Injured Inverness woman at end of financial rope
-by Rankin MacDonald
Stephanie MacNeil shows her injured knee.
For Stephanie MacNeil of Inverness life changed for the worse seven years ago.
Stephanie worked at the Inverness Consolidated Memorial Hospital for 15 years, and one day seven years ago she was hanging curtains when the ladder slipped and she fell, tearing all the ligaments in one of her knees.
She was off work for six months at which time she received Workers Compensation while taking physio in Port Hawkesbury.
After the six months it was determined that she was well enough to go back to work.
Soon after returning the pain came back, and to help her the hospital assigned her to work in the kitchen.
But the pain got worse and she began to receive cortisone shots.
She suffered through the pain until the cortisone shots were no longer helping, so she was referred by her doctor to a joint specialist.
The specialist recommended a knee replacement.
She felt that at last she was going to get rid of the pain and be back to “as normal” as she could be after her injury.
On May 9th she took a leave from work to have her surgery, but the surgery was cancelled twice and wasn’t done until June 13th.
She applied for the same claim at Workers Compensation because her EI would only last 15 weeks.
On June 15th she began physio, and all her papers were sent to Workers Compensation from her doctors, and Workers Compensation paid for the surgery.
On EI she was getting $1,310 a month of which $400 had to go to keep up her benefits on the hospital program, so things were pretty tight financially.
She was soon in overdraft at her bank.
On August 20th her EI ran out and there was still no word from Workers Compensation.
Her daughter was home from university for the summer and helped out, but she had to return to school and pay her own bills.
Workers Compensation called and told her she wasn’t eligible for benefits.
Last week needing oil and groceries and to pay other bills she had to resort to welfare.
There was no letter from Workers Compensation telling her she was refused, so she wasn’t able to appeal.
She was told that Workers Compensation opened a new claim on her, and that is why it was denied.
She maintains that she applied under the original claim.
With no money she doesn’t know what she will do, and as she said, her nerves are shot.
Stephanie needs more physio for her knee and her hip, which has gone out of line because of the knee, and to do that, to travel, to eat, to survive she needs the help she expected from Workers Compensation.
She said she can’t seem to get an ear at Workers Compensation and points out that the case should have been judged on the original claim number.
“The injury happened at my workplace,” she said. “How much clearer can it be?”
Stephanie said things are going well with her knee, but she can’t work just yet.
She pointed out that the hospital and the doctors all forwarded information pointed to the original claim, but there is still no help from Workers Compensation.
“I need a decision from Workers Compensation so I can deal with it or appeal,” she said.
She feels she is being treated badly after working hard all her life and now is in terrible financial shape as well as emotionally drained.
She just needs help from someone to move her life forward.
Facts surrounding this case:
Ms. MacNeil contacted WCB in April, 2013 to inform of pending surgery time off work. WCB assigned a new claim number as a result of the April, 2012 exacerbation and asked the employer for the accident report.
Ms. MacNeil continued working until May 10th, 2013, the scheduled date of surgery. This surgery date was cancelled several times by the surgeon due to issues not related to Ms. MacNeil. She remained off work.
April 29th, 2013 the employer contacted WCB and informed WCB this was not a new injury but related to the 2007 injury and the new claim should be merged with the 2007 claim number. WCB merged the claim without further investigation and without contacting Ms. MacNeil for her opinion/input, nor were the treating physicians contacted.
Surgery was performed on June 13th, 2013. Dr. Dodd diagnosed the condition as “post-traumatic osteoarthritis.” The only traumatic injury to the knee was the 2007 workplace injury.
WCB has yet to render a written, appealable decision on entitlement to benefits – Ms. MacNeil has been off work since May 9th, 2013, had surgery on June 13th, 2013 and has been receiving physiotherapy treatment as post-op rehabilitation. The position of the WCB case manager and board medical adviser is there is no ongoing medical evidence to connect the 2012 and 2013 knee symptoms and surgery to the 2007 workplace injury.
The Workers’ Compensation Act is clear: Section 10(4) states an injury is presumed to be related to employment as long as there is a causal connection between the symptomology and the employment activities. In this case the causal connection is clear:
– Medical evidence supports the arthritis that existed before the January, 2007 workplace injury was asymptomatic – that is, it did not require ongoing medical treatment and did not cause Ms. MacNeil to miss time from work. But for the workplace injury, the symptoms would have remained asymptomatic.
– Ms. MacNeil states the symptoms were ongoing since the 2007 injury. Dr. Dodd, the orthopaedic surgeon, stated the osteoarthtitis is post traumatic and is the reason Ms. MacNeil required surgery. The only traumatic injury to the knee was the 2007 workplace injury.
– As the causal connection is met, pursuant to section 10(4) it is legally presumed the requirement for a total knee replacement is due to the 2007 workplace injury unless the WCB and/or the employer provides evidence to prove the contrary. The burden of proof is on a more likely than not basis.
– The WCB has not provided any evidence to identify another cause for the surgery. The employer actually related the 2013 symptoms to the 2007 injury by informing the WCB this was not a new injury but due to the 2007 injury.
– Although not meeting their legal duty to prove the contrary, the WCB has not approved the claim and appears to be focused on denial.
– WCB requires Ms. MacNeil to provide medical evidence her symptoms were ongoing since her return to work in February, 2007 in order to show the need for surgery is related to the 2007 injury.
– WCB merged the new claim number in May, 2013 with the old 2007 claim number based only upon a telephone call from an employer representative stating this is not a new injury, was related to the 2007 claim.
– Injured worker clients of WCB face this every day according to Mary Lloyd of Pictou County Injured Workers. She said the WCB is not a neutral third party administrator of the system (as is legislated by the Workers’ Compensation Act) but is an organization that is focused on the disentitlement of benefits and services to injured workers regardless of the Act, regulations, board policies or the facts. The claim should be approved!
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