WORKPLACE SAFETY AND INSURANCE BOARD
APPEALS RESOLUTION OFFICER DECISION
decision number: 20180017
OBJECTING PARTY: Employer
REPRESENTED by: Employer Representative
RESPONDENT: Worker (Not participating)
HEARING: Hearing in Writing
HEARD by: M. Kimevski, Appeals Resolution Officer
Dated: March 28, 2018
ISSUES
The employer objects to:
The approval of loss of earnings (LOE) benefits up to March 20, 2017 as noted in the July 24, 2017 decision; and
The September 19, 2017 decision denying the employer’s request to reverse the costs of healthcare benefits associated with the assessments and treatment at the Back and Neck Speciality Program.
BACKGROUND
The claim was established for an accident on September 12, 2016 when the worker, then a 54 year old Vice Principal, was called to a classroom because a student with high needs was escalating in behaviour. The worker was struck in the back of the head with a shoe and entitlement was initially accepted for a mild degree concussion.
LOE benefits were allowed for shifts lost on September 13 and 14, 2016. The worker attempted a return to work on September 15, 2016 but could not continue; she returned to work again on September 19, 2016 to half days and was to self-accommodate. LOE benefits were allowed for the additional lost time on September 15 and 16, 2016 and partial LOE benefits were approved from September 19, 2016 ongoing up to March 20, 2017.
Entitlement was extended to include a neck strain and in November 2016 the worker was moved and accommodated in a smaller school. A referral was initiated to the Regional Evaluation Centre (REC) for a comprehensive musculoskeletal assessment and a Work Transition Specialist (WTS) was subsequently involved to assist with the progression of the return to work. Midway through the plan the worker’s condition deteriorated and the worker was referred to the WSIB Back and Neck Speciality Program for further assessment.
The worker decided she was going off work on a leave starting on March 20, 2017 and the Back and Neck Specialty Program provided recommendations for a rehabilitation program and a Concurrent Mood Assessment.
A letter dated July 24, 2017 was issued confirming entitlement in the claim was accepted for a neck strain injury and head concussion. Additional findings outlined in a cervical spine MRI were not accepted as related to the compensable injury. The letter also indicated that recent medical information suggests the worker recovered from the compensable neck strain injury and would be able to return to full hours and duties when school commences in September 2017. Further, the worker was not entitled to any LOE benefits beyond March 20, 2017.
A further letter dated August 11, 2017 advised that while there was no entitlement to a psychological condition, the Concurrent Mood Assessment of May 1, 2017 recommended treatment, which was approved to support the worker’s recovery and return to pre-injury work.
The employer’s representative objected to the extent of LOE and health care benefits. The Case Manager issued a letter of September 19, 2017 confirming the decision to allow LOE benefits up to March 20, 2017 and denied a request to reverse the costs of healthcare benefits related to assessments and treatment at the Back and Neck Speciality Program Rehabilitation. The case was subsequently referred to the Appeals Services Division for consideration of the outlined issues. The employer’s representative requested a hearing in writing to resolve the appeal; therefore, the decision was completed based on the information contained in the claim file.
AUTHORITY
Operational Policy
15-02-03 Pre-existing Conditions
17-01-02 Entitlement to Health Care
18-03-02 Payment and Reviewing LOE Benefits (Prior to Final Review)
ANALYSIS
It is the employer’s position that the medical information on file supports the worker’s ongoing neck impairment beyond December 13, 2016 was due to significant pre-existing issues with the neck and related to work and personal stressors, not to the work incident of September 12, 2016. Consequently, the employer’s representative submits that LOE and health care benefits should have ceased as of December 13, 2016.
I considered the arguments outlined by the employer’s representative and in reaching my conclusion I considered all of the available information in the context of the relevant operational policy and legislation. In this case, I find that LOE benefits were appropriately authorized to March 20, 2017 and the health care costs associated with assessments and resultant treatment were appropriate and accepted as a consequence of the work-related injury. I have outlined the information I find most relevant to the issue.
In this case, I note the Health Professional’s Report (Form 8) with a service date of September 12, 2016 indicated that the worker was diagnosed with a mild degree concussion. It was also noted that the worker had a concussion 30 years prior.
The worker was seen by Dr. Jensen, Neurologist, and a report dated October 3, 2016 indicated that the worker presented with worsening headache and neck pain following a minor trauma and it was possible she had a mild concussion. MRI of the cervical spine was requested and it was noted that she has a background history of chronic neck pain. Reassessment by Dr. Jensen on November 28, 2016 outlined that MRI of the cervical spine on November 22, 2016 demonstrated at C4-C5 a broad-based dorsal osteochondral bar with central canal stenosis and bilateral foraminal stenosis; at C5-C6 there was effacement of the thecal sac and bilateral neuroforaminal narrowing; and at C6-C7 milder changes were noted. While the MRI findings were later determined to be unrelated to the compensable injury, the Neurologist did recommend the worker continue with physiotherapy. It was also noted the worker had left mild carpal tunnel syndrome, for which I make no comment or findings as there was no ruling on the condition. No follow-up was arranged.
The worker was treated through the Musculoskeletal Program of Care (MSKPOC) and I note the Initial Assessment Report of November 2, 2016 confirmed the worker was being treated for a cervical spine strain. The subsequent MSKPOC Care and Outcomes Summary for discharge on December 28, 2016 indicated ongoing difficulties despite increased active range of motion and decreased tenderness of the cervical spine. It is important to note that while there is no dispute that the worker had a history of neck pain and even concussion, this report noted there were no factors delaying recovery or return to work.
Furthermore, I reviewed the prior medical records obtained from the worker’s chiropractor, which outline the worker attended regularly from 2011 to 2016 for various issues. I note that the last visit prior to the work-related accident was on August 3, 2016 and it is noted that the worker was better than usual. Additionally, prior medical records from the worker’s family physician confirm that prior the work-related accident, the worker had been seen on June 9, 2016 and that visit was for an unrelated problem.
Therefore, while the employer’s representative argues that a more timely review of the worker’s prior chart notes and the MRI would have negated ongoing entitlement, I do not concur with this view. While I agree that timely communication is important, with respect to the neck injury, I find compatibility of a neck strain is well within the scope of entitlement and my consideration of the prior medical and the MRI findings does not negate the acceptance of a strain, nor does is support the contention that LOE and health care benefits should have ceased as of December 13, 2016, which will be further discussed.
The worker was assessed at REC on December 20, 2016 and I note the worker reported a 70 to 80 percent improvement in her symptoms since the work-related accident. I note the worker was upfront in reporting she had a few head/neck injury claims in the past, the last being three years prior and she reported her symptoms were mostly resolved from these incidents, with the exception of intermittent neck pain for which she regularly visits a chiropractor. The worker reported that her head injury-related symptoms had subsided and that her neck symptoms were improved, but more problematic than the head injury.
The REC provided a diagnosis of cervical spine strain and the prognosis was that the worker had achieved partial functional recovery and full recovery to her pre-accident level was anticipated over six to eight weeks with implementation of the treatment recommendations. It was recommended that the worker continue with the therapy program for an additional six weeks with a focus on stretching and strengthening exercises for the neck and for posture. The worker was also to continue with a graduated return to full hours with modified duties and in the next six weeks try to progress to minimal or no restrictions.
It is clear based on the REC assessment that the worker was not at what was considered pre-accident level and further recommendations were provided in order for her to progress back to her pre-level of function. As stated in policy 15-02-03 entitled Pre-existing Conditions, the presence of a pre-existing condition does not necessarily mean it is a cause of the worker’s impairment or that the impairment is no longer work-related. When a pre-existing condition is evident, or becomes evident, the work-relatedness of the ongoing impairment must be monitored, which is what occurred in this case.
Following the REC assessment, arrangements were made for the additional recommended treatment and a WTS arranged a meeting with the workplace parties which occurred on January 26, 2017. A return to work plan was developed incorporating a return back to the worker’s pre-injury location (school) with a plan end date of March 17, 2017. Unfortunately, the worker reported a worsening of symptoms in mid-February 2017 and was referred to the Back and Neck Speciality Program for further assessment.
While I acknowledge that the employer’s representative is correct in identifying that the worker was anxious about returning to the pre-injury school, again as indicated in policy 15-02-03 benefits will generally continue as long as the work-related injury/disease continues to significantly contribute to the worker’s impairment. In this case, the Back and Neck Speciality Program comprehensive assessment of March 10, 2017 was very clear in providing an occupational diagnosis of cervical strain with concussion, thus supporting the work-related injury was in fact contributing to the ongoing impairment.
The Back and Neck Speciality Program also outlined the merits of a Concurrent Mood Assessment and recommended that a rehabilitation program should be six to eight weeks in duration, three to five days per week and should focus on postural training and strengthening the deep neck flexors and core cervical strengthening. Massage and acupuncture were also recommended. It was also noted that the worker may benefit from remaining with half days at work; however, the worker indicated she would be going on leave starting March 20, 2017. As noted earlier, at the time, the worker was involved in a return to work at reduced hours and in accordance with policy 18-03-02 entitled Payment and Reviewing LOE Benefits (Prior to Final Review), I find the worker was appropriately entitled to partial LOE benefits up to March 20, 2017.
I note there was a delay in the worker’s treatment as the community clinic was unable to provide the treatment recommended and consequently the treatment was arranged at the Altum Non-surgical Rehabilitation Program commencing April 27, 2017 and treatment was approved to June 22, 2017. An appointment was also arranged for a Concurrent Mood Assessment and the worker was seen on May 1, 2017. The report indicated that the worker was experiencing mood and anxiety symptoms associated with her injury and return to work issues and her symptoms appeared to be at the level of an adjustment disorder and it was recommended the worker be provided with individual psychological treatment to address the mood and anxiety symptoms, pain management, and injury adjustment-related challenges and this would be done best in tandem with the current rehabilitation on site to capitalize on progress attained.
While again, I note the employer’s representative raised concern over prior complaints of stress, the medical information as outlined supports the worker’s mood and anxiety symptoms were directly associated with the work-related injury and in accordance with policy 17-01-02 entitled Entitlement to Health Care, a worker is entitled to such health care as may be necessary, appropriate, and sufficient as a result of the injury. Thus, the need for psychological treatment was a result of the injury and necessary to support the worker’s recovery and assist with return to work.
In conclusion, the authorization of LOE benefits up to March 20, 2017 is appropriate and the health care costs, including those associated with the assessments and treatment at the Back and Neck Speciality Program are justified and attributed to the work-related injury in this case.
CONCLUSION
The issues are concluded as follows:
The approval of loss of earnings benefits up to March 20, 2017 is confirmed.
The decision denying the employer’s request to reverse the costs of healthcare benefits associated with the assessments and treatment at the Back and Neck Speciality Program is confirmed.
The employer’s objection is denied.
DATED March 28, 2018
M. Kimevski
Appeals Resolution Officer
Appeals Services Division