WORKPLACE SAFETY AND INSURANCE BOARD
APPEALS RESOLUTION OFFICER DECISION
decision number: 20172025
OBJECTING PARTY: Worker
REPRESENTED by: Representative
RESPONDENT: Company (Not participating)
REPRESENTED by: N/A
HEARING: Hearing in writing
Date: July 4, 2017
ISSUE
The worker objects to the decision denying payment for a propane generator for his home.
BACKGROUND
Briefly, this worker suffered traumatic amputations to both legs and his right arm on July 30, 1968 after a locomotive accident. He was 22 years old at the time. He was later granted entitlement for psychotraumatic disability and the left shoulder as a secondary injury. He is currently 71 years old.
He is in receipt of a 100% permanent disability (PD) pension that is payable for life. His severe disability entitled him to numerous benefits and services through the Workplace Safety and Insurance Board’s (WSIB) Serious Injury Program (SIP) including extensive home and car modifications and health care services for the home. He also receives an Independent Living Allowance which is meant to assist to improve his quality of life.
The current issue flows from the WSIB’s decision dated April 10, 2015 that denied payment for a home propane generator. The worker requested this modification to ensure that his home systems remained operational during power outages that are common in the rural area of Ontario where he lives.
The worker objected to the WSIB’s decision and the matter is now with the Appeals Services Division for further consideration.
AUTHORITY
Relevant operational policies:
17-06-02 – Independent Living Allowance
17-06-03 – Independent Living Devices
17-06-08 – Home Modification
ANALYSIS
I have carefully considered the worker’s objection including the submission made by his former representative dated March 12, 2015 and medical report from Dr. O’Shaughnessy dated January 21, 2015. Having done so, I grant the worker’s appeal and find that it is reasonable for the WSIB to pay for a power generator for his home. My analysis follows.
The salient facts of this claim are that the worker suffered devastating injuries as a result of his accident on July 30, 1968 and that he receives full benefits for life in the form of a 100% PD. He is also wheelchair dependent due to his injuries. The significance of his injuries entered him into the WSIB’s Serious Injury Program (SIP) which provides seriously injured workers with the specialized treatment, equipment, and services they need to maximize their recovery of function and quality of life.
Included with the SIP is the provision for home modifications to facilitate independent living when a worker sustains a permanent total disability/severe impairment. In this case, the WSIB has paid for extensive modifications to his principal residence. A recent construction approval dated March 9, 2017 for “Phase 1” of a construction project paid for design and construction fees and installation of an elevator lift totalling $151,029.30 and noted that the worker could only access areas of his home via his powered wheelchair. There were also prior home modifications and repairs that were paid for in this claim.
I also noted the WSIB approved payment for an air conditioner and heat pump for his home in 2013 because it would lessen the chance of tissue breakdown with his skin grafts. In December 2013 the WSIB approved payment of an alert system for emergency assistance when he was left alone.
The WSIB has also paid for innumerable devices to improve his quality of life and lessen the impact of his injuries including 2 powered wheelchairs (a primary and a back-up according to a memorandum dated November 4, 2016), repairs and replacement batteries for the wheelchairs, vehicle modifications, a Hoyer lifting device, a specialized bed, mattresses, under pad, commode, pillows and ongoing therapy and maintenance for his prosthetics. In April 2016 the WSIB replaced his computer.
The worker then fell at home on May 20, 2016 during a bed transfer and injured his left shoulder and was later found to have suffered a torn rotator cuff. An external Occupational Therapist’s Home Safety Assessment Report dated October 19, 2016, reported the fall left him mostly bedridden and socially isolated because he could not transfer himself to his vehicle. His wife indicated she was unable to assist with his transfers due to her own limited strength.
The report also describes the home as an extensively modified two-storey home which, at the time, had a broken elevator that prevented him from accessing the upper floor. There was also an issue with entering his house through a wheelchair ramp due to an exposed threshold.
On March 12, 2015 the worker’s former representative wrote to the WSIB asking for reimbursement for a propane generator to support his independence and ensure his quality of life safely in the event of a power failure or environmental incident. His letter goes on to state the worker has lived in this community for over forty years and has had to manage to sustain himself when there have been power outages. On those occasions he is left without access to home lighting, heating, laundry, kitchen amenities, washroom, elevator system and water systems for periods of time.
As well there was not an immediate support system available because his family did not reside close to him. The letter included a $25,430.65 estimate for a 36 KW generator, permits and installation.
The representative also included a medical note from the worker’s treating physician dated January 21, 2015 which supported the request for a home generator because power outages would leave him without heat during cold months, an inability to use his electric appliances, unable to charge his wheelchair and unable to use the elevator in his home. This would confine him to areas of the home that he could not escape during an emergency situation.
He would also not be able to use his washroom or bathe or flush the toilet because he is on a town water system and his home is vulnerable to flooding and the sump pump would be inoperable. This could lead to mould issues which would be detrimental to his health.
The worker lives in rural northern Ontario in the Muskoka region. I noted the memorandum dated January 26, 2016 outlines the results of a meeting the WSIB’s Home Modification Consultant had with the worker, his wife and the project supervisor for the renovations. The memorandum indicates the worker asked the contractor if some devices that were being installed on his elevator had battery back-up because “due to inclement weather near his home he does get periodic blackouts” and is concerned that he will be trapped in the shaft with no way to get out.
I also noted his current representative’s discussion with the SIP Case Manager (CM) on June 12, 2017 about wherein she explained that the worker’s skin grafts (due to his amputations) made him unable to sweat and he overheats quickly. She did not know how long the worker would last in the heat if the power went out. There was also a situation when the home modification contractors left a live electrical wire hanging in his house and took the smoke alarms and smoke detectors offline for a period of time when the circuit was turned off. This apparently caused the worker to have nightmares and undue stress about being left to burn alive in his home or having others suffer the same fate.
The request for a power generator was denied in the WSIB Occupational Therapist’s decision dated April 10, 2015 because it was not an item that is reimbursed by the WSIB. However, I disagree with the rationale used to deny the request for reasons I will explain.
The letter suggested that instead of relying on a generator the worker should develop an alternate “plan of action for medical services” because a generator may not be reliable in certain circumstances and would require ongoing maintenance. However, those circumstances are not explained and it is clear that the WSIB has not shied away from paying significant maintenance expenses for various devices and modifications over the years.
The decision also asked the worker to arrange an emergency plan with his local fire department but I question how this would be possible without electricity to power his phone, alarm, internet or other emergency system.
The letter then suggested he use his Independent Living Allowance (ILA) benefit to offset the cost of the generator and that they are available to the general public and not considered a health care specific device. I agree that a generator would not be considered a health care specific device because it is needed to maintain multiple systems (some of which were authorized and paid for by the WSIB) to sustain his life and facilitate independent living but I do not agree that he should have to use his ILA to fund what I believe is best described as a home modification.
In my view, a power generator would be best described as independent living device under policy 17-06-03.
Under that policy, severely impaired workers may be entitled to independent living devices that cost more than $250 per item, and are not intended to accomplish any of the objectives of the services covered under the independent living allowance.
The WSIB reimburses a severely impaired worker for a device if it
helps restore a worker's ability to
communicate
be mobile
engage in self-care
avoid further injury, or
prevent future health complications due to the work-related injury
is not intended to accomplish any of the objectives of the services covered by the independent living allowance (if the worker is receiving the allowance)
meets a permanent or long-term need
is appropriate, given the nature of the worker's impairment and functional limitations (e.g., it can be used safely and effectively)
is prescribed or recommended by a health care practitioner
is reasonable in terms of costs and anticipated benefits
is cost-effective considering alternatives on the market
meets performance standards generally accepted by medical or clinical rehabilitation specialists, and
is certified by Canadian Standards Association International (C.S.A.I.) or meets other applicable safety standards.
In my view, the provision of a power generator for a severely disabled worker in a rural area of Ontario would restore their ability to communicate, be mobile, engage in self-care, avoid further injury and prevent future health complications because it would ensure that all of the systems that the WSIB put in place as a result of his injuries would remain useable in a face of a prolonged power outage.
I also believe that a power generator would be allowable under the Home Modification policy (17-06-08) because, as required in that policy, it would allow the worker to have access to an area within the home, and any other areas utilized for ordinary living necessities during a power outage. It would also prevent him from being stranded or trapped in an elevator, for example, which is an electrically dependent system approved and paid for by the WSIB to mitigate his work-related injuries.
It would also ensure that his air conditioning and heat would function during a power outage which is critical to his survival due to his extensive skin grafts following his traumatic amputations. It would allow his sump pump to continue working during periods of flooding which he claimed his area was prone to. And it would allow him to contact emergency services in the event he was alone in a time of crisis.
Therefore, I am satisfied the worker’s request for a power generator for his home is warranted in this claim. However, I make no findings on the type, cost or installation of the device beyond finding that he has entitlement for one. The worker’s quote for over $25,000 may or not be the most appropriate and cost-effective choice for this application. Therefore, the administration of the matter and process by which a generator is sourced, chosen, installed and so on is a matter for the SIP to control.
CONCLUSION
The worker is entitled to have a power generator for his home. The administration of my ruling is left to the control of the operating area.
The worker’s objection is allowed.
DATED July 4, 2017
D. Giannobile
Appeals Resolution Officer
Appeals Services Division