WORKPLACE SAFETY AND INSURANCE BOARD
AMENDED APPEALS RESOLUTION OFFICER DECISION
claim: 20170014
OBJECTING PARTY: Worker
REPRESENTED by: Worker Representative
RESPONDENT: Employer
REPRESENTED by: Employer Representative
HEARING: In Writing
DATE: January 19, 2017
ISSUE
The worker objects to:
- The denial of initial entitlement - decisions dated July 14, 2016 and August 9, 2016.
BACKGROUND
On June 19, 2014, this then 45 year old Loader Operator claimed he was jumping from one machine to another when he slipped on the tracks and struck his face on the bar, and landing on his outstretched right arm. He did not submit a claim until July, 2015 at which time it was concluded he did not meet the time limits to claim. This decision was then reconsidered and it was concluded the worker did in fact meet the time limit to claim a work-related injury however in decisions dated July 14, 2016 and August 9, 2016, he was advised that entitlement would be denied as proof of accident had not been established. The worker objected to the adverse decision made and his file was referred to the Appeals Services Division for consideration.
AUTHORITY
11-01-01 – Adjudicative Process
ANALYSIS
I have considered all of the evidence pertaining to this case, including submissions made by the worker and the employer’s representative. In doing so, I am confirming the denial of initial entitlement in this claim for the following reasons:
Policy 11-01-01 stipulates that for a claim to be accepted, there must be an employer, a worker, a personal work-related injury, proof of accident and the diagnosis must be compatible to the accident history;
For proof of accident to exist, there must be an immediate onset of pain, immediate layoff from work, immediate reporting and immediate medical attention. If there are any delays, they must be reasonable. Furthermore, consistency is also considered relevant when determining proof of accident;
In this case, the worker noted on the form 6 that the accident occurred on June 19, 2014 when he was jumping from one machine to another in the rain when he slipped on the tracks and struck his face on the bar, falling onto his right wrist. The employer representative submitted information indicating that there was no rain on June 19, 2014. The worker’s representative concedes in correspondence dated July 19, 2016 that it was not raining on June 19, 2014. This is inconsistency number one. The worker’s representative maintains that this does not mean there was no slip and fall. While this is true, the inconsistency in accident history speaks to credibility which, when combined with the other factors which will be outlined below, lead me to doubt proof of accident;
The worker indicated he reported the incident on June 20, 2014. The accident employer, Mr. Chiacchia noted that he recalled the worker reporting that he had hit his face on a machine sometime in the summer of 2014, but there was no wrist injury reported until June, 2015, one year later. This is inconsistency number two and just because the worker reported a face injury, does not mean that there is evidence of an injury to the wrist;
While the employer confirms there was an incident reported in the summer of 2014, this was to the face, for which there was no medical attention sought and therefore would not attract entitlement under the Workplace Safety and Insurance Act;
The worker sought medical attention on July 6, 2014. The form 6 was not submitted until July, 2015. There was no mention of the worker hitting his face or of a slip in the rain. This is inconsistency number three;
The clinical note entry corresponding to the form 8 dated July 6, 2014, which is contemporaneous to the event, does not give a specific accident history. Instead, it was noted the worker complained of pain in the right wrist which was three weeks old. There was no mention of a slip and fall until an entry of September 30, 2014. This is inconsistency number four;
The worker was seen by Dr. Chess. His report of January 15, 2015 notes the worker reported a slip and fall about one year ago, which would place the accident in January, 2014. On April 29, 2015, it was noted the worker fell on a ‘tract’ (sic) approximately one year ago, placing the accident in and around April, 2014. These are inconsistencies five and six;
In addition to the inconsistencies, the worker also delayed in laying off work with no reasonable explanation. He delayed in seeking medical attention and delayed in reporting a specific injury to the wrist for approximately one year. He maintains that he was under the impression the doctors were taking care of the reporting aspects however this is not a reasonable explanation, given the ongoing right wrist symptoms the worker was having;
The worker’s representative contends that the medical documentation confirms the worker’s injury was work-related however given the inconsistencies and delays noted above, I am not satisfied proof of accident has been established. Furthermore, in his report of April 8, 2015, while Dr. Chess queries several reasons to explain the worker’s right wrist symptoms, there is no correlation made to a work incident. I therefore do not agree that the medical evidence is clear in establishing proof of accident;
The worker’s representative also notes that the employer offered modified work and as such, this confirms they were aware of the work-related injury. However, the modified job was offered in July, 2015 after they received notification of the wrist injury then. Furthermore, their willingness to offer modified work does not necessarily mean they accepted a work-related injury, but rather, accepted the worker needed accommodations for a wrist injury, whether it was work-related or not;
In considering all of the evidence above, I am unable to conclude that proof of accident has been established and the denial of initial entitlement remains.
CONCLUSION
I am:
- Confirming the denial of initial entitlement in this case.
The worker’s objection is denied.
DATED January 19, 2017
S. Marangoni
Appeals Resolution Officer
Appeals Services Division