The Appeal CommissionThe Workers Compensation Act of Manitoba

Preamble

The worker is appealing the decision made by the Workers Compensation Board ("WCB") that she was not entitled to further physiotherapy treatment in relation to her compensation claim. A file review was held on August 11, 2016 to consider the worker's appeal.

Issue

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

Decision

That the worker is not entitled to further physiotherapy treatment.

Background

On October 11, 2015, the worker fell, landing on her right knee, when carrying material into her workplace. Initial medical reports showed that the worker attended a hospital facility on October 12, 2015 and x-rays were taken. On October 16, 2015, the worker was diagnosed with a contusion to the right knee by her family physician and was referred to a physiotherapist for treatment. On December 1, 2015, the WCB accepted the worker's claim and authorized up to 20 visits with the physiotherapist.

In a physiotherapy discharge assessment dated January 19, 2016, it was recorded that the worker's knee had recovered to pre-injury status and no swelling was detected.

On March 7, 2016, the worker saw a second physiotherapist, who reported that the worker required 6 weeks of physiotherapy, twice per week, for the pain in her right knee.

On March 10, 2016, the worker was seen by her family physician, who described her complaints as follows:

Continued pain in medial aspect, radiates down to foot, in same area. Physiotherapy seemed effective. Saw…physiotherapy lately on Monday March 7, 2016. Noted to have continued swelling, given home exercises and currently doing same.

In terms of clinical findings, the physician noted the worker had tenderness and mild swelling in the medial knee. All ligaments were described as normal. There were no neurological signs and gait was antalgic. The treatment plan included an x-ray and to continue with physiotherapy.

By letter dated April 4, 2016, the worker was advised that the WCB was unable to relate her current right knee symptoms to the original incident of October 11, 2015. It was noted that her claim had been accepted for a right knee contusion, that this type of injury typically recovered within 6 to 8 weeks, and that the January 19, 2016 physiotherapy discharge report stated that her knee was at pre-injury status.

On April 25, 2016, the worker appealed the April 4, 2016 decision to Review Office. In support of her appeal, she provided an April 22, 2016 report from her family physician which stated:

[Worker] continues to have substantial pain in medial aspect of R knee. With exacerbation, pain continues to radiate to foot and ROM and mobility is impaired. X-ray from March 3, 2016 demonstrates degenerative osteophytes and joint space narrowing along the patella. She subjectively feels that physiotherapy continues to help every time that she attends.

In my medical opinion [worker] has a chronic medical issue that has certainly been exacerbated by the October 11, 2015 fall.

On May 17, 2016, Review Office determined that the worker was not entitled to additional physiotherapy treatment.

Review Office considered the information from the second physiotherapist and the family physician's report of April 22, 2016. While the medical information demonstrated the worker had degenerative changes, Review Office referred to the physiotherapy discharge report which stated the worker had no swelling in her right knee and had recovered to pre-accident status. Review Office acknowledged that the worker again started to have difficulties with her right knee approximately one and a half months after she was discharged from physiotherapy, but found no evidence to support that those difficulties were related to the workplace injury. On May 27, 2016, the worker appealed Review Office's decision to the Appeal Commission and a file review was arranged.

Reasons

Applicable Legislation and Policy

The worker was employed by a federal government agency and her claim is therefore adjudicated under the Government Employees Compensation Act ("GECA").

Under subsection 4(2) of the GECA, a federal government employee in Manitoba is to receive compensation at the same rate and under the same conditions as a worker covered under The Workers Compensation Act of Manitoba (the "Act").

Subsection 27(1) of the Act provides that the WCB "…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 (the "Policy") provides a comprehensive and coordinated approach to delivery of medical-aid services to injured workers. As it relates to physiotherapy, the Policy provides:

2. Medically Prescribed Treatments, Devices and Their Related Accessories

To minimize the impact of workers' injuries and to encourage recovery and return to work, the WCB approves the use of many prescribed and recommended treatments and devices…

a. Medically Prescribed Treatments and Prosthetic Devices

i) The WCB will generally pay for medically prescribed treatments (cosmetic, physical or psychological)…when required by reason of a compensable injury, and 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 was self-represented, and provided a written submission with attachments, for the panel's consideration.

The worker stated that the physiotherapist's discharge assessment report of January 19, 2016 indicating that she had fully recovered to her pre-accident status was not correct. She said she was still experiencing pain in her knee from her October 11, 2015 fall. She told the physiotherapist that she was still having problems, but the physiotherapist said she would be fine and did not need any more physiotherapy. Based on the physiotherapist's advice, and thinking that her condition would improve with time, she delayed seeking further treatment. When her condition did not change and the pain did not subside, she sought help from a different physiotherapist, but the WCB denied her coverage for further treatments.

The worker's position was that the problems she continued to have with her right knee all related to the October 11, 2015 incident. She had no previous injury and no problem with her knee prior to that incident, and had not had any other injury to her knee since then.

The worker noted that the WCB had approved 20 physiotherapy sessions to treat her injury. At the 9th session, she was told that no further physiotherapy was needed, even though she said she was still having problems. The worker submitted that the decision to deny coverage for further physiotherapy treatments was based on one physiotherapist's opinion that everything was at pre-accident status, which was not the case.

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 further physiotherapy treatment. For the worker's appeal to be successful, the panel must find that further physiotherapy treatment is required by reason of the worker's compensable injury. The panel is unable to make that finding.

The panel notes that following acceptance of the worker's claim, physiotherapy treatment was authorized for up to 20 visits. Treatment was provided between November 5, 2015 and January 19, 2016. On January 19, the treating physiotherapist discharged the worker on the basis that she had recovered from her workplace injury.

The panel considered the worker's submission that she had not recovered from her injury when her physiotherapy treatments ended, but was unable to find sufficient medical evidence to support that position.

The panel carefully reviewed the January 19 discharge assessment report from the treating physiotherapist which referred to the worker's current reported complaints as being "knee is pre-injury status." It was noted that the worker's level of pain was 0/10, and that no swelling was detected. Under work capabilities, the physiotherapist wrote that the "*knee has recovered to pre injury status*." It was also noted that the findings/recommendations had been discussed with the worker.

File information shows that there was a lack of medical follow-up between January 19, 2016 when the worker's treatments ended, and March 7, 2016 when the worker saw a second physiotherapist, then March 10, 2016 when she saw her family physician with a complaint of continued pain and swelling to her knee. In addition, the panel notes that the physician's report for March 10, 2016 indicates that the worker was complaining of a new symptom, namely that the pain "radiates down to foot, in same area." This is the first time there is any mention on file of the worker experiencing pain radiating down to her foot.

The worker's first contact with the WCB after mid-January 2016 was on March 7, 2016, when she called to advise that her knee had started hurting again a couple of days ago.

Based on the foregoing, the panel is unable to find that the worker's right knee condition subsequent to January 19, 2016 was related to her compensable injury.

The panel finds, on a balance of probabilities, that the worker had recovered from her compensable injury by January 19, 2016, and that no medical aid was required after that date by reason of her injury. The panel finds the worker is not entitled to further physiotherapy treatment.

The worker's appeal is dismissed.

Panel Members

M. L. Harrison, Presiding Officer
A. Finkel, Commissioner
P. Walker, Commissioner

Recording Secretary, B. Kosc

M. L. Harrison - Presiding Officer
(on behalf of the panel)

Signed at Winnipeg this 6th day of October, 2016