WORKPLACE SAFETY AND INSURANCE BOARD
APPEALS RESOLUTION OFFICER DECISION
decision number:
20150064
DECISION DATE:
June 8, 2015
OBJECTING PARTY:
Worker
REPRESENTED by:
Worker Representative
RESPONDENT:
Employer
REPRESENTED by:
Self-Represented
HEARING:
Hearing in Writing
HEARD by:
B. Mier-Pessoa, Appeals Resolution Officer
ISSUE
The worker is objecting to the Case Manager’s (CM) November 3, 2014 decision and is requesting permanent impairment for the left knee patella fracture.
BACKGROUND
On February 27, 2012 this now 64 year old building operator tripped on a skid in the facilities warehouse storage area, lost his balance and fell on a 3” metal pipe injuring his left knee. Emergency medical care confirmed the worker sustained soft tissue swelling and a patella fracture. The claim was allowed with Loss of Earnings (LOE) and Health Care Benefits extended.
The worker underwent open reduction internal fixation of the left patellar fracture on March 1, 2012. The worker returned to modified duties and hours on April 30, 2012.
The worker was off work again from August 27, 2012 until October 31, 2012. As the worker continued to have some difficulty with ongoing discomfort around his knee, hardware removal (3 K-wires) was recommended and the worker was put on the waitlist for the procedure.
The worker was seen for Comprehensive Assessment at the WSIB Surgical Specialty Program on July 18, 2013 at which time the hardware removal was again recommended, but the client wanted to defer the surgery until October 2013 because of a return to work and holiday plans.
The worker was seen at a Hip & Knee Specialty Clinic for comprehensive assessment on October 10, 2012 which concluded the worker would require some temporary restrictions with respect to his left knee for about three months, with ongoing formal physiotherapy for another six weeks. The worker was still awaiting hardware removal at that time.
The worker eventually had removal of hardware on October 31, 2013. Loss of Earnings benefits were extended from October 31, 2013 to November 20, 2013 when the worker again resumed modified and graduated hours of work until December 9, 2013.
The worker subsequently requested permanent impairment, which the November 3, 2014 CM’s decision denied. The worker objected and the file was referred to the Appeals Services Division for further consideration of permanent impairment.
AUTHORITY
Operational Policy Manual documents:
11-01-05 Determining Maximum Medical Recovery
11-01-14 Reconsiderations of Decisions
ANALYSIS
In considering the objection to the organic evidence of permanent impairment to the left knee due to the patella fracture, I have considered the file evidence and allow a permanent impairment of the left knee for the following reasons:
The Determining Maximum Medical Recovery Policy notes workers reach maximum medical recovery (MMR) when they have reached a plateau in their recovery and it is not likely that there will be any further significant improvement in their medical impairment. Permanent impairment means impairment that continues to exist after the worker reaches MMR.
The only issue before me is the left knee permanent impairment request. The medical information available from the outset confirms the worker sustained soft tissue injury and a fracture of his left patella. He underwent open reduction with internal fixation a few days after the accident and subsequently, due to continued difficulties, the worker underwent hardware removal on October 31, 2013.
The worker has indicated the hardware removal did not make much difference in his ongoing condition and this is confirmed by the medical reports.
When the worker requested recognition of a permanent impairment, he was referred for an Assessment. The September 22, 2014 Hip & Knee Specialty Clinic Comprehensive Assessment Report confirms the worker’s history and objective findings. The worker’s left knee flexion is reduced from normal at 90 degrees (normal is greater than or equal to 110 degrees) and with hyperextension of the left hip, the worker only has approximately 60 degrees of flexion in his left knee and 90 degrees on the right indicating a marked contracture of his left rectus femoris. The Clinic Assessment confirms the worker has plateaued in his recovery with a prognosis of partially recovered now and no further recovery expected. While no formal work restrictions are required, the worker still has limitations due to his compensable left knee cap fracture.
The Case Manager’s November 3, 2014 decision confirmed the clinic report suggested no further consultations were required, no limitations for current job, no formal work restrictions and no further treatment were required. On this basis, the CM determined the worker had reached maximum medical recovery on September 22, 2014 without any ongoing impairment.
While the worker does not have a significant impairment, and no functional precautions or further treatment is necessary noting the worker has plateaued, he still has limitation of movement of the left knee with no further improvement anticipated. This is by definition a permanent impairment within the relevant policy.
On this basis, I accept permanent impairment of the left knee (albeit of a minor nature) and do not concur with the adjudicative decision of full recovery.
CONCLUSION
I conclude:
There is evidence of permanent impairment on an organic basis of the left knee patella fracture. The worker is entitled to left knee permanent impairment.
The worker’s objection is allowed.
DATED
June 8, 2015
B. Maier-Pessoa
Appeals Resolution Officer
Appeals Services Division