Decision #100/15 - Type: Workers Compensation
Preamble
The worker disagreeswith the decision made by the Workers Compensation Board
to deny medical aidcoverage for two medications. A filereview was held on June 26, 2015 toconsider the worker's appeal.
Issue
Whether or not the worker is entitled to medical aidcoverage for the medications Metoprolol and Simvastatin.
Decision
That the worker is not entitled to medical aid coverage forthe medications Metoprolol and Simvastatin.
Decision: Unanimous
Background
The worker has an accepted claim with the WCB for chronic right lateral epicondylitis.
On May 24, 2013, the WCB advised the worker that he was not entitled to medical aid coverage for the costs associated with Metoprolol and Simvastatin as it was felt that these medications were not related to his compensable injury. On April 4, 2014, the worker's advocate appealed the decision to Review Office.
On June 6, 2014, Review Office confirmed that there was no entitlement to medical aid coverage for Metoprolol and Simvastatin. Review Office noted that Simvastatin was a medication prescribed to lower cholesterol and triglycerides in the blood. It also was used to lower the risk of stroke, heart attack and other heart complications. A listed side effect of this medication was joint and muscle pain. Review Office therefore concluded that this medication would not provide any benefits for the treatment of lateral epicondylitis.
Review Office stated that Metoprolol was a beta-adrenergic blocking agent prescribed for patients with high blood pressure and it would not be of benefit in the treatment of the worker's inflammatory elbow condition. On January 28, 2015, the worker's advocate 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 subsection 4(1) of the Act.
Medical aid payments for expenses such as medication are payable in accordance with subsection 27(1) of the Act. The WCB makes these payments where it determines that the medical aid is necessary to cure and provide relief from an injury resulting from an accident.
The WCB has established WCB Board Policy, 44.120.10, Medical Aid, which notes 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." The WCB pays for prescription medications under this policy. "All treatments must satisfy the WCB that their use will aid in the recovery of an injured worker or minimize the impact of the injury."
Worker's Position
The worker's Appeal From indicated that he required assistance to help pay for his medications.
Information on the worker's file indicates that he is diagnosed with right lateral epicondylitis.
Employer's Position
The employer did not participate in the appeal.
Analysis
The issue before the panel is whether or not the worker is entitled to coverage for the medications Metoprolol and Simvastin. In order for the worker's appeal to be approved, the
panel must find that the medications are necessary to cure and provide relief from the injury resulting from an accident. We are not able to make this finding.
The panel notes that the worker has an accepted claim for right lateral epicondylitis and also notes that the WCB covers the cost of pain medication for this condition.
The panel has considered the nature of the medications and notes that one medication is prescribed to lower cholesterol and triglycerides in the blood. The other medication is prescribed for patients with high blood pressure. Neither are known to be prescribed for use in treatment of lateral epicondylitis.
The panel has reviewed the worker's file and has found no information relating the use of these medications to the worker's workplace injury. The panel relies upon the following information on the worker's file in support of its decision:
- April 27, 2007 letter from treating physician which indicates that the worker is prescribed Metoprolol and Simvastin for ongoing hypertension and dyslipidemia. The physician indicates that these medications are not related to his injury.
- On an annual basis the treating physician provides a list of medications which the worker is prescribed for his injury. These medications have not been included in that list. The last annual report from his physician was received on January 13, 2015. It listed only one medication which was for pain and inflammation. The noted medications under appeal were not listed.
The worker's appeal is dismissed.
Panel Members
A. Scramstad, Presiding OfficerA. Finkel, Commissioner
P. Walker, Commissioner
Recording Secretary, B. Kosc
A. Scramstad - Presiding Officer
Signed at Winnipeg this 30th day of July, 2015