Highlights of Noteworthy Decisions

Decision 227 21
D. Revington - C. Sacco - S. Roth
  • Health care (necessary)
  • Health care (psychiatric treatment)
  • Loss of earnings {LOE} (employability)
  • Health care (maintenance treatment)

The worker suffered a low back injury in September 2005, for which the Board granted the worker a 13% NEL award. The Board extended entitlement for psychotraumatic disability, with a 25% rating for permanent impairment, resulting in a combined 35% NEL award. In Decision No. 1006/12, the Tribunal granted LOE benefits beyond October 2007.

The worker now appealed a decision of the Appeals Resolution Officer denying full LOE benefits at the final review in January 2015, and denying entitlement to further psychological treatment.
On the evidence, the Panel found that the worker was unemployable and that he was entitled to full LOE benefits at the final review in January 2015.
The Board Administrative Practice document on Maintenance Treatment provides that, when a worker reaches MMR, further treatment is generally not appropriate or necessary. Treatment after MMR is considered to be maintenance treatment, and is allowed only where the worker has a permanent work-related impairment. In determining whether to authorize maintenance treatment, the decision-maker must be satisfied that the treatment is necessary to achieve one or more of the following objectives: it enables the worker to continue working at suitable work; it leads to a reduction in the worker's pain or decreases the worker's use of medication; it maintains the worker's level of functioning; it teaches the worker independent management.
The worker submitted that Maintenance Treatment document applied to physiotherapy treatments, and was not relevant in this case. However, the Panel noted that Tribunal case law has found that the document also provides helpful guidance with respect to psychological treatment.
The Panel found that the worker was not entitled to ongoing psychological treatment. The first objective in the Maintenance Treatment document (enabling the worker to continue working at suitable work), did not apply since the worker has not worked for many years. Regarding the other three objectives, the Panel found no recent medical opinion that more psychological treatment was necessary or appropriate to reduce the worker's pain or level of medication, maintain his level of functioning, or teach him to manage his condition. The worker claimed that his psychological condition has been consistently worsening but this was not supported by medical opinion.
The appeal was allowed in part.