Highlights of Noteworthy Decisions

Decision 1981 13
27/11/2013
B. Goldberg - B. Wheeler - A. Signoroni
  • Consequences of injury (iatrogenic illness) (treatment) (surgery)
  • Health care (medical aid) (drugs)
  • Health care (independent living) (severely disabled worker)
  • Incontinence

The worker suffered a back injury in 1970, for which he was granted a 15% pension. He also suffered a shoulder injury in 1994, for which he was granted a 16% NEL award. The pension for low back disability was increased to 20% in 1998, and in 2009, it was increased to 25% retroactive to 2001 and to 30% retroactive to 2007. The worker appealed a decision of the Appeals Resolution Officer denying entitlement for loss of bowel control, denying a further increase in the pension, denying an independent living allowance and denying entitlement for a specific medication.

The worker had entitlement for the loss of bowel control as a result of surgery for his back. The Panel confirmed the 30% pension for the back disability as assessed by the Board. The worker did not have entitlement for an independent living allowance. Even considering also the NEL award for shoulder impairment, the worker was well below the threshold for entitlement.
The worker was not entitled to reimbursement for the cost of Lyrica. The drug has not been added to the Board formularies. There was a lack of study indicating any therapeutic or non-therapeutic advantage over appropriate comparators. There was also medical opinion that the worker had no objective medical changes from use of Lyrica. The worker had no adverse reaction to the prior drug treatment and there was no evidence of significance that the prior drug (Gabapentin) was unsuccessful for the worker.
The appeal was allowed in part.