The Appeal CommissionThe Workers Compensation Act of Manitoba

Preamble

The worker is appealing the decision made by the Workers Compensation Board ("WCB") that they are not entitled to medical aid benefits after May 10, 2023 for their left shoulder and back complaints. A file review was held on February 4, 2025 to consider the worker's appeal.

Issue

Whether or not the worker is entitled to medical aid benefits after May 10, 2023 for their left shoulder and back complaints.

Decision

The worker is not entitled to medical aid benefits after May 10, 2023 for their left shoulder and back complaints.

Background

The employer provided the WCB with an Employer’s Accident Report on January 5, 2022, reporting the worker was stabbed in their neck and right hand after an altercation with an individual on December 31, 2021 at work. The worker was taken by ambulance to a local emergency department for treatment.

The Emergency Visit Summary from December 31, 2021, indicated the worker presented with a stab wound in their neck, which was treated with several staples to close it. The treating emergency physician also noted a shallow v-shaped laceration to the mid left neck lateral to the trachea, mild tenderness to the soft right flank of the worker’s abdomen and a “Superficial appearing injury…” to the radial side of the worker’s third finger of their left hand. The physician recorded normal range of motion for the finger. A normal back examination was also indicated.

On January 7, 2022, the WCB contacted the worker to discuss their claim. The worker confirmed the mechanism of injury and corrected the employer’s information that they were stabbed in their left hand, not their right as reported. The worker also advised they injured their left knee and hip when they fell to the ground. The worker described their current symptoms as being sore and in pain, with the neck, hand, hip and knee all hurting. The WCB accepted the worker’s claim on January 13, 2022.

The worker attended for an initial physiotherapy assessment on January 31, 2022 and reported anterior shoulder pain, issues with lifting their left arm, low back pain which made it difficult to stand for longer than 30 minutes at a time and difficulty with sleeping. The treating physiotherapist found the worker had full shoulder flexion with pain at the end range and reduced flexion in the lumbar region. The worker was diagnosed with a left shoulder and low back strain. The restrictions put in place were no standing for more than 30 minutes, no bending and lifting greater than 10 pounds and no lifting, pushing, pulling with left arm to be in place for 4 weeks.

At a follow-up appointment with their family physician on May 19, 2022, the worker reported neck and lower back pain. The treating physician found full range of motion in the worker's neck and back with mild discomfort. The physician recommended ongoing physiotherapy and noted the worker could return to work on a gradual basis to a position that did not require standing for a long period of time.

A Physiotherapy Discharge Report was received by the WCB on June 7, 2022, completed by the treating physiotherapist on May 30, 2022. The Report noted the worker was still having issues standing for long periods of time, bending over and getting out of bed, and their left shoulder continued to be sore and raising their left arm was painful. The physiotherapist indicated the worker had not progressed with treatment and noted the worker's recovery was not satisfactory as they were unable to stand for long periods of time. Ongoing physical restrictions of no bending or lifting greater than 10 pounds and no standing longer than 10 minutes were recommended. On August 17, 2022, the worker attended for a follow-up visit with their treating family physician, reporting left shoulder pain with abduction, left lower back pain that radiated down their left leg to the bottom of their left foot, and pain under their left foot. The worker requested a referral to a chiropractor for treatment. The physician diagnosed the worker with mechanical left shoulder and lower back pain and referred the worker for an x-ray. The left shoulder and lumbosacral x-ray completed on August 19, 2022 indicated no significant bone or joint abnormality in the shoulder and, other than a "…questionable spina bifida occulta at S1", no further significant abnormalities were noted in the worker's lumbosacral spine.

At the request of the WCB, the worker attended a call-in examination with a WCB medical advisor on December 13, 2022. After examining the worker, the advisor opined the worker's diagnoses with respect to the December 31, 2021 workplace accident were a laceration to the left neck, laceration to the left hand, a low back strain and a left shoulder sprain. The advisor went on to provide that the worker exhibited left shoulder symptoms that did not appear to be medically accounted for and recommended advanced imaging of that shoulder to determine if there was an undiagnosed lesion that may have been causing those difficulties. With respect to the worker's low back difficulties, the WCB medical advisor further provided the lower limb symptoms first reported by the worker on August 17, 2022, including lower limb symptom referral/radiculopathy would not be accounted for in relation to the December 31, 2021 workplace accident and were considered non-specific in nature. The advisor went on to note that once a left shoulder MRI had taken place, a further opinion would be provided however, it was indicated the worker's psychological difficulties were likely a barrier to the worker returning to work.

The worker underwent a CT scan on February 2, 2023 and a MRI study on March 1, 2023, both of which were reviewed by a WCB medical advisor who placed an opinion on the worker's file on April 25, 2023 and spoke with the worker's treating family physician on April 24, 2023. During the discussion with the worker's family physician, the WCB medical advisor queried whether the worker was still reporting difficulties with their left shoulder. The family physician advised that the worker had not reported left shoulder pain for several months, with the focus currently being on their low back. The physician further provided the likely diagnosis with respect to the worker's low back symptoms was chronic mechanical low back pain. In reviewing the CT scan and the MRI study, the WCB medical advisor opined both documented degenerative changes that were pre-existing and a structural aggravation or enhancement of those degenerative conditions was not evidenced on the diagnostic imaging. The advisor went on to further provide the worker's reported low back symptoms radiating into their left lower limb was not supported by the imaging or related to the December 31, 2021 workplace accident. The WCB provided the worker with a decision letter on May 4, 2023 advising their entitlement to medical aid benefits with respect to the left shoulder and back difficulties would end as of May 10, 2023 as it had been determined they had recovered from those compensable injuries and their ongoing difficulties were not related to the workplace accident.

On October 18, 2023, an exposure therapist treating the worker requested the WCB provide coverage to the worker for physiotherapy as the treating therapist indicated the worker reported being too sore to meet with them. On November 2, 2023, the WCB approved 8 physiotherapy sessions for the worker to help support their exposure therapy. On March 31, 2024, the exposure therapist provided a report to the WCB noting the worker's improvement in therapy but indicating that since the worker's entitlement to physiotherapy treatment ended in December 2023, the worker reported being in discomfort during the exposure sessions and the therapist noted during those times, the worker became more focused on their pain and discomfort than the therapy. The therapist requested the WCB reconsider further physiotherapy treatment to help the worker fully participate in the desensitization therapy.

On June 14, 2024, the worker requested reconsideration of the WCB's decision that they were not entitled to further medical aid with respect to their left shoulder and low back difficulties. The worker indicated in their submission that they continued to experience difficulties with walking and standing and difficulties with their shoulder. In addition, the worker noted their treating healthcare provider supported their ongoing difficulties were related to the December 31, 2021 workplace accident and they required further treatment.

On July 23, 2024, the Review Office determined the worker was not entitled to medical aid benefits after May 10, 2023 for their left shoulder and back difficulties. The Review Office accepted and agreed with the April 24, 2023 opinion of the WCB medical advisor, who after speaking with the worker's treating family physician, opined the worker sustained a low back strain, with a natural history of recovery over the course of a few weeks and noted the treating family physician advised the worker had not reported left shoulder difficulties for several months. As such, the Review Office found a relationship between the worker's ongoing left shoulder and low back difficulties and the December 31, 2021 workplace accident could not be established.

The worker filed an appeal with the Appeal Commission on October 22, 2024 and a file review was arranged.

Reasons

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.

A worker is entitled to benefits under Section 4(1) of the Act when it is established that a worker has been injured as a result of an accident arising out of and in the course of the employment.

Section 27 of the Act allows the WCB to provide a worker with such medical aid “as the board considers necessary to cure and provide relief from an injury resulting from an accident.” The Act further provides that the medical aid provided to the worker 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.

Worker’s Position

The worker’s position is outlined in the Appeal of Claims Decision form, dated August 14, 2024.

The worker submits that they have not recovered from their injuries and continued to require medical aid benefits after May 10, 2023. The worker indicates that they have ongoing pain in their back, left hand and shoulder and have been taking medication since the injury occurred. The worker references difficulties in reaching or moving their hand and further advises that their latest MRI shows nerve damage and muscle issues.

In addition, the worker stated in the request to the Review Office that they have difficulty walking, standing and have back pain, hand and shoulder pain. The worker indicates that they take medication and see their doctor regularly.

The worker is seeking further physiotherapy treatment and medical aid benefits.

Employer’s Position

The employer did not participate in the hearing.

Analysis

The worker's appeal arises from the WCB’s decision that the worker is not entitled to benefits after May 10, 2023 for their left shoulder and back. For the appeal to succeed, the panel would have to find that the worker continued to require treatment for their left shoulder and back because of the compensable injury beyond that date. As detailed in the reasons that follow, the panel was not able to make such a finding and therefore the worker’s appeal is denied.

The panel considered whether the evidence supports the worker’s position that they were not recovered from the workplace accident by May 10, 2023 and that they continued to experience difficulties with their left shoulder and back beyond that date. The evidence before the panel does not support this position.

The medical evidence establishes that the worker’s left shoulder had recovered. The worker’s treating physician noted that the worker had not reported symptoms relating to his left shoulder for several months. Specifically, the Doctor Progress Notes from appointments on January 27, 2023, February 27, 2023, March 17, 2023 and March 30, 2023 do not mention any left shoulder symptoms. Additionally, the opinion of the WCB medical consultant from their examination of the worker on December 13, 2022 at the call in examination is that the worker’s left shoulder symptoms are “not accounted for patho-anatomically.”

With respect to the worker’s back complaints, the worker’s treating physician stated that the MRI of the worker’s lumbar spine demonstrated “mild degenerative changes concordant with osteoarthritis” and the physician’s opinion was that the diagnosis to account for the worker’s low back symptoms was chronic mechanical low back pain. The panel accepts the opinion of the worker’s treating physician that treatment for the worker beyond May 10, 2023 relates to a pre-existing condition rather than to the injury from the accident. The panel also accepts the WCB medical advisor’s opinion that the worker’s back pain is non-specific and that there is no causal relationship between the workplace accident and the worker’s ongoing symptoms.

Based on the evidence and on the standard of a balance of probabilities, we find that the worker is not entitled to medical aid benefits after May 10, 2023 for their left shoulder and back complaints. The worker’s appeal is denied.

The panel notes, however, that the worker referenced, in their request for reconsideration to the Review Office dated August 6, 2024 that they had ongoing hand pain (in addition to the back and shoulder pain). This issue was not addressed by the Review Office in their July 23, 2024 decision, which dealt solely with medical aid benefits related to the worker’s left shoulder and back. The workplace injuries the worker sustained on December 31, 2021 included being stabbed in the left hand. In addition, the evidence throughout the file mentions difficulties and pain to the worker’s left hand. Therefore, the panel refers the question of the worker’s medical aid benefits after May 10, 2023 for their left hand back to the WCB for determination.

Panel Members

R. Lemieux Howard, Presiding Officer
J. Peterson, Commissioner
M. Kernaghan, Commissioner

Recording Secretary, J. Lee

R. Lemieux Howard - Presiding Officer
(on behalf of the panel)

Signed at Winnipeg this 31st day of March, 2025