- Health care (attendance allowance) (psychological support)
The sole issue on appeal was the worker's entitlement to a re-assessment of her personal care allowance (PCA). The worker was granted a Non-Economic Loss (NEL) award of 60% for her Chronic Pain Disability.
The Vice-Chair allowed the appeal. The worker was entitled to a reassessment of her PCA, effective July 13, 2012. OPM Document No. 17-06-05 does not stipulate that the worker must be entitled to a NEL redetermination and/or an increase in the worker's NEL award, for a PCA reassessment to be accepted. A review may also be conducted if requested by the worker or the worker's health care professional. A review of the PCA can be initiated by the Board when a material change in the worker's condition has occurred, and the policy indicates that a review of the PCA "may also be conducted if requested by the worker, the worker's health care professional, employer or at the discretion of the WSIB." The policy supports that there must be some evidence that the worker's personal care attendant needs have changed for the PCA to be reassessed. The Vice-Chair found that there was sufficient evidence to support that the worker's personal care attendant needs had changed since the April 2008 initial assessment. The worker's recent needs were greater than the 546 or 595 minutes per week noted in the OT's May 2008 memoranda. The medical reporting, for example, indicated the worker's incapacity to do household duties or to travel outside of the home. As a result, a reassessment of the worker's PCA was warranted. Several past Tribunal decisions have found that a PCA should reflect the impact of a worker's compensable psychological condition on the worker's activities of daily living. They have determined that the worker's PCA assessment should reflect both the impact of the physical and psychological impairments. The Vice-Chair accepted that the worker's need for personal care assistance would also include the need for emotional support and some supervision due to her emotional state, as symptoms of the worker's compensable CPD condition. The degree of such emotional support would need to be determined during an assessment of the worker's activities of daily living, which further supported the need for a reassessment of the worker's PCA. The Vice-Chair also found that the worsening in the worker's GAF score, in part, supported the worker's increased need for personal care attendance.