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 the medications Venlafaxine, Gabapentin and Ropinirole. A file review was held on November 27, 2024 to consider the worker's appeal.

Issue

Whether or not the worker is entitled to coverage for the medications Venlafaxine, Gabapentin and Ropinirole.

Decision

The worker is not entitled to coverage for the medications Venlafaxine, Gabapentin and Ropinirole.

Background

The worker has an accepted WCB claim for an injury to the right side of their back, noted to be an enhancement of a pre-existing spinal fusion, arising from an incident at work that occurred on July 11, 2000. The worker’s compensable diagnosis was later updated to include chronic pain syndrome of their lower back and dry mouth and subsequent dental decay due to medication use for back pain. The worker received coverage for wage loss and medical aid benefits, including medications.

At the request of the worker, the WCB reviewed the worker's medications with respect to which of the medications they were prescribed were covered by the WCB. On September 21, 2011, the worker was advised that only medications related to opioid medications for their lower back pain, medications required for secondary issues due to taking those medications and anti-inflammatory medications, oral or gel/cream for their lower back pain would be covered by the WCB. It was noted at the time that the WCB had incorrectly paid for other medications in the past but would not going forward. On October 25, 2011, a pain clinic physician wrote a letter to the WCB stating that Venlafaxine was for the worker’s chronic depression associated with their chronic pain condition. On July 18, 2012, the WCB sent a further decision letter to the worker confirming the medication, Venlafaxine would not be covered by the WCB as it was prescribed for a medical condition not accepted by the WCB.

On April 22, 2013, the worker's treating physician provided the WCB with a list of the medications the worker was prescribed and the conditions the worker was being treated for. On May 6, 2013, the information from the physician was reviewed by a WCB medical advisor. The advisor provided an opinion on the medications listed by the physician and whether or not they related to the worker's compensable injury, noting with respect to Venlafaxine, a previous opinion on November 30, 2011 indicated that medication was not related to the compensable injury and remained unchanged. The worker was provided with a further decision letter setting out the same on May 24, 2013. A psychiatrist who had examined the worker on October 11, 2012, sent a report to the WCB on October 28, 2013, in support of the worker continuing to be covered for the medication, Venlafaxine, noting it provided the worker with "major improvements" in their pain and depression symptoms. The report was reviewed by a WCB medical advisor and on October 31, 2013, the worker was again advised they were not entitled to coverage for Venlafaxine.

On June 20, 2014, a pain clinic physician wrote that Ropinirole had been started to “manage their pain as well as [their] restless leg syndrome.”

The worker’s treating pain management clinic physician provided a report to the WCB on August 9, 2017, indicating the worker was taking Ropinirole and Venlafaxine for pain and requested the WCB provide coverage for those medications however, the report listed the worker’s complaints as shoulder and neck pain.

At the request of the WCB, the worker’s treating family physician provided an updated list of medications the worker was taking on November 1, 2017 and noted the pain management clinic physician had prescribed Ropinirole for pain and that the worker continued to take Venlafaxine, in addition to other medications. A medication review was conducted by a WCB medical advisor on November 27, 2017, who provided again that their opinion of November 30, 2011 remained unchanged and the use of Venlafaxine was not related to the worker’s compensable injury. On December 13, 2017, the WCB requested the pain clinic physician provide an explanation of why the worker was being prescribed Ropinirole and Venlafaxine and what they were being prescribed for. On January 6, 2018, the pain clinic physician advised they had not prescribed those medications for the worker. The worker’s file was reviewed by a WCB medical advisor on January 18, 2018 who provided that Ropinirole was a medication “…used to treat Parkinson’s Disease as well as Restless Legs Syndrome and as such its use in this case is unrelated to the compensable injury…”. A second WCB medical advisor reviewed the file on January 29, 2018 and provided that the reports from the pain clinic physician and a spine assessment clinic indicated the worker’s complaints of neck and upper extremity pain, which were noted to not be accepted compensable diagnoses for the worker and as such, the medications prescribed to treat those difficulties, being Gabapentin and Venlafaxine, were not eligible for coverage by the WCB. A formal decision letter advising the worker the WCB would not cover those medications was sent on February 27, 2018.

On September 22, 2021, a WCB Consultant provided a Memorandum which indicated that Venlafaxine is used to treat mood disorder and chronic depression and noted that the Pain Management Unit had concluded that the worker’s mood symptoms were not medically accounted for in relation to the compensable injury.

On November 23, 2021, the worker’s treating pain clinic physician submitted a report to the WCB indicating the worker was experiencing more significant pain in the shoulder and neck areas and noted a trial of Gabapentin would be attempted and requested the WCB consider coverage of this medication for the worker. A review of the request was conducted by a WCB medical advisor on December 9, 2021 who noted that the medication request was made due to the worker’s complaints of neck and upper extremity difficulties, which were not accepted compensable injuries. As such, WCB funding for the medication was not supported. The worker was advised of the decision by way of a letter on December 13, 2021. A further report from the pain clinic physician on April 11, 2022, noted the worker continued to use Gabapentin and wanted to retry the medication Venlafaxine. The physician documented the worker’s request that the WCB support coverage of those medications as they had been “…used for many years to help control [their] back and leg pain.” The worker’s file was again reviewed by a WCB medical advisor on June 22, 2022 and on the same date, the WCB advised the worker coverage would not be provided for Venlafaxine and Ropinirole. The pain clinic physician again submitted a report to the WCB on October 4, 2022 indicating the worker had requested they clarify that the Gabapentin, Venlafaxine and Ropinirole medications were being prescribed to the worker “…for enhancement of [their] pre-existing spinal fusion and chronic pain syndrome.” The report was reviewed by a WCB medical advisor on October 5, 2022, who noted the report did not provide any new medical information and did not change the prior opinions. The worker was again advised by decision letter on October 6, 2022, coverage for those medications would not be provided.

Further medication reviews of the worker’s file occurred after requests for coverage of Gabapentin, Venlafaxine and Ropinirole were made by the pain clinic physician in July 2023, September 2023 and December 2023. Each time, the WCB advised the worker no new medical information to support the use of those medications was provided and the previous decisions that coverage for those medications would not be provided remained unchanged.

The worker’s representative requested reconsideration of the WCB’s decision to deny coverage for the medications to Review Office on April 9, 2024. The representative noted the worker’s treating healthcare providers supported the medications had been prescribed, in part, for the worker’s chronic low back injury and as such, should be covered by the WCB. Review Office determined on June 10, 2024, the worker was not entitled to coverage for Venlafaxine, Ropinirole and Gabapentin. Review Office found that while some of the worker’s treating healthcare providers indicated the use of the medications may have been for pain control, it was noted the worker was also being treated for several other co-morbid conditions, which were not compensable. As such, Review Office further found that the medications were not prescribed for the worker’s compensable injury and they were not entitled to coverage.

The worker's family physician advised the WCB on September 26, 2023, Gabapentin was being prescribed for pain relief post motor vehicle accident.

The worker’s representative filed an appeal with the Appeal Commission and a file review was arranged. Following the file review, the appeal panel requested additional medical information prior to discussing the case further. The panel wrote to the pain clinic physician in November 2024, February 2025, October 2025 and March 2026 requesting that they clarify whether Venlafaxine, Ropinirole and Gabapentin were prescribed for pain and symptom management related to the July 11, 2000 workplace accident.

The requested information was later received and was forwarded to the interested parties for comment. On April 27, 2026, the appeal panel met further to discuss the case and render its final decision on the issues under appeal.

Reasons

Applicable Legislation and Policy

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

Subsection 27(1) of the Act states 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) states, in part, 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..."

WCB Policy 44.120.10, Medical Aid (the "Policy"), defines key terms and sets out general principles regarding a worker's entitlement to medical aid, which is defined in the Act to include drugs. The general principles governing the WCB's funding of medical aid, as outlined in the Policy, include the following:

• The Board determines the appropriateness and necessity of medical aid provided to injured workers in respect of the compensable injury.

…

• 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 Board will refuse or limit the funding of any medical aid it considers excessive, ineffective, inappropriate or harmful.

Schedule A to the Policy provides additional details concerning the WCB's funding of prescription and non-prescription medications. Schedule A states “Subject to the other provision of this policy, the WCB may refuse or limit the funding of any medications it considers non-traditional…”.

WCB Policy 44.10.20,10, Pre-existing Conditions, sets out general principles regarding a worker's entitlement and how pre-existing conditions may impact the provision of medical aid. This policy states “The WCB will consider the worker's pre-existing condition when providing medical aid to assist the worker in recovering from the effects of their workplace injury…”

Worker's Position

The worker was represented by the Worker Advisor Office on the appeal.

The worker's position, as outlined in their representative’s submission, was that Venlafaxine, Gabapentin and Ropinirole are required to provide relief from their compensable injury and they are entitled to coverage for that medication.

The worker submitted that Venlafaxine was being prescribed for pain management from their compensable injury as well as their chronic depression. Likewise, the worker submitted that Ropinirole was being prescribed for the dual purpose of pain management from their compensable injury as well as their restless leg syndrome.

The worker submitted that Gabapentin was being prescribed for pain management from their compensable injury as well as of their neck and shoulder pain.

Further, the worker submitted that on October 4, 2022 and again on December 15, 2022, a pain clinic physician wrote that Venlafaxine, as well as Ropinirole and Gabapentin, were being prescribed for the worker’s chronic lower back injury. Additionally, on June 30, 2023, the worker’s family physician wrote that this medication, as well as Ropinirole and Gabapentin, were being prescribed for the worker’s chronic lower back injury.

In conclusion, the worker submitted that the WCB's decision was in violation of the Act in not providing them with medical aid which is necessary to provide relief from the injury which resulted from the workplace accident, and their appeal should be accepted.

Employer's Position

The employer did not participate in the appeal.

Analysis

The issue before the panel is whether or not the worker is entitled to coverage for the medications Venlafaxine, Gabapentin and Ropinirole. For the worker's appeal to be allowed, the panel must find, on a balance of probabilities, that each of Venlafaxine, Gabapentin and Ropinirole is required to provide relief from the worker's injury resulting from the compensable injury. The panel is unable to make that finding, for the reasons that follow.

Based on our review of all of the information and submissions on file, the panel is unable to relate the worker's prescription for Venlafaxine, Gabapentin or Ropinirole to their compensable injury as specified in more detail below.

Venlafaxine

The panel acknowledges that the worker has been prescribed Venlafaxine for some time. There were several attempts by the worker to have this medication reviewed by WCB to determine its eligibility for coverage and each time the WCB found that there was insufficient evidence linking this medication to the worker’s compensable injury.

As indicated by the Review Office, the worker is being treated for several other co-morbid conditions, which were not compensable, including depression, restless leg syndrome and neck and shoulder pain. As such, Review Office further found that Venlafaxine was not prescribed for the worker’s compensable injury and they were not entitled to coverage for this medication.

The worker has requested to have Venlafaxine covered by WCB on several occasions and each request has been denied because the medication was not associated with the worker’s compensable injury. Support for this position is found in the October 25, 2011 letter from a pain clinic physician, stating that this medication was for the worker’s chronic depression associated with their chronic pain condition.

Additionally, on January 17, 2017 the worker’s family physician wrote a letter which listed this medication under the heading ‘non-WCB related meds’.

Further, the WCB Medical Advisor's Memorandum of September 22, 2021, indicated that the worker is being treated with Venlafaxine in relation to their mood disturbance and chronic depression.

However, as noted by the worker’s submissions, on October 4, 2022 and again on December 15, 2022 a pain clinic physician wrote that Venlafaxine, as well as Ropinirole and Gabapentin, were being prescribed for the worker’s chronic lower back injury. Additionally, on June 30, 2023, the worker’s family physician wrote that Venlafaxine, as well as Ropinirole and Gabapentin, were being prescribed for the worker’s chronic lower back injury. It is noted that these reports provided no new information regarding why the pain clinic physician, or the family physician, felt that Venlafaxine was being prescribed for the worker’s chronic lower back injury, not their depression or their neck.

Based on the inconsistencies in these reports and those provided by the WCB’s medical advisor, the panel sought further information from the physician at the Pain Management Clinic who has been treating the worker’s chronic pain. The panel wrote in November 2024, February 2025, October 2025 and March 2026 requesting that they clarify whether Venlafaxine, Ropinirole and Gabapentin were prescribed for pain and symptom management related to the July 11, 2000 workplace accident.

In response, in December 2024, the pain clinic physician stated that Venlafaxine is being used for pain management and symptom management related to the worker’s compensable injuries. In February 2025, the panel followed up to seek answers to its specific questions regarding the symptoms Venlafaxine is being used to treat. In response, in July 2025, the pain clinic physician provided the same information as that provided in December 2024, that Venlafaxine is being used for pain management and symptom management related to the worker’s compensable injuries. Accordingly, the panel again wrote in October 2025, with specific questions regarding the symptoms Venlafaxine is being used to treat. In March 2026, the pain clinic physician responded to the panel’s question regarding Ropinirole but did not address the panel’s question regarding Venlafaxine.

Based on the information on file, including the subsequent inquiries made by the panel, the panel finds that there is insufficient evidence that Venlafaxine was prescribed for pain and symptom management related to the worker’s compensable injuries instead of their non-compensable co-morbid conditions.

Ropinirole

The worker has requested to have Ropinirole covered by WCB on several occasions and each request has been denied because the medication was not associated with the worker’s compensable injury.

Support for this position is found in a letter of June 20, 2014, from the worker’s pain clinic physician which stated that Ropinirole had been started to “manage their pain as well as [their] restless leg syndrome.” Additionally, the WCB Medical Advisor's Memorandum of September 22, 2021 indicated that Ropinirole was used to treat Parkinson's and “off label” restless leg syndrome and noted that the May 25, 2015 report from the Sleep Disorder Center indicated that this medication was prescribed to treat the worker’s symptoms of restless legs syndrome.

Further, the worker’s family physician listed this medication under the heading ‘non-WCB related meds’ in a letter of January 17, 2017. Additionally, the worker’s treating pain management clinic physician provided a report to the WCB on August 9, 2017, indicating the worker was taking Ropinirole for pain, however, listed the worker’s complaints as shoulder and neck pain.

However, as noted by the worker’s submissions, on October 4, 2022 and again on December 15, 2022 the pain clinic physician wrote that Venlafaxine, as well as Ropinirole and Gabapentin, were being prescribed for the worker’s chronic lower back injury. Additionally, on June 30, 2023, the worker’s family physician wrote that Venlafaxine, as well as Ropinirole and Gabapentin, were being prescribed for the worker’s chronic lower back injury. It is noted that these reports provided no new information regarding why the pain clinic physician, or the family physician, felt that Ropinirole was being prescribed for the worker’s chronic lower back injury, not their restless leg syndrome or their neck and shoulder pain.

Based on the inconsistencies in these reports and those provided by the WCB’s medical advisor, the panel sought further information from a physician at the Pain Management Clinic who has been treating the worker’s chronic pain. The panel wrote to the pain clinic physician in November 2024, February 2025, October 2025 and March 2026 requesting that they clarify whether Venlafaxine, Ropinirole and Gabapentin were prescribed for pain and symptom management related to the July 11, 2000 workplace accident.

In response, in December 2024, the pain clinic physician stated that Ropinirole is being used for pain management and symptom management related to the worker’s compensable injuries. In February 2025, the panel followed up to seek answers to its specific questions regarding the symptoms Ropinirole is being used to treat. In response, in July 2025, the pain clinic physician provided the same information as that provided in December 2024, that Ropinirole is being used for pain management and symptom management related to the worker’s compensable injuries. Accordingly, the panel again wrote in October 2025, with specific questions regarding the symptoms Ropinirole is being used to treat. In March 2026, the pain clinic physician responded to the panel’s question regarding Ropinirole stating that they did not prescribe Ropinirole and accordingly could not answer the question of whether it was being prescribed for Parkinson’s or restless leg syndrome or symptoms due to the workplace accident.

Based on the information on file, including the subsequent inquiries made by the panel, the panel finds that there is insufficient evidence that Ropinirole was prescribed for pain and symptom management related to the worker’s compensable injuries instead of their non-compensable co-morbid conditions.

Gabapentin

The worker has requested to have Gabapentin covered by WCB on several occasions and each request has been denied because the medication was not associated with the worker’s compensable injury. Support for this position is found in a report of November 23, 2021, from the worker’s treating pain clinic physician which indicated that the worker was experiencing more significant pain in the shoulder and neck areas and accordingly a trial of Gabapentin would be attempted again. Further, the family physician advised the WCB on September 26, 2023, Gabapentin was being prescribed for pain relief post motor vehicle accident.

However, as noted by the worker’s submissions, on October 4, 2022 and again on December 15, 2022 the pain clinic physician wrote that Venlafaxine, as well as Ropinirole and Gabapentin, were being prescribed for the worker’s chronic lower back injury. Additionally, on June 30, 2023, the worker’s family physician wrote that Venlafaxine, as well as Ropinirole and Gabapentin, were being prescribed for the worker’s chronic lower back injury. It is noted that these reports provided no new information regarding why the pain clinic physician, or the family physician, felt that Gabapentin was being prescribed for the worker’s chronic lower back injury, not their neck and shoulder pain.

Based on the inconsistencies in these reports and those provided by the WCB’s medical advisor, the panel sought further information from a physician at the Pain Management Clinic who has been treating the worker’s chronic pain. The panel wrote to the pain clinic physician in November 2024, February 2025, October 2025 and March 2026 requesting that they clarify whether Venlafaxine, Ropinirole and Gabapentin were prescribed for pain and symptom management related to the July 11, 2000 workplace accident.

In response, in December 2024, the pain clinic physician stated that Gabapentin is being used for pain management and symptom management related to the worker’s compensable injuries. In February 2025, the panel followed up to seek answers to its specific questions regarding the symptoms Gabapentin is being used to treat. In response, in July 2025, the pain clinic physician provided the same information as that provided in December 2024, that Gabapentin is being used for pain management and symptom management related to the worker’s compensable injuries and added that they would attempt to adjust the worker’s prescription for Gabapentin. Accordingly, the panel again wrote in October 2025, with specific questions regarding the symptoms Gabapentin is being used to treat. In March 2026, the pain clinic physician responded to the panel’s question regarding Ropinirole but did not address the panel’s question regarding Gabapentin.

Based on the information on file, including the subsequent inquiries made by the panel, the panel finds that there is insufficient evidence that Gabapentin was prescribed for pain and symptom management related to the worker’s compensable injuries instead of their non-compensable co-morbid conditions.

Conclusion

In reviewing the evidence on file, the panel is satisfied that it demonstrates a direct line between Venlafaxine, Gabapentin and Ropinirole being prescribed for the worker’s co-morbid conditions.

It is the panel's understanding that Venlafaxine is indicated for and used to treat mood disorders and chronic depression. The panel notes that our understanding is consistent with the advice from the WCB consultant, who stated on September 22, 2021 that Venlafaxine is used to treat mood disorder and chronic depression.

It is the panel's understanding that Ropinirole is indicated for and used to treat Parkinson’s and “off label” for restless leg syndrome. The panel notes that our understanding is consistent with the advice from the WCB consultant of September 22, 2021.

The panel notes that the worker's argument appears to be that Venlafaxine and Ropinirole were prescribed for an off-label use to address pain management and symptoms of the compensable injury. The panel is unable to find that the evidence supports that argument. Rather, the panel finds that the medical evidence shows that Venlafaxine and Ropinirole were prescribed to treat the worker’s co-morbid conditions of chronic depression and restless leg syndrome.

It is the panel's understanding that Gabapentin is indicated for and used to treat the worker’s neck and shoulder pain. The panel notes that our understanding is consistent with the WCB Medical Advisor's report that on September 26, 2023, Gabapentin was being prescribed for pain relief post motor vehicle accident.

Based on the foregoing, the panel places more weight on the WCB consultants’ opinions and accordingly is unable to find that the worker's prescription for and use of Venlafaxine, Gabapentin and Ropinirole is related to their workplace accident or compensable injury. The panel therefore finds, on a balance of probabilities, that the medication Venlafaxine, Gabapentin and Ropinirole are not required to provide relief from the worker's injury resulting from the July 11, 2000 workplace accident, and the worker is not entitled to coverage for Venlafaxine, Gabapentin or Ropinirole.

The worker's appeal is dismissed.

Panel Members

N. Smith, Presiding Officer
J. Peterson, Commissioner
M. Kernaghan, Commissioner

Recording Secretary, J. Lee

N. Smith - Presiding Officer
(on behalf of the panel)

Signed at Winnipeg this 11th day of June, 2026