Highlights of Noteworthy Decisions

Decision 1520 22
K. Jepson
  • Procedure (submissions) (written submissions)
  • Health care (appliances or apparatus) (hospital bed)

The issue to be determined in this appeal was whether the worker should be granted entitlement to payment for the cost of an orthopaedic bed. The worker's whole person NEL award was 58%.

The appeal was allowed.
Section 50 of the Pre-1997 Act provides, in part: "50.(1) Every worker who is entitled to compensation under this Part...is entitled, (a) to such health care as may be necessary as a result of the injury..." OPM Document No. 17-01-02, "Entitlement to Health Care" was also applied. As stated in Decision No. 254/14, generally Tribunal decisions have allowed entitlement for medical devices or appliances when the medical evidence supports the request, and have denied entitlement when there is insufficient support that the health care item is necessary. An orthopaedic bed is found under OPM Document No. 17-06-03, "Independent Living Devices." It defines a "severely impaired worker" as a worker who has a combined total NEL award of 60% or greater. The policy lists 5 purpose considerations for determining if a device is appropriate for reimbursement, and at least one of the listed criterion should be met.
The Vice-Chair clarified that the condition at issue was the worker's low back, which was rated at 40%. The medical evidence indicated that the worker was getting insufficient sleep. The Vice-Chair was satisfied that the orthopaedic bed was necessary health care for the worker's low back injury within the meaning of section 50 of the pre-1997 Act. The bed satisfied at least one of the criterion set out in the policy: preventing future health complications due to the work-related injury. It was reasonable to infer that the worker's chronic lack of sleep would potentially result in future health complications.
The Vice-Chair in Decision No. 254/14 held the following: "...hospital beds, under Board policy 17-06-03, may be provided in cases where the worker's injury, requires that they be moved frequently and this cannot be done without mechanical help." Although this case involved the WSIA, the same principle would apply under the pre-1997 Act: the medical conditions listed in the policy requiring a hospital bed are not an exhaustive list encompassing the only instances in which a hospital bed may constitute appropriate and necessary health care. Therefore, the Vice-Chair concluded that an orthopaedic bed was a necessary health care device in relation to the worker's low back condition.