WORKPLACE SAFETY AND INSURANCE BOARD
APPEALS RESOLUTION OFFICER DECISION
DECISION NUMBER: 20100151
OBJECTION BY: Worker
PARTICIPANTS: Worker
HEARING DATE: N/A
ISSUE
The worker requests entitlement for an orthopaedic pillow.
HOW THE ISSUE ARISES
The worker was born in May 1943. She began working for the employer as a kitchen helper on May 20, 1985 working 30 hours per week. On October 11, 1985, she tried to get a box from a shelf and banged her left shoulder on the corner of the cooler door. The initial diagnosis is sprain of the left shoulder girdle.
The worker received temporary total benefits to February 10, 1986. She did return to work, but was laid off in March 1986 due to a work shortage. Ongoing entitlement was denied as it was determined that the worker had recovered from the minor work injury, supported by the medical evidence.
In August 1989, the worker’s representative requested entitlement under the WSIB Chronic Pain Disability (CPD) policy. The worker continued to complain of ongoing pain, in the absence of significant physical findings. Entitlement to CPD was initially denied, but was subsequently allowed by a Hearings Officer in a decision dated September 6, 1991. The worker underwent a permanent disability pension assessment for CPD and was initially granted a 0% pension award. The worker objected to this decision.
In a subsequent decision dated August 8, 1994, a Hearings Officer determined that the disabling effects of the chronic pain disability were of a minor nature and the worker is entitled to a 10% permanent impairment for CPD.
The worker requested entitlement to Section 147(4) supplementary benefits. Entitlement was denied as it was determined that the worker would benefit from vocational rehabilitation services, but presented as totally disabled. The worker objected, and in a decision dated March 11, 1997, the Hearings Officer offered the worker another opportunity to participate in a vocational rehabilitation program.
The worker underwent a vocational rehabilitation assessment, and was involved in an English upgrading program. It was determined that the worker would not meet the literacy level, and did not have the skills to return to the workforce in any type of work suitable to her injury.
The worker was granted entitlement to Section 147(4) and (14) supplementary benefits. in addition to Section 147 (14) benefits and her monthly pension award, she received Section 147(4) benefits from June 1, 1998 to she turned age 65, June 1, 2008,. She continues to receive her monthly pension award and s.147(14) benefits.
The worker requested reimbursement for an orthopaedic pillow. A note was submitted from the family doctor dated November 11, 2009 stating that the worker had a compensable neck injury in the 1980’s, was given an orthopaedic pillow, and it has now worn out. Entitlement to the pillow was denied as outlined in the Case Manager’s letter dated November 23, 2009.
The worker objected, and the claim was referred to the Appeals Branch.
METHOD OF RESOLUTION
I discussed the issue with the worker and she confirmed that she had no additional information to submit. The decision will be made based on the information in the claim file record.
AUTHORITY REFERENCE
Operational Policy 17-01-02 Entitlement to Health Care
ASSESSMENT OF THE EVIDENCE
In reviewing the issue before me, I have considered all of the information in the claim file record. I do not find that the evidence supports that the worker is entitled to reimbursement for an orthopaedic pillow.
The worker sustained a minor injury in October 1985 diagnosed as a shoulder strain. She was initially able to return to her regular duties February 10, 1986, and was laid off in March 1986 due to a work shortage. Entitlement was subsequently allowed for CPD, and the worker was granted a 10% pension recognizing that the disabling effects of the chronic pain were of a minor nature.
As noted in Operational Policy 17-01-02; a worker entitled to benefits under the insurance plan is entitled to such health care as may be necessary, appropriate, and sufficient as a result of the injury.
There is no medical evidence to support that an orthopaedic pillow is required for the treatment of the worker’s accident related minor chronic pain disability. The most recent detailed medical report from the family doctor is dated December 22, 1995 which notes the diagnosis continues to be cervical and lumbar disc disease and a secondary fibromyalgia syndrome. The most recent available x-rays dated October 27, 1995 confirm the findings of cervical and lumbar degenerative disc disease, which is a pre-existing age related progressive condition and is not related to the minor work injury.
The worker may find that the use of an orthopaedic pillow is helpful, and may alleviate some discomfort from the cervical disc degeneration. However, there is no evidence to support that it is necessary for the treatment of the remote left shoulder strain which developed into a chronic pain disorder.
CONCLUSION
After careful consideration, I conclude that the worker is not entitled to reimbursement for an orthopaedic pillow.
The worker’s objection is denied.
DATED August 25, 2010
D. McParland
Appeals Resolution Officer
Appeals Branch