The Appeal CommissionThe Workers Compensation Act of Manitoba

Preamble

The worker is appealing the decision made by the Workers Compensation Board ("WCB") that:

1. Their permanent restrictions have been properly determined; and 

2. They are not entitled to further physiotherapy treatment.

A videoconference hearing was held on February 14, 2023 to consider the worker's appeal.

Issue

1. Whether or not the worker’s permanent restrictions have been properly determined; and 

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

Decision

1. The worker’s permanent restrictions have not been properly determined; and 

2. The worker is entitled to further physiotherapy treatment.

Background

In a Worker Incident Report filed with the WCB on February 11, 2019, the worker reported an injury to their right shoulder from an incident at work on October 30, 2018. The worker described that on that date, they were lifting several heavy objects after which, their shoulder started to bother them, and they were in “…so much pain.” The worker also noted it was a particularly difficult day at work as they could not use machinery and the job duties had to be performed manually but the worker continued to work until they were laid off from their employment on November 12, 2018 when they sought medical treatment.

On February 19, 2019, the WCB spoke with the employer regarding the claim. The employer advised they were not aware of the worker’s injury as it was not reported to them. The worker’s report indicated they reported the injury to another worker, whom the employer confirmed was a coworker, but the employer stated there was no report to the worker’s supervisor.

When the WCB contacted the worker to discuss the claim on February 20, 2019, the worker confirmed that on October 30, 2018, they were moving heavy items all day by hand as their equipment could not be used, and afterward they experienced pain throughout their whole shoulder but no numbness or tingling. The worker advised they felt the pain most when lifting and carrying and it would subside a little when resting. The worker confirmed they had told a coworker about the pain in their shoulder but did not make any ongoing complaints and continued to work until they were laid off on November 12, 2018. The worker advised the WCB they notified the employer about their injury after they received MRI test results from their treating physician.

The WCB requested and received a January 21, 2019 report from the worker’s treating orthopedic specialist, in which the specialist recorded the worker’s report of an injury to the right shoulder at work in October 2018 with constant pain to the top of their right shoulder, loss of strength to their hand when carrying objects and pain at night. The physician noted the worker had x-rays taken and an MRI was conducted on December 29, 2018, which indicated “partial width tear at the posterior insertional supraspinatus tendon”. On examining the worker, the orthopedic specialist noted the worker had decreased range of motion, a positive impingement test and tenderness over the acromioclavicular joint and provided a diagnosis of a partial thickness rotator tear and possible acromioclavicular synovitis.

The WCB requested a report from the worker’s treating family physician and on March 19, 2019, received the Doctor’s First Report for the worker’s appointment on November 2, 2018. The physician noted the worker had a tender right shoulder and diagnosed a torn rotator cuff. Included with that report was a copy of the December 29, 2018 MRI study, which indicated “Full-thickness, partial width tear at the posterior insertional supraspinatus tendon. Background mild supraspinatus and infraspinatus tendinosis…”.

On March 21, 2019, the worker’s treating orthopedic specialist submitted a follow-up report noting the worker received a pain injection and that they recommended possible further injections if the worker remained symptomatic. The treating specialist noted on the report the worker did not fill out a WCB form after the injury but “…had told foreman but was not informed to contact WCB at the time”.

On the same date, the WCB advised the worker their claim was not accepted as it could not establish a relationship between their right shoulder difficulties and an accident arising out of or in the course of their employment due to the delay in reporting the injury.

On April 29, 2019, the worker requested reconsideration of the WCB’s decision to Review Office. In their submission, the worker provided the contact information for the coworker they reported their injury to. On May 15, 2019, Review Office contacted the coworker, who advised they were the worker’s supervisor/crew foreman and confirmed the worker had discussed their sore shoulder with them near the end of the season. The coworker advised they saw the worker showing signs of having a sore shoulder including rubbing their shoulder and trying to take it easy and would assign lighter duties to the worker. Further, the coworker advised they had told the worker to complete a green slip but did not press them on it and advised the WCB they would need to contact the safety officer to confirm if a slip was completed. The WCB contacted a second coworker on May 16, 2019, who also confirmed the worker had advised them they had a sore right shoulder and had asked them if they had any pain relief medication. The coworker also confirmed the first coworker had requested them to help the worker due to a sore shoulder.

Review Office requested and received chart notes from the worker’s treating family physician on May 23, 2019 and sought clarification of those notes from the physician’s office on June 5, 2019. On June 6, 2019, Review Office found the worker’s claim was acceptable and returned the worker’s file to the WCB’s Compensation Services for further adjudication.

A WCB medical advisor reviewed the worker’s file on July 13, 2019 and provided an opinion that the worker’s diagnosis related to the workplace accident was a right shoulder strain in the environment of pre-existing degenerative changes, with improvement in pain and function noted to occur within several months.

On July 16, 2019, the worker attended an initial physiotherapy assessment reporting right shoulder pain, weakness, limited range of motion, weak grip strength, with pain that spreads to their neck and forearm. The physiotherapist noted the diagnosis of a full thickness, partial width supraspinatus tear/tendinosis as indicated on the December 29, 2019 MRI study report and that the worker had been referred to a surgeon. The physiotherapist provided restrictions of administrative duties only and no lifting greater than 3 pounds with the right arm.

An August 7, 2019 report from the treating orthopedic specialist noted they treated the worker since January 21, 2019 and had provided pain relief injections. The specialist recommended continued physiotherapy for the worker and indicated that if there was no improvement, surgery was a possibility. A follow-up report received on August 23, 2019 indicated the worker was referred to an orthopedic surgeon.

On September 4, 2019, the WCB authorized 20 physiotherapy sessions for the worker.

The worker attended an initial appointment with the orthopedic surgeon on September 11, 2019. The surgeon examined the worker and found tenderness to palpation in the bicipital groove and greater tuberosity, with limited range of motion, positive Hawkins, Jobe and Speeds testing but no tenderness over the acromioclavicular joint. The surgeon noted the full thickness supraspinatus tear indicated on the MRI study and recommended a right arthroscopy with rotator cuff repair. On September 17, 2019, the WCB provided approval for the proposed surgery, which took place on February 25, 2020.

On March 4, 2020, the worker attended post-surgical follow up. At that time, the surgeon noted normal healing and recommended physiotherapy. The worker attended for initial physiotherapy assessment on March 10, 2020 and on March 11, 2020, the WCB authorized a 20 session series of post-surgery physiotherapy.

In follow-up on April 1, 2020, the treating orthopedic surgeon noted well healed surgical wounds and reasonable range of motion in the worker’s shoulder. The surgeon noted that due to the COVID-19 pandemic, most physiotherapy clinics had closed and that a home exercise program had been provided. At further follow-up on June 8, 2020, the surgeon noted the worker was able to attend in-person physiotherapy sessions again and noted improvement in the worker’s recovery.

On July 9, 2020, the treating physiotherapist noted the worker still had reduced range of motion, guarded movements, weakness and heavy job demands and as such, requested an extension of treatment. The WCB granted an additional 10 sessions on July 10, 2020.

On August 21, 2020, in follow-up with the treating orthopedic surgeon, the surgeon noted the worker’s delayed start of physiotherapy due to the COVID-19 pandemic and as a result, the worker’s shoulder was stiff but encouraged the worker to continue with physiotherapy. The worker reported some decreased sensation in their fingers and part of their forearm and the surgeon referred the worker for a nerve conduction study.

The WCB authorized a further 8 session extension of physiotherapy on August 28, 2020, with an additional 4 sessions approved on October 8, 2020.

Following the nerve conduction study on October 27, 2020, the physiatrist reported that the study findings were normal, noting “There is no evidence today on electrodiagnostic testing to suggest a previous or post operative brachial plexopathy or cervical radiculopathy. Further testing also ruled out a median neuropathy at the wrist as well as a (sic) ulnar neuropathy at the elbow.”

A WCB physiotherapy advisor authorized a further extension of physiotherapy treatment for 4 sessions on November 3, 2020, noting that “On completion of these visits [the worker] should continue with a home program at 9+ months post surgery.” The Physiotherapy Progress Report of December 10, 2020 noted the worker’s complaints of pain when lifting their arm and weakness when lifting objects. The treating physiotherapist noted reduced range of motion in the worker’s right shoulder, noted positive Hawkins and empty can tests and further noted the worker had been in a motor vehicle accident in October 2020 that delayed progression in the worker’s strength and conditioning program. They recommended restrictions of no lift, push, pull or carry greater than 40 pounds at waist level, no lifting greater than 5 pounds above the shoulder and avoid repetitive overhead movements. At a January 15, 2021 appointment, the physiotherapist noted the worker’s complaint of pain in their arm while sleeping with their arm overhead, stiffness in their shoulder in the morning and pain with lifting and reaching. Positive testing was noted again with restrictions updated to no lifting, pushing, pulling greater than 100 pounds at waist level, no lifting greater than 25 pounds overhead and no lifting greater than 50 pounds from the ground. A copy of these restrictions were provided to the employer on January 18, 2021.

The treating orthopedic surgeon saw the worker again on January 25, 2021, noting the worker’s report that their right shoulder was much better than prior to the surgery, but finding that it still was “…lacking the last few degrees of forward elevation and still has some weakness with overhead activity.” The worker advised the surgeon they did not feel they could return to their pre-accident duties, with the surgeon advising it could take 12 to 18 months to “…reach a clinical plateau and recovery after surgery such as this.”

On February 9, 2021, the worker’s treating physiotherapist submitted a request for additional treatment noting the worker had shoulder capsular weakness and that their treatment was delayed due to the non-compensable motor vehicle accident in October 2020. A WCB physiotherapy advisor reviewed the worker’s file on February 11, 2021 and concluded that a home exercise program would suffice as the worker was now 11.5 months post-surgery. On the same date, the WCB advised the worker’s physiotherapy clinic of the WCB’s decision, with a copy to the worker.

On February 19, 2021, the treating orthopedic surgeon provided a letter in support of the worker receiving further physiotherapy, and on May 17, 2021, provided a further letter in support of further physiotherapy treatment after the worker had attended for a follow-up appointment. The surgeon noted the worker’s progress was slow and may be related to the delay in initial physiotherapy after the worker’s February 25, 2020 rotator cuff repair surgery due to the COVID-19 pandemic.

At the request of the WCB, the worker’s file was reviewed by a WCB medical advisor on June 18, 2021. The medical advisor opined that the worker required ongoing workplace restrictions and that the restrictions of avoid repetitive overhead tasks with the right upper limb, lifting and carrying no more than 50 pounds and pushing/pulling limited to 100 pounds should be considered permanent. The WCB medical advisor also provided that any further in-person physiotherapy would be unlikely to provide “…a sustained improvement in right shoulder function.” Further, the advisor opined that at 16 months’ post-surgery, the worker was likely at maximum medical improvement.

On June 21, 2021, the WCB advised the worker of the restrictions, which were now considered permanent and provided with a decision letter confirming the worker was not entitled to further physiotherapy treatment.

On July 5, 2021, the worker’s representative submitted the May 17, 2021 report from the worker’s treating orthopedic surgeon and a June 24, 2021 report from the worker’s treating physiotherapist to the WCB and noted the reports indicated the worker’s treating healthcare providers believed the permanent restrictions set for the worker were insufficient, and further, that the worker required ongoing physiotherapy treatment. The WCB also received a July 7, 2021 report from a physician with an interest in occupational medicine, who noted that the extended period the worker’s right arm was in a sling after surgery and while awaiting physiotherapy, may have led to ongoing difficulties, and recommended the worker receive continued physiotherapy.

On July 14, 2021, a WCB medical advisor reviewed the worker’s file at the request of the WCB and recommended further review by a WCB physiotherapy advisor. On August 3, 2021, the WCB physiotherapy advisor requested a narrative report from the worker’s treating physiotherapist due to a difference in restrictions noted in the treating physiotherapist’s January 2021 and June 2021 reports, which narrative report was received by the WCB on August 17, 2021. After reviewing the report, on September 9, 2021, the WCB physiotherapy advisor opined there was no medical basis for a change to the recommended permanent restrictions and the worker was not entitled to further physiotherapy treatment as further in-clinic treatment would not likely provide long term sustained functional gains. The WCB advised the worker’s representative of the WCB’s physiotherapist’s opinion in a September 15, 2021 decision letter.

On September 29, 2021, the worker’s representative re-submitted the March 17, 2021 report from the worker’s treating orthopedic surgeon and the June 24, 2021 report from the worker’s treating physiotherapist and requested Review Office reconsider the WCB’s decision as the worker’s treating healthcare providers supported a change to the worker’s permanent restrictions set by the WCB and the worker’s need for ongoing physiotherapy treatment. Review Office determined, on December 7, 2021, that the permanent restrictions were appropriate, and the worker was not entitled to further coverage for physiotherapy treatment. Review Office accepted and agreed with the opinion of the WCB physiotherapy advisor that a change from the permanent workplace restrictions set out on January 15, 2021 was not medically supported by the information provided by the worker’s treating physiotherapist, who noted in their August 17, 2021 request for a change in the restrictions that the worker had an unexplained setback. With respect to the request for further physiotherapy treatment, Review Office noted the worker had been provided with extensive physiotherapy treatment and agreed with the opinion of the WCB physiotherapy advisor further in-clinic treatment was unlikely to lead to sustained functioning to the worker’s right shoulder.

The worker’s representative filed an appeal with the Appeal Commission on August 29, 2022 and a hearing was arranged.

Reasons

Applicable Legislation and Policy

The Appeal Commission and its panels are bound by the provisions of the Act, regulations under the Act and the policies established by the WCB's Board of Directors. The provisions of the Act and WCB policies 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. Under s 4(2), a worker injured in an accident is entitled to wage loss benefits for the loss of earning capacity resulting from the accident, but no wage loss benefits are payable where the injury does not result in a loss of earning capacity during any period after the day on which the accident happens.

When the WCB determines that a worker has sustained a loss of earning capacity, an impairment or requires medical aid because of an accident, compensation is payable under s 37 of the Act. Section 39(2) of the Act sets out that wage loss benefits are payable until the worker's loss of earning capacity ends or the worker attains the age of 65 years.

Section 27 of the Act allows the WCB to provide medical aid “as the board considers necessary to cure and 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 set 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 healthcare 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.

Worker’s Position

The worker appeared in the hearing represented by legal counsel. The worker provided evidence through questions posed to them by their lawyer and by members of the appeal panel. The worker’s lawyer made oral submissions on behalf of the worker.

The worker’s position with respect to the determination of their permanent restrictions is that the restrictions that the WCB established are not sufficiently narrow but are rather too generous and do not appropriately reflect the worker’s actual physical limitations and abilities, which the WCB failed to assess before determining the permanent restrictions. The worker relies upon the limitations put in place by their treating physiotherapist and noted that despite further treatment and a resulting increase in mobility since the WCB placed its permanent restrictions upon the worker, they remain unable to use their shoulder to the extent outlined in those restrictions. Counsel for the worker noted that the worker described continuing symptoms of tingling and numbness in their right hand and arm, referring into the radial aspect of the right forearm and hand, as well as weakness in handgrip with common activities of lifting and carrying, lack of range in overhead reaching and reaching behind their back, as well as difficulty with extending their right elbow and backward extension. Counsel pointed to the report from the treating orthopedic surgeon of March 17, 2021 which outlined that the worker was “…still having significant pain with overhead activity and it may be challenging for [them] to lift 25 pounds overhead or 100 pounds below the waist with [their] affected arm.”

The worker’s position with respect to the question of their entitlement to further physiotherapy treatment is that the evidence indicates that the worker continued to make gains in their function and mobility with further physiotherapy, which was supported and recommended by their treating physician. The worker found that the at-home exercises were helpful and they continue to do those exercises, but in-person physiotherapy was even more effective in increasing the worker’s functional abilities and strength. Counsel for the worker noted that both the treating physiotherapist and the treating orthopedic surgeon supported the need for the worker to continue with their physical therapy as it was improving the worker’s shoulder function, and further, the consulting physician with a specialty in occupational health also supported the worker’s ongoing need for physiotherapy.

The worker testified as to the initial mechanism of injury and as to the physical nature of the job duties in that employment. The worker noted that they found physiotherapy to be helpful and that they believed they made more progress with in-clinic therapy, using the machines there, than doing only the at-home exercises. The worker confirmed that they continue to do the at home exercises recommended by the physiotherapist and have not attended physiotherapy since coverage was discontinued in 2021. The worker testified that they are able to lift their fully extended right arm up to shoulder level but not above shoulder level, and that they can move their right arm back to their side only, not behind their back. The worker noted that they continue to follow the restrictions provided to them by the treating physiotherapist. The worker stated they believe that another surgery is required in order to regain their mobility.

The worker testified to having taken a new job in March 2022 making deliveries of food from restaurants. The worker stated these are small items that they are able to carry but that they cannot do other work.

In sum, the worker’s position is that physiotherapy provided additional benefit to the worker in terms of increasing mobility and strength of their injured shoulder and that a home program alone was not sufficient to increase the worker’s shoulder mobility and strength. With respect to the permanent restrictions established by the WCB, the worker’s position is that these are not appropriate as they do not reflect the worker’s actual abilities at that time, nor at the present time.

Employer’s Position

The employer did not participate in the appeal.

Analysis

There are two questions for the panel to determine in this appeal: firstly, the panel must determine whether the worker’s permanent restrictions have been properly determined; and secondly, the panel must determine whether the worker is entitled to further physiotherapy treatment. For the worker’s appeal on the first question to succeed, the panel would have to find that the evidence does not support the permanent restrictions established by the WCB for the worker. As set out in the reasons that follow, the panel was able to make such a finding and therefore refers this claim back to the WCB for further adjudication. For the worker’s appeal on the second question to succeed, the panel would have to find that further physiotherapy treatment is appropriate and necessary in relation to the injuries the worker sustained arising from the compensable workplace accident of October 30, 2018. As detailed in the reasons that follow, the panel was able to make such a finding and therefore the worker’s appeal of this question is granted.

With respect to the determination of the worker’s permanent restrictions, the panel noted that these were initially determined by the WCB at a point in time when the worker was not fully recovered from their injury, shortly after the WCB determined not to fund additional physiotherapy. The worker’s restrictions established on February 24, 2021 were based upon the treating physiotherapist’s January 15, 2021 assessment of the worker and recommendation for workplace restrictions, which they stated were to be in place for 2 weeks and then reviewed again. The WCB medical advisor, in their February 17, 2021 opinion, noted that the job description information on file “lacks specificity with respect to requirements for lifting and carrying, pushing and pulling” and stated their belief that the worker would have “ongoing difficulties” with respect to repetitive overhead tasks with their right arm, lifting and carrying more than 50 pounds and pushing and pulling more than 100 pounds. The medical advisor went on to state that these were likely to be permanent restrictions and that “At one year after repair of the rotator cuff, it is generally considered that maximum medical improvement would have been achieved from the surgery, although the attending surgeon is hopeful for some further gains.” The WCB claim file documents that these very restrictions were confirmed as permanent on June 24, 2021.

The panel considered the treating orthopedic surgeon’s comment with respect to the restrictions put in place in February 2021, set out in their March 17, 2021 correspondence with the worker’s counsel, that:

“I am not certain how the Workers Compensation Board has decided upon these restrictions for [the worker], but I hope that they were measured objectively and not arbitrarily assigned…. That said, when I last saw [the worker, they were] still having significant pain with overhead activity and it may be challenging for [the worker] to lift 25 pounds overhead or 100 pounds below the waist with [their] affected arm.”

The panel further noted that on June 18, 2021, the WCB orthopedic surgery consultant noted that “If more specific clarifications of permanent workplace restrictions are sought regarding more specific poundages and frequency of workplace activities, then an external functional capacity evaluation (FCE) should be sought and can be arranged….” Further information was subsequently received in terms of the workplace activities, but there was no further assessment of the worker’s capacity in relation to the specific job-related requirements before the WCB determined that the then current restrictions were permanent. The panel considered that both the WCB orthopedic surgery consultant and the treating orthopedic surgeon suggested the need for the objective assessment of the worker’s abilities and limitations, but there is no evidence to indicate that this recommendation was ever acted upon, or even considered and rejected by the WCB.

The panel agrees that the worker’s permanent restrictions appear not to have been determined on the basis of objective assessment of the worker’s abilities, but on “an apparently arbitrary basis”, as described by the treating orthopedic surgeon, and therefore may or may not have accurately reflected this worker’s actual abilities and limitations at that time. While the completion of an FCE or other such assessment is not required in every instance, in this case, we rely upon the recommendations of both the treating and consulting orthopedic surgeons that further assessment was required. The panel also noted that the file evidence documents the worker’s changing functional abilities over the post-surgical recovery period, the delays in receiving in-clinic physiotherapy due to the pandemic-related closures, and the difference of opinion as between the treating orthopedic surgeon and the WCB orthopedic surgery consultant as to whether the worker had reached their maximal medical recovery in the period leading up to the confirmation of the permanent restrictions. In these circumstances, the panel is not satisfied that the WCB appropriately investigated and assessed what the permanent restrictions should be for this worker before establishing those restrictions.

On the basis of the evidence before the panel and on the standard of a balance of probabilities, we find that the worker’s permanent restrictions were not properly determined, and we refer the question of determination of the worker’s permanent restrictions back to the WCB for appropriate assessment.

With respect to the question of whether the worker should be entitled to further physiotherapy, the panel noted that when the WCB determined on February 11, 2021 that the worker was not entitled to additional physiotherapy, it was based upon the WCB physiotherapy advisor’s February 9, 2021 opinion that there was no further benefit to additional in-clinic treatment as the worker was 11.5 months post-surgery. No further explanation was provided by the WCB physiotherapy advisor, although the WCB’s decision letter to the worker of February 11, 2021 indicated the basis for the decision was that there was “no evidence” that further in clinic treatment was warranted.

The panel does not accept that there was no evidence of benefit or ongoing need for physiotherapy. We note that the impetus for the WCB’s February 11, 2021 decision was the February 9, 2021 request by the treating physiotherapist for approval of additional treatment which sets out that the worker was “lacking end of range for forward flexion and external rotation” and experiencing “pain and weakness with overhead activities, pain with loaded reaches”. The physiotherapist noted the worker’s recovery was not satisfactory and that it was complicated by both the “prolonged time in sling” post-operatively which resulted in shoulder capsular weakness, and further by the delayed strength and conditioning program resulting from the unrelated motor vehicle accident in October 2020. The physiotherapist’s stated rationale for the requested extension of treatment was the worker’s ongoing weakness with overhead weakness and that the worker required equipment and weights for strength progressions.

The panel also noted that the WCB orthopedic surgery consultant indicated on February 17, 2021 that the “attending surgeon is hoping for some further gains” noting there was a set-back in relation to the recent motor vehicle accident. The treating orthopedic surgeon stated in their February 19, 2021 report that “I think it is very reasonable for [the worker] to continue with formal physiotherapy but I also feel that it is important for [them] to develop a good home based exercise program for the long term.” In a further report dated May 17, 2021, the treating orthopedic surgeon noted that “…it can take between 12 and 18 months on average for a person to reach a clinical plateau after rotator cuff repair but [the worker’s] may in fact take longer in part due to the delay in [their] initial physiotherapy. I feel that it would be very valuable for [the worker] to continue with formal physiotherapy to regain the best function [they] possibly can out of [their] shoulder.”

We further note that although there were no further physiotherapy reports provided to the WCB after it discontinued coverage for those treatments, in fact, the worker did continue in their therapy in relation to the additional injuries sustained in the non-compensable motor vehicle accident. When a second WCB physiotherapy advisor reviewed the worker’s claim in July and again in August, 2021, they spoke with the treating physiotherapist in early August 2021, who confirmed the worker’s treatment until June 23, 2021, at which time the worker was provided with instruction in a home-based exercise program and in-clinic treatment concluded.

The panel is satisfied by the recommendations of both the treating physiotherapist and treating orthopedic surgeon for further formal physiotherapy for the worker beyond February 2021, and that these recommendations, together with their clinical reports, provide sufficient evidence that further physiotherapy was medically appropriate for the worker, in order to meet the Medical Aid Policy objectives of promoting a safe and early recovery and return to work, enabling activities of daily living, and eliminating or minimizing the impacts of a worker's injuries.

On the basis of the evidence before the panel and on a standard of a balance of probabilities, we find that the worker is entitled to further physiotherapy treatment. The worker’s appeal on this question is granted.

Panel Members

K. Dyck, Presiding Officer
J. Witiuk, Commissioner
M. Kernaghan, Commissioner

Recording Secretary, J. Lee

K. Dyck - Presiding Officer
(on behalf of the panel)

Signed at Winnipeg this 31st day of March, 2023