Have you ever been told that once you reach Maximum Medical Recovery (MMR), the WSIB will no longer fund your treatment? I can’t tell you how many times we hear this from injured workers who contact our office for assistance, and it’s simply not true.
MMR means your medical condition is stable, and unlikely to improve significantly with additional treatment. In other words, your recovery has hit a plateau. However, it is sometimes necessary to continue with treatment to keep your condition stable, and that treatment is commonly referred to as “maintenance treatment”.
The WSIB has an Administrative Practice Document entitled Maintenance Treatment that sets out the criteria for entitlement. You can find it here.
The WSIB may approve maintenance treatment if it meets certain objectives, like helping the worker stay employed, reducing pain or medication use, maintaining function, or teaching the worker to manage their condition independently.
When deciding on a request for maintenance treatment, WSIB looks at factors like:
- Whether the treatment is supported by specific medical evidence
- If it helps the worker stay in a suitable job within their physical limits
- Whether the worker has tried home exercises to manage symptoms
- If past attempts to stop treatment led to worsened function or job status
- If it might help reduce pain or medication use
- Whether it teaches self-management techniques or has prevented symptom worsening
While the practice document was written with physical injuries in mind, it also applies to psychological injuries.
In a recent case we brought before the Workplace Safety and Insurance Appeals Tribunal (WSIAT), the Vice-Chair approved maintenance treatment for an injured worker who not only had permanent physical injuries, but a permanent psychological injury as well. In this case, maintenance treatment was allowed because it had a positive impact on the worker’s ability to maintain employment and develop skills to allow them to be more independent in their personal and professional life. You can read the decision here.