WORKPLACE SAFETY AND INSURANCE BOARD
APPEALS RESOLUTION OFFICER DECISION
DECISION NUMBER: 20100091
OBJECTION BY: Worker
EMPLOYER: Not Participating
PARTICIPANTS: Worker, Worker’s Representative
HEARING DATE: N/A
ISSUE
The worker is objecting to the denial of entitlement to chronic pain disability (CPD).
HOW THE ISSUE ARISES
This file was established with an accident date of July 19, 1978 after this worker, employed as a truck driver was involved in a motor vehicle accident (MVA) when he was driving along the Highway 401 between Highway 10 and Dixie Road and the truck’s driveshaft broke causing his brake line to develop a leak. To avoid hitting another vehicle travelling in front of him, he pulled to the side of the road and smashed into the guardrail doing minor damage to the truck and sustaining injuries to the right side of his body including a sore neck, sore back, and bruised left elbow.
Benefits were accepted by the claims adjudicator.
The worker subsequently claimed entitlement to CPD, and in a decision of July 9, 2009 the adjudicator noted that a review had been conducted by one of the WSIB’s medical consultants who indicated that based on the medical reporting available, the symptomatology presented did not reflect the CPD, and the adjudicator noted that there was a lack of medical reporting from 1982 to 1994. It was noted that the worker underwent a comprehensive evaluation at the Downsview Rehabilitation Centre (DRC) in 1981 and was diagnosed with neurosis for which only a provisional psychotraumatic disability was recognized for a period of two years.
The adjudicator noted that the reports on file do not support that the worker continued to have consistent and genuine pain for six months or more. It was also concluded that there was no evidence to support the degree of pain was inconsistent with the organic findings noting the complete lack of medical findings between 1982 and 1994. It was also noted the worker did not return to gainful employment after the accident, but there was no medical reporting to support his inability to work as a result of the compensable injury, and after considering all of the
information on the claim record the adjudicator concluded that marked-life disruption had not occurred and the worker had not met the criteria for CPD.
The worker has objected to this decision.
AUTHORITY REFERENCE
Operational Policy Manual Document:
15-04-03 – CPD.
ASSESSMENT OF THE EVIDENCE AND SUBMISSIONS
All of the information on the claim record has been carefully considered, particularly as it relates to the denial of entitlement to CPD.
As previously stated, the accident date in this claim is July 19, 1978, and the only ongoing entitlement that was accepted in this claim was a provisional psychiatric award that was granted on a two year basis and it subsequently expired.
The worker is now claiming entitlement to CPD, and this accident occurred over 30 years ago.
I have noted in reviewing all of the information on the claim record that there is a lack of medical reporting for many years, and the adjudicator has already recognized that there are no medical findings from 1982 to 1994. With this lack of medical information, there is no evidence to support that there has been a constant, consistent, and genuine pain from the accident date.
In a previous decision of May 5, 2005, an Appeals Resolution Officer (ARO) noted when considering entitlement to a possible psychiatric condition that the absence of medical treatment for so many years does not support an ongoing condition as if it had existed, it would reasonably be expected to have been identified by the family doctor and appropriate referrals would have been made and would have been evident in the medical record.
I agree that had there been constant, consistent, and genuine unrelenting pain, there would have been documentation available to support this ongoing condition.
In addition, the WSIB medical consultant has reviewed the case thoroughly and has clearly indicated that as far as the medical criteria for CPD is concerned, the criteria has definitely not been established in this case as the opinions of the consultants who examined the worker reflected an anxiety neurosis hysteria as opposed to CPD.
I agree with the review of the medical consultant, and noting the lack of medical reporting in this case there is no basis to consider entitlement to CPD as there is no evidence of constant, genuine and consistent pain since the accident date, and the medical criteria has not been met.
CONCLUSION
The ARO confirms the denial of entitlement to CPD.
The objection is denied.
Dated: March 8, 2010
D. Mosser
Appeals Resolution Officer
Appeals Branch