Workplace Health, Safety & Compensation Review Division

Transcription

1 Workplace Health, Safety & Compensation Review Division WHSCRD Case No: WorkplaceNL No: Decision Number: Keith Barry Review Commissioner The Review Proceedings 1. This review application hearing was held at the Gander Hotel in Gander, NL on March 9, The worker attended the hearing and represented himself. 2. The employer attended the hearing and was represented by Mike Kennedy. 3. WorkplaceNL did not attend or participate in the hearing process. Introduction 4. The worker sustained a compensable injury to his lower back on August 13, 2014 while in the process of loading/offloading heavy baggage. He underwent treatment as directed by his treating health care providers. This treatment included follow-up with his general practitioner and physiotherapy. The worker also attempted early and safe return to work program but he was unable to complete the program. 5. On August 26, 2015 the worker s physiotherapist requested additional treatments be provided for the worker. In a decision later the same day the case manager advised the worker his request for extended coverage had been denied. The case manager believed the worker to be well versed in a home program and saw no need for further clinic based physiotherapy especially if the worker added an active walking program as an additional form of rehabilitation. 6. The worker appealed this decision and in an internal review decision dated October 20, 2015 he was advised the appeal was disallowed. The worker appealed to the Review Division. Issue 7. The worker is requesting a review of the decision of WorkplaceNL dated October 20, 2015 and is asking I find he is entitled to additional clinic based physiotherapy sessions as requested in his treating physiotherapist s August 26, 2015 report. 1

2 Outcome 8. It is my finding WorkplaceNL acted in accordance with the Act and Policies and did not err in its decision dated October 20, 2015 to deny the worker s request for an extension of clinic based physiotherapy treatments. With respect, the review is denied. Legislation and Policy 9. The jurisdiction of the Review Commissioner is outlined in the Workplace Health, Safety and Compensation Act (the Act), Sections 26(1) and (2), 26.1 and Also relevant and considered in this case are Sections 2(1)(r), 60(1), 84(1) and 85(1) of the Act, along with Policy HC-01: Physiotherapy Services Private Clinics, Policy HC-13: Health Care Entitlement, Policy EN-20: Weighing Evidence, Procedures 58.0: Definition of Medical Effectiveness and Procedure : Medical Effectiveness of Treatment/Devices. Relevant Submissions and Positions 11. The worker began his presentation with a brief description of the mechanism of injury to his lower back and the subsequent medical investigation and treatment (i.e. physiotherapy which he began within two weeks from the date of his injury). He noted he participated in a multi-disciplinary EMPOWER team assessment in October 2014 which recommended he continue with his physiotherapy and he participate in a clinic based occupational rehabilitation program which he did for approximately 11 weeks. 12. The worker stated he had a CT scan in the Fall of 2014 which indicated that he had serious issues with his back (i.e. multi-level degenerative disc disease and nerve root compromise at L1, 3, 5 and S1). 13. The worker indicated he began an easeback program on July 21, 2015 and worked until August 5, 2015 when he had a flare-up and was taken off work by his treating physician. The worker noted this was his last day working. 14. The worker expressed his dissatisfaction with how the easeback program was handled, particularly with respect to communication. He noted it was his understanding all parties (i.e. family physician, worker, etc.) had to agree with the plan. He pointed out, however, this was not the case. He indicated he did not receive the plan until July 6, 2015 while he was on a two week vacation, which started on July 5, He indicated he did not actually view the plan until he returned from his vacation on July 18, 2015, advising he was to start his easeback on Monday July 20, 2015 just two days later. The worker noted his family physician advised him that, not only had she not seen the plan, she disagreed with the alternate work being offered by the employer. 15. The worker noted he had not had any physiotherapy treatments since it was discontinued on August 26, He pointed out he tried to walk on his treadmill for approximately 20 2

3 minutes as often as possible. The worker noted he had completed a functional assessment on September 17, He also noted he completed a labour market re-entry assessment on July 9, 2015 wherein the labour market re-entry planner indicated it was predicted, following his discharge from his clinic based occupational rehabilitation program, and he had an eight-hour workday tolerance at a limited degree of strenuousness. 16. The worker referenced an from his employer to his case manager dated August 7, 2015, specifically the following comment: It is obvious that [the worker] does not want to return to work and is trying numerous avenues to avoid it. After going thru the process assigned to him by WHSCC he continues to revert back to his family doctor until he gets the results he is looking for The worker strongly expressed his disagreement with this comment, noting he wanted to return to work. 17. The worker referenced the August 21, 2015 correspondence from the worker s case manager to the employer s representative, specifically the reference to the following comment from the physiotherapist who provided both the clinic based occupational rehabilitation discharge report and the worksite occupational rehabilitation report: The service provider did note however persistent symptoms and difficulty in progressing the worker s functional level would make the probability of returning to full work capacity uncertain. The worker interpreted the physiotherapist s comment to mean he believed there may be challenges to his return to work. 18. The worker also referenced the report from the orthopedic surgeon dated January 13, 2015 who examined him as part of his EMPOWER program, specifically the following comment: However I think he is going to have difficulties in getting back to his job as a attendant with the continuous lifting of heavy objects and getting into awkward positions 19. The employer s representative, Mr. Kennedy, began his presentation with a brief description of the mechanism of the worker s injury noting he believed the worker began his physiotherapy treatment in the first week following his injury. He pointed out the worker had a total of 48 sessions and in each report the worker s physiotherapist indicated the worker demonstrated no functional improvement. Mr. Kennedy noted he remained in constant communication with the worker s case manager throughout the entire process. 20. Mr. Kennedy expressed his frustration in trying to manage the issues related to the worker s injury and resultant absenteeism, specifically with the worker s treating health care providers. He noted the physiotherapist, in each of her reports, indicated she would not clear him to return to work. Mr. Kennedy noted each time he requested she reassess the worker s return to work capabilities, the physiotherapist refused to do so, despite the fact the worker was not demonstrating any functional improvement. He noted he experienced the 3

4 same frustration with the worker s treating physician over the same issue (i.e. failure to clear the worker for return to work). 21. Mr. Kennedy referenced the worksite occupational rehabilitation report from the physiotherapy service provider dated June 23, 2015, specifically the reference to the meeting dated May 26, He noted the purpose of the meeting was to clarify the types of work and scheduling options which could be offered by the employer for the worker. He noted, besides himself, the other attendees were the service provider, the worker, the worker s case manager and the early and safe return to work facilitator. He noted options for a modified work duty assignment were discussed with the worker and agreed to by the worker. He believed this refuted the worker s argument he was not aware of his return to work easeback plan until he opened it after returning from his vacation on July 18, Mr. Kennedy further referenced the worksite occupational rehabilitation report, pointing out it listed the duties which the service provider believed were safe positions for the worker such as a groomer, lead hand, etc. He noted it also contained a number of other duties which were unsafe including his pre-injury duties of baggage loading/offloading and cargo loading. 23. With respect to the worker s claim his treating physician never received a copy of his easeback plan, Mr. Kennedy referenced correspondence in the file dated June 30, 2015 which noted the plan was indeed forwarded to the physician on May 21, He also referenced an dated August 7, 2015 to the worker s case manager wherein he stated, in part: A WSOR plan was developed based on his assessment from [the service provider] with [the service company] on GFW. [The worker] was cleared for ESRTW and as soon as he was advised [the worker] immediately requested 2 weeks of vacation which I granted. He finished his vacation and started his ESRTW on July 20 th. His assigned duties were as per the WSOR... Mr. Kennedy felt this action by the worker helped to support his belief It is obvious that [the worker] does not want to return to work and is trying numerous avenues to avoid it 24. Following Mr. Kennedy s presentation, the worker commented on Mr. Kennedy s reference to the worksite occupational report, specifically the reference to the May 26, 2015 meeting with all parties to discuss his return to work easeback plan. He noted after being informed of the particulars of the plan, he was hesitant about his ability to perform the modified duties as they were presented. He noted he didn t want to have a set back. The worker expressed his belief he would have been more suited to returning to work as a lead hand which included the already suggested modified duties (i.e. cleaning/grooming duties) along with being responsible for clerical type work such as completing daily paperwork for work performed by their shifts. 25. WorkplaceNL s position was contained in the internal review decision dated October 20, The internal review specialist began his decision by referencing the worker s request for review which was submitted on his behalf by the Office of the Workers Advisor. The internal review specialist noted the Workers Advisor pointed out that it was the worker s position he still required ongoing clinic based physiotherapy for his work injury. The 4

5 internal review specialist also referenced specific sections of the Act and Policy which he felt were relevant to the worker s claim. 26. The internal review specialist reviewed the medical evidence on file beginning with the final report from the EMPOWER multi-disciplinary team assessment which provided a diagnosis of right sided L3-4 disc protrusion, Degenerative Disc Disease (DDD), and osteoarthritis of the hip. He noted the team had suggested physiotherapy of eight to ten sessions and if the worker had plateaued, then he should progress to clinic based occupational rehabilitation. The internal review specialist also referenced the report from the worker s orthopedic surgeon who indicated surgical intervention was being contemplated but the worker did not wish to proceed in that manner. 27. The internal review specialist referenced a physiotherapy report dated January 22, 2015 which indicated the worker had availed of 31 treatments. The report noted the worker s subjective reporting to be difficulty walking, interrupted sleep and radiating pain. He noted the therapist indicated mild improvement in walking and sleep issues and significant improvement with radiating pain. Objectively, the therapist indicated no change in the worker s hypertonicity or hypomobility. The range of motion finding showed mild improvement, as well as straight leg raise. Functional limitations included no lifting, no bending/twisting, avoid kneeling, ramps/ladders and frequent changes when sitting. No return to work was indicated. 28. The internal review specialist noted the worker restarted his physiotherapy on the basis of his orthopedic surgeon s report dated January 13, The decision referenced a physiotherapist report dated March 11, 2015 which noted mild improvement in all subjective reporting and objective findings with the exception of the worker s straight leg raise issues. The therapist continued to indicate the worker should not lift, bend or twist and that the worker had attended 11 additional sessions since restarting same. 29. The internal review specialist referenced the worker s discharge report from his clinic based occupational rehabilitation program dated June 12, 2015 recommending a return to work. However, the report cautioned there were subjective/perceptual barriers indicated. The report noted there were concerns with regard to the worker s perception in transitioning from clinic based occupational rehabilitation to worksite occupational rehabilitation, which was eventually attempted. 30. The internal review specialist referenced the final two reports from the worker s physiotherapist which he summarized, as follows: On August 6, 2015 the treating therapist requested additional treatment. In this report it is noted that as a result of return to work you were now experiencing difficulty with standing and sitting. Objectively, along with the previously identified issues it is now noted you had abnormal reflexes. The therapist indicated your functional limitations continued to be no lifting, no bending/twisting, and to avoid static postures. It was not recommended you consider return to work until approximately five treatments were provided to settle the flare up. 5

6 The final report from physiotherapy for consideration is the August 26, 2015 request. In this the therapist noted you had attended five treatments and that there was moderate improvement regarding your pain level. There was no change indicated in the radicular symptoms you were reporting or your sitting issues. Mild improvement had been noted with standing tolerance. Reviewing the information regarding your objective findings, it is noted there was only mild change seen in hypertonicity and hypomobility. No change was seen in your range of motion findings or your reflexes. Your straight leg raise testing was noted to be With regard to functional tolerances there was no change reported. No defined return to work is being considered. 31. The internal review specialist noted the case manager had indicated she had a team review with all relevant parties to determine direction for return to work, treatment, etc. The case manager indicated, as a result of this review, it was felt the worker should be well versed in a home program and to engage in walking as a form of rehabilitation. Accordingly, no further physiotherapy would be approved. 32. The internal review specialist acknowledged, in reviewing the worker s case, it was clear certain activities would cause flare-ups and it would be appropriate to indicate these types of activities should be avoided. The internal review specialist noted, at the present time, the worker was not involved in a return to work program which could possibly be supported by an ongoing program, as per policy. The internal review specialist noted further options were being explored with respect to return to work (i.e. labour market re-entry assessment) and should the worker actually return to work and experience difficulties his physiotherapist can bring further requests back to WorkplaceNL for approval. However, as the situation currently stood, the worker s appeal was denied. Analysis 33. I find, after listening to the worker s presentation, his primary arguments were: The return to work easeback plan was incorrectly set up in that neither the worker nor his treating physician had an opportunity to view the plan beforehand. Both of the worker s treating health care providers (i.e. family physician and physiotherapist) had recommended he continue with his clinic based physiotherapy treatments. 34. I find, after listening to Mr. Kennedy s argument, and reading the October, 2015 internal review decision of WorkplaceNL, they agreed that the denial of the physiotherapist s request for an extension of the worker s clinic based physiotherapy treatments lay in the fact, after approximately 50 treatments, there was no overall sustained evidence of functional improvement. As such, they submitted WorkplaceNL s decision was made in accordance with the Act and related Policies. 35. I note, during the presentations of both the worker and Mr. Kennedy, a great deal of time was devoted to the circumstances related to the return to work easeback plan. Specifically, 6

7 the worker believed the easeback plan was set up incorrectly in that neither he nor his physician had an opportunity to review the plan. However, while I find this to be a related issue, it is not the issue under review. The issue I am being asked to review is whether or not WorkplaceNL s decision to deny the worker s physiotherapist s request for additional clinic based treatments was correctly made in accordance with the Act and related policies. The possibility of the worker returning to work is one of the factors WorkplaceNL does consider in assessing the medical effectiveness of treatments as per Policy HC-13: Health Care Entitlement. 36. The relevant sections of the legislation which address the issue of medical aid are as follows: Section 2(1) of the Act states, in part: In this Act (r) medical aid means medical, surgical and dental aid, hospital and skilled nursing services and a prosthesis or apparatus and the repairing and replacement of them, transportation and other matters and things that the commission may authorize or provide; Section 84(1) of the Act states: The commission shall provide a worker who is entitled to compensation under this Act or who would have been entitled had he or she been disabled longer than the day of the injury with the medical aid that in the opinion of the commission may be necessary as a result of the injury. Section 85(1) of the Act states: The supervision and control of medical aid and questions as to the necessity, character and sufficiency of medical aid which is provided shall be determined by the commission. 37. I note, as was pointed out by the internal review specialist, Sections 2(1) and 84(1) are permissive and not mandatory in that they allow WorkplaceNL discretion when providing medical aid. However, Section 85(1) is mandatory in that it places a legal obligation on WorkplaceNL to supervise and control medical aid. These provisions clearly establish WorkplaceNL s right to manage issues related to medical aid, such as clinic based physiotherapy, as, in their opinion, they consider necessary. 38. As I have already noted, the primary focus of the worker s presentation was with the return to work easeback plan developed by the physiotherapist who coordinated the worker s clinic based occupational rehabilitation program. Specifically, the worker expressed his opinion the easeback program was incorrectly set up in that neither he nor his treating physician had an opportunity to view the plan prior to its implementation and provide feedback. 39. However, I note the service provider, in his report dated June 23, 2015 referenced a meeting which took place with the worker in an attempt to clarify the types of work and scheduling 7

8 options that could be offered by the employer to assist him in his return to work on modified duties. I note, in attendance besides the worker and the service provider, was Mr. Kennedy, the worker s case manager and the early and safe return to work facilitator. The service provider noted over the course of the meeting, options for a modified work duty assignment were discussed along with scheduling arrangements. 40. What is now known is that the worker was rescheduled for modified duties and he was cleared to perform the duties described in the WSOR report. The worker did attempt the modified duties, as was expected of him under Section 89 of the Act, however. 41. The early and safe return to work plan did not succeed, and the worker has not worked for the injury employer since August of Following this, WorkplaceNL commenced the labour market re-entry process, as contemplated by Section 89.2 of the Act. That also is not the issue before me, but the fact that the early and safe return to work program failed does have some relevance to the medical aid question in this case. 42. With respect to the recommendations by the worker s treating health care providers that the worker continue with his physiotherapy treatments, I note the worker s treating physician had consistently recommended the worker s treatments be physiotherapy and rest. The physician had been consistently making this recommendation both before and after the worker s clinic based treatments were discontinued. This is a blanket recommendation for physiotherapy without any indication to whether gains could be achieved through a home program, which forms the basis of WorkplaceNL s decision. 43. As for the treating physiotherapist s request the worker continue to receive ongoing clinic based physiotherapy treatments, I note the physiotherapist has more often than not made similar requests on the majority of her reports. I also note, after reviewing the findings provided by the physiotherapist, I could find little indication of any lasting significant improvement in the worker s functional limitations, despite having received approximately 50 treatments of clinic based physiotherapy since his injury. It seems to have been useful for treating flare-ups, but has not produced much in the way of a greater overall improvement in the worker s condition. In addition the physiotherapist continued to recommend the worker remain off work yet indicated she would not be reassessing the worker s return to work capability on all of her reports. This makes it difficult for WorkplaceNL to assess why the worker needs the physiotherapy in the first place, and which objective of medical effectiveness the treatments will advance. 44. I note the worker, during his presentation, indicated he has not returned to the workforce since August, 2015 despite having had approximately 50 treatments of clinic based physiotherapy supplemented by 11 weeks of clinic based occupational rehabilitation. I find it apparent the medical treatments provided to the worker to date, particularly the clinic based physiotherapy, have not been demonstrated to be medically effective. 45. I find the opinions of the worker s treating health care providers to be significant and must be taken seriously, particularly on questions of clinical history. However, WorkplaceNL is not expected to simply accede to treating providers when managing a medical aid claim. Under the model in the Act, WorkplaceNL directs and manages the medical aid claim, including the ability to determine whether the requested treatment is necessary. WorkplaceNL is allowed to determine the necessity, character, and sufficiency of medical 8

9 aid. WorkplaceNL is also entitled to determine whether the treatments, specifically the clinic based physiotherapy in this case, are justified. Whether it is justified depends on balancing the likely effectiveness, versus costs, in the context of certain objectives. 46. I find, from both a functional and cost perspective, continued approval of clinic based physiotherapy treatments without any improvement in function or any willingness by the treating physiotherapist to reassess the worker s return to work capability is not justified, I find the Act, specifically Section 85(1) places a legal obligation on WorkplaceNL to control and supervise medical aid and obligates them to assess how the physiotherapy, if required, is administered (i.e. clinic based versus home exercise). 47. This is identified in WorkplaceNL s general policy on medical aid, which is Policy HC-13: Health Care Entitlement. In determining whether the requested medial aid or health care is appropriate, WorkplaceNL considers the following; Determining Appropriate Health Care When determining what constitutes appropriate health care, WorkplaceNL will consider: i. The recommendation of the treating health care provider; and, ii. The intended benefit of the treatment, service or device in relation to the compensable injury. Where the intended benefit of the treatment, service or device is unclear, WorkplaceNL may then consider, in consultation with the treating health care provider: i. Current scientific evidence with respect to the demonstrated effectiveness of the treatment, service or device; ii. iii. The opinion of the appropriate WorkplaceNL Health Care Consultant(s); and The professional accreditation of the licensed health care provider. 48. However, as I have already noted WorkplaceNL is also allowed to weigh the cost of the treatments against the potential benefit of the treatment. The policy has a specific provision which states: WorkplaceNL will pay for treatments, devices and accessories prescribed by licensed health care providers, as long as the treatment, device or accessory, in the opinion of WorkplaceNL: a. will improve or maintain the worker's functional abilities; b. will improve the likelihood of early and safe return to work; 9

10 c. will minimize the risk of further injury or aggravation of the original injury; or, d. will reduce the severity of symptoms where the work injury has a significant impact on the activities of daily living. If WorkplaceNL accepts that the treatments will have, in its opinion, one of the desired effects in the Policy, this would weigh in favour of WorkplaceNL exercising its discretion in favour of the worker. 49. When weighing evidence on the balance of probabilities, the assignment of weight is influenced by the authority of the evidence, its basis, its origin, etc. In this particular case the worker s physiotherapist has requested, in her August 26, 2015 report, an additional eight treatments at a frequency of two per week as he is not ready for any ESRTW yet. This I find may be possible. However mere possibility is not the test for further clinic based physiotherapy entitlement. The balance of probabilities (i.e. more likely than not ) is the test, as noted in Section 60(1) of the Act. 50. I note the issue of clinic based physiotherapy services is also addressed in Policy HC-01: Physiotherapy Services Private Clinics. I note the relevant sections of this policy are Sections 2.3 and 2.4 which state: Treatment Authorization and Duration 2.3 Physiotherapy continuation requests beyond 12 treatments must be made in writing to Compensation Services using the appropriate form. 2.4 Physiotherapy continuation requests beyond 12 treatments will only be considered where evidence from outcome measures data indicates that functional improvement has occurred and further functional improvement is likely, and the continued treatment will result in the worker remaining in or returning to the workforce. All requests for extensions require approval from Compensation Services. (emphasis mine) I note one of the key points contained in Section 2.4 is the requirement there is an indication from outcome measures data that functional improvement has occurred and further functional improvement is likely. 51. As I have already pointed out, after approximately 50 treatments of clinic based physiotherapy, I could find no evidence to indicate that the worker s symptomology had resolved. In addition, I could find no indication of any significant change in his functional limitation. With respect to the Form 8/10 reports from the worker s treating physician, I note in none of the reports did the physician provide any updated status for subjective reporting or objective findings. 52. However, I note in her August 26, 2015 decision to deny the physiotherapy s request for the additional eight treatments the worker s case manager noted she had coordinated a team review to assess the worker s medical, investigations and rehabilitation to date. With 10

11 respect to the specific request for an extension to the worker s clinic based physiotherapy treatments the case manager, in a claim note dated August 14, 2015, stated, in part: The worker has recently commenced physiotherapy once more, reviewed this with OT Consultant and Medical Consultant. At this time, the worker should be well versed in home program and to engage in walking as a form of rehab as well. No further physio will be approved. 53. I find it significant that the decision to discontinue support for further clinic based physiotherapy was made prior to receiving the physiotherapist s August 26, 2015 request for approval of an additional month of treatment (i.e. eight treatments at a frequency of two per week). I also find it significant that at no time in the worker s presentation nor in the file did the worker make the argument that he required the extension to his clinic based physiotherapy treatments because he believed they were necessary for him to return to work or to maintain medical effectiveness. I note the worker is currently not working and has not done so since August However, I note, in the August 14, 2015 claim note referenced above, the case manager stated If the employer is unable to make a permanent accommodation, will refer to labour market re-entry for follow up assessment. From my review of the file it appears the labour market re-entry process had already been completed in July 2015 and three alternate employment options had been identified. 54. With respect to medical effectiveness I note this is also addressed in Procedure 58: Definition of Medical Effectiveness and Procedure : Medical Effectiveness of Treatment/Devices which states, in part: Definition of Medical Effectiveness WorkplaceNL defines medical effectiveness as treatments, services, devices, equipment, or accessories prescribed by licensed health care providers, which: i) improve or maintain the worker s functional abilities; or, ii) improve the likelihood of early and safe return to work; or, iii) minimize the risk of further injury or aggravation of the original injury; or, iv) reduce the severity of symptoms where the work injury has a significant impact on the activities of daily living. The decision maker will consider the medical necessity of the prescribed treatment or device. Coverage will be provided where the treatment or device meets the definition of medical effectiveness in section 58.0 unless a reasonable, non-prescription alternative exists. (emphasis mine) 55. I note the worker, in his presentation, indicated he has not received any physiotherapy treatments since the approval of his clinic based treatments had been discontinued in August I note, however, WorkplaceNL is not suggesting he discontinue doing physiotherapy 11

12 but are only suggesting that it is no longer necessary to do his physiotherapy exercises in a clinic based sitting. At the time of its decision, WorkplaceNL could no longer identify an objective that the clinic-based treatments would be effective in addressing. 56. Procedure states, in part, that Coverage will be provided where the treatment/device meets the definition of medical effectiveness in Section 58.0 unless a reasonable, nonprescription alternative exists I find the alternative suggested by the case manager in her August 26, 2015 decision (i.e. home program/walking) constitutes a reasonable, nonprescription alternative which appears practical and cost effective. WorkplaceNL s conclusion was based on the evidence following a coordinated status review of the claim. As I have noted earlier, WorkplaceNL is not under an obligation to accede to a blanket recommendation from a treating provider without some insight into what recognized objective the treatment would provide. Symptom relief alone is usually not one of those objectives. WorkplaceNL concluded, in the absence of sustained improvement, the recommended treatment was not providing a benefit that home exercises would not. That was the basis of the conclusion and it was not contradicted. 57. Section 85(1) permits WorkplaceNL to supervise and control medical aid, on a case by case basis, as the circumstances arise. That is what the Act intends. WorkplaceNL, in making medical aid decisions, must explore all of the evidence with respect to the type of medical aid being requested. This would include in this particular case ensuring the cost of the physiotherapy treatments are not only justified but are being administered in the most efficient and effective manner. After reviewing all of the evidence, I could find no evidence to demonstrate what exactly additional clinic based physiotherapy treatments would accomplish more than what the worker could accomplish doing the exercises at home. There is a recommendation that they continue, but no rebuttal of the opinion that home exercises would not also be effective at this point. 58. Accordingly, I find WorkplaceNL s decision to deny the worker s request for an extension of clinic based physiotherapy treatments to be in accordance with Sections 84(1) and 85(1) of the Act, along with Policy HC-01: Physiotherapy Services Private Clinics and Policy HC- 13: Health Care Entitlement. WorkplaceNL has management authority over medical aid claims under the Act. Policy HC-01: Physiotherapy Services Private Clinics specifically establishes the parameters with respect to requests for extensions of clinic based physiotherapy treatments. While the worker or his provider may consider the clinical therapy to be desirable, WorkplaceNL has found that they are not necessary, which is the issue. As noted in the decision, this can always be assessed at some point in the future should there be evidence demonstrating why the clinical variety of treatment is necessary and effective in advancing one of the objectives in Policy HC-13: Health Care Entitlement and/or Procedure

13 Decision 59. It is my finding WorkplaceNL acted in accordance with the Act and Policies and did not err in its decision dated October 20, 2015 to deny the worker s request for an extension of clinic based physiotherapy treatments. With respect, the review is denied. Review Denied Keith Barry Review Commissioner May 24, 2016 Date /dho 13