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 medical aid benefits in relation to her compensable accident. A hearing was held on May 10, 2017 to consider the worker's appeal.

Issue

Whether or not the worker is entitled to medical aid benefits.

Decision

That the worker is not entitled to medical aid benefits.

Background

On May 26, 2015, the worker filed a claim with the WCB stating that she slipped and fell on ice while carrying a garbage bag and sustained injuries to her left middle back to the knee.  The worker reported that the accident happened in December 2014 and that she could not recall the exact date.  Two to three days after the accident, she felt pain and could not walk.  She attended a physician for treatment and x-rays were taken.  The x-rays did not show any findings and she was prescribed different medications which did not help.  On May 17, she was sent for an MRI and was awaiting the results.  The worker noted that she was still working her regular job duties and that she was prescribed physiotherapy treatment but could not afford the costs.    

The Employer Injury Report dated July 3, 2015, stated that the worker slipped on ice and injured her low back and upper leg.  The accident was reported to her supervisor on December 20, 2014. 

On June 9, 2015, the worker spoke with a WCB adjudicator, through an interpreter, to discuss her claim.  The worker advised that she was throwing out the garbage and slipped on ice, landing on her buttocks and hurt her lower back.  The worker noted that she sought medical attention in late December 2014 as she thought her injury would get better.  She did not know how to file with WCB.  She continued to work her duties and when her back got sore and it was not too busy at work, a helper would assist her with the duties. 

Medical reports on file showed that the worker sought medical attention for back complaints on January 6, 14, and 27, 2015 and from a physiotherapist on June 4, 2015.   The worker also underwent various diagnostic tests which were read as follows:

• January 14, 2015 lumbosacral spine x-rays:  There is almost complete sacralization of L5.  Facet arthrosis at L4-5 is present.  The disc spaces are maintained.
• January 2015 CT scan:  Suspected left parapelvic renal cysts.
• May 17, 2015 MRI lumbar spine:  At the L4-5 level, there is an annular tear and a mild broad-based central/right paracentral/right foraminal disc protrusion which mildly encroaches the right L5 nerve root.  There is mild facet joint OA (osteoarthritis).  There is mild right-sided foraminal narrowing without significant canal narrowing.  The remainder of the levels in the lumbar spine are unremarkable apart from mild facet joint degenerative changes.

On July 2, 2015, a manager confirmed that the worker slipped on ice when taking out garbage and that she made ongoing complaints to staff but did not miss time from work.

On July 22, 2015, the worker was seen at the WCB offices for a call-in assessment.  On August 11, 2015, the WCB physical medicine consultant opined as follows:

• The initial diagnosis in relation to the low back/left leg symptoms first described at the sports medicine assessment of January 14, 2015 was non-specific non-radicular low back pain.  The diagnosis was equivalent to the diagnosis of mechanical low back pain cited in the January 14, 2015 sports medicine physician's report.
• The usual recovery period for non-specific non-radicular low back pain is variable, from days up to several weeks.
• The symptoms reported by the worker at the call-in assessment were not neurologic in nature and the physical examination findings did not indicate a musculoskeletal or neurologic lesion.  He was therefore not able to confirm the presence of a current musculoskeletal or neurologic structural pain generator to account for the worker's presentation.
• In the absence of a probable structural lesion stemming from the mid December 2014 fall, the worker's current presentation could not be accounted for.  

On August 31, 2015, the worker was advised that based on a review of the file information which included the significant delay in seeking medical treatment and the opinion provided by the WCB medical consultant, the case manager was unable to establish a relationship between her current condition and the workplace incident that occurred in mid-December 2014. 

On September 9, 2015, the WCB advised the worker that the medication receipts she submitted would not be reimbursed.

On October 13, 2015, the worker filed an appeal with Review Office as she disagreed with the WCB's decision to deny responsibility for her treatment costs.

On November 16, 2015, Review Office determined that there was no coverage for medical aid benefits.  Review Office referred to specific medical information on file to support that a relationship had not been established between the worker's medical findings in January 2015 and beyond to the compensable back injury sustained in December 2014.

Review Office noted that the worker delayed in seeking medical attention and there was no work-related reason for her back pain when she attended a physician on January 6, 2015.  Review Office stated that it was not able to account for the CT scan findings in relation to the workplace accident.  It opined that the x-ray findings represented a pre-existing degenerative condition and it was unable to account for the worker's right-sided findings in the MRI to her left-sided complaints following the December 2014 accident.  Review Office also relied on the opinion provided by the WCB physical medicine consultant who examined the worker in July 2015.

On January 18, 2016, the worker appealed Review Office's decision to the Appeal Commission and an oral hearing 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 WCB 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 27(1) provides that medical aid will be paid by the WCB for so long as is necessary to cure and provide relief from the injury.

The worker has an accepted claim for an injury arising from a December, 2014 accident. She is seeking coverage for medical aid benefits. 

Worker's Position

The worker participated by teleconference.  She was self-represented and was assisted by an interpreter.

Through the interpreter she answered questions from the panel and advised:

• after her workplace accident she could not work
• she wants treatment so that she can work
• the WCB stopped paying for her medication when she moved out of the province
• she is better but still cannot work
• she received Employment Insurance
• she did not get "chiro" treatment because it was too expensive
• she provided the name of her current physician
• initially when she moved, she saw the new physician once a month, but she has not seen the physician in 2017
• she had kidney surgery in Winnipeg and would like a check up
• her new physician told her the medications did not work and recommended that she use Tylenol and Advil
• she had terrible headaches and had a CT of head and back
• she saw a surgeon in Winnipeg for a kidney problem and had an ultra sound in her new location
• there is a long wait to see a surgeon in her new location so she is going to her birth country to see a physician
• she does stretching but cannot lie on her back, and she must sleep on her side
• she still has pain in her left leg
• the pain is like a shock and results in swelling in her left leg.  This is random and can come 4 to 5 times in a week and last 4 to 5 hours
• she has no problem with her right leg her medical problems and worry have caused her to have high blood pressure
• the pain remains the same
• she gave her current physician all her documents and told him of her problems
• her current family physician does not say anything about her back and has told her to relax and get exercise
• she is currently going to school to English language classes
• she was told her problem is due to aging but she feels it is caused by the accident

The worker indicated that she is returning to her birth country in the very near future to obtain a medical assessment and advice.  She wants to know who she can speak with at the WCB when she gets this information.  She asked whether the WCB will pay for her treatment and medicine.

The worker also expressed concern that the WCB refuses to pay medical bills incurred at her new location because she moved out of Manitoba.   

Employer's Position

The employer did not participate in the appeal.

Analysis

The worker has an accepted claim for a workplace injury; however, the WCB has refused to pay medical expenses that she claims are related to her accepted injury.  For the worker's appeal to be approved, the panel must find that the medical expenses claimed by the worker are for her compensable injury.  The panel was not able to make this finding.

The panel notes that the worker injured her back when she slipped and fell on ice in December 2014.  However, an examination of the medical and other information supports a finding that the worker recovered from the accident soon after, and that the worker has other conditions which are causing her ongoing difficulties.  Given this finding, the panel concludes that the worker is not entitled to further medial aid benefits and the WCB is not required to pay for further treatment.

The panel notes the findings of the sports medicine physician who examined the worker on January 14, 2015.  He noted that the worker reported a fall in December 2014 and complained to her physician of lower back pain, left greater than right, which radiates to the left buttock and down the left leg.  He provided a possible diagnosis of mechanical back pain and queried whether there was nerve root irritation.  He recommended physiotherapy and medication. The worker did not attend this physician again. The panel relies on this report to conclude that the worker did injure her back when she slipped and fell on ice in December 2014.

In finding that the worker's current symptoms are not related to workplace injury, the panel notes that the worker has undergone diagnostic tests which show findings that are not consistent with the lower back injury that the worker sustained, including:  

• CT scan which showed parapelvic renal cysts.  The panel finds that this is not related to the workplace injury.
• x-rays which showed "almost complete sacralization of the L5.  Facet arthrosis at the L4-L5. The disc spaces are maintained."  The panel understands that sacralization is a congenital condition in which the lumbar vertebra fuses completely or partially with the sacrum on either or both sides.  The panel finds that this condition is not related to the workplace accident.
• May 17, 2015 MRI  which indicated "At the L4-L5 level there is an annular tear and mild broad based central/right paracentral/right foraminal disc protrusion which mildly encroaches upon the right L5 nerve root."  The panel notes that this condition is not known to cause left sided pain and therefore finds that it is not related to the workplace injury which affected her left side.

The panel attaches weight to the August 11, 2015 opinion of the WCB physical medicine consultant.  The panel notes that the consultant examined the worker on July 22, 2015. The consultant noted the January 14, 2015 opinion of the sports medicine physician who examined the worker and provided a diagnosis of mechanical low back pain.  The consultant opined that:

At the July 22, 2015 examination, the symptoms reported by [the worker] were not neurologic in nature and the physical examination findings did not indicate a musculoskeletal or neurologic lesion.  As such, I am unable to confirm the presence of a current musculoskeletal or neurologic structural pain generator to account for the [worker's] presentation.

The consultant also opined that:

In providing this opinion, it is highlighted that the May 17, 2015 MRI findings involving the L4-5 disc are not accounted for in relation to the mid December 2014 injury.  

The worker advised the panel that she has not undergone any treatment for her back since she left Manitoba in 2015 due to the cost of treatment and asked the panel for future coverage.  The panel's decision does not authorize any further treatment.

At the hearing, the worker expressed concern that the WCB was not willing to provide medical aid benefits to her as she had moved from Manitoba to a different province.  The panel finds no evidence to support this assertion.  The panel clarified at the hearing and reiterates our decision that benefits are not payable, is not related to the worker's change of residence, but rather it is based on the medical information which does not support a continuing relationship between her accepted injury and her current symptoms.  

The worker's appeal is dismissed.

Panel Members

A. Scramstad, Presiding Officer
A. Finkel, Commissioner
M. Kernaghan, Commissioner

Recording Secretary, B. Kosc

A. Scramstad - Presiding Officer
(on behalf of the panel)

Signed at Winnipeg this 12th day of May, 2017