WORKPLACE SAFETY AND INSURANCE BOARD
APPEALS RESOLUTION OFFICER DECISION
deCISION NUMBER: 20110008
OBJECTION BY: Employer
WORKER: Not Participating
REPRESENTATIVEs: Employer Representative
ISSUE
The employer representative, on behalf of the employer, is objecting to the Case Manager’s decision dated May 21, 2010 which denied the employer claim cost relief under the Second Injury and Enhancement Fund (SIEF) Policy.
HOW THE ISSUE ARISES
The worker, then 56 years old, with the employer since June 5, 2000 was working as a Stock Clerk at the time of his injury. On March 9, 2010 the worker was walking backwards pulling a row of shopping carts when he pivoted on his left foot and felt pain in his left knee.
The worker sought medical attention on the date of accident for a diagnosed left knee ligamentous injury. The doctor advised the worker was to limit weight bearing for seven to ten days.
The Eligibility Adjudicator contacted the employer representative on March 16, 2010 and was advised the employer would be offering the worker modified duties, however, as per the Employer’s Progress Report (Form 42) dated April 1, 2010 the employer was unable to accommodate the worker’s precautions.
The worker saw his family doctor for a follow-up appointment on April 5, 2010 and the doctor advised the worker was capable of returning to work with precautions working reduced hours. The worker was subsequently referred for x-rays and a M.R.I. of the left knee.
The worker underwent x-rays of the both knees on April 20, 2010, the results of which demonstrated evidence of extensive chondrocalcinosis and slight tri-compartmental osteoarthritis of both knees. The worker underwent a M.R.I. of the left knee on May 3, 2010 which demonstrated slight medial compartment osteoarthritis and mild osteoarthritis of the patellofemoral compartment and possible medial meniscus tear.
The worker saw his family doctor for a follow-up appointment on May 13, 2010 and was authorized to return to work with a precaution of climbing stairs/ladders at his own pace. The doctor anticipated complete recovery within one month. The worker returned to work on May 17, 2010.
The employer representative, in his fax dated May 17, 2010, requested consideration to claim cost relief under the SIEF Policy noting the results of the x-rays and MRI. The Case Manager, in her decision dated May 21, 2010, concluded the worker’s recovery was not prolonged and denied the request.
The employer representative objected to this decision. The Case Manager reviewed the employer representative’s objection and obtained the opinion of a WSIB Medical Consultant regarding the impact of a pre-existing condition on the worker’s recovery. The Case Manager, in her letter dated October 13, 2010, confirmed the previous decision to deny the employer cost relief under the SIEF policy. The matter has been referred to the Appeals Branch for further review.
AUTHORITY
Operational Policy Manual Document
Policy 14-05-03 Second Injury and Enhancement Fund (SIEF)
RESOLUTION METHOD AND PROCESS
The employer representative agreed to a decision based on the claim file record and his previous submissions dated May 17, 2010 and August 20, 2010. The worker did not return the Worker’s Participant Form.
ASSESSMENT OF THE EVIDENCE
In reaching my conclusion I considered the claim file record and the relevant policy and legislation.
Policy 14-05-03 states:
If a prior disability caused or contributed to the compensable accident, or if the period resulting from an accident becomes prolonged or enhanced due to a pre-existing condition, all or part of the compensation and health care costs may be transferred from the accident employer in Schedule 1 to the SIEF. Both physical and psychological disabilities are included.
Analysis
The employer representative submitted that the worker’s pre-existing condition caused or contributed to the injury and/or enhanced the worker’s recovery.
To consider granting claim cost relief under the SIEF policy there must be evidence that a prior disability caused or contributed to the accident or evidence to establish the worker suffered from a pre-existing condition or disability that prolonged or enhanced the worker’s recovery.
Policy 14-05-03 states in part:
The severity of the accident is evaluated in terms of the accident history and approved definitions. Accident History Components
mechanics (lift, push, pull, fall, blow, etc.)
position (kneeling, standing, sitting, squatting, bending, etc.)
environment (lighting, temperature, weather conditions, terrain, etc.)
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”
On March 9, 2010 the worker was walking backwards while pulling approximately six or seven shopping carts. The worker pivoted on his left foot to turn the carts around when he felt a pop and immediate pain in his left knee. The Case Manager, as per memo # 9 dated May 21, 2010, concluded the accident history was of moderate severity. In this case I accept the Case Manager’s conclusion that he had a moderate workplace accident. The worker was walking backwards while pulling several shopping carts when he pivoted on his left foot to turn the shopping carts and twisted his left knee. I find the accident history is consistent with an accident that one would expect a disabling injury and thus fits the definition of a “moderate” accident.’
Although the above policy defines the ‘severity of an accident’, it does not provide for determining the medical significance of a worker’s pre-existing condition. However, it indicates the medical significance of a pre-existing 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.
The worker sought medical attention on March 9, 2010 for a diagnosed left knee strain. The worker continued to seek medical attention with his family doctor. The worker was cleared to return to work with precautions; however, the employer was unable to accommodate the worker’s precautions.
The Eligibility Adjudicator contacted the worker on March 26, 2010 as per memo # 3. The worker advised he had not had prior problems with his left knee. Entitlement was subsequently granted for a left knee sprain.
The worker subsequently underwent x-rays of both knees on April 20, 2010. The results of the x-rays demonstrated evidence of extensive chondrocalcinosis and slight tri-compartmental osteoarthritis of both knees. The worker underwent a M.R.I. of the left knee on May 3, 2010. The MRI demonstrated evidence of slight medial compartment osteoarthritis and mild osteoarthritis of the patellofemoral compartment and evidence of a possible medial meniscus tear.
The worker saw his family doctor for a follow-up assessment on May 13, 2010. The doctor advised the worker was capable of returning to work with the precaution of climbing stairs/ladders at his own pace. The doctor anticipated the worker would return to full function within one month.
The Case Manager issued progress reports to the worker on May 19, 2010 requesting an update on the worker’s condition. To date the worker has not responded. Based on the evidence before me I find the worker fully recovered within one month of his return to work on May 17, 2010 as anticipated by the family doctor.
The claim file was reviewed by a WSIB Medical Consultant as per memo # 14 dated October 15, 2010. The Medical Consultant opined that an absence from work from March 10, 2010 until May 17, 2010 would not be prolonged considering the possibility of a meniscal tear that may have healed on its own over that period. I accept this opinion.
While I appreciate the employer representative’s submission, I find insufficient evidence to establish that the worker suffered from a pre-existing disability that caused or contributed to the work accident. I find the worker sustained a left knee strain as a result of twisting his left knee while walking backwards, pulling several shopping carts and attempting to turn them.
After carefully considering the file and medical information, I find that the weight of evidence supports that a reasonable classification of the severity of the pre-existing condition is ‘minor’. However, I am persuaded and give greater weight to the Medical Consultant’s medical opinion and find that this gentleman’s recovery was not prolonged due to this pre-existing condition. I find the worker’s absence from work and recovery consistent with the diagnosed left knee strain.
CONCLUSION
I conclude the worker sustained a left knee strain as a result on an accident at work on March 9, 2010. I further conclude the worker did not suffer from a disability that caused or contributed to the accident nor did the worker’s minor pre-existing condition prolong or enhance the worker’s recovery.
The employer’s objection is denied.
DATED January 7, 2011
D. Duguay
Appeals Resolution Officer
Appeals Branch