Highlights of Noteworthy Decisions

Decision 1137 18
04/05/2018
D. Revington
  • Health care (acupuncture)
  • Health care (maintenance treatment)

The worker suffered arm and wrist disablement in 2007. In Decision No. 1437/12, the Tribunal found that the worker was entitled to further LOE benefits and an LMR assessment.

The worker now appealed a decision of the Appeals Resolution Officer denying reimbursement for acupuncture treatment after April 2016.
The ARO granted reimbursement for acupuncture treatment from January 2014 to April 2016, finding that the treatment was needed to alleviate symptoms caused by activities in the college course of his work transition program, but denied reimbursement after April 2016, finding that the worker would no longer be exposed to factors that would aggravate his arm and wrist condition.
Board policy does not specifically address maintenance treatment. There is a Board administrative practice document on maintenance treatment, dated April 2015, which replaces a best approaches document on maintenance treatment, dated December 2005. These documents are not Board policy but they provide relevant and helpful guidance for this case. The first Board decision on maintenance treatment was made after the administrative practice document replaced the best approaches document. Accordingly, the Vice-Chair referred to the administrative practice document.
The document lists four objectives for maintenance treatment: enables the worker to continue working at suitable work; leads to a reduction in pain or decrease in use of medication; maintains the worker's level of functioning; teaches the worker independent management of the condition. The document also lists factors to consider when determining whether maintenance treatment is necessary to achieve any of the four objectives.
Based on consideration of the factors identified in the document, the Vice-Chair found the evidence did not demonstrate that maintenance treatment was necessary to achieve any of the four factors. Regarding the first factor, there was no current and specific medical evidence to support the maintenance treatment after April 2016; rather, the worker was relying on older reports used to support the entitlement during his work transition program. The Vice-Chair also considered the other factors, noting there was no evidence about the worker's employment since 2016, no evidence that further acupuncture treatment would enable the worker to undertake home exercise that would permit self-management of his condition, and no evidence of attempt to discontinue the treatment.
The appeal was dismissed.