Decision #154/18 - Type: Workers Compensation
Preamble
The worker is appealing the decision made by the Workers Compensation Board ("WCB") that she is not entitled to further physiotherapy treatment. A file review was held on October 11, 2018 to consider the worker's appeal.
Issue
Whether or not the worker is entitled to further physiotherapy treatment.
Decision
The worker is not entitled to further physiotherapy treatment.
Background
The worker reported an injury to her left shoulder and the left side of her body after falling on the sidewalk while at work on November 15, 2017. She reported the incident to her employer on the same date and to the WCB on November 20, 2017.
During an initial conversation with the WCB on November 22, 2017, the worker advised that she had not yet attended at her doctor's office but would be attending for an assessment with her physiotherapist on November 27, 2017. She reported missing two days of work but she had returned to her full duties after that.
At her initial appointment with the physiotherapist on November 27, 2017, the worker reported slipping on ice at work and falling onto the left side of her body. She was diagnosed with a left rotator cuff strain and it was recommended that she limit overhead reaching and no lifting over ten pounds. At her initial doctor's appointment on December 7, 2017, she was diagnosed with a "contusion left shoulder" and it was noted that the worker had returned to her regular duties as of November 18, 2017.
The WCB advised the worker's physiotherapist that they were approving twenty visits for the worker's treatment. The worker's claim for a left rotator cuff strain was accepted on December 11, 2017. The payment of wage loss and other benefits started.
The WCB received a progress report from the worker's physiotherapist on January 5, 2018 indicating that the worker was having ongoing issues with pain related to her left wrist and it was recommended that she avoid lifting more than ten pounds with her wrist, pending the results of an x-ray. On January 16, 2018, the WCB advised the worker that her claim was accepted for a left rotator cuff strain only and no medical treatment or work restrictions would be approved related to her left wrist. The worker contacted the WCB on January 30, 2018 to advise that she did not initially know her left wrist pain was related to her workplace incident as she had not felt the symptoms until approximately three weeks after the incident. The WCB followed up with the worker on January 30, 2018 and confirmed that as there was no medical evidence on her claim file to connect an injury to her left wrist to the workplace incident, her left wrist difficulties had been disallowed.
The worker's treating physiotherapist requested an extension of treatment on February 6, 2018 as the worker was still experiencing stiffness in her neck and shoulder, difficulty with sleeping on her left side and with some overhead movements. The request was reviewed by the WCB medical advisor who opined: "The medical diagnosis was a contusion. The physiotherapy diagnosis was a rotator cuff strain. Funding for additional therapy is not authorized 3 months post soft tissue injury. She should continue to improve with a home program." The physiotherapist and the worker were informed by the WCB on February 9, 2018 that the extension request was not approved.
On February 20, 2018, the worker requested reconsideration of the WCB's decision to Review Office. The worker noted that the physiotherapist was using manual manipulation therapy, which requires a long process to see change, among other methods of therapy that would not be available to her at home.
Review Office advised the worker on May 2, 2018 that she was not entitled to further physiotherapy treatment. Review Office relied on the WCB medical advisor's February 9, 2018 opinion that the worker should not require further treatment for a soft tissue injury three months post-accident and that she would continue to improve with a home program. Review Office noted that at the time of the extension request and the worker's request for reconsideration, she still had several physiotherapy treatments remaining. As such, Review Office concluded that the evidence did not support the requirement for further coverage for physiotherapy related to the workplace incident.
The worker filed an appeal with the Appeal Commission on May 16, 2018. 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.
Subsection 4(1) of the Act provides 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.
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."
Subsection 27(10) of the Act further states that “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.”
Board policy 44.120.10, Medical Aid, (the Medical Aid policy) states “The provision of medical aid attempts to minimize the impact of the worker’s injury and to enhance an injured worker’s recovery to the greatest extent possible.”
Worker's Position
The worker provided a written submission in advance of the file review that took place on October 11, 2018.
The worker reported that on November 15, 2017 she slipped and fell on a snow- and ice-covered sidewalk between buildings associated with the workplace. The worker missed two days of work and saw a physiotherapist on November 27, 2017 who provided a diagnosis of a left rotator cuff strain.
The worker's position is that there should be further coverage for physiotherapy treatment (beyond the 20 treatments approved by WCB). “…without further therapy my shoulder will not heal properly. A home exercise program will not give me the manual manipulation which is currently helping me.” In addition, the worker expressed “…I am over 50 years old and may take longer to heal.”
Employer’s Position
The employer’s representative provided a submission outlining their position that the worker is not entitled to further physiotherapy treatment.
The employer’s representative stated “…by all accounts, the physiotherapy the worker received for the compensable injury had resulted in the worker achieving full range of motion. The worker can execute the full scope of her work responsibilities. We agree with the review office position that a home-based exercise program would have sufficed at the end of the physiotherapy treatment.”
Analysis
The issue before the panel is whether the worker is entitled to further physiotherapy treatment. For the worker's appeal to be successful, the panel must find that additional physiotherapy treatment is required because of the worker's November 15, 2017 compensable injury. The panel is unable to make that finding, for the reasons that follow.
The worker has an accepted claim for a left shoulder injury that resulted from a workplace accident. The panel accepts the original diagnosis of a left shoulder soft tissue injury and is satisfied that it is consistent with the mechanism of injury as described in the information reviewed in the file.
Based on our review of all the information before us, the panel is unable to conclude that further physiotherapy treatments will facilitate continued improvement to the left shoulder. The panel notes that the worker had achieved full range of motion and was completing regular work duties at the conclusion of the physiotherapy regimen. This is consistent with the Medical Aid policy which states “The provision of medical aid attempts to minimize the impact of the worker’s injury and to enhance an injured worker’s recovery to the greatest extent possible.”
The panel acknowledges the worker's concerns with respect to healing time; however, the panel accepts the review provided on February 9, 2018 by the WCB physiotherapy advisor who opined that the physiotherapy provided was sufficient for the treatment of a soft tissue injury, and his recommendation of continued home exercises. This is consistent with minimizing the impact of the worker’s November 15, 2017 injury.
Based on the foregoing, the panel finds, on a balance of probabilities, that the worker does not require further physiotherapy treatment beyond the approved treatments arising from the November 15, 2017 compensable injury. As a result, the worker is not entitled to additional treatments.
The worker's appeal is denied.
Panel Members
B. Hartley, Presiding Officer
A. Finkel, Commissioner
M. Kernaghan, Commissioner
Recording Secretary, J. Lee
B. Hartley - Presiding Officer
(on behalf of the panel)
Signed at Winnipeg this 7th day of November, 2018