WORKPLACE SAFETY AND INSURANCE BOARD
APPEALS RESOLUTION OFFICER DECISION
decision number:
20150057
DECISION DATE:
May 20, 2015
OBJECTING PARTY:
Worker
REPRESENTED by:
Worker Representative
RESPONDENT: REPRESENTED by:
Employer Employer Representative
HEARING:
Hearing in Writing
HEARD by:
S. Godin, Appeals Resolution Officer
ISSUE
The worker is objecting to the August 29, 2014 claims decision which determined the worker did not suffer a permanent impairment as a result of the August 14, 2013 accident.
BACKGROUND
This claim was allowed for an accident arising on August 14, 2013 where this then 52 year old female working as a Personal Support Worker (PSW) slipped and fell in the employer's parking lot. Entitlement was accepted for injuries to the worker's head - concussion, neck strain, and bilateral knee abrasions. Entitlement was denied for the worker's non-compensable right shoulder, left heel, as well as for degenerative disc disease. Aside from these non-compensable problems, the worker had other non-work related issues relating to a diagnosis of Temporomandibular Joint Disorder (TMJ). She was also diagnosed with a high level pre-existing anxiety.
As a result of her work related injuries accepted under this claim, the worker was referred to the Complex Injury Outpatient Rehabilitation Program.
In a claims decision dated August 29, 2014, the WSIB Case Manager confirmed the worker did return to work on a graduated return to work plan effective March 4, 2014, where she gradually increased her hours and eventually resumed full time hours effective May 19, 2014 yet remained on modified duties. As part of this decision, it was noted the worker was dealing with some health issues which were in no way related to this claim. The additional health issues appeared to be impacting the worker's ability to resume her full time duties.
The Case Manager then determined there was no indication this worker had sustained a permanent impairment (PI) as a result of these accepted injuries resulting from her August 14, 2013 slip and fall accident.
This was clearly outlined in a claims decision dated August 29, 2014. The worker is now objecting to this decision.
AUTHORITY
The Workplace Safety and Insurance Act and Operational Policy Manual Documents:
11-01-05 – Determining Maximum Medical Recovery (MMR)
18-05-03 – Assessing Permanent Impairment
18-03-02 – Payment of LOE Benefits Prior to Final Review
ANALYSIS
While reviewing this worker's objection, I have had regard for the claim file information, submission received, relevant policy and legislation, as well as for the arguments presented.
Having reviewed the evidence before me, I find the worker did not suffer any permanent impairment as a result of the August 14, 2013 accident. My rationale is as follows:
WSIB Operational Policy 18-05-03 states:
A “permanent impairment” is defined as follows: “Permanent impairment means any permanent physical or functional abnormality or loss (including disfigurement) which results from an injury, and any psychological damage arising from the abnormality or loss. A worker's degree of permanent impairment is expressed as a percentage of total permanent impairment of the whole person.”
“Workers who have a work-related permanent impairment are eligible for non-economic loss (NEL) benefits. To rate permanent impairments, the WSIB uses a prescribed rating schedule, the report from a NEL medical assessment (if one is conducted), and all relevant health information in the claim file”.
I have carefully reviewed the claim file information and note that, as a result of this worker's injuries, the worker was referred to the Complex Injury Outpatient Rehabilitation Program and was assessed by the various practitioners involved on November 7, 2013. As a result of this examination, a variety of diagnoses were noted including a direct head injury associated with a cerebral concussion or mild traumatic head injury. A favorable prognosis for the eventual resolution of the worker's symptoms was noted, but, given the persistence of the worker's symptoms, it was identified that this claim and the worker's recovery may be prolonged.
The worker was also assessed at Altum Health Group by a neurologist who confirmed a diagnosis of mild traumatic brain injury, but was unable to account for the worker's neurological complaints and recommended a further review/assessment in six months and treatment for a suspected mood disorder.
The worker then did participate in further psychological assessment conducted on January 6th and January 8, 2014, where the assessment identified that while the prognosis for recovery from the mild traumatic brain injury was favorable, the recovery had been complicated by the worker's high somatic and pain focus, tendency for catastrophization, avoidance, and overall difficulty in dealing with stress. The assessment also identified a high level of pre-existing background anxiety.
On April 3, 2014, the worker was reassessed by the doctor who noted in his clinical summary that the worker had markedly improved, and went on to note residual short lasting headaches (lasting 10 to 15 minutes), daily dizziness lasting seconds, frequent tinnitus lasting seconds, and a general sense of decondition. The doctor then provided instruction for a resumption of full duties on a graduated basis and a gradual suspension of prescription medication. The worker was then subsequently discharged from the Complex Injury Rehabilitation Program with recommendations deferring to the assessment and the established treatment/return to work plans in place.
The worker was then reassessed by the same neurologist again on June 23, 2014 where it was reported the worker had significant improvement symptomatically with a return to modified duties and operating a personal motor vehicle without difficulty. A repeat neurological examination was also unremarkable.
Based on my review of the medical information on file, it appears as though the medical evidence available does in fact support this worker was progressing in her recovery from the injuries sustained, although at a slower pace than normally anticipated. This was largely due to pre-existing personality traits.
The reports from the treating specialist confirm that the worker's injuries were resolving as was her ability to resume active and unrestricted employment. The worker's Functional Abilities Form completed by the worker's family doctor supported the continued progression of the worker's abilities with the recommendation to progress in both the assignment of duties and hours of work as tolerated.
All in all, it can’t be ignored this worker is dealing with many non- compensable health related issues which would be impacting her ability to return to work. They include a history of high level anxiety, a diagnosis of TMJ, a right shoulder condition, a left heel condition, and degenerative disc disease. These non-compensable conditions appear to have overwhelmed the worker’s compensable injuries. Furthermore, the worker and her representative have not provided any objective medical information persuading me to accept any permanent impairment arising from the injuries sustained in the August 14, 2014 compensable accident. It has therefore not been demonstrated this worker suffered any permanent physical or functional abnormality or loss (including disfigurement) or any psychological damage arising from the abnormality or loss.
Consequently, I confirm the claims decision of August 29, 2014 which denied this worker suffered a permanent impairment as a result of her August 14, 2013 work-related accident.
The worker's objection is denied.
CONCLUSION
The worker’s objection to the August 29, 2014 claims decision which denied the worker had suffered a permanent impairment as a result of the August 14, 2013 accident, is denied.
May 20, 2015
S Godin
Appeals Resolution Officer
Appeals Services Division