Highlights of Noteworthy Decisions

Decision 1457 22
V. Patel
  • Health care (chiropractic)
  • Health care (maintenance treatment)
  • Health care (vehicle purchase)

The issues under appeal were whether the worker had entitlement to a new vehicle and to chiropractic treatment from August 2, 2016 to September 28, 2018.

The appeal was allowed, in part. The worker did not have entitlement to a new vehicle.
Treatment beyond the rehabilitative stage is generally referred to as maintenance treatment. OPM Document No. 17-01-03 states that the initial physiotherapy treatment is limited to 12 weeks, with additional treatment to be authorized by the Board. There is no guidance in Board policy for the approval of treatment extensions, treatment subsequent to a recurrence, or ongoing maintenance treatment. Tribunal decisions have considered whether the treatment is necessary as a result of the accident and whether it is useful in reducing the pain and allowing the worker to remain employed (see Decision No. 4/89).
The Board's Administrative Practice Document titled Maintenance Treatment, December 2020, describes maintenance treatment as treatment beyond maximum medical recovery (MMR) with the purpose of preventing deterioration or reducing use of medication, rather than rehabilitation. It states that in determining whether to authorize maintenance treatment, the decision-maker must be satisfied based on objective medical findings, that the treatment is necessary to achieve one or more of the outlined objectives: a) enables the worker to continue working; b) leads to reduction in the worker's pain and/or medication use; c) maintains worker's level of functioning; and, d) teaches the worker independent management of the condition.
The Vice-Chair found that the chiropractic treatment from August 2, 2016 to September 28, 2018 was necessary, appropriate and sufficient for the worker's workplace injuries. It was noted that any delay to her treatment, such as during the COVID-19 pandemic, caused the worker to feel a definite relapse in some of her symptoms and pain management, which affected her day to day life tasks as well as work tasks. In considering the medical evidence from the relevant period, the evidence supported that treatment led to a reduction of medication use and a reduction of the worker's pain, and while the worker would never fully recover, there were still noted functional and mobility improvements with treatment. The chiropractic treatment also helped the worker continue to work.
OPM Document No. 17-06-07 does not contemplate the provision of new motor vehicles for workers. It speaks only of modifications to existing vehicles. In Decision No. 198/13, the Tribunal made it clear that they were awarding partial reimbursement for the cost of the vehicle under "exceptional circumstances" and merits and justice. The worker also had an 98% NEL award. The Vice-Chair did not find there were exceptional circumstances in this case to allow a departure from OPM Document No. 17-06-07, which only contemplates the WSIB authorizing vehicle modification and not the purchase (or partial purchase) of a new or used vehicle.