- Asthma
- Health care (medical aid) (drugs)
The worker was awarded a 53% non-economic loss (NEL) benefit for his respiratory impairments, neurological impairment (meningitis) and immunological impairment. The issue to be determined in this appeal was whether the worker had entitlement to coverage for the medication benralizumab.
The appeal was allowed. The medication benralizumab was demonstrated to be necessary, appropriate and sufficient for the treatment of the worker's complex work-related lung and airways conditions and syndromes. The Vice-Chair noted that the worker's treating practitioner had continued to recommend the benralizumab on an ongoing basis. This was evidence that the specialist was of the view that the drug helped the worker maintain respiratory function. It was stated that the worker "noticed a definite improvement in his symptoms in the first several weeks after the Fasenra injection." The worker continued to report ongoing benefit.The worker's representative argued that the worker's diagnoses of asthma and eosinophilic lung disease were part of his overall entitlement for his work-related lung and respiratory conditions. The Vice-Chair agreed with this submission. The worker had entitlement for all of his lung conditions, including eosinophilic lung disease and asthma. The medical reporting indicated that the worker's syndromes describe symptom clusters. The worker's eosinophilic lung disease was an included condition, as part of the overall work-related RUDS/RADS and asthma. An article provided indicates that RADS and IAA are closely related. It explains that: "Irritant-induced asthma (IAA) is a general (umbrella) term to describe an asthma-like syndrome that results from a single or multiple high dose exposures to irritant products."The Vice-Chair found that the benralizumab for eosinophilic asthma was not prescribed in isolation. Rather, it was prescribed as part of a broader drug regimen to treat the worker's cluster of lung and airways conditions in order to maintain function. The medical reporting overwhelmingly indicated that the worker had multiple lung airways conditions that were both overlapping and interactive. The worker's respiratory conditions were being treated as a whole, and in doing so, the worker's treating practitioner had determined that benralizumab was on the whole beneficial for the worker's lung and airways conditions. The Vice-Chair applied greater weight to the evidence of the worker's two treating specialists, as they were involved in the worker's care on an ongoing basis.