Worker v. Employer, 2021 CanLII 65265

WORKPLACE SAFETY AND INSURANCE BOARD

APPEALS RESOLUTION OFFICER DECISION

Decision number: 20210004

OBJECTING PARTY: Worker

REPRESENTED by: Worker Representative

RESPONDENT: Employer

REPRESENTED by: Employer Representative

HEARING: Teleconference – February 25, 2021

HEARD by: Kelly Gordon, Appeals Resolution Officer

ADDITIONAL ATTENDEE: Observer (with the worker representative)

DATED: March 12, 2021

ISSUE

The worker, through her representative is objecting to the Occupational Disease (OD) Adjudicator’s decision dated March 11, 2020. In this decision, the OD Adjudicator denied entitlement to a December 16, 2019 recurrence of the compensable psychotraumatic disability.

PRELIMNIARY ISSUE

Prior to the start of the hearing, the worker representative advised that the clinical notes submitted to file with the Appeal Readiness Form (ARF) were not included in their copy of the file. The worker representative contacted the employer representative prior to the hearing, and he advised he also did not have the clinical notes submitted with the ARF. Therefore, the worker representative sent the clinical notes to the employer representative a day prior to the hearing. The worker and the employer representative agreed that since the clinical notes are being reviewed late, we would continue with the hearing, but the representatives would provide their closing arguments to me in a submission prior to March 2, 2021. As both parties agree, I advised I have no issues with accepting the closing arguments after the hearing.

BACKGROUND

On June 9, 2019, this police sergeant searched a suspect, and found a wrapped piece of foil. The sergeant unwrapped the foil, and noticed it contained a blue crystalline substance. While handling the foil, the worker accidently inhaled the substance, and got it on her hands. The worker put Isogel hand sanitizer on her hands, but then became dizzy and started to hallucinate. The worker was taken to the hospital by ambulance, and the substance was later determined to be Fentanyl. The worker returned to her regular job duties on her next shift. Entitlement was accepted in this claim for a fumes inhalation exposure to Fentanyl.

On July 23, 2019, the worker sought medical attention for anxiety and depression. As per the Health Professional’s Report of Injury, Form 8, the worker’s exposure to Fentanyl triggered lingering effects of heightened anxiety and depression. The worker also experienced flashbacks of past trauma at work, and due to her emotional reaction, the worker was authorized off work. The worker underwent a psychological assessment with Dr. Ekblad, psychologist, and the worker was diagnosed with Other Specified Trauma/Stressor Related Disorder. Secondary entitlement was allowed in this claim for the worker’s anxiety and trauma-related symptoms as the exposure incident triggered past traumatic experiences. The worker continued to receive psychological treatment with Dr. Ekblad, and starting July 22, 2019, the worker was paid full loss of earning (LOE) benefits.

With the assistance of a WSIB Return to Work Specialist, the worker returned to work on December 16, 2019. The return to work plan was for the worker to increase her hours and duties of work gradually. Prior to returning to work, the employer sent an email to the worker’s work email address. This email contained the worker’s annual review. The worker read the email and the negative performance review when she returned to work on December 16, 2019. After reading the negative performance review, the worker developed an increase in her psychological symptoms, and had to leave work. The worker remained off work claiming the negative performance review caused a significant deterioration in her psychological symptoms.

In the decision dated March 11, 2020, the OD Adjudicator states the negative performance review from the employer could not be related to the exposure incident allowed in this claim. As a result, the OD Adjudicator denied entitlement to the December 16, 2019 psychological recurrence.

The worker representative submitted the ARF dated September 23, 2020, confirming the worker’s objection to the denial of the December 16, 2019 psychological recurrence. The OD Adjudicator reviewed the information submitted with the ARF, and although the OD Adjudicator reconsidered the decision on October 5, 2020, the denial of the December 16, 2019 psychological recurrence was upheld.

The worker’s objection to the denial of the December 16, 2019, psychological recurrence forms the basis of this appeal.

AUTHORITY

Operational Policy:

15-02-05 Recurrences

ANALYSIS

I find the worker does have entitlement to the December 16, 2019 recurrence. In coming to this decision, I have considered the worker’s testimony, the worker representative’s submission, the employer representative’s submission, the information in the claim file, as well as the appropriate Operational Policy.

The worker representative provided a submission dated March 1, 2021. In this submission, the representative refers to the decision dated November 18, 2019, that notes the worker had been experiencing a trauma related to stress, complicated by the fact that the worker was re-experiencing incidents from earlier in her career. As such, the representative states the worker’s stress reaction was not solely to the isolated Fentanyl exposure, but also to her approximately 20 year career as a police officer.

The representative states that on December 16, 2019, the performance evaluation received would not constitute a significant new incident or what the CM concluded to be a post-accident change in circumstances. It is important to note the evaluation itself did not bear significant consequences for the worker. There was no discipline flowing from the evaluation, and while the worker continues to dispute the validity of the evaluation, it was not the reason for her continued symptoms beyond December 2019. It is no doubt a concurrent stressor, but not the sole cause for her ongoing psychological impairment, and inability to return to work as planned in December 2019. Instead, the representative states the evidence supports it is the work-related psychological impairment that is the significant contributor to the recurrence. The worker was still in a fragile state when she returned to work on December 16, 2019, and there is evidence the worker continued to have a psychological impairment when the return to work plan was developed. The representative states the medical evidence on file confirms there was a significant deterioration in the worker’s psychological condition following her return to work attempt, such that she was unable to continue working. The worker’s loss of earnings from that time until she returned to work are the result of her work-related psychological condition, and the worker’s symptoms of increased panic attacks, suicidal thoughts, and need for a psychiatric referral all indicate a deterioration. For the reasons stated, the representative is requesting this appeal allow the worker’s objection, and grant entitlement to the December 16, 2019 recurrence.

As per the employer representative’s submission dated March 8, 2021, the representative states the worker testified about three (3) stressful work-related events, and two (2) stressful personal circumstances. The representative notes that in 2018, the worker was involved in an altercation at a work sanctioned baseball tournament in another city. Following an investigation by the worker’s employer, the worker was charged and convicted of discreditable conduct under the Police Services Act. By December 2019, the proceedings related to this charge had not yet been concluded. The worker was then directed by the employer to undergo a psychological counselling session with Dr. Ekblad. The worker testified she continued to seek ongoing treatment with Dr. Ekblad leading up to the date of accident accepted in this claim. The representative reviewed Dr. Guzar’s clinical notes, and refers to the note dated July 19, 2019. The worker describes the 2018 altercation at the bar, the repercussions around her employment, and the relationship with her daughter. The worker states these issues have been very stressful. The worker describes the stresses from these issues prior to discussing her exposure to Fentanyl. The representative states the medical evidence supports the worker had a strong and emotional reaction to the events leading up to June 2019. The worker was feeling isolated within her career due to serious professional discipline for the bar altercation in the other city, and the pending Police Services Act proceedings. This culminated with a decision of the worker’s daughter that she wanted to move out. The representative states the relationship with her daughter was the trigger to the worker “falling apart”, and not the workplace exposure to Fentanyl.

The employer representative states the evidence supports that leading up to her return to work on December 16, 2019, the worker was feeling good. Dr. Ekblad’s clinical note dated December 17, 2019 supports this, and in the note dated January 22, 2020, Dr. Ekblad states that when the worker did return to work, the worker was greeted warmly, and did not feel judgement from co-workers. There was a single incident on December 16, 2019, that triggered the worker’s deterioration. This was the worker’s performance review, and the worker read the review in an email. The worker was not happy with the manner in which the review was given, and the content of the review upset her. The worker was provided with an adverse assessment of her performance. The representative argues the worker’s sudden deterioration in her psychological condition was caused from reading the poor performance assessment, and as such, the worker should not be granted entitlement to the December 16, 2019 recurrence. The representative is requesting this appeal uphold the decision to deny the December 16, 2019 recurrence.

During the hearing, the worker testified she worked for the employer for almost 20 years, and was promoted to sergeant approximately two (2) years before the workplace accident. The worker also testified she had always had very good performance reviews, and never had a negative one (1) before the workplace accident.

The worker testified that prior to the workplace accident she was involved in an altercation at a bar. This altercation led to her being disciplined by her employer. As part of the disciplinary action, the worker was ordered to attend a psychological counselling session. The worker underwent this counselling session with Dr. Ekblad on March 16, 2019. The worker then continued to see Dr. Ekblad for nine (9) more treatment sessions from March 2019 to June 2019. The worker testified the treatment sought was to assist her with everyday mental health issues as well as the issues she was dealing with pertaining to the altercation at the bar, and the disciplinary actions taken by her employer. Although a disciplinary action hearing took place regarding the altercation at the bar, the hearing took place after the worker’s return to work on December 16, 2019.

The worker testified that following the work-related accident, she developed psychological symptoms that she did not have before the accident. These symptoms included anxiety, depression, nightmares, visions of dead bodies, and tingling and pain in both hands.

I find it significant here to note the OD Adjudicator’s decision dated November 18, 2019. As per this decision, secondary entitlement was allowed in this claim for the worker’s anxiety and trauma-related symptoms. The OD Adjudicator also accepted the clinical evidence on file supports the worker was not able to work as the exposure incident triggered past traumatic experiences that the worker is experiencing and re-experiencing. Entitlement was accepted for the diagnosed Other Specified Trauma/Stressor Related Disorder, and psychological treatment was recommended prior to the worker returning to work. Full loss of earning (LOE) benefits were allowed from June 22, 2019 to December 16, 2019.

The worker testified she sought treatment with Dr. Ekblad 13 times between June 9, 2019 and December 2019. The worker stated that during this time she was severely depressed, and would often cry in her car. The worker was also experiencing severe anxiety, and stated she felt like a failure. The worker is a sergeant, and testified she felt that she should be tough and get through this. The worker did not start losing time from work until June 26, 2019, when she could not get out of bed due to the anxiety and depression.

The worker stated that prior to the accident; she was not prescribed any medication for psychological symptoms. After the accident, the worker was prescribed Effexor, and confirmed her psychological medication has changed many times. The worker continues to be prescribed medication for her depression and anxiety.

The worker testified that on December 12, 2019, she met with the WSIB Return to Work Specialist (RTWS), and the employer. They discussed a plan to return to work. The worker stated the plan included the worker returning to administration duties in the major crime unit. During RTW discussions, the worker stated that although she was excited to be returning to work, the worker was still not 100 percent, and she was still experiencing the same ongoing psychological symptoms. The worker stated she was also still taking medication for her symptoms, and the medication was helping her.

The worker testified she returned to work on December 16, 2019, as per the return to work (RTW) plan. The worker’s shift started at either 8 am or 9 am. Prior to arriving, the worker had a panic attack, and had to meditate. The worker stated she was feeling inadequate, and although she was supposed to be a strong sergeant, she felt broken. The worker was also nervous about how her colleagues would react to her. When the worker arrived, the worker stated her colleagues were friendly and warmly greeted her. The worker did not feel judged by her colleagues.

The worker stated that when she arrived to work on December 16, 2019, the employer was not prepared for her arrival, and she was not immediately assigned work. The worker was advised to go through her work emails. The worker did so, and opened an email stating she had to approve her annual performance review. When the worker read her review, she was very surprised to see the review was very negative. The worker testified that prior to coming into work on December 16, 2019, the worker felt as if she was a failure, and lost confidence in herself. Within an hour of being at work, the worker read the review, and the worker stated this diminished the rest of her confidence. The worker walked to the photocopy machine, and had a panic attack. The worker started envisioning the dead bodies again and her hands became painful and tingling. The worker’s psychological symptoms intensified. The worker called her union president who advised her to leave work, and the worker left. The worker testified that on December 16, 2019, she was at work for one (1) hour and 45 minutes prior to leaving.

The worker testified that the performance review was not the reason for her recurrence. Instead, the worker testified that prior to returning to work she was still suffering psychological symptoms, and was on medication for the symptoms. Although the worker was excited to return to work, the performance review worsened the symptoms she was already experiencing.

During the hearing, the worker was asked about the OD Adjudicator’s memorandum dated February 21, 2020. As per this memorandum, the OD Adjudicator states that prior to returning to work on December 16, 2019, the worker reported she was 95 percent better. The worker testified she does not remember saying this, and that she disagrees with this statement. The worker testified she was not 95 percent better prior to returning to work and Dr. Ekblad’s clinical reports confirm this.

The worker testified that she separated from her common law partner in June 2020. The worker stated her work-related depression and anxiety contributed to the separation as her partner was not supportive.

During the hearing, the worker was also asked about Dr. Guzar’s clinical notes. Dr. Guzar is the worker’s family doctor. The worker stated she might have reported to Dr. Guzar that she was sad about something before the accident, but the worker was not depressed prior to the June 9, 2019 workplace exposure. The worker also advised that approximately 10 years prior to the workplace accident; she did seek psychological treatment with two (2) psychologists, and at the time, she was going through a divorce.

The worker testified she contacted Dr. Ekblad, and was able to get in to see him on December 17, 2019, the day after the failed RTW. The worker has continued to see Dr. Ekblad frequently, and from December 2019 to present, the worker stated she has seen Dr. Ekblad 40 times.

The worker also testified that on April 29, 2020, she started seeing Dr. Poopala, psychiatrist who has been prescribing medication for her depression and anxiety. The worker has had phone sessions (due to Covid) with Dr. Poopala 12 times, and she continues to see Dr. Poopala. Although the worker reports seeing this psychiatrist, I did not find any reports from Dr. Poopala on file.

The worker testified she returned to work in May 2020, and she is gradually increasing her hours of work.

In reviewing entitlement to the recurrence in this claim, I refer to Policy 15-02-05 that states a worker may be entitled to benefits for a recurrence of a work-related injury/disease if the worker experiences a significant deterioration that

• does not result from a significant new incident/exposure, and
• is clinically compatible with the original injury/disease.

A significant deterioration refers to a marked degree of deterioration in the work-related impairment that is demonstrated by a measurable change in the clinical findings. Indicators of a significant deterioration may include

• the need for active (non-maintenance) clinical treatment
• a change in functional abilities, or
• a change in the ability to perform a job or suitable occupation

To establish that the significant deterioration is clinically compatible with the original injury/disease, the WSIB must determine that

• the body parts and/or functions affected now are the same as, or related to, those affected by the original injury/disease, and
• there is a causal link between the significant deterioration and the original injury/disease.

To make these determinations, the WSIB considers the nature and severity of the significant deterioration, the original injury/disease and any relevant non-work-related conditions that are present

The WSIB may also consider whether a worker has experienced continuing symptoms since the original injury/disease. Generally, continuing symptoms are an indicator of a causal link, though they are not required to establish a causal link. Indicators of continuing symptoms may include

• continuing clinical treatment
• continuing workplace accommodations, or
• evidence that continuing symptoms were reported to health care providers, supervisors or co-workers on an ongoing basis.

As per Dr. Ekblad’s clinical report dated September 10, 2019, Dr. Ekblad confirms treatment is being provided to the worker on a regular basis noting her psychological symptoms since the workplace exposure. Dr. Ekblad states the worker continues to describe numerous dead bodies flashing through her vision multiple times per day. The worker also describes a feeling of needles in her hands consistent with the feeling she had when she was exposed to fentanyl in the summer of 2020. The worker reported her pain level in her hands as 70 out of 100. The worker also reported the tingling and the scrolling of dead body images are much more prominent when she is not focused on something else. The worker reported significant difficulty with behavioural activation such as running, and a deterioration in her sleep. The worker has a strong desire to get back to work.

Dr. Ekblad’s clinical notes confirm the worker reported the same symptoms when seen September 24, 2019, October 2, 2019, and October 8, 2019. In the clinical noted dated October 8, 2019, Dr. Ekblad states the worker reported she felt the previous visit was a “wake up call” regarding her depression. The worker noticed she has been more behaviourally active and saw a trainer. However, the worker also noted the tingling in her hands and images of dead bodies are at the same levels as the week prior. The worker reported two (2) nightmares from the previous week.

Dr. Ekblad states the following:

“In consultation with colleagues, fellow psychologists agreed that behavioural activation and acceptance skills are the most appropriate methods of treatment for the worker’s symptoms and that evidence in the form of PTSD treatment may not be appropriate at this time due to the client’s symptoms which do not include a typical memory of an incident but rather flashing images.”

In the notes dated October 15, 2019, and October 16, 2019, Dr. Ekblad states the worker has been receiving treatment for anxiety and low mood following the fentanyl exposure in June 2019. Since the exposure, the worker has been experiencing and re-experiencing trauma related symptoms that she had not experienced earlier in her career. The worker also experiences atypical symptoms such as a painful tingling in her hands that is similar to the sensation she had in her hands when she was exposed to the fentanyl. The worker experiences a kind of re-experiencing of traumatic memories, although this also occurs in a manner that is not typical of PTSD. Rather than responding to specific traumatic triggers, the worker occasionally sees a “film reel” of many different dead bodies flashing through her vision.

Dr. Ekblad states that while this is clearly a kind of trauma related distress, it is complicated by the fact that this re-experiencing is different from the experience of memory and images that is common in PTSD.

Dr. Ekblad states the worker’s experiences meet the diagnostic criteria for other specified trauma/stressor related disorder, and the worker did not suffer these symptoms prior to the Fentanyl exposure.

Dr. Ekblad submitted clinical notes for the worker’s visits on October 29, 2019, November 5, 2019, November 13, 2019, November 19, 2019, and December 3, 2019. As per these notes, the worker reported an improvement in symptoms, and the worker continued to express a desire to return to work. Dr. Ekblad noted a return to work schedule was being put in place for the worker to return to work in December 2019. In the clinical note dated December 3, 2019, Dr. Ekblad stateds the worker is still not back to work and is waiting for WSIB approval. The worker reported she continues to experience poor sleep, tingling in hands, and periods of high anxiety at roughly the same frequency as the last several weeks.

In the clinical note dated December 17, 2019, Dr. Ekblad stateds the worker attempted to return to work on December 16, 2019. While the worker was enthusiastic about returning to work, the worker described intense distress when she returned to work and read an email with negative documentation regarding her annual review. Reading this email and the annual review caused the worker to become extremely distressed and tearful. The worker reported her symptoms of tinging in her hands and images of dead bodies severely increased. Dr. Ekblad also notes that although the worker broke her leg in a fall two (2) weeks prior, the worker reported this does not cause her excessive pain, and the injury did not affect her return to work. Dr. Ekblad states the negative performance review triggered the worker’s trauma related symptoms.

In the note dated December 20, 2019, Dr. Ekblad stated the worker was contacted by phone, and the worker reported she continues to experience intense trauma related distress and symptoms that mirror her symptoms before her return to work, though symptoms now are extreme.

Dr. Ekblad submitted clinical notes confirming the worker was seen for treatment on January 15, 2020, January 22, 2020, January 29, 2020, February 12, 2020 and February 26, 2020. These notes confirm there has been some improvement in the worker’s mood and trauma related stress with a discussion about returning to work.

In the note dated March 11, 2020, the worker reported she was upset at receiving information from WSIB denying her claim. The worker also reported feeling overwhelmed by the amount of documentation she has been asked to complete from work. The worker reported increased trauma related symptoms in her hands and her vision. The worker also reported increased thoughts of death and passive suicidal ideation for the first time in her life. The worker was adamant that she would not attempt suicide due to the impact she fears this would have on her children.

I have also considered the clinical notes on file from the worker’s family doctor, Dr. Guzar. Dr. Guzar submitted clinical notes for the five (5) years prior to June 9, 2019, and the notes after June 9, 2019. While I note there is mention of the worker seeing a psychologist in the clinical note dated June 19, 2014, I do not see any other clinical notes prior to June 9, 2019, that support the worker was being treated for a pre-existing psychological condition, or that the worker was medicated for a pre-existing psychological condition. In the note dated January 24, 2020, Dr. Guzar states the worker returned to work to a different role in December 2019. The worker returned to administration duties only, and the worker was seeing a psychologist who works with the police department. The psychologist and the worker were working on how to transition the worker back to work as the worker continued to experience symptoms including panic attacks. On the worker’s first day back, the worker was told she had to review her evaluation, and the worker was “side swiped”. The worker’s supervisor had given her a negative evaluation (written in September and the worker saw it in December). The worker did not deal well with this. The worker experienced a panic attack, and her hands were tingling. The worker called her union representative who told her to leave work. The worker has not been back since. The worker is frustrated, as she really wanted to get back to work, and feels this has set her back significantly. The worker is again having panic attacks when she thinks about going back to work. The worker continues to see the psychologist regularly, and the worker remains on Cipralex 20 mg. Dr. Guzar states the worker has work-related anxiety, and has been re-traumatized on return to work.

I find it significant here to note the OD Adjudicator’s decision dated November 18, 2019. In this decision, the OD Adjudicator accepts Dr. Ekblad’s psychological reports do support secondary psychological entitlement in this claim. Specifically, the OD Adjudicator allowed secondary entitlement to the worker’s anxiety and trauma-related symptoms. The OD Adjudicator also determined the clinical evidence on file supports the worker is unable to return to work activities because of the exposure incident, which has triggered past traumatic experiences the worker is experiencing and re-experiencing. Psychological treatment was approved prior to the worker returning to work. The OD Adjudicator also allowed full LOE benefits as of July 22, 2019. The OD Adjudicator terminated entitlement to full LOE benefits when the worker attempted to return to work on December 16, 2019.

In reviewing entitlement to a psychological recurrence in this claim, I have considered the evidence that supports whether the worker suffered a significant deterioration that

• does not result from a significant new incident/exposure, and
• is clinically compatible with the original injury/disease.

Significant deterioration

As previously noted Policy 15-02-05, states a significant deterioration refers to a marked degree of deterioration in the work-related impairment that is demonstrated by a measurable change in the clinical findings.

Indicators of a significant deterioration may include

• the need for active (non-maintenance) clinical treatment
• a change in functional abilities, or
• a change in the ability to perform a job or suitable occupation

I find the medical evidence on file does support that on December 16, 2019, the worker suffered a significant deterioration in the compensable psychological conditions. In stating this, I have placed significant weight on Dr. Ekblad’s clinical notes before and after December 16, 2019. Dr. Ekblad’s clinical notes confirm the worker attended treatment four (4) times in October, three (3) times in November and, again on December 3, 2019. While I accept these clinical notes confirm the worker was improving and was looking forward to returning to work, the notes also confirm the worker continued to receive regular treatment, and the worker continued to experience the same ongoing psychological symptoms. The notes also confirm the worker was taking medication for anxiety and depression. The December 3, 2019, note states the worker still experiences poor sleep, tingling in her hands, and has periods of high anxiety at roughly the same frequency as the last several weeks.

The worker attempted to return to work on December 16, 2019, and was only at work for one (1) hour and 45 minutes when she had to leave due to her reaction to reading the negative performance review.

The worker sought medical attention with Dr. Ekblad on December 17, 2019, and as per the clinical note for this visit, Dr. Ekblad states the negative review triggered the worker’s trauma related symptoms.

Dr. Ekblad states that after the worker read the negative annual review, the worker’s symptoms of tinging hands, anxiety, and images of dead bodies severely increased.

I find Dr. Ekblad’s clinical notes prior to December 16, 2019 support the worker was receiving active psychological treatment, and was prescribed medication to assist the worker with managing her symptoms of depression and anxiety. As such, although the clinical notes confirm the worker was ready to try to return to work, the clinical notes do not support the worker recovered, or had nearly recovered from the psychological condition accepted in this claim. I also accept the clinical note dated December 17, 2019, supports a significant increase in the worker’s compensable psychological symptoms that changed the worker’s ability to perform suitable work. I have also placed weight on Dr. Guzar’s January 24, 2020 note that confirms the worker had a significant set back when she attempted to return to work on December 16, 2019. Dr. Guzar states the worker has work-related anxiety, and has been re-traumatized on return to work. The worker continues to see the psychologist regularly, and the worker remains on Cipralex 20 mg.

For the reasons stated above, I find the evidence does support the worker suffered a significant deterioration in the compensable psychological condition.

Significant new incident/exposure

In this case, the worker returned to work on December 16, 2019. The worker worked for one (1) hour and 45 minutes. During this time, the worker read an email that contained a negative performance review. Reading this negative performance review caused the worker’s compensable psychological symptoms to increase (anxiety, vision of dead bodies and tingling hands), and the worker had to leave work.

Having considered all of the evidence on file including the worker’s testimony, I do not accept the negative performance review was a significant new incident/exposure. In stating this, I have placed significant weight on the medical evidence that supports this exposure caused the worker’s existing compensable symptoms to increase. While the symptoms had decreased prior to this exposure, the symptoms had not gone away. I also place weight on the worker’s testimony as the worker stated that prior to returning to work on December 16, 2019 she had a panic attack, and had to meditate. The worker stated the compensable condition caused her to feel like a failure, and reduced her self-confidence. The worker stated she had these feelings in the morning before starting work on December 16, 2019. The worker testified that reading the performance review, enhanced these feelings confirming her feelings of failure. The worker testified she would have been able to deal with the review better had if not been for the compensable psychological symptoms.

I do not find an annual performance review would be a new significant exposure. The worker had worked for many years with the employer, and although this was her first negative review, the worker was use to receiving annual performance reviews. I accept the worker’s testimony that had it not been for the compensable psychological symptoms, the worker may not have reacted to the review as she did.

Clinically compatible

To establish that the significant deterioration is clinically compatible with the original injury/disease, the WSIB must determine that

• the body parts and/or functions affected now are the same as, or related to, those affected by the original injury/disease, and
• there is a causal link between the significant deterioration and the original injury/disease.

To make these determinations, the WSIB considers the nature and severity of the significant deterioration, the original injury/disease and any relevant non-work-related conditions that are present.

In this case, I find the worker’s psychological condition after December 16, 2019 is clinically compatible and causally linked to the psychological condition accepted in this claim. In stating this, I again refer to Dr. Ekblad’s clinical notes that confirm the worker experienced an increase in symptoms, not new symptoms when seen on December 17, 2019.

For the reasons stated above, I find the criteria to allow entitlement to a recurrence has been met. I also accept the evidence on file supports that as of December 17, 2019, the compensable psychological condition rendered the worker unable to return to work. As such, I find the worker is entitled to full LOE benefits from December 17, 2019 to March 11, 2020.

CONCLUSION

I find the worker does have entitlement to the December 16, 2019 recurrence.

I also find the worker does have entitlement to full LOE benefits from December 17, 2019 to March 11, 2020.

I ask the Operating Area to obtain updated medical information beyond March 11, 2020. Once received, I ask that the Operating Area consider further entitlement to LOE benefits.

The worker’s objection is allowed.

DATED March 12, 2021

Kelly Gordon

Appeals Resolution Officer

Appeals Services