- Health care (medical aid) (drug formulary)
The issue under appeal was whether the worker was entitled to health care benefits in the form of an analgesic Multiprofen-CC Plus Compound Cream. The Board granted the worker entitlement to a 17% Non-Economic Loss (NEL) benefit for the permanent impairment in his surgically treated left shoulder region.
The Panel allowed the appeal.The Panel found that the Multiprofen-CC Plus Compound Cream was necessary, appropriate and sufficient to treat the worker's compensable left shoulder injury. The ARO had determined that entitlement to the Multiprofen-CC Plus Compound Cream was not appropriate as the cream was not listed on the WSIB's drug formulary. However, this Tribunal has recognized that the denial of funding for Multiprofen-CC Plus Compound Cream, solely because it was not included on the list of drugs available for funding from the WSIB, is insufficient to establish that a medication is not necessary, sufficient or appropriate (see Decision No. 245/21).The Panel noted that there is considerable debate about whether topical analgesics are effective in treating chronic pain. As noted in Decision No. 245/21, there is sufficient medical literature to support the proposition that there can be a significant advantage in using analgesic creams to relieve pain in acute and chronic conditions, and that there is a lower risk of adverse events associated with its use. The Panel also noted that entitlement should not be denied because the cream was prescribed for the compensable left shoulder injury as well as the right shoulder injury. The question to be determined was whether the treatment was necessary, appropriate and sufficient for the compensable injury, even if it also may have been prescribed for another non-compensable condition.The Panel recognized that the worker had been granted a significant NEL award, including 17% for the left shoulder impairment and 25% for psychotraumatic disability. The Panel also noted that there were exceptional circumstances that would support entitlement for the Multiprofen-CC Plus Compound Cream. The worker had tried a variety of pain medications and treatment modalities since 2008 and found that they had not been effective. The medical evidence indicated that injections were providing less and less relief of ongoing symptoms for the worker. Lastly, the cream was recommended by the worker's orthopaedic surgeon and supported by his family doctor. The medical evidence indicated that a combination of pain management treatment modalities was best suited for the worker's pain management. The worker's surgeon had agreed that the Multiprofen-CC Plus Compound Cream had proved beneficial in managing his chronic shoulder pain effectively along with his other prescribed treatments and medications.