WORKPLACE SAFETY AND INSURANCE BOARD
APPEALS RESOLUTION OFFICER DECISION
DECISION NUMBER: 20100035
OBJECTION BY: Employer
WORKER: Not Participating
EMPLOYER: Participating
REPRESENTATIVE: Employer
ISSUE
The employer is objecting to the denial of Second Injury and Enhancement Fund (SIEF) relief in this claim.
HOW THE ISSUE ARISES
This now 22 year old General Labourer injured his left thumb on March 2, 2007 when a drum the worker was moving leaned forward and pulled his thumb.
The original diagnosis was injury to left first metacarpal joint. The initial medical report indicated the doctor was unaware of any prior condition. Medical information was submitted indicating x-rays were taken showing no fractures and the diagnosis was changed to ligamentous strain left thumb. The employer requested SIEF relief as the recovery was prolonged. The Case Manager after reviewing the information submitted to the claim file concluded there was no evidence to suggest a pre-existing condition was present and therefore the employer was not entitled to SIEF relief in this claim. A letter confirming this decision was issued
January 23, 2009.
The employer disagrees with this decision, and the case has been referred to the Appeals Branch for further consideration.
AUTHORITY
Policy documents:
- 14-05-03 Second Injury and Enhancement Fund (SIEF)
RESOLUTION METHOD AND PROCESS
The employer representative has submitted a 60 Day option form dated January 14, 2010.
This election requires the Appeals Branch to make an expedited decision (within 60 days) based on the information on file.
ASSESSMENT OF THE EVIDENCE
Upon assessing the available information contained in the claim record I find that the employer is not entitled to SIEF relief in this claim.
In arriving at my decision, I considered the evidence and submissions in the context of the relevant legislation and Workplace Safety and Insurance Board (WSIB) policy. The following is a summary of my observations and assessment.
File documentation
The Employer’s Report of Injury/Disease dated April 17, 2007 indicated that on March 2, 2007 the worker was tilting a drum off a skid when the skid cracked causing the drum to lean forward and pulled the worker’s left thumb and index finger.
The initial medical report from a walk in clinic dated March 10, 2007 indicated the diagnosis was injury to first metacarpal joint. The doctor stated they were not aware of any pre-existing condition or other factors delaying recovery.
The next report from the walk in clinic dated March 27, 2007 provided a diagnosis of left thumb metacarpal phalangeal joint radial collateral ligament partial tear. Again the report noted no pre-existing conditions.
A progress report dated April 18, 2007 provided a diagnosis of ligamentous strain left thumb. The report also noted that x-rays had been taken which showed no fractures. The doctor noted no significant factors delaying recovery.
The employer representative submitted an objection form to the denial of SIEF on May 26, 2009 and provided an attached submission letter of the same date. The employer representative noted that there was a delay in seeking initial medical attention and therefore the injury would appear to have been a minor injury. The representative also noted changes in the diagnosis with the last being ligamentous strain and argued the optimal duration of disability was 42 days for that type of injury with the maximum being 56 days. The representative argued that the worker’s duration far exceeded the maximum recommended duration and that the employer should be entitled to SIEF relief.
Analysis
Policy 14-05-03 provides guidelines on determining the quantum of SIEF relief in claim files.
When reviewing medical and other information present in the claim file, the decision-maker considers whether the information suggests that a pre-existing condition is present and whether it
- contributed to the work-related accident, or
- prolonged or enhanced the work-related disability.
If it is likely that such circumstances exist, a recommendation to apply the SIEF is made, as well as the rate at which to do so.
When evaluating the medical significance of the pre-existing condition, the decision-maker will seek an opinion from a WSIB medical consultant.
The medical significance of a condition is assessed in terms of the extent that it makes the worker liable to develop a disability of greater severity than a normal person. An associated pre-accident disability may not exist.
The severity of the accident is evaluated in terms of the accident history and approved definitions.
Definition - "Severity of Accident"
Minor: expected to cause non-disabling or minor disabling injury
Moderate: expected to cause disabling injury
Major: expected to cause serious disability probable permanent disability
In reviewing this issue, I note the employer representative has suggested the employer is entitled to cost relief as the worker’s duration of disability exceeded the norm for this type of injury. Although the worker’s recovery may have been longer than suggested in disability duration guidelines, guidelines are not necessarily representative of every case and there may be exceptions to the rule. This is also not a valid reason to accept SIEF relief.
Policy 14-05-03 is very specific in that for an employer to have entitlement to cost relief there must be a pre-existing condition present and an evaluation of the pre-existing condition is then made to determine if this condition has prolonged the recovery or enhanced the injury.
A review of the medical reports submitted to the claim file have revealed no pre-existing condition in the worker’s thumb to have prolonged or enhanced the injury.
I find the employer is not entitled to SIEF relief in this claim as there is no evidence to support a pre-existing condition existed.
CONCLUSION
The employer is not entitled to SIEF relief in this claim.
The employer’s objection is denied.
DATED February 25, 2010
M. Flaherty
Appeals Resolution Officer
Appeals Branch