Decision #65/22 - Type: Workers Compensation
The worker is appealing the decision made by the Workers Compensation Board ("WCB") that they are not entitled to concurrent physiotherapy and chiropractic treatment. A file review was held on May 10, 2022 to consider the worker's appeal.
Whether or not the worker is entitled to concurrent physiotherapy and chiropractic treatment.
The worker is not entitled to concurrent physiotherapy and chiropractic treatment.
The Employer provided an Employer Accident Report to the WCB on December 6, 2021, reporting the worker injured their right lower back and left hand and wrist on November 30, 2021 when they slipped and fell on ice while at work. The worker submitted their Worker Incident Report on December 7, 2021 and reported "I went around the corner and slipped on ice, fell to the ground injuring myself." The worker noted they had self-treated their injuries as they did not think the injuries were that serious.
On December 7, 2021, the worker attended for an initial chiropractic assessment, reporting right wrist pain and left sided lower back pain. The chiropractor reported decreased lumbar range of motion and edema over the right sacroiliac joint and provided a diagnosis of a right wrist sprain and left sacroiliac sprain/strain.
In a discussion with the WCB on December 9, 2021, the worker confirmed the mechanism of injury and advised they continued to have lower back left side pain, along with pain in their right wrist. They advised the WCB they had attended for chiropractic treatment, which helped but the pain came back the next day. The worker advised they would be seeking an assessment with a physiotherapist. The WCB advised the worker their initial assessment with the physiotherapist would be covered by the WCB; however, the worker would need to decide which treatment they would like to continue with as the WCB did not provide coverage for both physiotherapy and chiropractic treatment at the same time.
At the initial assessment with the physiotherapist on December 13, 2021, the worker reported pain in their right wrist, with difficulty gripping and left lower back pain, worse when bending forward, walking and lifting. The physiotherapist noted slightly decreased flexion and extension in the worker's lumbar spine and wrist and diagnosed a lumbar strain and a right wrist sprain, grade 1.
On December 20, 2021, the WCB spoke with the worker who advised they wished to continue physiotherapy treatment as they found the treatment helped. The worker also indicated they wanted to continue with their chiropractic treatment as they found that treatment beneficial as well. The WCB advised the worker the claim would be reviewed for the concurrent treatment request and that the WCB would advise the worker of the decision after review.
A WCB physiotherapy advisor reviewed the worker's file on December 31, 2021 and provided that concurrent physiotherapy and chiropractic care was not medically supported as either treating healthcare provider could effectively treat both areas injured in the workplace accident.
On January 14, 2022, the WCB advised the worker that concurrent physiotherapy and chiropractic treatment was not approved and as they had indicated their preference to continue with physiotherapy treatment, their chiropractic treatment was approved to December 12, 2021.
On February 1, 2022, the worker requested reconsideration of the WCB's decision to Review Office, noting their belief that receiving both chiropractic and physiotherapy treatment allowed them to recover from the November 30, 2021 workplace accident more quickly. The worker advised they received benefit from both kinds of treatment, with the chiropractic treatment enabling them to return to work the same day and the physiotherapy treatment allowing them to continue to work and not miss time.
Review Office upheld the WCB's decision on March 3, 2022 and determined the worker was not entitled to concurrent physiotherapy and chiropractic treatment. Review Office agreed with the opinion of the WCB physiotherapy advisor that the medical evidence did not support the worker required both types of treatment to recover from the workplace accident.
The worker filed an appeal with the Appeal Commission on March 8, 2022. A file review was arranged for May 10, 2022.
Applicable Legislation and Policy
The Appeal Commission and its panels are bound by the provisions of The Workers Compensation Act, regulations under the Act and the policies established by the WCB's Board of Directors. The provisions of the Act in effect as of the date of the worker’s accident are applicable.
A worker is entitled to benefits under s 4(1) of the Act when it is established that a worker has been injured as a result of an accident at work.
When the WCB determines that a worker requires medical aid because of an accident, compensation is payable under s 37 of the Act. Section 27 allows the WCB to provide a worker with such medical aid as the board considers necessary to cure or provide relief from an injury resulting from an accident.
The WCB has established Policy 44.120.10, Medical Aid (the “Policy”) to define key terms and sets out general principles regarding a worker's entitlement to medical aid. The Policy notes that medical aid, as defined in the Act, includes treatment or services provided by a health care providers. The Policy goes on to set out that the general principles governing the WCB's funding of medical aid include the following:
• The Board is responsible for the supervision and control of medical aid funded under the Act or this policy.
• The Board determines the appropriateness and necessity of medical aid provided to injured workers in respect of the compensable injury.
• In determining the appropriateness and necessity of medical aid, the Board considers:
o Recommendations from recognized healthcare providers;
o Current scientific evidence about the effectiveness and safety of prescribed / recommended healthcare goods and services;
o Standards developed by the WCB Healthcare Department.
• The Board promotes timely and cost-effective access to medical aid.
• Workers are entitled to select their own health care provider, subject to the Board's control and supervision of medical aid.
• The Board's objectives in funding medical aid are to promote a safe and early recovery and return to work, enable activities of daily living, and eliminate or minimize the impacts of a worker's injuries.
The worker’s position in this appeal from the March 3, 2022 decision of the Review Office that they are not entitled to concurrent chiropractic and physiotherapy treatment is as noted in the worker’s request to Review Office appealing the WCB decision. The worker believes that as a result of receiving concurrent physiotherapy and chiropractic treatment they could have healed and returned to their pre-accident condition more quickly. The worker believes that it was due to the initial chiropractic treatment that they were able to return to work the same day and due to the physiotherapy treatment, that they were able to continue working after the injury occurred. The worker stated their belief that although they continued only with physiotherapy as a result of the WCB decision, chiropractic treatment would have complemented the physiotherapy and possibly allowed for a speedier recovery.
The employer did not participate in the appeal.
The question on appeal is whether the worker is entitled to concurrent physiotherapy and chiropractic treatments. For the panel to grant the worker’s appeal, the panel would have to find that the concurrent treatment requested is necessary to cure and provide relief from the workplace injury. As set out in the reasons that follow, the panel was not able to make such a finding and therefore, the worker’s appeal is denied.
Section 27(1) of the Act sets out that the WCB has discretion to provide medical aid if it determines that aid is necessary to cure and provide relief. These provisions of the Act give discretion to provide medical aid only where necessary to cure and provide relief from a compensable injury. The WCB Medical Aid Policy provides further guidance as to how the WCB determines what kind of medical aid is required. The Policy confirms that the WCB is responsible to determine the appropriateness and necessity of medical aid provided, taking into account the recommendations from healthcare providers, current scientific evidence as to effectiveness and safety of treatment and standards developed by the WCB’s Healthcare Department. The objectives in funding medical aid include promotion of timely and cost-effective access to treatment, safe and early recovery and return to work, enablement of activities of daily living and elimination or minimization of the impacts of a workplace injury.
The facts here are, briefly, that the worker slipped and fell on ice at work on November 30, 2021, sustaining injury to their left lower back and right hand and wrist. They first sought chiropractic treatment on December 7, 2021, and the chiropractor recommended 3 treatments weekly for 4 weeks, for spinal manipulation and active rehabilitation. On December 13, 2021, the worker was assessed by a physiotherapist who recommended twice weekly treatments for 8 weeks, with a home program as well.
The panel noted that on receiving the worker’s request for concurrent physiotherapy and chiropractic treatment, the WCB physiotherapy advisor advised that “Concurrent care is not medically supported. Both the chiropractor and the physiotherapist can effectively treat both areas.” The WCB advised the worker accordingly and indicated that the worker could choose which treatment to continue. The file record reveals that the worker chose to continue with the physiotherapy.
Subsequently, on February 9, 2022, the worker sought treatment from their family physician in respect of these injuries. On March 16, 2022, the physician recommended continuing physiotherapy and ordered an MRI study, which took place on April 7, 2022.
Based upon the reports received from the treating physiotherapist and the treating chiropractor, the WCB determined that medical aid, in terms of either physiotherapy treatment or chiropractic treatment, was necessary to cure and provide relief from the worker’s injury. The WCB exercised its discretion to provide necessary medical aid in the form of physiotherapy but did not exercise its discretion to also provide concurrent chiropractic treatment. The worker’s position is that because he perceives actual and potential benefit from both therapies in his recovery from the compensable workplace injury, the WCB should provide medical aid for both therapies. The WCB physiotherapy advisor who had access to the worker’s full file stated unequivocally that there was equal benefit to both treatments, but no benefit to concurrent treatment. The panel also noted that when consulted in March 2022, the worker’s family physician recommended continuation of the physiotherapy.
While the panel accepts that there may be, in some cases, circumstances where concurrent physiotherapy and chiropractic treatment could be necessary to cure and provide relief from a compensable injury, there is a lack of evidence here to suggest that this is such a case. Taking into account the factors the WCB must consider in determining whether medical aid is appropriate and necessary, the panel finds that the WCB has appropriately applied the Policy and finds no reason to depart from the WCB’s decision in this case.
On the basis of the evidence before us and on the standard of a balance of probabilities, the panel is satisfied that the worker is not entitled to concurrent physiotherapy and chiropractic treatment.
Therefore, the appeal is denied.
K. Dyck, Presiding Officer
J. Peterson, Commissioner
M. Kernaghan, Commissioner
Recording Secretary, J. Lee
K. Dyck - Presiding Officer
(on behalf of the panel)
Signed at Winnipeg this 14th day of June, 2022