The Appeal CommissionThe Workers Compensation Act of Manitoba

Preamble

A file review was held on February 17, 2016 to consider the worker's appeal regarding the Workers Compensation Board ("WCB") decision to deny additional physiotherapy treatment.

Issue

Whether or not the worker is entitled to additional physiotherapy treatment.

Decision

That the worker is not entitled to additional physiotherapy treatment.

Decision: Unanimous

Background

On February 17, 2015, while moving boxes at work, the worker twisted to the left while putting down a heavy box and felt pain in his left shoulder.

In a report dated March 19, 2015, the worker’s physician stated that the worker complained of pain limitation and could not raise his left arm above shoulder level. The worker was diagnosed with a left shoulder sprain and referred to a physiotherapist for treatment.

When seen for an initial assessment on March 30, 2015, the physiotherapist noted that the worker complained of constant aching and a stabbing pain aggravated by overhead activity, heavy lifting and carrying. The physiotherapist diagnosed a shoulder girdle strain/sprain and recommended treatment two to three times per week for five to eight weeks.

On May 21, 2015, the physiotherapist requested additional funding for physiotherapy treatment. On June 2, 2015, the WCB authorized an extension of six treatments at a frequency of two visits per week for three weeks for "strengthening."

On June 9, 2015, the treating physician noted that the worker was being referred for a left shoulder MRI and that he should continue with physiotherapy treatment. An MRI assessment on June 29, 2015 revealed mild to moderate AC joint degenerative changes and mild distal supra and infraspinatus tendinosis. No rotator cuff tear was seen.

On July 15, 2015, the physiotherapist again requested additional funding for physiotherapy treatment. On July 23, 2015, a WCB physiotherapy advisor approved funding for two additional sessions for progression of an exercise-based home program, and then self-management. For ongoing problems, the advisor commented that the worker should attend his physician for consideration of a subacromial injection.

On July 27, 2015, the physiotherapist requested funding for additional physiotherapy treatment in order to reduce the worker's pain and increase strength in overhead ranges. On August 4, 2015, the WCB physiotherapy advisor stated:

The criteria to be met to fund treatment beyond the initial course of therapy are measurable evidence of a sustained improvement of function as determined by validated outcome measures and the movement towards return to work. Based on the medical information on file the criteria has not been met...There is no medical evidence on file to support the need for further in clinic physiotherapy. A sufficient home program should have been provided to date.

On August 4, 2015, the WCB wrote the treating physiotherapist to confirm that the WCB was unable to approve the extension request for treatment based on the comments outlined by the WCB physiotherapy advisor.

On August 13, 2015, the worker filed an appeal with Review Office regarding the decision of August 4, 2015.

In a doctor progress report of August 24, 2015, the worker’s physician noted that the worker had pain and clicking in his left shoulder and range of motion was 90 degrees. The physician recommended that the worker continue with physiotherapy treatment.

On September 21, 2015, Review Office determined that the worker was not entitled to additional physiotherapy treatment. Review Office noted that the worker received 24 physiotherapy treatments in total and although he had improved somewhat with treatment, he continued to report ongoing difficulties with his left shoulder. Review Office acknowledged the treating physician's recommendation to extend the worker's physiotherapy treatment; however, it agreed with the WCB physiotherapy advisor's comments of August 4, 2015.

On October 4, 2015, the worker appealed Review Office's decision to the Appeal Commission and a file review was arranged.

Reasons

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 39(2) of the Act provides that wage loss benefits will be paid until the loss of earning ends. Subsection 27(1) provides that medial aid will be paid by WCB for so long as is necessary to cure and provide relief from the injury.

Delivery of medical aid services to injured workers is addressed by the WCB in its Policy 44.120.10, Benefits Administration – Medical Aid (“the Medical Aid Policy”). That policy sets out that the “…provision of medical aid attempts to minimize the impact of the worker’s injury and to enhance the injured worker’s recovery to the greatest extent possible.” Medical aid for medically prescribed treatments, such as physiotherapy treatment, will generally be paid when required by reason of the compensable injury and where the treatment is “likely to improve function or minimize the chance of aggravating the existing injury or of causing a further injury.”

Worker’s Position

The worker’s position is that he is entitled to additional physiotherapy treatment. The worker relies on the recommendation of his physician, who has continually monitored his recovery from the workplace injury, that he receives physiotherapy treatment to aid in his recovery. He states that there has been substantial improvement in the movement and pain levels with previous physiotherapy treatment and that home treatments do not enable the professional input or equipment used in clinic.

The worker notes that he has continued to receive physiotherapy treatment at his own expense “…to keep the pain manageable.” Although the pain persists in his shoulder, he argues that “…all courses of action should be taken to alleviate this pain and discomfort as the injury continues to heal and until the doctor recommends different.”

Employer's Position

The employer did not participate in the appeal.

Analysis and Decision

To find that the worker is entitled to additional physiotherapy treatment, the panel must find on a balance of probabilities that the medical aid requested is necessary to cure and provide relief from the injury.

The information on file confirms the worker received a total of 24 physiotherapy treatments before the August 4, 2015 decision of the WCB that no further treatment would be approved. The worker’s treating physiotherapist, in her discharge report of August 5, 2015 noted the worker had a full range of motion and that his status was “improving.” Further, the question whether the worker’s recovery is satisfactory is answered in the affirmative.

Although the worker’s treating physician continued to recommend physiotherapy after that date, the worker himself acknowledged to the WCB, as outlined in the September 22, 2015 memo on file, that “…due to his lack of improvement with physiotherapy, the doctor is now looking to have him undergo cortisone injection.” In this regard, we note that the file reveals the worker did subsequently receive cortisone injections in September 2015 and again in January 2016.

In the view of the panel, the evidence leads to a conclusion that by early August 2015, the worker reached a point where further physiotherapy treatment was not necessary to cure and provide relief from the injury. By that point in time, there were no signs of further improvement or benefit to the worker’s function arising out of the physiotherapy treatment.

Considering all the evidence before us, we determine on a balance of probabilities that the worker is not entitled to further physiotherapy treatment. The worker's appeal is therefore denied

Panel Members

K. Dyck, Presiding Officer
A. Finkel, Commissioner
M. Kernaghan, Walker, Commissioner

Recording Secretary, B. Kosc

K. Dyck - Presiding Officer

Signed at Winnipeg this 6th day of April, 2016