- Health care (medical aid) (escorts)
The worker appealed two ARO decisions, dated April 21, 2020 and February 15, 2023, both of which found that the worker was not entitled to be escorted by a non-professional escort (NPE) to his medical appointments. The worker was injured in a motor vehicle accident on October 31, 2002. He was granted a Non-economic Loss (NEL) benefit of 70% for the permanent impairments resulting from the October 31, 2002 workplace accident, including for a traumatic brain injury.
The Panel allowed the appeal.OPM Document No. 17-01-08 "Escorts" states: "If a worker must be escorted to health care or WSIB-arranged appointments, the WSIB pays the escort a standard fee and any approved travel and related expenses." In addition, the WSIB can pay for non-professional escorts, "if the worker must be accompanied for legal or basic clinical reasons. A non-professional escort can be a parent, friend, or spouse."The Panel clarified that a PCA allowance is a separate and distinct benefit than the NPE benefit. OPM Document No. 17-06-05, "Personal Care Allowance", states that severely impaired workers who have difficulty with the activities of daily living are entitled to a personal care allowance to hire attendants. An NPE is provided to workers who need to be escorted to their health care appointments. It was clear from the worker's testimony that he was aware of the differences between benefits for a PCA and entitlement for an NPE. The worker's testimony and that of his spouse focused on the worker's needs after leaving his home to attend his medical appointments.The Panel found that the worker needs an NPE to assist him with his medical appointments because of his reduced strength and mobility, which affects his ability to attend his appointments alone. His mobility issues affect his ability to get on and off an examining table or a table used for imaging testing. The Panel also found that an NPE is needed in view of the worker's recognized conditions relating to dizziness and incontinence. Lastly, the Panel found that an NPE is needed to undress and dress the worker. The Panel considered the worker's NEL rating and the medical findings as noted in his NEL assessments.When all of these factors were considered, the Panel concluded that the worker must be accompanied for legal and basic clinical reasons. The NPE was required for all of the worker's compensable and non-compensable health care appointments and WSIB arranged appointments, noting that but for the injuries sustained in the October 31, 2002 compensable injury, the worker would not require this assistance. This fell within the ambit of section 32(h) of the Act as a measure that will improve the quality of life of severely impaired workers.