The Appeal CommissionThe Workers Compensation Act of Manitoba

Preamble

The worker is appealing the decision made by the Workers Compensation Board ("WCB") to deny responsibility for travel expenses to attend a CT scan appointment. A hearing was held on May 11, 2015 to consider the matter.

Issue

Whether or not the worker is entitled to travel expenses in order to attend a CT scan.

Decision

That the worker is not entitled to travel expenses in order to attend a CT scan.

Decision: Unanimous

Background

The worker has an accepted claim with the WCB for a left knee injury that occurred in the workplace on August 11, 1999.

By letter dated May 29, 2015, the worker was advised that the WCB was unable to compensate him for travel expenses for a CT scan of his spine as it was unrelated to his compensable knee injury. Compensation Services referred to Policy 44.120.10, Medical Aid, as the basis for its decision. On June 20, 2015, the worker appealed the decision to Review Office.

On July 28, 2015, Review Office confirmed that there was no entitlement to financial reimbursement for travel expenses to attend the CT scan that took place on May 14, 2015.

Review Office referred to the worker's appeal letter of June 20, 2015 where he compared his pursuit of diagnostic testing for a low back problem prior to surgery to the need for pre-operative testing for a heart condition that had been an accepted cost by the WCB. Review Office disagreed with the worker's position.

Review Office referred to Appeal Commission Decision No. 59/15, noting that the decision accepted partial responsibility for an angiogram procedure on October 31, 2014 on the basis that it was needed to obtain pre-operative medical clearance for a proposed compensable surgical procedure.

Review Office noted that the CT scan for the worker's low back, a non-compensable condition, was not a required element for pre-operative medical clearance. Therefore, it was unable to find that the need for this treatment was a necessary consequence of the compensable injury, either in whole or in part.

On August 12, 2015, the worker appealed Review Office's decision to the Appeal Commission and an oral hearing via teleconference was held on May 11, 2016.

Following the hearing, the appeal panel requested additional medical information from the attending physician prior to rendering a decision on the issue under appeal. On May 19, 2016, the worker was provided with the medical information that was obtained by the appeal panel and was asked to provide comment. On June 7, 2016, the panel met further to discuss the case and rendered its final decision.

Reasons

Applicable Legislation and Policy

The Appeal Commission and its panels are bound by The Workers Compensation Act (the “Act”), regulations and policies of the Board of Directors.

The worker is seeking reimbursement of mileage expenses in order to attend a CT scan.

The payment of compensation for medical expenses falls under the heading of Medical Aid.

The Act empowers the board to provide such medical aid as it deems necessary:

Provision of medical aid

27(1) 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.

Medical aid to be under supervision of board

27(10) Medical aid furnished or provided under any of the preceding subsections of this section shall at all times be subject to the supervision and control of the board; and the board may contract with health care providers, hospitals or other health care facilities for any medical aid required, and agree on a scale of fees or remuneration for any such medical aid.

The WCB Board of Directors established WCB Policy No. 44.120.10, Medical Aid ("the Policy"), that addresses the criteria and provision of medical aid.

Worker's Position

The worker advised the panel that:

…they want to do this knee replacement and…my back was… giving me a lot of trouble and…they send me for pre-ops…to make sure I’m physically well in order to go for…this knee replacement, partial knee replacement. So basically...my back was giving me problems so I thought…I want to check that out before I get my knee done, because, you know, I have a bad back, I've got a sore back and…I don't need a sore back and, like, a knee replacement, a partial knee replacement, which…is pretty significant surgery…

they check every other part of your body to make sure you’re capable of withstanding this operation.

The worker advised that his back was bothering him for a while and he complained to his family physician but it was not noted on the reports to WCB because it was not a WCB matter. He acknowledged that he asked the family physician about getting the CT scan because he did not want to have to deal with a back problem and knee surgery at the same time.

In answer to a question, the worker advised that his back is always sore. He said that "It's not at the point where you need to get an operation for, you know, for the intervention or something." He advised that the painkillers he takes for his knee injury help his back condition.

Regarding whether his family physician was concerned about having a knee operation when he had a bad back the worker advised that "As far as saying no…you can't have an operation because of your back, no, he didn't say that."

The worker confirmed that his family physician did not express an opinion on his back in relation to the worker's proposed knee surgery. He also confirmed that he did not speak to his orthopedic surgeon about his back and the proposed knee surgery.

Analysis

The issue before the panel is whether the worker is entitled to travel expenses in order to attend a CT scan appointment. In order for the worker's appeal to succeed, the panel must be satisfied that the expenses are necessary to cure and provide relief from an injury resulting from an accident. The panel is not able to make this finding.

The evidence on the file and provided at the hearing indicates that the worker wished to have a CT scan of his back because he was concerned about the relationship between his back condition and the proposed surgery for his knee. He believed that obtaining a CT scan was a reasonable pre-operative test. This concern was not shared or noted by the surgeon who is going to perform the proposed knee surgery nor the worker's family physician. The worker advised that he did not

discuss the need for a CT scan with the surgeon. With respect to his family physician, he advised that the family physician did not express an opinion on the relationship between the proposed surgery and his back condition.

The panel notes that the family physician's medical charts obtained after the hearing, do not identify or support a need for the CT scan in relation to the proposed knee surgery.

The panel finds that the CT scan of the worker's back was not a necessary pre-operative test in relation to the proposed knee surgery. The expense is therefore not necessary to cure and provide relief from the injury resulting from an accident as noted in subsection 27(1) of the Act. The panel finds that the worker is not entitled to travel expenses in order to attend the CT scan appointment.

The worker's appeal is dismissed.

Panel Members

A. Scramstad, Presiding Officer
A. Finkel, Commissioner
P. Walker, Commissioner

Recording Secretary, B. Kosc

A. Scramstad - Presiding Officer

Signed at Winnipeg this 29th day of July, 2016