Highlights of Noteworthy Decisions

Decision 419 18
S. Ryan
  • Continuing entitlement
  • Chronic pain
  • Out of province (health care)

The worker suffered a low back injury in October 2008. The worker appealed a decision of the Appeals Resolution Officer denying entitlement for psychotraumatic disability or chronic pain disability, denying entitlement for surgery in Mexico in January 2013 and denying LOE benefits after January 2013.

On the evidence, the worker had entitlement for chronic pain disability.
The worker testified that she went to Mexico to obtain a second opinion on treatment for her back and that the doctor there told her she required surgery within two weeks or she would end up in a wheelchair. The worker submitted that Board policy allows entitlement for emergency health care outside of Ontario without prior approval of the Board.
The Vice-Chair found that the surgery was not necessary and that it was not required due to any emergency circumstance. The surgery in Mexico was the result of the worker's choice and not the result of an emergency. The worker did not provide any medical evidence to support her testimony that she was told by the doctor she would end up in a wheelchair if she did not undergo the surgery within two weeks. There was no medical evidence indicating that the surgery was necessary to improve her condition or to prevent her from being wheelchair bound.
The worker did not have entitlement for the surgery in Mexico. However, she was entitled to ongoing LOE benefits. The worker was not capable of any employment as a result of her chronic pain disability before she underwent the surgery.
The appeal was allowed in part.