APPEALS RESOLUTION OFFICER DECISION
decision number:
20210038
OBJECTING PARTY:
worker
REPRESENTED by:
WORKER representative
RESPONDENT:
employer, not participating
HEARING:
HEARING IN WRITING
HEARD by:
kim mcdonnell, appeals resolution officer
ISSUE
The worker, through their representative, has objected to the Eligibility Adjudicator’s May 4, 2021 decision. That decision denied initial entitlement to bilateral wrist tenosynovitis.
BACKGROUND
On April 22, 2021, this mid 50-year-old right-hand dominant worker reported they had been diagnosed with tenosynovitis in both wrists. They related the injury to repetitive typing and had experienced similar wrist pain two years earlier. At the time of the injury, the worker had been with the employer since March 2005 in the role of a gatehouse operations clerk.
The Eligibility Adjudicator (EA) reviewed the information in the claim file and was unable to establish that the worker’s injury arose out of and in the course of employment. The worker had reported that their work duties had not changed since 2005 and they could not point to one incident that had caused their injury. The issue of initial entitlement to bilateral wrist injuries is now before me.
AUTHORITY
Section 13(2) of the Workplace Safety and Insurance Act (WSIA)
Operational Policy Manual
Published
11-01-01 Adjudicative Process
15-02-01 Definition of an Accident
November 3, 2008
October 12, 2004
ANALYSIS
I have carefully considered all of the available information, legislation and relevant operational policies in reaching this decision. I find the worker is entitled to a claim for bilateral wrist tenosynovitis. The worker’s objection is allowed.
Worker’s Position
On May 31, 2021, the worker’s representative provided an Appeal Readiness Form and stated that the worker’s injury was severe and the injury prevented them from performing their job duties. The worker had experienced a wage loss that had not been recovered. The representative stated the worker needed treatment and time off work to heal.
Employer’s Position
The employer is not participating in this appeal.
Evidence
On April 27, 2021, the employer provided an Employer’s Report of Injury (Form 7) and stated that the worker had reported chronic constant pain in both wrists due to repetitive typing on April 21, 2021 to the crew lead. The Form 7 stated that the worker reported an aggravation of their chronic pain that day and was scheduling an appointment with their family doctor. The Form 7 stated that the worker was being accommodated with modified work following the instructions from the family doctor.
On April 22, 2021, the worker’s physician Dr. Dhailwal provided a Health Professional’s Report (Form 8). I found the following information in the Form 8:
- The injury was due to long-term repetitive typing.
- The worker had been diagnosed with tenosynovitis in the past.
- The doctor recommended rest, bracing, physiotherapy, and possibly steroid injections.
- The worker was able to return to modified work while limiting activities involving wrists (i.e. typing, writing, and lifting).
On May 3, 2021, a Customer Service Representative (CSR) spoke with the worker and I found the following information:
- Their family physician had diagnosed them with tenosynovitis, bilateral wrists.
- The pain had started around the beginning of the month.
- The worker described working on a computer all day every day and attributed their injury to constant typing.
- They regularly worked 10-hour shifts, four days a week. However, one of the offices shut down one week ago and the worker had been working seven days a week.
- They reported that they had not yet started physiotherapy.
- They had undergone an ultrasound.
- They had experienced similar pain about two years prior to this incident. They stated that a cortisone injection along with braces at night helped the numbness.
Policy
Policy 15-02-01 (Definition of an Accident) categorizes three different types of accidents, including:
- A wilful and intentional act, not being the act of the worker;
- A chance event occasioned by a physical or natural cause; and
- A disablement arising out of and in the course of employment
A disablement may be as an unexpected result of work duties or a gradual onset.
For chance event or willful act types of claims, there is a presumption clause in the WSIA that does not apply in a disablement situation.
The WSIA, Section 13(2) that states the presumption:
“If the accident arose out of employment, it shall be presumed that it occurred in the course of employment unless the contrary is shown. If it occurs in the course of the worker’s employment, it shall be presumed that it arose out of employment unless the contrary is shown.”
Policy 11-01-01(Adjudicative Process), states that all claims are adjudicated based on the same five-point check system. The evidence on file must support all five points for a claim to be allowed. The five points that must be met are the establishment of an employer, a worker, a personal work-related injury, proof of accident, and the compatibility of the diagnosis to the accident history.
Decision-makers may consider the following when examining proof of accident,
- Does an accident or disablement situation exist?
- Are there any witnesses?
- Are there discrepancies in the date of accident and the date the worker stopped working?
- Was there any delay in the onset of symptoms or in seeking health care attention?
Findings
Type of accident – gradual onset disablement type injury
I find the accident history provided by the worker documented a gradual onset disablement injury. Policy 15-02-01 (Definition of an Accident) outlines three different types of accidents. In the case of a gradual onset disablement injury, the WSIA, Section 13(2) presumption does not apply. The onus is on the worker to provide evidence that the accident arose out of and in the course of employment. The working duties must be shown to be a significant contributing factor in the development of the injury. Simply because the worker was at work and felt pain is not sufficient evidence that the injury is work- related. There must be something about the work that contributed to the development or worsening of the injury.
Initial entitlement
I find the worker has entitlement to bilateral wrist tenosynovitis. Policy 11-01-01 (Adjudicative Process) states that all claims must meet the five-point check system to be an allowable claim. In this case, there is a worker and an employer. This is not in dispute. For the reasons set out below, I find there is sufficient evidence of a personal work-related injury, proof of accident, and compatibility of diagnosis to the accident history.
Personal work-related injury
I acknowledge that the worker complained of prior bilateral wrist pain. They were treated for the condition with cortisone injections and given a brace to wear at night. The worker then returned to their regular work for two years. There is no evidence in the claim file that the worker required modifications to their work, lost time due to the condition, or required ongoing treatment. I concluded that injury had largely resolved. Two years is a significant period of time and, in my view, establishes that the worker had recovered.
The worker reported that their wrists had become painful around the beginning of April 2021. They also stated that a week before they reported the injury to their employer, their work hours had increased. In the May 3, 2021 record between the CSR and the worker, the worker stated that one of the employer’s offices had closed and they had been working seven days a week. This is an increase of three 10-hour shifts over the regularly scheduled four 10-hour shifts the worker had previously completed. In my view, the 30 extra hours that the worker completed in the week before they reported their injury is sufficient information to establish that the work duties were a significant contributing factor in the development of the bilateral wrist tenosynovitis.
I accept that the worker’s wrist condition arose out of and in the course of employment. The worker reported they typed all day for each 10-hour shifts. There were no other duties involved with their work. I accept that the repetitive nature of their work, sustained flexion and extension of the wrists while typing, and forceful finger movements significantly contributed to the diagnosis of tenosynovitis.
Proof of accident
I find that proof of accident has been established. A disablement situation existed in this case. The worker was performing repetitive movements and postures with their hands and wrists over a period of increased activity. The increase in hours of work from 40 to 70 hours in one week might reasonably lead to a disablement situation.
There is no evidence in the claim file of witnesses. However, the Form 7 stated the worker reported the injury to their crew lead.
While the worker reported the pain had started about three weeks prior to the date they reported the injury to the employer, I do not find this delay is significant. In my view, due to the nature of injury (gradual onset), the delay in reporting is not significant. It was only after the worker’s hours increased that they were unable to sustain the work and reported the injury.
There was no delay in seeking medical attention. The worker reported the injury on April 21, 2021 and they were assessed by their family physician on April 22, 2021.
Compatibility of the diagnosis to the injury history
The diagnosis of bilateral wrist tenosynovitis is compatible with the gradual onset of wrist pain from repetitive typing duties that had significantly increased over the prior week. In the April 22, 2021 Form 8, the family doctor stated the diagnosis was tenosynovitis from long-term repetitive typing. I accept that the doctor causally linked the worker’s duties with their diagnosis.
In summary, the worker’s claim of bilateral wrist tenosynovitis has met the five-point check system and thus is an allowable claim. The gradual onset injury arose out of the worker’s increased work duties including repetitive typing and sustained wrist postures. I am returning the claim to the operating area to determine the nature and extent of benefits flowing from this decision, subject to the usual rights of appeal.
CONCLUSION
The worker’s objection is allowed.
DATED November 5, 2021
Appeals Resolution Officer
Appeals Services Division