Doctor suggested massage could relieve symptoms of shoulder condition
This instalment of You Make the Call involves an injured worker's request for continued benefit coverage for “maintenance” massage therapy and chiropractic services, and the decision that followed.
The Ontario worker was left with permanent impairment to her right shoulder and neck as a result of a workplace accident in 1995. She received a 6 per cent non-economic loss benefit in 2000, an award that was bumped up to 22 per cent in 2006 for chronic pain disability. She was also receiving benefits for an injury to her lower back under a different claim.
The worker was diagnosed with “early osteoarthritic changes about her right shoulder” as well as cervical dysfunction and “myofascial pain causing her symptoms.” Her doctors recommended on-going chiropractic care and massage therapy to relieve her pain and reduce her intake of pain medication.
In June 2007, the worker was deemed competitively unemployable and granted future economic loss (FEL) benefit until the age of 65. A month later, her maintenance massage treatments were denied and, in 2009, she filed an objection. She was again denied and appealed to the Ontario Workplace Safety and Insurance Appeals Tribunal.
A specialist in sports medicine said the therapies could relieve “trigger points,” while her family physician suggested they could relieve muscle spasms in her neck. Her doctors recommended treatments ranging from therapy twice a week to six weekly 30-minute treatments.
The employer argued the worker was no longer employed, her condition had not deteriorated and the request for massage therapy was not directly related to work activities nor was it the result of a workplace injury.
You Make the Call
Was the worker entitled to compensation for ongoing treatment?
OR
Was the treatment outside the workers’ compensation coverage?
If you said this treatment is outside the workers' compensation coverage, you're right.
There were two central issues in this case: how effective the treatment had been and whether they could make a difference, and worker's status as “competitively unemployable.”
On the first point, the Board's medical consultants argued the research on the effectiveness of massage for improving neck pain and function is “unclear” and questioned the specific nature of the therapy. One consultant noted that massage therapy varies considerably from one therapist to another, so it would be necessary to see a detailed description of how the massage is done and to what specific body areas.
One assessor noted after reviewing the evidence, “I see no indication that chiropractic or physiotherapy treatments have enabled the worker to continue working, reduced her pain or increased her level of functioning.”
The Tribunal cautioned that it was unclear if the doctors recommending massage therapy were not aware of the worker's accompanying degenerative disc problems, nor did they detail how massage therapy would be preferable to self-directed exercises or other rehabilitative measures.
The Tribunal also noted that none of the injured worker's treating physicians could agree on the length or duration of the necessary treatments and concluded that massage therapy would have “no meaningful impact” on the worker's condition. In 15 years, the worker had not had positive results from any therapies, including physiotherapy, chiropractic and cortisone shots, and had deteriorated significantly in chronic pain and functioning.
One the second point, the Tribunal found Board policy isn't well established where a workers is no longer employed or has been deemed competitively unemployable, meaning entitlement must be determined on a case by case basis based on whether it would have a meaningful impact on the worker's condition.
