New Brunswick's Court of Appeal has told the province's workers' compensation commission to implement a worker's successful medication-funding ruling by considering her opioid prescriptions together, rather than treating the decision as confined to one form of medication.
In Knox v. Workplace Health, Safety and Compensation Commission, 2026 NBCA 102, released September 10, 2026, the court upheld the Workers' Compensation Appeals Tribunal's decision and formally dismissed Sanda Knox's appeal. But it supplemented the tribunal's reasons and sent implementation back to the commission to the extent that prescribed opioids were being denied because they exceeded its policy ceiling.
The result is not an unrestricted entitlement to every medication a physician prescribes. The court preserved the commission's authority over medical-aid funding, while emphasizing that it must respect the tribunal's ruling in Knox's particular case. No reimbursement total was fixed.
A successful appeal left a practical dispute
Knox injured her right knee in a workplace accident in 2005. Her compensation claim was accepted and, as the injury became chronic, the commission funded loss-of-earnings, medical-aid and rehabilitation benefits.
Medication coverage had already produced years of proceedings. In a 2020 appeal, the court found that her pain resulted from her compensable workplace injury regardless of the disputed diagnosis. Following a new hearing, the tribunal accepted in 2021 that chronic pain from the accident made a prescribed methadone treatment compensable.
The dispute that reached the court in 2026 began with a March 2022 refusal to fund both tablet and liquid forms of hydromorphone. A later commission decision expressly addressed only the tablets. The internal review maintained the refusal because the medication, together with her existing prescription, exceeded the opioid policy's dosage ceiling.
The tribunal hearing was ultimately framed around funding the tablets. In April 2025, Knox won: the tribunal directed the commission to pay for that medication while prescribed and reimburse her own expenditures upon presentation of receipts.
The tribunal gave significant weight to the specialists who had assessed, treated and monitored her over time, rather than a paper prescription review. It found that other treatments had not worked or had caused adverse effects, while her existing regimen improved pain control and function. In those exceptional circumstances, it rejected a rigid application of the policy limit.
Why appeal a decision she had won?
Knox argued that the tribunal's reasoning should apply beyond the particular tablets identified in its conclusion. She asked the court to direct funding for all medication prescribed for her compensable injury under her treating physician's supervision.
The commission responded that the tribunal had decided the specific question before it and that an order covering every prescription would improperly remove the commission's statutory authority to approve and supervise medical aid. Alternatively, it acknowledged that Knox might reasonably have expected the liquid medication to be addressed and proposed sending that issue back to the tribunal.
The appeal court found no reviewable error in the tribunal's decision. The key problem was how its reasoning and narrow concluding direction fit together.
The original refusal had concerned two forms of medication, and the commission knew they formed part of a broader treatment plan. Yet the way the later decisions and hearing framed the dispute created uncertainty. The court also noted that Knox had not had legal representation through the process.
The policy finding could not be confined to one prescription
The court treated the applicability of the commission's policy as a legal question, reviewed for correctness. It agreed that the tribunal had properly considered the legislation, policy, medical evidence and particular circumstances.
Although the tribunal's conclusion named only the tablets, its reasoning necessarily decided that strict adherence to the opioid ceiling was inappropriate for Knox. Because her pain-management plan involved more than one opioid, the court said her prescriptions should be considered together.
The court therefore supplied additional reasons clarifying the tribunal's existing rationale. It described that approach as exceptional, not a licence for courts to replace administrative decision-makers' reasons with different ones.
Another tribunal hearing was unnecessary, the judges concluded, because its interpretation was already clear and there was no reason to expect a different rationale for the other opioid prescriptions. Repeating the process would also use time and resources without resolving the implementation problem.
What remains for the commission
The final order upheld the tribunal's decision and dismissed the appeal, while returning the matter to the commission for implementation if funding was being refused because of the opioid ceiling. The commission must also consider the tribunal's ruling and the court's additional reasons when deciding reimbursement for opioids prescribed between the April 2025 tribunal decision and the September 2026 court reasons.
The court did not have a record establishing exactly what the commission had reimbursed after the tribunal ruled. Its direction was therefore conditional, not a finding that every alleged later refusal had occurred.
Other benefit claims and challenges to earlier tribunal decisions were not properly before the court and were left unaddressed. The ruling does not establish that the disputed diagnosis was caused by the accident, prescribe treatment, set a new general dosage limit or prove that reimbursement has since been paid.
