WORKPLACE SAFETY AND INSURANCE BOARD
APPEALS RESOLUTION OFFICER DECISION
DECISION NUMBER: 20180049
OBJECTING PARTY: Worker
REPRESENTED by: Worker Rep
RESPONDENT: Employer (Not Participating)
HEARING: Oral hearing on August 30, 2018
HEARD BY: L. Mansueti, Appeals Resolution Officer
DATE: September 6, 2018
ISSUES
The worker objects to:
The Case Manager (CM) decision dated September 1, 2017 denying entitlement to benefits for psychotraumatic disability
The CM decision dated September 6, 2017 denying the payment of loss of earnings (LOE) benefits beyond September 2, 2017
The worker representative confirmed at the oral hearing he was not pursuing the objection to the denial of benefits for a concussion or mild traumatic brain injury (MTBI), or entitlement to further benefits for the left elbow, forearm, and hand, as communicated in the decision letter dated September 6, 2017.
BACKGROUND
On March 11, 2017 the worker plugged in a power bar into a floor outlet and received an electric shock at work. She sustained injuries to her left elbow, forearm and hand. The worker was 40 years of age at the time of injury, working as a Pit Manager. She had worked with the employer for approximately 20 years.
Initial entitlement was accepted for the electric shock, and the areas of entitlement included her left elbow, forearm, and hand. LOE benefits were approved from March 14, 2017 onward. The worker reported experiencing post-concussive symptoms, anxiety, and depression, for which she sought entitlement to benefits under this case.
The decision letter dated September 1, 2017 denied entitlement to benefits for psychotraumatic disability. The decision letter dated September 6, 2017 denied entitlement to benefits for a concussion or MTBI; advised the worker reached maximum medical recovery (MMR) for her left elbow, forearm, and hand; and denied the payment of LOE benefits beyond September 2, 2017.
The worker objected to the decisions dated September 1, 2017 and September 6, 2017, and these are now before the Appeals Services Division (ASD).
AUTHORITY
Section 2, 13, 33 and 43 of the Workplace Safety and Insurance Act (WSIA)
Operational Policies:
15-02-03 Pre-existing Conditions
15-04-02 Psychotraumatic Disability
18-03-02 Payment and Reviewing LOE Benefits (Prior to Final Review)
ANALYSIS
For the reasons that follow, I find the worker is entitled to benefits for psychotraumatic disability and further LOE benefits. In arriving at my decision, I have reviewed and considered the information contained in the record, as well as the testimony provided by the worker, in accordance with the above noted legislation and operational policies.
The worker was tearful throughout her testimony. She stated her work duties as a Pit Manager involved scheduling staff, conflict resolution, and deescalating arguments on the gaming floor. The worker indicated she would routinely deal with issues with patrons which involved theft, cheating at play, over gambling, and collusion between dealer and player. The worker indicated that prior to the work accident she did not have significant mental health issues. She advised that she took Prozac intermittently due to symptoms of depression and lack of sleep; however, she did not miss significant time from work for mental health issues. The worker testified she started taking Prozac in December 2016 to help with her mood, which she advised was somewhat helpful. The worker also stated she started using marijuana in December 2016 to help her wind down and relax after work.
The worker attended xxxxx Hospital emergency department on March 11, 2017 following the electric shock at work. The triage report indicated the worker was plugging in a shuffleboard machine with 120 volts and she sustained a shock to her left hand. The worker indicated she was seeing black spots; her lips were tingling; and her head, left hand, and elbow were tingling as well. There were no burns noted. The worker underwent an electrocardiogram (EKG) which yielded normal results. The worker was diagnosed with an electrical injury.
The worker testified that following the work accident she experienced very intense feelings. She advised her eyes hurt, her head hurt, and she felt as though a lightbulb exploded in her head. The worker endorsed feeling fearful and she did not want to be around anyone. A few days following the accident, she indicated she was experiencing insomnia, she was confused, and she could not stop shaking. The worker indicated she felt as though she had no control over her body. She described feeling full of anxiety, worry, and panic.
Dr. C. Westbrook assessed the worker on March 15, 2017. The worker advised she had been ill since March 11, 2017. The worker was diagnosed with a concussion. The worker was determined to be unfit for work as of March 15, 2017 due to concussion symptoms. It was expected her total disability would end by March 22, 2017. Dr. Westbrook’s chart note for this visit indicated the worker endorsed feelings of nervousness, anxiousness, and worry. The worker reported she continued to have headaches since the electrocution and her eyes and back hurt. Dr. Westbrook surmised the worker’s presentation was in keeping with a concussion.
Dr. Westbrook reassessed the worker on March 21, 2017. The report indicated the worker advised she had been ill since March 15, 2017. The worker planned to return to regular work on March 28, 2017. The report stated the worker continued to have post-concussion headaches.
On March 27, 2017 the worker advised the operating area she was experiencing anxiety and headaches. The worker indicated she experienced anxiety and depression in the past, but it had been under control for the last 20 years. She indicated she was feeling scared to return to work and indicated she had social anxiety. The worker indicated she did not feel the same since the work accident and she felt as though she was having a nervous breakdown. She advised that she loved her job and wanted to go back to work; however, she felt embarrassed about having to explain to people what happened and having to explain her anxiousness.
On April 4, 2017 a WSIB Return to Work Specialist (RTW) met with the parties to discuss a future return to work plan. The worker reported she was continuing to have post-concussive symptoms which precluded her from returning to work. The employer indicated there was limited alternative work away from the gaming area. It was noted the worker’s pre-accident job duties were performed on the gaming floor. It was determined the worker was unfit to return to work due to the high cognitive demands involved with working on the gaming floor including handling money, dealing with patrons which can lead to potentially confrontational situations, multi-tasking, and constant background noise and peripheral movements.
Memorandum A0008 dated April 19, 2017 indicated entitlement was accepted for a concussion as a result of the March 11, 2017 work accident.
In May 2017 Dr. Westbrook submitted the worker’s pre-accident clinical chart notes to the record. It was noted the worker had a history of depression and anxiety in 2005 due to a situational crisis. The following was noted in the chart notes:
10May2012 seen by Dr. N. Kazarian – 28 weeks pregnant, requesting medical leave from work. She had a placenta abruption at 38 weeks with her last pregnancy. She is concerned about the role of stress in this pregnancy as well as harassment suit against her boss (he was found guilty but he is still working and she has to work with him, she led the lawsuit), she is very upset that “something will happen,” she is worried about a recurrent abruption and loss of child and/or herself
17May2012 seen by Dr. A. Armstrong – patient concerned she may have another abruption and is fearful the baby will not survive. She reported fears her baby may have a chromosomal anomaly, and was more fearful she may not be able to take her baby home. Dr. Armstrong agreed to put her off work at 30 weeks for stress.
14Feb2013 seen by Dr. A. Armstrong – patient has always been a worrier, currently worrying about her daughter’s recurrent pneumonia. Patient did not do well on Effexor, did have good results with Prozac; however, she would not like to initiate medication at this time.
13Jan2014 seen by Dr. A. Armstrong – patient injured her back on December 15 while at church when she reached down and felt pain in her right lower back. Neck pain associated with headaches ongoing for years and fluctuates over time, worse right now. Dull aching, radiates from left shoulder to top of neck, worse with tension at the end of her shifts, takes Naproxen for headaches
16Apr2015 seen by Dr. Westbrook – diagnosis: anxiety neurosis, hysteria, neurasthenia. Left foot 3rd phalanx fracture occurred on February 14th when she slipped. Patient acknowledged depressed mood for months, she responded to Prozac favourably in the past, she dealt with some social anxiety at the time as well. She currently has poor sleep largely due to her children getting up in the middle of the night. Patient interested in starting Prozac when breastfeeding stops should she need it.
15Jun2015 seen by Dr. Westbrook – patient finished breastfeeding, requesting to start Prozac, she had 2 anxiety attacks the previous week.
30Jun2015 seen by Dr. Westbrook – waking frequently with difficulty falling asleep, ongoing fatigue, reduced energy level, snapping at children and husband, previous episodes of depression in 2005 and 1997 sparked by relationship loss, previous use of Prozac, currently taking Prozac 20mg, good response from medication.
25Aug2015 seen by Dr. Westbrook – not depressed but irritable and agitated. Her son’s sleeping issues are a major part of this irritability
10Mar2016 seen by Dr. Westbrook – left sided back pain since having son, not more depressed just more irritable. Prozac is helping. Sleep is better, reduced energy, mild guilt about being away from children how that she is working full-time, concentration is ok, snapping at children and husband.
23Dec2016 seen by Dr. Westbrook – follow-up for anxiety, feels about the same since last visit, stopped Prozac as she missed a lot of doses in September, feels more anxious now. Dr. Westbrook cannot support the nightly marijuana use, expressed concern regarding being impaired while the children are at home. Long conversation about husband being overbearing, irritable, annoyed and unable to relax. Prozac prescribed 20mg.
15Mar2017 seen by Dr. Westbrook – headaches since she electrocuted herself, eyes hurt, she is presenting with symptoms consistent with a concussion, headaches post-injury worse with physical or mental exertion.
28Mar2017 seen by Dr. Westbrook – patient is supposed to go back to work Wednesday. With headaches and stress, she knows she cannot return to work otherwise she will have a breakdown.
30Mar2017 Dr. Westbrook spoke to worker on the telephone. She reported worsened anxiety and agitation, which was noted to have preceded the work accident but has been significantly worse since the accident. She reported having significant social phobia and was very concerned about returning to work and dealing with many people. She advised she had similar episodes in her 20s and even on the night of her wedding. She reported she was worried about having a panic attack at work. Her headaches were settling but she is still having difficulties with concentration, focus, and mood. Prozac at 40mg, may increase to 60mg, then to 80mg, Ativan prescribed for panic
26Apr2017 Dr. Westbrook referral for mental health assessment at Ontario Shores – Patient having difficulty managing anxiety, social anxiety, and panic attacks. She suffered from anxiety and depression her whole life and required Prozac on a few occasions, more recently in mid-2015 after she weaned her 4th child from breastfeeding. She suffered an electrocution at work and did not experience any concerning acute issues but presented with post-concussion symptoms on several occasions. Her anxiety and panic have increased rapidly and severely since the injury. She has not been responding to Prozac the way she normally does.
On May 4, 2017 the worker was assessed by Dr. C. McKeever and H. Pennel, Registered Nurse, for a mental health assessment at xxxxx. It was noted the worker had a long history of anxiety and depression and recently experienced a worsening of her symptoms following an electric shock at work. The worker reported she was managing her symptoms since December 2016 with a low dose of Prozac; however, this dose increased and 5mg of Aripiprazole was added in April 2017. The worker decreased her Prozac to 40mg and stopped the Aripiprazole due to increased anxiety. She was managing insomnia with Zopiclone 7.5mg and Lorazepam 1-2mg as needed. It was noted the worker was advised to stop using cannabis.
The worker advised the assessment team that at the time of accident she was reaching under a table while on her hands and knees to plug in a power cord and was electrocuted. Since that time, she reported a significant increase in anxiety and panic as well as difficulties with focus, memory, and concentration. She indicated she was having almost daily panic attacks with shortness of breath and feelings of having a tornado in her chest. The worker described experiencing intrusive memories of being electrocuted, reported feeling hypervigilant about everyday activities, and was experiencing avoidance (returning to work, going into her basement). She described being worried that something “bad” was going to happen. She indicated her energy was low; she had poor sleep, and she endorsed having social anxiety. She worried about being judged and stigmatized for her mental health difficulties. The worker advised she did not believe her employer was being supportive. She reported having difficulties making phone calls and engaging in everyday social interactions that previously were not a problem for her. The worker indicated she was now more aware of her status as an aboriginal Canadian, and feels this also contributed to her sense of vulnerability. The worker reported she feared she sustained permanent damage to her brain from the electrocution. She indicated her husband was supportive and her mother was coming to stay with her to help out at home.
The worker indicated her issues with depression began at age 19. She experienced low mood and sadness but no suicidal or self-harm ideations. At the time she was attending college away from home and was feeling lonely. She was on Amitriptyline; however, she experienced hypersomnia so she switched to Fluoxetine and felt better after 6 months. Her mood was stable for the next 9 years until she experienced a long-term relationship break-up. She was drinking heavily and was prescribed Venlafaxine which she took for 3 months. She experienced dizziness and low mood. She continued to use alcohol for the next year until she met her current spouse. It was noted her parents also had a history of depression. The worker reported she had been using cannabis since she was a teenager. She didn’t use cannabis for many years when she had her children. She recently started using it again in December 2016 to help her relax. She reported she smoked one joint per day.
The report indicated the worker developed symptoms of post-traumatic stress disorder (PTSD) following the work accident. Dr. McKeever indicated:
While I would defer to the opinion of the brain injury team on this matter, I think it is relatively unlikely that the electrocution itself has led to [the worker’s] worsening symptoms.
Dr. McKeever surmised the etiology of the worker’s symptoms were multifactorial. It was noted she may well have a biological and/or temperamental predisposition to difficulties with anxiety and mood given her family history. While she was previously able to manage her symptoms with a combination of coping mechanisms and medications, the injury at work was frightening and caused her to feel an increased sense of vulnerability which led to a cycle of worsening anxiety and avoidance as well as decreased mood. The worker was recommended to receive cognitive behavioural therapy (CBT). It was believed the worker had Generalized Anxiety Disorder and a Recurrent Major Depressive Disorder which were exacerbated by the recent accident, as well as PTSD.
On May 15, 2017 the worker underwent a magnetic resonance imaging (MRI) brain scan because of her ongoing headaches. There was no indication of any mass, mass effect, acute infarction, or hemorrhage. No abnormality was identified. The results were unremarkable.
On May 11, 2017 the worker was assessed by Dr. F. Al-Rawi at xxxxx clinic. The report indicated that on March 11, 2017 the worker was plugging something into a raised floor outlet under a table while on her hands and knees. She sustained a shock and felt her left arm contract. The worker advised she experienced a “tingling” on the top of her head. It was noted she did not fall, hit or head, or lose consciousness. She got up and realized she was seeing black spots. She was taken by ambulance to hospital. The hospital tests yielded negative results. The worker reported her symptoms had worsened since the accident. The worker’s current symptoms included:
Feels like she has a lot of energy, like she is buzzing
Can’t slow her thoughts down
Sleeping ~5 hours per night
Occasional headaches, twice per week due to lack of sleep
New phobia of going into basement
Social anxiety
Can’t focus on conversation and will be distracted by her environment
The worker advised she underwent a psychiatric assessment in early May 2017 and she was told she may have PTSD and she likely did not have a brain injury. The worker was recommended to undergo CBT. At the time of the assessment the worker was taking Prozac and marijuana. The report indicated she started taking 20mg of Prozac in December 2016 due to feeling irritable and stress from taking care of four young children. Since the work accident, her doctor increased the dose to 60mg and she was to increase the dose further to 80mg. The worker advised she started to use marijuana in December 2016 to help her sleep. Since the accident, she reported she smoked marijuana three times per day to help relax.
The report indicated the worker did not have any prior injuries, accidents, or concussions. The worker reported she had a history of depression. When she was 17 years of age, she was diagnosed with depression and took Prozac for 6 months. She indicated she also had anxiety in 2006 and was took Effexor for three to four months. The worker also indicated she abused alcohol while taking Effexor in 2006.
In terms of her activities of daily living (ADLs), the worker indicated she resided on a 102-acre farm with her husband and four children aged 8, 6, 4, and 2. Prior to the work accident, the worker did all the household chores and grounds keeping for the farm. Following the work accident, the worker had her mother move in to help with her children and household duties. The worker reported she was independent with self-care tasks. She indicated she gets distracted easily and was unable to sit and watch a television program.
Dr. Al-Rawi observed the worker arrived early for her appointment, she was noted to be appropriately groomed and dressed, and her affect was generally normal although flat at times. Dr. Al-Rawi completed a series of musculoskeletal, neurological, and balance testing of the worker. He surmised the worker’s clinical presentation did not meet the Ontario Neurotrauma Foundation (ONF) MTBI guidelines definition for a concussion noting there was no history of trauma. Dr. Al-Rawi submitted the worker’s diagnoses included anxiety, acute stress disorder and potential PTSD, and possible adjustment disorder. The worker’s prognosis was dependent on a psychiatric assessment.
The report indicated the worker did not feel she was ready to return to work. Dr. Al-Rawi indicated that based on his assessment, the worker did not have any current functional abilities, limitations, or restrictions; however, she would need to be cleared by a psychiatrist first.
T. Betrim, Clinical Counsellor, and Dr. P. Pajouhandeh, Clinical Psychologist, submitted a psychological assessment report dated June 7, 2017. The worker was assessed on May 16 and 25, 2017. She was noticeably emotional and was observed to be crying throughout the sessions. The worker described the work accident wherein she sustained an electric shock at work, and she advised she believed she was going to die. Since the accident the worker experienced poor appetite, avoidance, lack of focus, exhaustion, noise intolerance, social withdrawal, suicidal thoughts, and feared going out. The worker reported her husband was not supportive as he did not appear to understand mental illness. She also reported a lack of support at work, as a Native employee. The worker indicated she struggled with anxiety in the past. She indicated she loved her job and described the people she worked with as family. The worker reported she noticed she had been making careless mistakes, she had difficulty paying attention, she did not seem to listen when spoken to directly, and she was forgetful. She also reported she was easily annoyed by others, she would have sudden panic attacks with intense anxiety, and she endorsed depressive symptoms of feeling unhappy, hopeless, and worthless. The worker indicated she had a conviction that others were against her or will hurt her. Upon testing, the worker scored in the severe range for anxiety and depression. The assessment team surmised the worker’s symptoms appeared to be consistent with DSM-V diagnosis of Adjustment Disorder with Mixed Anxiety and Depression. It was noted the worker was experiencing psychological distress as a result of her work-related accident. The treatment goal was to help the worker develop effective coping strategies to alleviate the depressive and anxious symptoms. The worker was determined to be unable to work. She was recommended to undergo 6 counselling sessions before considering returning to work. Once she is ready to return to work, it was recommended she be provided with an additional 8 to 10 sessions of treatment as part of her transition back to work.
Memorandum A0024 approved 10 psychological treatment sessions to assist with return to work and recovery.
The operating area subsequently rescinded entitlement for concussion and MTBI, as documented in memorandum A0027.
The worker testified she began experiencing flashbacks of a previous sexual assault in September 2017 while she was receiving psychological counselling with one of Dr. Pajouhandeh’s associates. She indicated she started to remember details of the sexual assault during her treatment.
On November 18, 2017 Dr. C. Ojiegbe, Psychiatrist, completed an Independent Medical Evaluation (IME) of the worker. The report indicated the worker’s medications included Prozac 80mg and Zopiclone. The worker reported she used marijuana regularly and was seeing a psychologist for counselling on a weekly basis. The worker reported she experienced high anxiety while driving past the casino where she worked and she felt vulnerable and was worried she would have a breakdown if she returned to work. She reported she worked as a Pit Manager at gambling tables. She indicated she was popular among her co-workers and even trained a lot of them over the years.
The worker reported she was raised by her biological parents in Sault Ste. Marie, Ontario. Her father was taken from his family at age 4. He suffered from depression and also had problems with alcohol. The worker witnessed frequent arguments between her parents. Her father passed away a few years ago from heart problems. The worker advised her mother was not aboriginal. She also suffered from depression and was taking medications. She indicated her relationship with her mother was not very good. The worker reported she was raped at age 14. The worker advised she had one older sister and one brother. She indicated her sister suffered from fibromyalgia. The worker indicated she did not have a good relationship with her sister. She indicated her brother suffered from depression, anxiety, and alcohol abuse. The worker indicated she was not close to her brother. The worker indicated she used cannabis on a daily basis for about 1.5 years. She indicated it helped her sleep better and also helped her cope better with situations that cause her irritability.
With respect to the work accident, the worker indicated that when she got the shock she felt it go to her head. She felt hot in her head. The worker indicated the electricity went through her left hand and travelled to the top her head and it felt as though a light bulb exploded in her head. Following the shock, she screamed and went to the first aid room where security checked her vital signs. She began experiencing pain in her eyes immediately after the shock, and felt disoriented. She was taken to hospital by ambulance and was sent home after tests were completed.
The worker advised she completed Grade 12. She did one year of college at Cambrian College but had a nervous breakdown. She indicated she was 19 years of age and was not able to cope. The worker reported she felt overwhelmed and anxious. She reported that at age 19 her boss kissed her on the gaming floor on New Year’s Eve. She felt very embarrassed and felt everyone knew what happened and was talking about her. She later found out that the boss did the same thing to four other aboriginal co-workers of hers. She indicated the boss was fired. The worker advised she did not receive any support, as everyone believed the boss was fired because of her. It was at this time that she started drinking excessively.
The worker indicated she worked with the employer for approximately 20 years. She indicated her job involved solving problems and getting rid of people who cause problems. The nature of her job involves getting verbally abused a lot. She indicated she felt unsupported by her bosses whenever she expressed concerns about safety matters. On March 11, 2017, the date of the accident, it was brought to her attention that one of the shuffling machines was not working. She called for help but no one came. She decided to plug in the machine when she realized it was unplugged. She went underneath the table on her hands and knees when she received an electric shock. She indicated that approximately one month after the accident in April 2017, she attended a meeting with WSIB and her bosses. She reported she felt very uncomfortable and was on the verge of tears. It was determined the meeting was not appropriate and she was allowed to leave. She reported her WSIB benefits stopped in September 2017, and she had been receiving long-term disability (LTD) disability benefits.
Following the electric shock in March 2017 the worker endorsed the following symptoms:
Mind racing
Insomnia and still not sleeping well
Reduced concentration
Increased sensitivity and hypervigilance, unable to tolerate noise
Increased irritability
Tremors
Social phobia, worsened anxiety to the point she could not go out
Anxiety with physical symptoms of numbness in her arms, tingly sensation along her arms
Became too empathic and cried a lot
Became suicidal
The worker reported her emotional status deteriorated in September 2017 after WSIB informed her that her claim would no longer be acknowledged. She reported she experienced flashbacks of the rape she experienced at age 14 and felt as though she was losing control of her body and felt very vulnerable. During her emotional worsened state, her psychologist informed her she could no longer treat her because she needed “more help.” The worker indicated she had been replaying the rape and other trauma in her head and could not stop thinking about it. The worker’s diagnoses included PTSD; Major Depressive Disorder, recurrent; and Generalized Anxiety Disorder. The psychosocial stressors identified were her pre-existing relationship discord with her employer and family discord.
Dr. Ojiegbe indicated the worker’s high anxiety symptoms, panic, and hypervigilance would interfere significantly with her ability to attend and carry out her job or any gainful occupation. The worker was recommended to continue with trauma therapy and then engage in CBT once her condition stabilizes. The worker’s prognosis for successfully returning to work was fair to good. A successful return to work plan would depend on a successful outcome with trauma therapy, which could take 6 months. It was noted the worker expressed some issues with her bosses at work; however, she also reported she loved her job. Dr. Ojiegbe opined the worker’s symptom severity was precluding her from returning to work.
The worker testified she was terminated from her employment in January 2018 because she forgot to sign her contract on time. She advised she was not receiving any psychological treatment at that time.
The record contains a Mental Health Act Form 42 wherein it was stated the worker was assessed by Dr. B. Fuller on April 9, 2018 and had made an application for her to undergo a psychiatric assessment. The physician confirmed the worker threatened or attempted or was threatening or attempting to cause bodily harm to herself or others and that she was suffering from a mental disorder that likely will result in serious bodily harm to herself. The worker testified she was not doing well emotionally at that time. She testified she did not want to be with her children.
On April 10, 2018 Dr. M. Zakaria, Psychiatrist, assessed the worker at xxxxx Hospital. The report indicated the worker was seen by emergency physician, Dr. Fuller, on April 9, 2018 and was placed on a Form 1. The worker presented at hospital emergency with increasing depression and suicidal thoughts. She told the triage nurse she wanted to jump in front of a car. The worker was noted to be receiving LTD benefits. The report indicated she was working up until March 2017 when she was electrocuted at work, and since developed depression and anxiety. The worker was diagnosed with generalized anxiety disorder and major depressive disorder, both of which were exacerbated by the accident at work. It was also noted the worker was diagnosed with PTSD. Her current medication regimen consisted of Prozac 80mg, Seroquel 25mg, and medical marijuana. The report indicated the worker was treated for depression when she was 20 years old, and took Prozac for 4 months. She indicated that since that time she had not suffered any depression in a major way, only occasional minor depression. The report indicated that since the electrocution accident at work, she was feeling depressed and anxious. She advised she was afraid to plug in any electric appliance. She reported feelings of sadness, feeling down, low energy, low motivation, and problems with concentration and memory.
Dr. Zakaria’s report indicated the worker was experiencing flashbacks of a rape that happened when she was 14 years old while she was undergoing treatment following the electrocution. The worker indicated at age 14 she was living in Sault Ste. Marie, Ontario and she had known the person who raped her. She recalled she was drugged but she remembers being raped. She brought charges against the person who raped her approximately 1 week ago. The worker indicated she was having flashbacks of the rape, but no nightmares. She indicated she has memories of the electrocution, but she denied having any flashbacks or nightmares in relation to the electrocution accident. The worker was diagnosed with chronic major depression, social anxiety, and PTSD in relation to the rape at age 14. Dr. Zakaria indicated there was no clear cut history of PTSD symptoms related to the work accident. The worker was admitted to the psychiatric floor on a Form 1.
The worker was discharged from xxxxx Hospital on April 12, 2018. The discharge report indicated the worker’s diagnosis was major depressive disorder. She was to follow-up with Dr. Zakaria, and she was referred to xxxxx Mental Health Services. The worker denied any active thoughts of self-harm or suicide.
Dr. Y. Kwamie, Psychiatrist, assessed the worker on June 9, 2018 in response to Dr. Westbrook’s referral in December 2017. The report indicated the worker was electrocuted at work in March 2017 and this triggered memories and recollections of her being sexually assaulted when she was 14 years old. She endorsed experiencing flashbacks and nightmares of the experience. The report indicated the worker was terminated from her employment in January 2018. The worker indicated she was angry with her former employer, WSIB, and Blue Cross. The worker indicated she experienced crying spells, difficulty sleeping, poor memory, and difficulty concentrating. Her interest in social activities was reportedly reduced. Throughout the assessment the worker appeared emotionally distressed and cried throughout. Dr. Kwamie diagnosed the worker with major depression with anxious distress, severe; and PTSD; severe. Dr. Kwamie indicated the worker would benefit from CBT.
Dr. L. Trépanier, Neuropsychologist, assessed the worker on June 28, July 21 and 26, 2018. It was noted the assessment was arranged by the employer’s insurance carrier. The worker engaged in a clinical interview and completed several tests. The results indicated the worker’s anxiety was severely elevated, loss of control was evident, and her anger was elevated to a high moderate range. The worker described her anger stemmed from a belief that her and her people (indigenous Native Americans) have been treated unfairly and/or abused in a variety of ways. The unfairness and pain she felt during the electrocution symbolized the pain she felt in other ways, although she is aware the electrocution was not intentional. The report also indicated the worker struggled with shame-based anger and self-esteem secondary to her perceived mistreatment at work and from other remote historical events (rape at age 14 and thought the boys were going to drown her). The worker’s depressive symptoms were severely elevated, and she endorsed cognitive/affective as well as somatic symptoms of depression.
Dr. Trépanier’s report indicated the worker viewed her life as severely disrupted by a variety of physical problems, some of which may be stress-related. These problems have left her tense, unhappy, and have probably impaired her ability to concentrate on or perform important life tasks. The worker endorsed experiencing a discomforting level of anxiety and tension. She indicated she was experiencing specific fears or anxiety surrounding certain situations, and she is likely to display a variety of maladaptive behaviour patterns aimed at controlling her anxiety.
It was noted the worker experienced a disturbing traumatic event(s) in the past that continues to distress her and produce recurrent episodes of anxiety. There was some indication of peculiarities in thinking. It was noted her pattern of responses were likely marked by confusion, indecision, distractibility, and difficulty concentrating. The worker reported drug use may be the source of some of her problems in her life, including strained interpersonal relationships and vocational and/or legal problems. It was noted the worker has been using CBD oil for the last couple of years and has a medical marijuana license to obtain it.
Dr. Trépanier submitted the worker had PTSD in the severe range for both traumatic life events (sexual assault and electrocution). The worker came across as genuine about the psychic pain she was in from several lifetime events, including the sexual assault as a teenager, witnessing the trauma in her father from, and her perceived unfair treatment of Native aboriginal peoples at work, then her electrocution on the gaming machine at work in 2017. Dr. Trépanier indicated the worker met the criteria for complex PTSD in the severe range. She exhibited clinically significant levels of dissociation, heavy use of medicinal marijuana to manage her psychological symptoms, and endorsed struggles with suicidal ideation. The report indicated the worker took herself to hospital in April 2018 as she was concerned she might end her life. She was encouraged to return to the emergency department should these strong thoughts and feelings come back. Dr. Trépanier indicated the worker also met the criteria for Major Depressive Episode, recurrent; and Generalized Anxiety Disorder. It was also noted she displayed borderline traits in her personality but she did not have the full disorder. Dr. Trépanier recommended the worker engage in treatment every 7 to 10 days with some reading and homework in between, for a period of four to six months.
The worker testified she continued to see Dr. Kwamie and Dr. Trépanier since the initial assessments. She indicated treatment is being paid by her employer’s insurance carrier as part of her LTD claim. The worker advised she was approved for LTD benefits in July 2017 prior to her termination. The worker indicated the treatment she has received has been helpful in that she is thankful to have someone to talk to. She indicated she feels very alone otherwise.
- Psychotraumatic Disability
Operational policy 15-04-02 states, in part:
Entitlement for psychotraumatic disability may be established when the following circumstances exist or develop
Organic brain syndrome secondary to
traumatic head injury
toxic chemicals including gases
hypoxic conditions, or
conditions related to decompression sickness.
As an indirect result of a physical injury
emotional reaction to the accident or injury
severe physical disability/impairment, or
reaction to the treatment process.
The psychotraumatic disability is shown to be related to extended disablement and to non-medical, socioeconomic factors, the majority of which can be directly and clearly related to the work-related injury.
In terms of the first criterion, there is no evidence of an organic brain syndrome secondary to a traumatic head injury, toxic chemicals, hypoxic conditions, or conditions related to decompression sickness.
The worker representative submitted the second criterion has been met in this case. I agree with the worker representative on this point. I find the evidence supports the worker sustained an emotional reaction to the accident. It is noted the worker reported feelings of anxiousness and nervousness on March 15, 2017, just a few days post-accident. Dr. McKeever assessed the worker on May 4, 2017 and it was noted the worker had a history anxiety and depression and she was taking a low dose of Prozac prior to the work accident. Dr. McKeever indicated the worker’s post-accident symptoms were in keeping with PTSD, anxiety, and recurrent depression; however, it was unlikely the electrocution alone led to a worsening of her symptoms. Dr. McKeever indicated the etiology of the worker’s symptoms was multifactorial and it was suggested she may have a biological and/or temperamental predisposition to difficulties with anxiety and mood.
I agree with Dr. McKeever in that it appears the worker may have a predisposition to difficulties with anxiety and mood.
Operational policy 15-02-03 states, in part:
Consistent with the “thin skull” doctrine, the fact that a worker may have a pre-existing condition that could increase susceptibility to injury/disease is not considered during the initial determination of entitlement in a claim. In such cases, workers are compensated for the work-related injury/disease and the claim is not denied due to the existence of a pre-existing condition.
I accept the worker has a pre-existing condition for anxiety and depression as confirmed by Dr. Westbrook’s pre-accident chart notes and the assessment reports. I find the worker’s pre-existing anxiety and depression would not preclude her from entitlement to benefits for a psychotraumatic disability. The evidence supports the worker managed her anxiety and depression for many years with a low dose of Prozac on an intermittent basis. Prior to the work accident, the worker cared for her four young children, managed her household, and maintained her employment as a Pit Manager. Following the work accident, the worker’s anxiety and depression worsened to the extent she was unable to return to work, and she had difficulty managing day to day activities due to her psychological state. The worker representative submitted the electrocution at work was a significant precipitating event that interfered with her family life and job. I accept the work accident was a significant intervening event which caused the worker to develop recurrent depression and increased anxiety.
The worker representative submitted he is seeking entitlement to benefits for depression. In review of the evidence before me, it is noted there were several diagnoses provided for the worker by the various health care professionals. The worker was consistently diagnosed with Major Depressive Disorder, recurrent; and Generalized Anxiety Disorder, which I accept are in keeping with the workplace accident. It is noted the worker was also diagnosed with PTSD. The record indicated the worker began experiencing flashbacks of a rape she experienced when she was 14 years of age in September 2017. Dr. Ojiegbe and Dr. Kwamie did not indicate whether the PTSD was attributable to the work accident, sexual assault or both; Dr. Zakaria was of the view the worker’s PTSD was associated with the sexual assault; and Dr. Trépanier indicated her PTSD was severe for both the sexual assault and electrocution at work. Given the worker did not endorse having clear cut nightmares or flashbacks of the electrocution, as indicated in Dr. Zakaria’s report, I find entitlement is not in order for PTSD under this claim.
Based on the evidence before me, I accept entitlement is in order for a psychotraumatic disability. The accepted diagnoses include Major Depressive Disorder, recurrent; and Generalized Anxiety Disorder. It does not appear the worker has reached maximum medical recovery (MMR) for her psychotraumatic disability. The worker indicated she has continued to receive treatment from Dr. Kwamie and Dr. Trépanier for her psychotraumatic disability, which I accept is a responsibility of this claim.
- LOE Benefit Entitlement from September 2, 2017
Operational policy 18-03-02 states, in part:
Payment of full LOE
If the nature or seriousness of the injury completely prevents a worker from returning to any type of work, the worker is entitled to full LOE benefits, providing the worker co-operates in health care measures as recommended by the attending health care practitioner and approved by the WSIB.
In review of the facts and circumstances of this case, I find the worker’s compensable psychological condition rendered her unable to return to work in any capacity. Dr. Ojiegbe’s report indicates the worker’s high anxiety, panic, and hypervigilance would interfere with her ability to attend and carry out her job duties or any gainful occupation. Dr. Zakaria, Dr. Kwamie and Dr. Trépanier’s reports do not comment on the worker’s ability to return to work; however, the clinical findings support the worker’s depression and anxiety symptoms were severely elevated. The medical evidence in the record supports the worker is totally disabled and unable to work as a result of her non-organic condition. As such, I find the worker is entitled to further LOE benefits from September 2, 2017.
CONCLUSION
I conclude:
The worker is entitled to benefits for psychotraumatic disability. The accepted diagnoses include Major Depressive Disorder, recurrent; and Generalized Anxiety Disorder.
The worker is entitled to LOE benefits from September 2, 2017.
The operating area shall determine the extent and duration of benefits flowing form this decision.
The worker’s objection is allowed.
DATED September 6, 2018
L. Mansueti
Appeals Resolution Officer
Appeals Services