APPEALS RESOLUTION OFFICER DECISION
DECISION NUMBER:
20220030
OBJECTING PARTY:
EMPLOYER
REPRESENTED by:
REPRESENTATIVE
RESPONDENT:
WORKER – NOT PARTICIPATING
HEARING:
HEARING IN WRITING
HEARD by:
C. MARR, APPEALS RESOLUTION OFFICER
February 12, 2022
ISSUE
The employer is objecting to the Case Manager’s (CM) decision dated January 6, 2020 in which cost relief under the Second Injury and Enhancement Fund (SIEF) was denied.
BACKGROUND
On May 2, 2018, this machine operator was conducting a roller change on a machine. They reached into the machine so as to adjust the core. When they did this, their right thumb was caught by the roller. They sustained an amputation to the tip of the thumb.
The worker had an emotional reaction to the workplace accident and injury. Entitlement to benefits was granted for a psychotraumatic disability.
The worker remains off work and on full loss of earnings (LOE) benefits at this time. They have not returned to work since the date of injury. They remain in treatment for their psychological condition.
The employer requested cost relief under the SIEF. As explained in correspondence dated
January 6, 2020, cost relief under the SIEF was denied. The CM found that there was no evidence to support that the worker’s recovery from the compensable organic and psychological conditions was enhanced or prolonged by a pre-existing condition.
The employer objected to this decision. The CM reviewed the employer representative’s submission on October 15, 2021. The CM determined that the workplace accident was of major severity. The CM also accepted that the worker’s pre-existing psychological issues likely enhanced the worker’s recovery from the compensable psychological condition. The pre-existing condition was assessed as being of minor significance. As per the relevant policy, an accident of major severity combines with a pre-existing condition of minor significance to warrant zero percent cost relief under the SIEF.
Employer’s Position
The employer representative argues in part that the worker’s pre-existing psychological issues made them more likely to have a psychological reaction to the workplace accident and injury. They state that the workplace accident was of minor severity. The representative states that cost relief under the SIEF should be granted.
AUTHORITY
Operational Policy
Published
14-05-03 Second Injury and Enhancement Fund (SIEF)
February 20, 2006
ANALYSIS
I have carefully considered all of the available information, legislation and relevant operational policy in reaching this decision.
WSIB Operational Policy 14-05-03 Second Injury and Enhancement Fund (SIEF) states in part:
If a prior disability caused or contributed to the compensable accident, or if the period resulting from an accident becomes prolonged or enhanced due to a pre-existing condition, all or part of the compensation and health care costs may be transferred from the accident employer in Schedule 1 to the SIEF.
Both physical and psychological disabilities are included.
The policy also states in part:
With psychological conditions, the possibility of prior psychic trauma resulting from life experience could be considered as evidence of vulnerability, and justify recommending relief to the employer, even in the absence of pre-existing psychological impairment.
In determining cost relief, consideration is given to the medical significance of the pre-existing condition and the severity of the accident.
Severity of Accident
I find that the workplace accident in which this worker was injured was of major severity.
On May 2, 2018, this worker reached into a machine in order to adjust a core that had shifted. According to a statement attached to the Worker’s Report of Injury/Disease (Form 6), this task was performed in a manner as the worker had been instructed. The worker’s right thumb was crushed by a paper roller, which reportedly weighed more than a tonne. The worker sustained an amputation injury to the tip of the thumb.
In their submission dated July 11, 2021, the employer representative states that the worker’s “injury was minor for SIEF purposes.” I believe the representative meant to state that the workplace accident was minor, not the injury.
The severity of workplace accidents is assessed based on the mechanics involved, not the actual injury sustained by the worker. The severity is determined by considering the degree of injury likely to result from the accident.
In my opinion, the accident in which this worker was injured would reasonably be expected to cause serious disability or probable permanent disability, making it one of major severity under the policy. Any part of a worker’s body caught under a roller weighing more than a tonne would be crushed, likely to a degree beyond any possibility of full recovery. A digit could not be pressed under such a piece of equipment and only sustain a non-disabling injury.
One must also consider that an accident that would likely cause a serious or permanent injury would also be likely to cause a mental stress injury as well, which would also be disabling.
Therefore, the workplace accident in which this worker was injured was of major severity.
Significance of Pre-existing Condition
This worker was granted initial entitlement to benefits for an amputation injury to the tip of their right thumb. It was also accepted that they had an emotional response to the accident and injury. Entitlement to benefits for major depressive disorder (MDD) and post-traumatic stress disorder (PTSD) was granted under this claim. In order for cost relief under the SIEF to be warranted, the medical evidence must support that a pre-existing condition enhanced or prolonged the worker’s recovery from the compensable conditions.
There is no medical evidence to support that a pre-existing condition impacted the worker’s recovery from the thumb injury. The employer representative did not make any arguments to this affect. There is no basis for granting cost relief under the SIEF in relation to the worker’s compensable thumb injury.
The employer representative does argue that the worker had pre-existing psychological issues. They state that this made the worker more likely to experience a greater degree of psychological symptoms in the post-accident period. The representative argues that the pre-existing condition enhanced and prolonged the worker’s recovery from the compensable psychotraumatic disability. They did not suggest a degree of significance for the pre-existing condition.
The worker’s family doctor’s (FD) chart notes from five years prior to the date of injury are on file. I note that the worker was treated for anxiety. They were prescribed medication for this for at least five years before the workplace accident. Based on the available chart notes, the worker saw their FD approximately once per year for symptoms of anxiety. They did not take the prescribed medication regularly, but only when they felt it was required for their symptoms. The worker saw their FD on
March 20, 2018, reporting that they were having an increased degree of panic attacks the previous month. There was no precipitating cause identified. This was approximately six weeks prior to the date of injury.
A psychologist and a psychiatrist assessed the worker through the Mental Health Specialty Program on November 19, 2019. The worker reported that they had a five-year history of anxiety for which they took medication as required. The worker said that this condition did not cause any degree of functional impairment. The worker’s prior history of anxiety was identified by the assessing team as a potential barrier to their recovery from the work-related psychological condition.
The worker has participated in extensive psychological treatment. The treating psychologist did not identify the worker’s pre-existing psychological issues as a significant contributing factor to their post-accident psychological impairment.
There were some events and factors in the post-accident period that may have served to prolong the worker’s recovery from the compensable psychological impairment. The worker experienced the loss of two family members. The pandemic and related restrictions affected their mental health. These also served to disrupt treatment for the work-related conditions. The worker’s psychological symptoms increased following further interventions for their thumb injury. These factors do not form a basis for consideration of cost relief under the SIEF, however, as they are unrelated to a pre-existing condition.
The workplace accident and injury would reasonably be expected to cause an emotional or psychological response. This has been accepted under the claim. In my opinion, this would be the case even in the absence of the worker’s pre-existing anxiety. I find that the pre-existing psychological condition was of minor significance in terms of the impact it had on the worker’s recovery from the compensable psychological condition, and the degree to which it made the worker more susceptible to developing psychological symptoms from the accident and injury.
As per policy 14-05-03, a workplace accident of major severity combines with a pre-existing condition of minor significance to warrant “zero percent” cost relief under the SIEF. Therefore, the employer is not entitled to cost relief under the SIEF in this claim.
CONCLUSION
The workplace accident was of major severity. The worker’s recovery from the compensable conditions was enhanced and prolonged by a pre-existing condition of minor significance. The employer is not entitled to cost relief under the SIEF as per policy.
The objection is denied.
DATED February 12, 2022
C. Marr
Appeals Resolution Officer Appeals Services Division