WORKPLACE SAFETY AND INSURANCE BOARD
APPEALS RESOLUTION OFFICER DECISION
decision number:
20150065
DECISION DATE:
April 22, 2015
OBJECTING PARTY:
Worker
REPRESENTED by:
Self-Representative
RESPONDENT:
Employer
REPRESENTED by:
Self-Representative
HEARING:
Hearing in Writing
HEARD by:
Mr. M. Ranalli, Appeals Resolution Officer
ISSUE & OUTCOME
The worker objects to the November 24, 2014 decision, which denied ongoing entitlement after November 21, 2014.
BACKGROUND
On May 30, 2014 while employed as a Driver, this worker slipped and fell injuring his right shoulder and right upper back area. The worker was 51 years of age at the time of the accident and was working on a one day contract for the employer.
The worker was diagnosed with a fracture of the right scapula and upper back strain/sprain when seen at the hospital.
The employer was un-co-operative and did not supply earnings information or an Employer’s Report of Accident, therefore the worker’s claim was paid based on a temporary rate. The worker has not yet supplied additional earnings information so that an adjustment could be made to the wage rate. The worker was paid to November 21, 2014, at which time it was determined that he had recovered from the accident.
The decision of November 24, 2014 advised the worker that he was capable of return to work and had made a full recovery.
The worker has objected to the above decision and has requested that the issue be referred to the Appeals Services Division for further review and consideration.
AUTHORITY
11-01-01 Adjudicative Process
11-01-02 Decision-Making
18-03-02 Payment and Reviewing LOE Benefits (Prior to Final Review)
ANALYSIS
I have reviewed the submission and objection sent to the claim record by the worker which is dated November 19, 2014. The worker has indicated that he is suffering from various injuries including the thoracic back, head and shoulder injuries.
Entitlement in this claim is limited to the right scapula and upper back.
There is limited information regarding the organic impairment in the claim record. There is a medical report from the treating doctor with regards to a heart issue, and the Regional Evaluation Centre (REC) report indicates that the worker’s perception of his injury is not in keeping with the organic findings.
The REC report of November 6, 2014 outlines the following;
Active range of motion of the cervical spine, thoracic spine and shoulders was within normal limits in all directions
Neurological examination of the upper extremities revealed no remarkable findings
Motor strength was graded at 5/5 bilaterally in the upper limbs
Reflex testing of the upper extremities (C5, C6 and C7) was normal and rated +1 bilaterally
Sensory testing of the upper extremities revealed normal findings bilaterally
Palpitation of the surrounding cervical, thoracic and right shoulder/arm musculature revealed normal tone and symmetry on both sides
Local tenderness with digital palpitation over the right periscapular region as well as right trapezius musculature
Partial recovery achieved and full functional recovery is anticipated in 4 weeks
The Case Manager (CM) determined that the worker would be fully recovered four weeks after this assessment which is approximately the date of the closure of LOE benefits on November 21, 2014.
The medical report of November 14, 2014 is the most current medical report subsequent to the REC report. In this report, the doctor comments that the worker has right shoulder inflammation and impingement and provided the worker with an injection to the shoulder. The doctor also comments that the worker presented an x-ray showing potential loss of height in the thoracic spine.
When reviewing the worker’s submission and the available medical information contained in the claim record, I note the following;
Entitlement is granted for a right scapula fracture and upper back strain
There is no entitlement granted for a disc herniation or compression fracture of the thoracic spine
There is no entitlement granted for depression, head injury or heart problems
The REC report identified that the worker would make a full recovery within 4 weeks of the October report date
The medical report of November 14, 2014 outlines shoulder problems, which are not part of the entitlement in this claim. Physiotherapy was also recommended for the thoracic spine due to the possible compression fracture which had yet to be confirmed, and for the potential loss of space which would be a degenerative process.
A worker who has a loss of earnings (LOE) as a result of a work-related injury is entitled to payment of LOE benefits beginning when the loss of earnings begins. The payment can continue until the day on which the worker is no longer impaired as a result of the injury.
I am of the opinion that the worker has recovered from his work related injury. The scant medical information suggests that the worker’s right scapula fracture and right upper back strain/sprain have resolved. I find that the worker’s ongoing problems with the shoulder and mid back are not related to the compensable accident. There is very little medical information to support that these other injuries are in any way related to the initial accident.
In summary, I accept the findings supplied in the REC report as they are the most detailed and substantial with regards to objective findings contained in the claim record.
It is my finding that the worker reached maximum medical recovery as of November 21, 2014 without permanent impairment and therefore ongoing entitlement to benefits, both in the form of health care and LOE were correctly terminated as of this date.
The worker has indicated he had the right to an interpreter and has identified that this may have somehow caused a different medical opinion to be given by the REC assessors. The REC report identified that the worker was given the option to stop the assessment at any time and that the worker agreed to proceed with the assessment both verbally and in written form. There is no indication that the worker did not understand the process or the assessment as there was no indication that he wished it to stop. The medical information and findings are objective observations and the presence of an interpreter would not have changed the outcome of the findings supplied to the WSIB.
The worker has also identified that the temporary rate used is incorrect and I do agree that it would more than likely be a low rate for the position and work performed although there is no information in the claim record from which to change the temporary rate currently used. The worker has been made aware that should any further information be procured and received in the claim record, it would be reviewed. No new earnings information has been received to date and therefore the rate cannot be adjusted. The CM has made every attempt to secure additional information without success.
CONCLUSION
Ongoing entitlement for the right scapula and right upper back is denied as MMR was reached as of November 21, 2014 with no permanent impairment. LOE benefits after November 21, 2014 are therefore denied.
The worker’s objection is denied.
DATED April 22, 2015
Mr. M. Ranalli
Appeals Resolution Officer
Appeals Services Division