Highlights of Noteworthy Decisions

Decision 645 19
A. Baker
  • Health care (medical aid) (alternative treatment)
  • Health care (surgical aid)
  • Out of province (health care)

The worker suffered a right knee injury in June 1979. He underwent surgery several times. The last surgery did not heal, resulting in the need for amputation in 2014. The worker has had problems with the prosthetic fitting over the years since the amputation. The Board granted the worker a 55% pension for permanent disability. The worker requested entitlement for surgery called osseointegration, which is currently not performed in Ontario. The worker appealed a decision of the Appeals Resolution Officer denying entitlement for the surgery.

At the time the worker first requested the surgery, it was performed only in Australia. Since the worker's request, and the Board's denial of benefits for the operation, the surgery is now conducted in Canada, although not yet in Ontario, and has been funded in some cases by the Ontario Board.
The worker was left with a high level of disability, rated for a 55% pension. The worker participated in numerous efforts to make his prosthetics more comfortable and less likely to cause infection. Successful surgery is likely to improve the worker's health and well-being, making it more likely than not that it is a necessary, appropriate and sufficient health care measure in this case.
The risks and benefits of the surgery have been reviewed with the worker by several doctors. While there are risks, the worker is a good candidate for the surgery. Although the procedure is not yet performed in Ontario, it is now performed in Canada and no longer appears to be an experimental procedure. The procedure has been funded by OHIP and the Board in other cases.
The Vice-Chair concluded that the worker was entitled to health care benefits for osseointegration surgery, to be performed in Canada. The appeal was allowed.