has chosen is specifically designed for side sleeping.

Employer's Position

The employer did not participate in the appeal, but at the time of the Review Office decision, noted through its representative that the employer agreed with the initial decision that the worker was not entitled to further physiotherapy treatments.

Analysis and Decision

There are two issues for determination by the panel:

1. Whether or not the worker is entitled to further physiotherapy treatment;

2. Whether or not responsibility should be accepted for the purchase of a pillow.

With respect to physiotherapy treatment, the panel must find on a balance of probabilities that the worker continued to suffer personal injury as a result of an accident arising out of and in the course of employment that would require medical aid in addition to the treatment already approved by the WCB.

With respect to the purchase of a pillow, the panel must find on a balance of probabilities that the purchase of a pillow was prescribed or recommended as a medical aid, to minimize the impact of the worker’s injury and to enhance his recovery to the greatest extent possible.

The clinical findings reviewed include numerous reports from the worker’s treating physiotherapist. The initial assessment took place on February 18, 2014 and the report includes detailed findings with respect to the diagnoses of cervical strain and right lateral epicondylitis. In this report, the physiotherapist noted that the worker reported difficulties sleeping and that he was unable to get comfortable. Reported findings set out in the Physiotherapy Initial Assessment include a numeric pain rating of 8 and a Roland Morris Back Pain score of 10. The worker’s cervical range of motion was decreased. His right elbow and shoulder range of motion were decreased.

The Physiotherapy Progress Report dated April 10, 2014 noted a numeric pain rating of 4, with decreased cervical range of motion and decreased range of motion to the worker’s right shoulder, tenderness to palpation of the right elbow and decreased strength to the right upper extremity. This report notes that the worker had returned to work and was progressing well but limited some activities at work.

The application for additional physiotherapy treatment, dated May 6, 2014, noted decreased cervical range of motion as well as decreased right shoulder and right elbow range of motion. The numeric pain rating is noted at 4 and the Roland Morris Back Pain score is 6. The physiotherapist noted that the worker required additional treatment because he was having difficulties with the return to work at regular duties, which were aggravating his signs and symptoms.

The physiotherapy progress report provided to the WCB dated May 14, 2014 noted pain in the right upper back/neck, right shoulder and right forearm. Decreased cervical range of motion is noted as well as decreased right shoulder and right elbow range of motion. The numeric pain rating is noted at 4 and the Roland Morris Back Pain score is 6. The physiotherapist noted that the worker was gradually increasing duties as tolerated.

The physiotherapist’s chart notes of June 3, 2014 indicate the worker’s function was improving noting that the worker stated the return to work “is going ok” and that although his pain persists, it was “not as bad as previous.” The physiotherapist noted a good response to treatment and discharged the worker with a home exercise program.

In the panel's view, the clinical findings suggest a functional change over time with physiotherapy treatment. There is evidence of progress up to and including June 3, 2014 when the physiotherapist discharged the worker from treatment.

Therefore, having reviewed and considered this evidence, we have determined on a balance of probabilities that the worker is entitled to physiotherapy treatment up until June 3, 2014 inclusive, when he was discharged to a home program, but not beyond that date.

With respect to the claim for responsibility for the purchase of a pillow, the panel notes that although there is some evidence that the worker complained of difficulty sleeping, no recommendation was made by the attending healthcare providers for the purchase of a pillow. Neither is there any evidence before the panel to suggest that the purchase of a pillow would contribute to minimize the impact of the worker’s injury or enhance his recovery.

In the absence of evidence that the purchase of a pillow was recommended or prescribed to minimize the impact of the worker’s injury and enhance the worker’s recovery to the greatest extent possible, the panel has determined on a balance of probabilities that responsibility should not be accepted for the purchase of a pillow.