Non-standard medical aid treatment decision

Bone Growth Stimulators are recommended for the treatment of fractures.

The safety and effectiveness of these devices has not been established for:

• patients lacking skeletal maturitySkeletal maturity refers to the state at which a person's bones have fully developed and reached their adult form.,
• pregnant or nursing women,
• patients with cardiac pacemakers,
• for fractures secondary to bone cancer; or
• for patients with poor blood circulation or clotting problems.

If a worker has any of these conditions, a medical consultant review is required. 

The use of an ultrasonic or electrical bone growth stimulator may be approved without a WCB medical consultant review, if the condition being treated has been accepted under the claim, the device has been recommended by an orthopedic or plastic surgeon as an adjunct to conservative or surgical management, and one of the following is present:  

• Documented radiologic evidence of delayed union or non-union of a fracture affecting the scaphoidScapyhoid bone is one of the bones in the wrist and is located on the thumb side of the wrist., neck of talusTalus is the ankle bone., 5th metatarsalMetatarsal refers to a group of five long bones in the foot, located between the ankle bone and the toes. or any long bone (i.e. femurFemur refers to the thigh bone., tibiaThe tibia is commonly known as the shinbone., fibulaThe fibula is the smaller of the two bones in the lower leg, the other is the tibia., metatarsal, humerusThe humerus is the long bone in the upper arm, extending from the shoulder to the elbow., radiusThe radius is one of the two bones in the forearm, the other being the ulna. It is located on the thumb side of the forearm and extends from the elbow to the wrist., ulnaThe ulna is the longer of the two bones in the forearm, the other being the radius. It is located on the side opposite the thumb and extends from the elbow to the wrist. , metacarpal, phalanxA phalanx (plural: phalanges) refers to the bones in the fingers and toes.), OR
• A history of previous delayed union or non-union, or
• An acute scaphoid, neck of talus or 5th metatarsal fracture in a worker where the combination of comorbiditiesComorbidities refer to the presence of one or more additional medical conditions coexisting with a primary condition. These conditions can affect your overall health, treatment options, and prognosis. increase the risk for non-union.  Comorbidities may include:
  • chronic diseases such as diabetes, osteoporosis, obesity, malnutrition.
  • certain medications such as NSAIDS (non-steroidal anti-inflammatory medications), glucocorticoidsGlucocorticoids are a class of steroid hormones that are very effective at reducing inflammation and suppressing the immune system., chemotherapy agents, anti-coagulantsAnti-coagulants are commonly known as blood thinners..
  • environmental factors (e.g., cigarette smoking and/or excessive alcohol use).
• An acute closed or grade I open tibial shaft fracture treated with conservative management, or
• Failed arthrodesis of the upper or lower limbs where there is documented radiologic evidence to confirm the absence of progression of healing for 3 or more months despite appropriate care.

For all other conditions, refer the recommendation for a bone growth stimulator to a WCB medical consultant for review.

Document the decision to approve or not approve a bone growth stimulator. The Medical Aid team will refer to this file note when determining entitlement to payment.

Recommendations for Botox injections are reviewed on a case-by-case basis and require a medical consultant review. 

Concurrent care is when a worker wishes to receive:

• Both physiotherapy and chiropractic treatment for the same body part/injury at the same time, or
• Physiotherapy or chiropractic treatment at one clinic and acupuncture treatment at another facility.  

Concurrent physical therapy and chiropractic treatments for work-related injuries involving the same body part may be appropriate in some cases.

Refer the 4-2 Community treatments procedure when a request for concurrent physical therapy and chiropractor treatments is received. 

Decompression therapy commonly known as DRS or VAX-D is considered experimental treatment and is not covered by the WCB. The decision maker can deny the treatment without a medical consultant review. 

Recommendations for Extracorporeal shockwave therapy (ESWT) are reviewed on a case-by-case basis and require a medical consultant review. 

Topical formulations may be approved at the decision maker's discretion for the treatment of pain. All other formulations of Ketamine require a medical consultant review. Refer to the 4-7 Opioid Management procedure to determine authorization for other formulations of Ketamine (besides topical) and the Electronic Workplace/Business Tools/Opioid and Cannabis Claim Management/Opioid Info/Special Drugs.

Laser therapy, also called cold laser therapy or low-level laser therapy (LLLT) is considered an experimental treatment and is not covered by WCB. The decision maker can deny the treatment without a medical consultant review. 

Massage therapists do not have a regulatory licensing body or governing legislation in the province of Alberta and are not covered under the Health Professions Act; therefore, massage therapy is not covered by the WCB.

Massage therapy may be used as part of the physiotherapy treatment by a licensed physiotherapist or part of an interdisciplinary treatment program (usually pain management) as physiotherapy is regulated under the Health Professions Act. If massage therapy is provided as a part of a physiotherapy program, the cost of the massage is covered in the active physiotherapy fee. No provision is given for extra billing. For massage therapy provided by a licensed physiotherapist, refer to the 4-2 Community treatments procedure.

The College of Naturopathic Doctors is regulated under the Health Professions Act in Alberta. WCB will consider a naturopath's opinion as one piece of evidence when making entitlement decisions; however, this evidence must be evaluated and weighed in relation to all the available medical evidence. When the only evidence is reporting from a naturopath, consider arranging a medical assessment to confirm the diagnosis. 

Recommendations for naturopathic treatment must be reviewed by a medical consultant to determine if the treatment is indicated for the worker's compensable injury and must meet the criteria for non-standard medical aid.

In situations where the worker is treated by a chiropractor who is also a naturopath, the treatment must adhere to Policy 04-06 and the treatment must be of a chiropractic nature. For chiropractic treatment, refer to the 4-2 Community treatments procedure.

The WCB will not pay for generic Oxycontin prescriptions. Pharmacies cannot direct bill for WCB for these medications and workers who purchase Oxycontin are not reimbursed for the prescription costs.

WCB will continue to authorize payments and reimburse costs for OxyNEO (when authorized under the Opioid policy). Refer to Policy 04-06, Part II, Application 4 - Prescribed Opioid Analgesics (Narcotics) and the 4-7 Opioid management procedure.

PRP is a fraction of whole blood containing concentrated growth factors and proteins derived from the patient's own blood. Recommendations for PRP therapy are reviewed on a case-by-case basis and require a medical consultant review.

Pool therapy or aqua therapy is not covered under the Health Disciplines Act as a healing art in the province of Alberta. However, it may be provided as part of a larger therapy program like a rehabilitation program offered at a treatment centre (e.g., Millard Health) that is supervised by the treatment provider.

Pool therapy may also be recommended as part of a specialized physiotherapy program and approval must be obtained from the decision maker.  Refer to the 4-2 Community treatments procedure for additional information on specialized physiotherapy.

For information related to supervised fitness club and swim passes for severely injured workers, refer to the 4-6 Special services and equipment procedure. 

Prolotherapy is also known as proliferation therapy, regenerative injection therapy, or proliferative injection therapy.

Prolotherapy recommended for chronic back pain is not covered by WCB and the decision maker can deny the treatment without a medical consultant review. Prolotherapy for other conditions (tendinopathy, fasciopathy etc.) requires a medical consultant review.

A treating psychologist may recommend a number of services or items to help a worker recover from a psychological injury. Common recommendations not normally covered by WCB include:

• Acupuncture
• Equine therapy
• Float Therapy
• Gaming or virtual (VR) headsets (for independent use outside of formal counselling).
• Gym memberships or passes, swim passes
• Massage therapy
• Mental health medical applications (i.e. Apps such as Calm, Headspace, I Am)
• Yoga
• Vagus nerve stimulator

The above treatment or service is not approved when there are other conventional treatments available that have not been tried. 

Before determining coverage for a treatment or service not normally approved:

• A written submission that presents a case for the service or item must be received from the treating physician or psychologist,
• specific criteria outlined in Policy 04-06, Part II, Application 1, Question 11 must be met, and
• a review by a WCB psychological consultant must be completed.

The TENS program was cancelled for new clients on July 1, 2007. For workers who were approved for coverage of a WCB-provided TENS machine on or before June 30, 2007, the WCB pays for their TENS supplies, as needed.

For continued coverage for supplies and reviews for existing clients using TENS, refer to 4-6 Special services and equipment procedure.

Vision therapy is an umbrella term for a variety of treatments based around eye exercises. Recommendations for vision therapy should be reviewed on a case-by-case basis by an ophthalmology medical consultant.