APPEALS RESOLUTION OFFICER DECISION
decision number:
20220092
OBJECTING PARTY:
employer
REPRESENTED by:
employer representative
RESPONDENT:
woker (not participating)
HEARING:
HEARING IN WRITING
HEARD by:
Sujethra Nadarajah, appeals resolution officer
may 30, 2022
ISSUE
The employer objects to the Case Manager’s (CM) decision of October 18, 2021 that granted 25 percent cost relief under the Second Injury and Enhancement Fund (SIEF).
BACKGROUND
On August 13, 2018, this dispatcher’s claim was approved for loss of earning (LOE) and healthcare benefits for Post-Traumatic-Stress-Disorder (PTSD) developed because of the traumatic incidents they were exposed to in their job.
The employer representative (ER) requested cost relief under the SIEF and on May 3, 2021, the claim was reviewed and the employer’s request was denied.
The ER objected to the SIEF decision, and on October 18, 2021, it was reconsidered and overturned. The WSIB granted the employer 25 percent cost relief.
The ER submitted an Intent to Object Form dated November 2, 2021 and as no new information was provided for consideration, it did not result in a change in the decision. On December 30, 2021, the ER submitted the Appeal Readiness Form (ARF). The employer’s objection to the SIEF quantum forms the basis of this appeal.
AUTHORITY
Operational Policy Manual
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 policies in reaching this decision. I find, as I will explain, the employer is entitled to 50 percent cost relief under the SIEF.
In reaching my conclusion, I also reviewed the ARF and ER submission dated August 29, 2021.It is opined that cost relief is warranted because the worker’s pre-existing conditions of hypertrophic cardiomyopathy and asthma contributed to the PTSD and prolonged the worker’s recovery.
The worker was not a participant in the appeal; thus, no information was submitted for consideration.
The WSIB’s policy for applying 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.
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
Policy 14-05-03, Second Injury and Enhancement Fund (SIEF) sets out the severity of the accident and approved definitions:
Minor: Expected to cause non-disabling or minor disabling injury
Moderate: Expected to cause disabling injury
Major: Expected to cause serious disability, probable permanent impairment disability
In determining the severity of the accident, factors to be considered include the mechanics (lift, push, pull, fall, blow, etc.); positioning (kneeling, standing, sitting, squatting, bending, etc.) and the environment (lighting, temperature, weather conditions, terrain, etc.). The actual injuries are not considered but rather the extent of disability the accident would reasonably be expected to cause.
In this case, I find on a balance of probabilities that the accident was minor in nature. The worker worked as a dispatcher from August 31, 2005 to May 24, 2018. Although this role is stressful, given the length of time they worked as a dispatcher, the worker would have been accustomed to such type of calls. Further, there is no evidence the worker was performing duties outside of their regular role; the worker’s PTSD was due to cumulative traumatic exposure experienced in the course of their career. Accordingly, based on the accident history components, I find the accident would be expected to cause non-disabling or minor disabling injury.
Thus, the severity of the accident is considered minor.
Significance of Pre-existing Condition
The policy also outlines that the medical significance of a condition is assessed regarding the extent that it makes the worker liable to develop a disability of a greater significance than a normal person. The medical evidence in this case demonstrates the worker had a psychological reaction to their hypertrophic cardiomyopathy, which made them slightly more vulnerable to develop a disability of greater severity than a “normal” person.
The worker’s hypertrophic cardiomyopathy symptoms began around 2005 and they were formally diagnosed in 2017. The symptoms include chronic chest pain, light-headedness, dizziness, shortness of breath and some numbness in both arms. Although the worker was prescribed medication for this condition, the worker discontinued it noting it made them tired, lethargic and negatively affected their ability to perform their duties at work.
The family doctor’s chart notes from 2017 confirm the worker was increasingly concerned with their breathing difficulties and their chronic chest pain. The neurology report of June 20, 2017 and the family doctor’s chart notes confirm the worker had anxiety. On May 2, 2017, the family doctor prescribed an antidepressant to reduce the worker’s anxiety.
On a balance of probabilities, I find the history of anxiety related to the worker’s psychological reaction to the diagnosis of hypertrophic cardiomyopathy demonstrates and supports a pre-existing psychological vulnerability that contributed to and played a role in prolonging the recovery. I note however, that while the worker had taken time off work due to hypertrophic cardiomyopathy, they were able to continue in the role until their compensable mental stress injury rendered them unable to work. Therefore, in considering the circumstances and cumulative impact of the pre-existing condition, I find the significance of the pre-existing condition is considered minor as it made the worker slightly more liable to develop a disability of greater severity than a normal person.
While the WR indicated the worker’s asthma also had an impact on their compensable PTSD, I do not agree. In order to attract cost relief under the SIEF, the evidence must demonstrate the period resulting from the accident became prolonged or enhanced due to asthma. As the treating healthcare providers did not indicate this was a barrier post injury, I am not able to identify the worker’s asthma enhanced the work-related disability or prolonged the worker’s recovery.
To conclude, I find the accident was minor in severity and the significance of the pre-existing condition was minor. In these circumstances, policy provides for cost relief of 50 percent.
CONCLUSION
I conclude the employer is entitled to 50 percent cost relief under the SIEF.
The employer’s objection is allowed.
DATED May 30, 2022
Sujethra Nadarajah
Appeals Resolution Officer
Appeals Services Division