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 coverage for mileage expenses after August 26, 2024. A teleconference hearing was held on February 25, 2025 to consider the worker's appeal.

Issue

Whether or not the worker is entitled to coverage for mileage expenses after August 26, 2024.

Decision

The worker is not entitled to coverage for mileage expenses after August 26, 2024.

Background

The worker filed a Worker Incident Report with the WCB on July 26, 2024 to report an injury to their lower back that occurred after lifting a heavy object at work on July 19, 2024. The worker obtained medical treatment on July 22, 2024 and was diagnosed with lower back pain. The worker’s claim was accepted by the WCB on August 1, 2024.

On July 25, 2024, the worker attended an initial chiropractic assessment reporting extreme low back pain. After examining the worker, the treating chiropractor diagnosed the worker with a lumbar disc herniation and requested further treatment for the worker. The worker also attended an initial physiotherapy assessment on August 1, 2024, and in an August 2, 2024 discussion with the WCB, advised they would be continuing with chiropractic treatment over physiotherapy. On the same date, the WCB advised the worker that they were entitled to chiropractic treatment for a maximum period of 8 weeks to September 19, 2024.

The worker submitted a travel expense claim to the WCB on August 20, 2024 for the mileage they travelled to attend physiotherapy treatment between July 25, 2024 and August 16, 2024. The worker noted they travelled outside of their home community and received treatment at a chiropractic office approximately 161 kms away round trip. In a discussion with the worker on August 26, 2024, the WCB advised the worker that they would only cover their travel expenses to their nearest treatment facility. The worker advised they had attended a local clinic but was not satisfied with the treatment and chose to attend another clinic instead. The WCB advised the worker that they can choose which facility to attend for treatment, however, the WCB only covers travel incurred over and above their normal travel to work to the nearest facility. On the same date, the WCB provided the worker with a formal decision letter advising they were not entitled to reimbursement for their travel expenses for treatment between July 25, 2024 and August 16, 2024. It was noted in the letter there were several chiropractic clinics in the worker’s area.

The worker requested reconsideration of the WCB’s decision to Review Office on September 10, 2024. In their submission, the worker noted not all of the treatment they were receiving at the chiropractic clinic was available in their home community and they noticed a difference in their symptoms after one treatment at the clinic. As well, the worker noted in speaking with the WCB, they were not advised they had to attend treatment at the nearest clinic. The worker also noted their regular chiropractor was not available at the time they sought treatment.

The Review Office determined on September 23, 2024 that the worker was entitled to coverage for mileage expenses until August 26, 2024. The Review Office could not determine if travel expenses to attend medical treatment was specifically discussed with the worker by the WCB during an initial discussion on July 30, 2024, and the Review Office found there was no discussion where the clinic the worker would attend was located in the discussion with the WCB on August 2, 2024. The Review Office further found that when the worker did submit a travel expense form on August 16, 2024, they did not have a clear understanding of the principles related to reimbursement for travel expenses. The Review Office found it was not until a discussion with the WCB on August 26, 2024 that the worker understood they would only be reimbursed for travel expenses over and above their normal work travel to their nearest facility and as such, the Review Office determined the worker was entitled to coverage for expenses up until that date.

The worker filed an appeal with the Appeal Commission on November 14, 2024 and a hearing was arranged.

Reasons

Applicable Legislation and Policy

The Appeal Commission and its panels are bound by the provisions of The Workers Compensation Act (the "Act"), regulations under that Act and the policies established by the WCB's Board of Directors.

When it is established that a worker has been injured as a result of an accident at work, the worker is entitled to compensation under Section 4(1) of the Act. That compensation includes wage loss, medical aid and awards for permanent partial impairment, as set out in Section 37 of the Act, reproduced below.

Compensation payable

37 Where, as a result of an accident, a worker sustains a loss of earning capacity or an impairment, or requires medical aid, the following compensation is payable:

(a) medical aid, as provided in section 27; 

(b) an impairment award, as provided in section 38; and 

(c) wage loss benefits for any loss of earning capacity, calculated in accordance with section 39.

Section 27(1) of the Act provides the WCB with authority to provide the worker with medical aid as is "…necessary or advisable to cure or give relief to the worker or for the rehabilitation of the worker."

The WCB has established Policy 44.120.10, Medical Aid (the “Policy”), to provide guidance as to workers’ entitlement to medical aid under the Act. The Policy sets out, in Schedule D, the general principles related to reimbursement of expenses incurred to attend compensable medical treatment, and states, as follows:

1. The WCB may reimburse an injured worker's reasonable expenses related to receiving compensable medical treatment such as wage-loss, travel, accommodations, meals, childcare and reasonable telephone charges. 

2. The WCB will generally reimburse only those transportation costs which are in excess of costs that would be incurred by the worker while travelling to and from work. 

3. The WCB may reimburse expenses incurred by a support person's travel, accommodation, meals and wage loss if it is determined that the injured worker's functional level requires it or if it is unsafe for the injured worker to travel alone. 

4. Reimbursement of expenses will be based on the most cost-effective alternative, taking into account the injured worker's level of function.

Worker’s Position

The worker represented themselves on the appeal and set out their position in the Appeal of Claims Decision form and in a written submission to the Review Office. The worker also provided evidence by way of responses to questions posed by members of the appeal panel.

The worker noted that they attended treatment at a clinic in their city, but that it was not helpful and did not alleviate their pain. They then attended for treatment in another city and found great improvement and relief. The worker submits that the treatment was necessary for their recovery and states that not all of the treatment they received would have been available at their local treatment provider.

The worker also states that switching treatment providers part way through their treatment, once aware the treatment would not be covered, would not have been to their benefit.

The evidence of the worker was that the chiropractor that they had seen in the past was out of the country and that this is another reason why they attended for treatment in another City.

The worker’s position is that the mileage costs they incurred to obtain treatment after August 26, 2024 should be covered by the WCB.

Employer’s Position

The employer did not participate in the appeal.

Analysis

For the worker's appeal on this issue to be successful, the panel must find that the requested mileage expenses satisfy the requirements of the Act and the Policy. The panel is unable to make that finding, for the reasons that follow.

Schedule D of the Policy sets out general principles for reimbursement of expenses to attend compensable medical treatment. Point 2 of Schedule D provides that generally the WCB will only reimburse “transportation costs which are in excess of costs that would be incurred by the worker while travelling to and from work.” This provision is intended to provide payment of expenses where a worker has to travel a greater distance for medical treatment than the distance the worker had to travel for work. This provision limits the reimbursement to the expenses which are greater than the worker would have normally had if they had been working.

However, it is also set out in the Schedule that the reimbursement of expenses will be based on the most cost-effective alternative, taking into account the injured worker's level of function. Considering the evidence regarding the worker’s injury, the panel is of the view that there were adequate alternatives available in the worker’s City and it finds that the worker ought to have explored their local options, prior to attending for treatment in another locale.

While the panel is sympathetic that the worker preferred the treatment provider that was in another City, that in and of itself does not justify coverage of mileage. The panel finds that the circumstances in this instance do not warrant a deviation from the Policy. The evidence before the panel does not indicate that the injury to the worker was particularly unique or demanding that it required specialized treatment that was unavailable by the local treatment provider. The panel also notes that the worker’s treatment was covered by the WCB and it is only mileage that is at issue.

Based upon the above facts and in compliance with the Policy, the panel finds that the worker is not entitled to coverage for mileage expenses after August 26, 2024. The panel finds that these expenses arose solely out of the worker’s personal decision to travel to another city, notwithstanding that services were available in their community.

The worker's appeal is dismissed.

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 25th day of April, 2025