Highlights of Noteworthy Decisions

Decision 1992 15
S. Martel
  • Permanent impairment {NEL} (degree of impairment) (psychotraumatic disability)
  • Travel expenses (treatment)
  • Benefits (overcompensation)

The worker suffered a low back injury in 2005, for which he was granted a 27% NEL award, increased by the Tribunal in Decision No. 692/08 to 33%. The Board granted entitlement for psychotraumatic disability, for which it assessed a 35% rating. The worker appealed a decision of the Appeals Resolution Officer denying an increase in the quantum of the NEL rating for psychotraumatic disability and denying ongoing payment of travel expenses for medical appointments.

Operational Policy Manual, Document No. 18-05-11, on assessing permanent impairment due to mental and behavioural disorders, provides the rating schedule for both chronic pain disability and psychotraumatic disability. Chronic pain disability is a holistic award that considers all aspects of a worker's disability, from organic and psychiatric sources, whereas psychotraumatic disability recognizes the additional impairment caused by a psychiatric diagnosis. In this case, the worker already had a significant NEL award to recognize his physical impairment.
The possibility of double compensation arose in this appeal. The NEL clinician was aware of this possibility when noting that the worker's activities of daily living was significantly impacted by co-existing organic low back impairment.
To be complementary to the organic award and to avoid duplication, compensation for psychotraumatic disability should generally not include any significant element attributable to the organic condition. In this case, the worker was having difficulties with many activities including walking, bending, lifting, shopping, performing housework and driving, but these deficits were largely attributable to the organic condition and, therefore, already reflected in the 33% rating for organic impairment. The psychotraumatic rating should only take into account the additional impairment caused by psychological factors. In this case, those factors were frequent crying, panic attacks and some noise intolerance. He has not withdrawn from his family or developed severe noise intolerance.
The Vice-Chair concluded that the 35% NEL rating for psychotraumatic disability in the mid-range of Class 3 of the rating schedule was appropriate. The worker was not entitled to an increase.
Section 32 of the WSIA defines health care as including extraordinary transportation costs to obtain health care. Operational Policy Manual, Document No. 17-01-09, on travel and related expenses, states that the Board pays all reasonable expenses incurred, on the direction or approval of the Board. This policy statement should be interpreted with regard to the definition of health care, which limits coverage to extraordinary transportation costs. Such a definition does not include transportation costs incurred to attend regular appointments located in the city where the worker lives.
The Board was not required to continue paying travel expenses in the circumstances, and it advised that worker that, as a result of stabilization of his condition, it would no longer reimburse for travel expenses. The worker was not entitled to further travel expenses for medical appointments.
The appeal was dismissed.