The Appeal CommissionThe Workers Compensation Act of Manitoba

Preamble

The worker is appealing thedecision made by the Workers Compensation Board (“WCB”) to deny the costs ofmassage therapy in relation to her neck, back and hip complaints.  A file review was held on May 21, 2015 toconsider the matter.

Issue

Whether or not responsibilityshould be accepted for the costs of massage therapy.

Decision

That responsibility should not beaccepted for the costs of massage therapy.

Decision: Unanimous

Background

The worker filed a claim with the WCB for injuries to her hips, right arm, neck and back resulting from a slip and fall at work on August 20, 2014. Following the accident, the worker sought medical treatment from a chiropractor and was diagnosed with a left sacroiliac/lumbosacral strain/sprain and a cervical strain/sprain.

On October 15, 2014, the worker contacted the WCB to advise that she had received deep tissue massage treatments which provided her with pain relief to her neck and hips and asked whether the WCB would pay for the treatments.

At the request of WCB case management, a WCB medical advisor reviewed the file on October 15, 2014 and stated: “It is unlikely that massage therapy would be associated with a sustained improvement in function. WCB financial responsibility for massage therapy is therefore not recommended.” On October 15, 2014, the worker was advised that no responsibility would be accepted for massage therapy treatments. The worker disagreed with the decision and an appeal was filed with Review Office.

On January 12, 2015, Review Office confirmed that no responsibility should be accepted for the cost of massage therapy. Review Office noted that the worker received 12 weeks of chiropractic treatment for her compensable injuries and by mid-November 2014, the treating chiropractor opined that the worker required maintenance treatment rather than treatment for an acute injury. Review Office found no evidence to support that the worker required massage therapy as an integral part of her treatment plan or that it was necessary to cure and provide relief from an injury.

In February 2015, the worker asked Review Office to reconsider its decision based on a report from the treating massage therapist who outlined the opinion that with continued treatment, the worker would achieve full range of motion without stiffness or pain.

On March 17, 2015, Review Office upheld its decision that no responsibility would be accepted for the cost of massage therapy. Review Office accepted the treating chiropractor’s opinion that the worker was making satisfactory recovery and that a home exercise program was a sufficient treatment plan. Review Office found no evidence to support that the worker required massage therapy as an integral part of her treatment plan, or that it was necessary to cure and provide relief from an injury. On March 27, 2015, the worker appealed Review Office’s decision to the Appeal Commission and a file review was arranged.

Reasons

Applicable Legislation and Policy:

The panel’s decision on this matter is guided by subsection 27(1) of The Workers Compensation Act (the "Act") which provides "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.”

WCB Policy 44.120.10, Medical Aid, elaborates on the Act. Subsection 2(b) identifies massage therapy as treatment which may be approved:

“Medically Recommended Treatments

i) Other medically recommended treatments include, but are not limited to, acupuncture, massage therapy, swimming, fitness therapies, obus, as well as new treatment modalities constantly being introduced to the market place.

ii) The WCB may approve the use of these treatments or medications subject to preapproval by the WCB on a case by case basis. All such treatments must satisfy the WCB that their use will aid in the recovery of an injured worker or minimize the impact of the injury.”

Analysis:

The reality of the situation relates to the nature of the treatment itself which can be best characterized as being maintenance or preventative nature. The panel finds that the clinical findings provided by the worker’s chiropractor support the worker was making a satisfactory recovery and a home exercise program was a sufficient treatment plan. The evidence supports that there was a full range of motion in the low back and neck by mid- November 2014 and that the request was made for maintenance care rather than extension of treatment for the acute injuries.

The worker received an extended course of chiropractic treatment (12 weeks). As noted earlier, by mid-November 2014 the worker’s chiropractor was of the opinion the worker required maintenance treatment rather than treatment for an acute injury.

The panel also finds that there was no medical referral in order to allow for the maintenance treatment being sought, leading the panel to its conclusion that responsibility should not be accepted for the costs of massage therapy.