Highlights of Noteworthy Decisions

Decision 245 21
15/04/2021
N. Perryman
  • Health care (medical aid)
  • Health care (medical aid) (drug formulary)

The worker was granted entitlement for a low back sprain injury, including a 10% permanent disability award granted in December 1975, and later confirmed in 1997 and 1983. The worker also had received entitlement for anxiety neurosis and depression in Decision No. 37/88, following which the worker was granted an additional 10% permanent disability award.

In this appeal the worker was seeking entitlement for compounded topical analgesic cream containing Ketoprofen, Multiprofen-CC Plus as health care for his compensable low back condition. The Board denied entitlement as the cream was not listed on the WSIB drug formulary.
The Vice-Chair found that the cream was necessary, appropriate and sufficient to treat the worker's compensable organic low back condition.
The worker had tried a variety of pain medication in the past and had either found that they did not help with pain management or produced unwanted side-effects. The worker's family doctor opined that the use of Tylenol 2 with the Multiprofen-CC Plus likely provided better pain control for the worker's moderate to severe pain and associated neuropathic pain. There was evidence that Tylenol 2 upset the worker's stomach when taken on a regular basis and that the worker had no recent access to Tylenol 3. The medical literature suggested that not only was the cream effective but had lower risk of adverse effects.
The Vice-Chair found that the fact that the cream was not on the formulary was not a sufficient basis to deny entitlement for the cream as health care.
The appeal was allowed.