WORKPLACE SAFETY AND INSURANCE BOARD
APPEALS RESOLUTION OFFICER DECISION
DECISION NUMBER: 20100044
OBJECTION BY: The worker
EMPLOYER: Participating
REPRESENTATIVE: Employer
ISSUE
The worker is objecting to the September 22, 2009 Claims decision denied initial entitlement for a right shoulder injury occurring on June 30, 2009.
HOW THE ISSUE ARISES
On August 14, 2009, this carpenter reported to his employer that he had injured his right shoulder while lifting metal shelving units on June 30, 2009. The claim was then reviewed by a Workplace Safety and Insurance Board (WSIB) case manager who determined that initial entitlement for this claim should be denied given that they were unable to establish that the worker’s right shoulder condition was related to a workplace incident that occurred on
June 30, 2009, and as such, proof of accident cannot be established.
This is clearly outlined in a Claims decision dated December 22, 2009 and the worker is now objecting to this decision.
AUTHORITY
Workplace Safety and Insurance Act (the Act) and Operational Policy Manual Document:
11-01-01 – Adjudicative Process
15-02-02 – Definition of an Accident
RESOLUTION METHOD AND PROCESS
The worker has opted to resolve this objection by means of a 60 day expedited decision. The employer’s representative is participating in the objection; however, neither party had any additional submissions to provide.
ASSESSMENT OF THE EVIDENCE
In reviewing this objection, I have had regard for the claim file information, relevant policy and legislation and for the arguments presented.
All adjudicators use the same criteria for ruling on initial entitlement to WSIB benefits. According to WSIB Policy 11-01-01:
A claim created by the WSIB for a workplace accident/disease is adjudicated based on entitlement principles and the facts of the case.
Five point check system All adjudicators use the same criteria for ruling on initial entitlement to WSIB benefits. This system is known as the "five point check system." An allowable claim must have the following five points
- an employer
- a worker
- personal work-related injury
- proof of accident, and
- compatibility of diagnosis to accident or disablement history.
Proof of accident Some points adjudicators consider when examining proof of accident are
- Does an accident or disablement situation exist?
- Are there any witnesses?
- Are there discrepancies in the date of accident and the date the worker stopped working?
- Was there any delay in the onset of symptoms or in seeking health care attention?
I have carefully reviewed the claim file information and it appears that this worker claimed that he injured his right shoulder while lifting metal shelving units which he relates back to an incident occurring on June 30, 2009. At this time, the worker indicated that he noticed the pain in his right shoulder the following day; however, explained that he did not report his injury immediately to his employer as he thought it was a simple muscle pull which would go away with time. As the pain did not subside, the worker both reported his injury to his employer and sought medical attention for the first time on August 14, 2009.
According to the Health Professional’s Report (Form 8), the diagnosis at the time of this assessment was that of a repetitive strain injury of the right shoulder and investigations were ordered for an ultrasound.
This worker delayed in both reporting his injury as being work-related to his employer as well as seeking medical attention until August 14, 2009 which is approximately a six week delay. According to Memo 1 dated September 28, 2009, the worker indicated that he had mentioned his right shoulder pain to his manager during a meeting; however, his manager never asked him the cause of his pain. The worker indicated that the manager should have asked him the cause of his pain; however, it should be noted that reporting a work-related injury is in fact the responsibility of the worker as the employer would not have knowledge of a work-related incident until it was officially reported to them. Once an injury would be reported as being work-related, it would then be the responsibility of the employer to notify the WSIB of the workplace injury. I therefore disagree with the worker’s thought process that the employer should be asking him if his injury is work-related. Furthermore, I note this worker also had three prior WSIB claims established in the past with one of which he would have received WSIB benefits which would therefore make him well versed in the process of reporting a workplace injury.
According to the Worker’s Report of Injury/Disease (Form 6), the worker was unable to provide any witnesses to corroborate his claim that he sustained a workplace injury on June 30, 2009. Furthermore, there were also no complaints to coworkers about his right shoulder pain aside from his comment to his manager during a team meeting as previously outlined above. At this time however, there was no mention by the worker of the injury being related to the work he was performing on June 30, 2009.
Noting the worker’s significant delay in both reporting his injury to his employer as being work-related and also seeking medical attention (six week delay) as well as the fact that he never told anyone about his right shoulder pain being work-related, I am unfortunately unable to establish proof of an incident resulting from the worker’s duties on June 30, 2009 while he was lifting metal shelving units. As a result, I confirm the case manager’s September 22, 2009 decision denying initial entitlement in this claim for the right shoulder.
CONCLUSION
The worker’s objection to the denial of initial entitlement for a right shoulder injury occurring on June 30, 2009 is denied.
The worker’s objection is denied.
DATED: April 23, 2010
S. Godin
Appeals Resolution Officer
Appeals Branch