Decision #91/17 - Type: Workers Compensation
Preamble
The worker is appealing the decision made by the Workers Compensation Board ("WCB") to deny responsibility for dental treatment related to teeth #11 and #12 in relation to his compensable accident. A file review was held on May 9, 2017 to consider the worker's appeal.
Issue
Whether or not responsibility should be accepted for the treatment of teeth #11 and #12.
Decision
That responsibility should not be accepted for the treatment of teeth #11 and #12.
Background
The worker has an accepted claim with the WCB for injuries he sustained to his forehead and teeth as a result of a slip and fall incident that occurred on September 30, 1985. The worker's retainer was also damaged at the time of the accident according to claim information.
In December 2015, the WCB received a report from a dentist which stated that the worker required dental treatment as follows:
• Tooth 11, the right upper central incisor
• Tooth 12, the right upper lateral incisor
• Tooth 21, the left upper central incisor
• Tooth 22, the left upper lateral incisor
On January 15, 2016, a WCB dental consultant noted to the file that based on the initial hospital report dated September 30, 1985 and dentist's report of November 16, 1985, the proposed dental work for teeth 21 and 22 was approved and that no responsibility was accepted for the dental
treatment related to teeth 11 and 12 as they were not injured in the compensable accident. A letter was sent to the worker dated January 18, 2016 advising him of the decision.
On February 16, 2016, the worker advised the WCB that he had experienced problems with the front four teeth of his upper jaw ever since the accident. He said the accident happened two weeks after he had his braces taken off. The worker stated that two of his teeth were directly dislodged in the accident and the other two also sustained a hit.
The WCB dental consultant reviewed the additional information that was provided by the treating dentist on April 15, 2016. In a decision dated April 19, 2016, it was confirmed to the worker that dental treatment for teeth 11 and 12 was denied as they were not involved in the compensable accident. On June 28, 2016, the worker appealed the decision to Review Office.
On October 4, 2016, Review Office determined that there was no dental treatment coverage for teeth 11 and 12. Review Office stated that it agreed with the opinion that was outlined by the WCB's dental consultant on January 15, 2016. Review Office referred to the information provided by the worker in his appeal but stated that it placed greater weight on the information in closest proximity to the accident.
On December 14, 2016, the worker appealed Review Office's decision to the Appeal Commission and a file review was arranged.
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 WCB's Board of Directors. The panel notes that the worker's claim dates back to 1985. Accordingly, the worker's benefits are to be assessed under the Act as it existed at that time.
Subsection 4(1) of the Act, as it read in 1985, provided that 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.
Payment for treatment in addition to compensation was provided for under subsection 24(1) of the Act, which read as follows:
24(1) In addition to the other compensation provided by this Part, the board may provide for the injured worker such medical, surgical, and hospital treatment, transportation, nursing, attendant care, medicines, crutches, and apparatus, including artificial members, as it may deem reasonably necessary at the time of the injury, and thereafter during the disability, to cure and relieve from the effects of the injury; and the board may adopt rules and regulations with respect to furnishing medical aid to injured workmen entitled thereto, and for the payment thereof.
Worker's Position
The worker provided a written submission outlining his reasons for appealing the Review Office decision.
The worker is seeking payment for dental treatment to teeth 11 and 12. The worker's position was that those two teeth were also damaged in the September 30, 1985 workplace accident and that the dental treatment was related to and required as a result of that accident.
The worker referred to three statements which he had submitted in June 2016. The statements were from the co-worker who witnessed the accident and drove him to the hospital in 1985; the worker's stepfather, who was the worker's liaison with the WCB and reported on his behalf that the worker's retainer was broken in the accident; and the worker himself. It was submitted that the broken retainer was significant, as the worker was wearing it at the time of the accident, and it had a wire which went across his upper teeth. Evidence regarding the broken retainer also helped validate that his teeth were sensitive and fragile, as the braces on his upper teeth had been removed only two months earlier.
The worker noted that the hospital report from September 30, 1985 refers to canine teeth, and he told the doctor at that time that all of his teeth in between the canine teeth were hit. He remembered that it was difficult to talk following the accident, and the doctor told him that they were not dentists. It took almost three weeks to see a dentist.
The worker said that he had not realized that he had a claim or how the WCB worked, and did not return to Manitoba as a resident until 2015. He would have contacted the WCB earlier and would not have paid for all the prior dental work if he had realized that he had a claim.
Employer's Position
The employer did not participate in the appeal.
Analysis
The issue on this appeal is whether or not responsibility should be accepted for the treatment of
teeth #11 and #12. For the worker's appeal to be successful, the panel must find that treatment for those two teeth was required as a result of the workplace accident on September 30, 1985. The panel is unable to make that finding, for the reasons that follow.
The panel notes that file information includes a hospital report dated September 30, 1985 and a dentist's first report dated November 16, 1985. The hospital report documented that the worker "Bumped L (left) forehead and has L front incisor half-knocked out", and that the diagnoses were "contusion forehead" and "partial avulsion L upper incisor and canine teeth." The dentist's first report indicated that only teeth 21 and 22 on the left side of the worker's mouth were injured. There is no reference in either report to any injury to teeth 11 and 12. The panel finds that the hospital report and the dentist's report do not support that an injury occurred to the right side, or to teeth 11 and 12 specifically, as a result of the accident.
The panel notes that there is little or no information on file to show ongoing concerns or attendances for dental treatment for teeth 11 and 12 in the 30 years following the accident, and no medical evidence to show how the damage to those teeth would first appear so many years after the accident.
In his May 15, 2016 statement, the worker said that the dentist used both his thumbs to press his teeth back into place, and they were bonded together. He said that all of the incisors between the canine teeth were bonded. His teeth remained loose for years and he was careful not to stress them in any way. Teeth 11 and 12 had very shallow roots, had blackened and were in need of replacement. In his submission, the worker said that his teeth have now been repaired and he paid half the cost.
The panel acknowledges the 2016 statements from the worker, his co-worker and his step-father, respectively. The panel finds that those statements are consistent with the fact that the accident occurred. The panel is looking, however, for specific evidence that the right side of the worker's mouth and the two front teeth on that side were injured in the accident. The panel is unable to find such evidence.
Based on the foregoing, the panel finds that the dental treatment for teeth #11 and #12 was not required as a result of the workplace accident on September 30, 1985, and that responsibility should not be accepted for the treatment of teeth #11 and #12.
The worker's appeal is denied.
Panel Members
M. L. Harrison, Presiding Officer
A. Finkel, Commissioner
M. Kernaghan, Commissioner
Recording Secretary, B. Kosc
M. L. Harrison - Presiding Officer
(on behalf of the panel)
Signed at Winnipeg this 22nd day of June, 2017