APPEALS RESOLUTION OFFICER DECISION
DECISION NUMBER:
20250008
OBJECTING PARTY:
worker
REPRESENTED by:
Worker representative
RESPONDENT PARTY:
employer
HEARING:
VIDEOCONFERENCE – December 9, 2024
HEARD by:
L. Cirillo, appeals resolution officer
DECEMBER 19, 2024
ISSUE
The worker objects to the Adjudicator’s decision dated September 6, 2023, which denied initial entitlement for the worker’s heart condition arising out of and in the course of his employment on July 25, 2023.
BACKGROUND
This claim was established in August 2023, upon receipt of a Form 6, Worker’s Report of Injury and Form 8, Health Professional’s Report. The worker reported that his job as a Project Superintendent is very demanding and sometimes stressful; however, on July 25, 2023, he was involved in two meetings where he was expected to explain the reasons why the previous shift did not meet their targets.
The worker stated that the meetings (5:15 a.m. and 1 p.m.) became tense, stressful, antagonistic, and adversarial. Further, the client representative became upset and condescending towards him and criticized him for circumstances that were beyond his control and threatened his position. The worker explained that during and after the second meeting he began to feel nauseous and lightheaded, and he realized that something was wrong because he had difficulty breathing and chest pain.
The worker went to the nursing station and was given two aspirin to put under his tongue. He was then transported to hospital where he was diagnosed with a heart attack. At the time, the worker had been working for the employer for 5 years.
The Form 8 completed by Dr. S. Qasha on August 11, 2023, stated the worker suffered an acute myocardial infarction (AMI) at work.
The worker claimed that the workplace duties were a significant contributing factor in the development of his cardiac event. However, it was ultimately concluded that the work duties did not play a role in the worker’s cardiac condition. Further, it was determined that there was no evidence of unusual physical exertion and/or an acute emotional stress event, which preceded the medical emergency. In addition, it was determined that the work incident of July 25, 2023, was something the worker would experience on a regular basis while being employed for the employer and as a result initial entitlement as denied. The decision was communicated to the worker in correspondence dated September 6, 2023.
On the Intent to Object (ITO) form dated September 12, 2023, the worker’s representative objected to the denial of initial entitlement. In support of his position, he argued that the facts and circumstances of this claim were almost identical to the facts in a previous decision (WSIAT decision 1068/06). In that case the board requested the assistance of Dr. Beanlands, and it was concluded that the events of the day just prior to the heart attack were sufficient to create an acute emotional stress at work, which entitled the worker to benefits.
In correspondence attached to the Appeal Readiness Form (ARF) dated July 12, 2024, the worker’s representative submitted an independent medical assessment report completed by Dr. Vexler, Cardiologist dated June 18, 2024. In that report, Dr. Vexler provided a summary of the events which took place and opined that the workplace events played a causative role in the worker’s acute cardiac event while at work on July 25, 2023.
Despite the above, it was once again concluded that the worker did not experience any unusual physical exertion and/or acute emotional stress at work in the course of his duties on July 25, 2023, and as a result there was no evidence that satisfied the entitlement criteria outlined in operational policy. Therefore, the previous decision remained upheld. The reconsideration decision was communicated to the worker in correspondence dated August 13, 2024.
As the worker continued to object and the decision remained unchanged, the matter was referred to the Appeals Services Division for further consideration.
Worker’s Position:
At the oral hearing, the worker provided robust detail with respect to their pre-injury job duties and the events that occurred on July 25, 2023, which will not be repeated in its entirety. However, I note the following pertinent information:
He is currently 58 years old and has worked for the employer as a Project Superintendent for 18 years. Prior to that he was a Miner;
The worker explained that he works for the employer of record and the owner of the mine he was working at contracted the employer, which is a mining contractor. They are contracted to build mines and construct underground infrastructure so that they can reach ore bodies and extract the product they are there to remove;
The worker explained a typical workday. He noted that he usually arrives to the mine around 3:40 a.m. and does a quick review with the Supervisor coming off the night shift (i.e., quick report on how production went);
The worker explained that his role involved managing and coordinating the underground work;
Usually at 5:15 a.m. he had a quick meeting with all the department heads, maintenance, construction, electrical, engineering, ground control, senior site control, the site superintendent and managers (all department heads – who are employed by the mine owner). He stated he is the only employee of his employer in attendance. During this meeting they recap the previous day and what progress was made from the day before. They discuss safety concerns/any incidents, specific equipment needs and what the targets are. He then meets with the supervisor to catch the tail end of that meeting and plans the rest of the day, which can include logistics, getting material underground, what manpower is required etc.;
After this meeting he completes spreadsheets, phone calls, makes sure there is manpower in place for the day, he could be hiring etc. He stated it is basically a lot of managerial stuff and keeping up with the work;
Somewhere around 7 or 7:15 a.m., he usually goes underground, which is about 7500-8000 feet where he does a lot of walking, in dirty, muddy conditions. There is high energy, power cables, explosive around you. They drill and blast. The conditions are also very hot 30-40 degrees and very high humidity;
The goal is to visit all the crews and focus on safety and make sure everyone has what they need to do the job safely;
The worker explained that usually he is underground 4-5 days out of 7 days per week;
The worker stated that the mental demands of his job include problems solving, identifying hazards, planning where their crew has to be and ensuring the safety of himself and his workers. There is a lot of multi-tasking and things going on at the same time;
The worker outlined that there is pressure for production and to meet goals; however, the plan does not always go the way you want;
The worker stated that when he is done underground, he comes up, usually around 12:30 to 1 p.m., he showers up and prepares for the oncoming shift. He stated he would usually leave somewhere between 5 and 6 p.m., and usually stuck around to have a good conversation with the night supervisor;
The worker recalled that after work hours, normally every day, he would get a text about someone who did not show up, equipment issues, issues with blasting and issues where crews did not get underground on time as well as dealing with injuries etc.;
The worker explained that after work he would go home, get washed up, eat and go to bed and start the routine all over again the next day. The worker stated that his usual shift was 21 days on and 21 days off;
On July 25, 2023, he was on his second last shift, so 20 days in;
After a long three week run, after having worked in high temperatures he did not want to do anything for at least a week;
The worker outlined that prior to July 25, 2023, his general health was good. He was a smoker and smoked about ¾ packs of cigarettes per day since he was 16 or 17 years old, but he rarely drank alcohol;
The worker stated he did not have any known blood pressure or cholesterol issues and no other medical problems. He stated he was pretty healthy and was quite physical;
The worker recalled that on Thursday July 20, 2023, it was a typical day. He went to work early and did his morning routine. He is not sure if he went underground on that day but normally between 2 and 3 p.m. had a planning meeting that would take them through the rest of the week. During this meeting they discussed what work needed to be done, they set targets and production goals. For that specific week, they had a large ventilation schedule that would have required 80-90% of their manpower. They were going to leave a small portion of their men to mine and the rest of them to work on the ventilation;
On Friday July 21, 2023, he got a phone call to meet the guys in the conference room. Most of the people there were the ones that were in the normal production meeting. He recalled that they were changing the plan for the weekend. He stated that they knew and discussed that this would drastically inhibit his men’s ability to reach the targets (blast the stope) that were set the previous day. He stated that he voiced concerns that this would affect his crews’ ability to meet the target, but they went ahead with the change anyway;
The worker explained that his crew worked on the weekend, but the changes affected their ability to complete the ventilation upgrade in a couple different areas;
On July 25, 2023, the worker was back at work, and he went in as normal and completed his usual meeting with the night supervisor and talked to the day shift supervisor. He stated that he attended the 5:15 a.m. meeting, with the typical department heads, and had a quick recap on what happened on the previous shift. He recalls that the meeting took place on a Tuesday, he could not recall why, but they were not there on the Monday for some reason. During this meeting, they discussed what was going to happen in the next couple of days. They went around the room, and everyone took a few minutes to report on what they achieved during the previous shift. They also discussed what was needed and if there were delays. Basically, they discussed the needs for the upcoming days and logistics;
The worker recalled that initially, the meeting was going pretty normal until it came to his turn to talk. He explained to everyone in the room, what his footage and tonnages were moved over the weekend, but he was not able to get too far into the explanation because his manager started aggressively questioning him. The worker stated that his voice, tone and demeanour were condescending and confrontational;
The worker stated that he tried to explain that the delays were caused because of the change in the planning that the client had decided to do but no one listened, and they were pointing their fingers at him. They were not accepting the explanations as to how the delays were caused. The worker explained that the manager blamed him (while in front of all the captains) and stated “why didn’t you do this? Why didn’t you do that?” The worker tried to explain that most of these things were out of his control but the meeting became very heated;
The worker stated that the mine manager did not accept his explanation and he did not question the others in the room, who had actually made those changes. He just asked him to make a report, with spreadsheets on how many men were on site at the time and he stated that he needed to complete this with all the answers by the 1 p.m. meeting. The worker stated that the meeting was not very long, but it was intense and heated, and he was put on the spot and blamed for decisions that he had not made;
The worker recalled that he was feeling frustrated and angry because they were not listening to what actually happened. He stated he was hot and shaking and he felt his blood rushing to his head. His stress level was somewhere around an 8-9 out of 10, in other words, it was elevated quite a bit;
After the meeting, up until the next meeting at 1 p.m. he spent a lot of time preparing, what notes he could, including the weekend reports, manpower reports and details about all of the hours worked;
The second meeting took place with the underground mine superintendent and underground mine captain (client employees) at 1 p.m. He stated that one of these employees was relatively new to the job. The worker recalled that his stress level was still somewhere between a 7- 8 out of 10 at that point. He also noted that while he knew these people well and they had a good working relationship, they were expecting an explanation on what they already knew;
The worker described that the actions of the other managers during the second meeting were condescending, aggressive and bullying to the point of being disrespectful to him;
The worker stated that his stress level during their questions began climbing back to an 8-9 out of 10;
The worker stated that he was extremely nervous about what was going to happen next and at the end he was told that the client was going to start overseeing the employer’s crews and supervisor and directing the work. This was essentially taking over his role and threatening his job because they said you can’t do it;
The worker stated that it was at this point that everything went over the top and he became very nauseated and lightheaded and felt like he was going to faint;
He recalled going to his office and sitting in his chair. His clerk asked if he was ok, and he said he did not think so. He went to the nurse’s office, and she gave him two aspirin to put under his tongue. The next thing he saw was that the paramedics were there and they put him in the ambulance, and he was then flown to City A;
The worker explained that approximately a year and a half prior to this, there was a time when the mine owner had a mine captain that caused him a lot of grief. That mine captain would undermine his supervisor and redirect his crews and inform his supervisor all behind the scenes and behind his back. The worker stated that as a contractor he has a liaison, and they give instructions and direct and control their men. The worker stated that for about a year and a half, he felt like he had a target on his back but then that person was removed from the site for behaviour that was not accepted. So, when this incident occurred, he felt like he was going back to that again;
It was his belief that his position at the job site was in jeopardy. He had no control over what the client wanted, and he could very well be moved to another site if they did not like his answers and he could be replaced. The worker stated that this drove up his stress level and he worried about whether he would still have a job;
The worker explained that he was being blamed for something he did not cause or have any control over, and this put him over the top. He stated there was nothing he could do, and no one supported him;
The worker stated that the stress he felt that day was much more aggressive and much stronger than anything he had experienced before and/or what he usually dealt with
Employer’s Position:
The employer attended the oral hearing; however, made no further argument.
AUTHORITY
Section 13 Workplace Safety & Insurance Act (WSIA), 1997
Operational Policy Manual
Published
11-01-01 – Adjudicative Process
15-02-01 – Definition of an Accident
15-03-10 – Heart Conditions
November 3, 2008
October 12, 2004
October 12, 2004
ANALYSIS
I have reviewed the record and considered the information, legislation and relevant operational policies in reaching this decision. In considering all of the evidence, including the medical opinion on file, the testimony provided at the oral hearing, and the arguments presented, I find the worker experienced an acute emotional stress during the course of his employment on July 25, 2023, and as a result, suffered, without any significant delay, an acute inferior wall myocardial infarction. As a result, initial entitlement is allowed.
The rationale for my decision is as follows.
Prior to my analysis, I must note that while I have had regard for the previous case law, which has been referred to, the WSIB is not bound by this decision and each case is adjudicated based on its own merits.
The Workplace Safety & Insurance Board’s (WSIB) policy for the Adjudicative Process states in part:
A claim created by the WSIB for a workplace accident/disease is adjudicated based on entitlement principles and the facts of the case.
Five point check system
All decision-makers use the same criteria for ruling on initial entitlement to WSIB benefits. This system is known as the "five point check system."
An allowable claim must have the following five points
an employer
a worker
personal work-related injury
proof of accident, and
compatibility of diagnosis to accident or disablement history
Proof of accident
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?
Diagnosis
If it is not clear that the (injury or disablement) diagnosis provided is the result of the accident or disablement history described, a decision-maker may consult with the WSIB's clinical staff to assist in making this determination.
As is outlined above, the worker claims that their cardiac event occurred while they were in the course of their employment on July 25, 2023, performing their regular job duties as a Project Superintendent. The worker also stated that on that particular day, over the course of 12 hours, he experienced several confrontational events, which provoked a significant emotional response.
Operational Policy 15-02-01 states:
Accident includes
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
Chance event
A chance event is defined as an identifiable unintended event, which causes an injury. An injury itself is not a chance event.
Disablement
The definition of disablement includes
a condition that emerges gradually over time
an unexpected result of working duties.
The record fails to reveal that an identifiable unintended event caused the worker’s condition. Instead, according to the evidence on file, the worker claims that he suffered a cardiac event as a result of a disablement arising out of and in the course of his employment. Under these circumstances, the worker does not have the benefit of the presumption clause under s. 13(2) of the WSIA, which states in part:
“If the accident arises out of the worker’s employment, it is presumed to have occurred in the course of the employment unless the contrary is shown. If it occurs in the course of the worker’s employment, it is presumed to have arisen out of the employment unless the contrary is shown”.
As a result of the above, the worker has the burden to prove the work-relatedness of his cardiac condition. Further, proof of accident, as outlined in operational policy 11-01-01, is not the foundation upon which entitlement depends on. Instead, entitlement for heart conditions is adjudicated based on the entitlement criteria outlined in operational policy 15-03-10, which states in part:
The WSIB accepts claims as work related when:
a causal relationship is shown between the cardiac condition and an accident at work, or
the cardiac condition is established as a disablement "arising out of and in the course of employment."
The WSIB accepts entitlement for cardiac conditions under any of the following circumstances:
traumatic injury, either penetrating or non-penetrating injuries to the chest wall
electric shock producing irregular cardiac rhythm
inhalation of smoke and various noxious gases and fumes, e.g., fire fighters, and
complication of treatment for a work-related injury, e.g., anaesthesia with an interval of hypotension, hypoxia or cardiac arrest.
NOTE
When entitlement is established under the above points for a cardiac condition, there will be no limitation of ongoing entitlement as long as the subsequent condition is related to the work-related cardiac condition,
Or
- unusual physical exertion for the individual and/or acute emotional stress with no significant delay in the onset of symptoms [my emphasis added].
NOTE
This instance is allowed on the basis of aggravation of a pre-existing non-work-related condition.
There is limited medical information on file; however, I note the following:
Form 8, Dr. Qasha: AMI
Independent Medical Assessment Report dated June 18, 2024 - Dr. R. Vexler, Cardiologist
Over the course of more than 12 hours, the worker experienced several confrontational events which provoked a robust emotional response;
During one such meeting, described by the worker as “antagonistic and adversarial”, he began to experience intense nausea and light-headedness. Shortly thereafter, he was assessed by the staff nurse and medical assistance was requested;
The worker was admitted to hospital with an acute inferior wall myocardial infarction and subsequently developed ventricular fibrillation which was successfully reverted. Additional complications included ventricular tachycardia and complete heart block. Angiography revealed a totally occluded right coronary artery, with significant disease in the circumflex vessel and moderate disease in the left anterior descending artery. Following stent insertions, he also received an implantable cardio-defibrillator;
The worker suffered an acute cardiac event while at work on July 25, 2023. He is now under the care of a cardiologist on a regular basis;
Diagnosis/Prognosis: Acute inferior wall MI complicated by ventricular arrhythmias and transient complete heart block. The worker has multiple vessel coronary disease so there is some significant risk of recurrence;
There are two potentially predisposing factors in his history – nicotine and family history;
In this specific event, the worker suffered an acute cardiac illness during a particularly long and stressful day, characterized as confrontational and adversarial. These events would almost certainly have produced a hormonal response with elevated levels of adrenal hormones;
The role (of long hours of work and shift conditions) is not causative but may, in the long run, have contributed to the development of atherosclerosis and the development of the blockages which are a direct cause of heart attack and stroke;
The worker experienced several stressful events on the day of his acute cardiac event. He experienced his first encounter with his employer which was stressful and confrontational. He was then given extraordinary and unusual tasks for the remainder of the morning. A further adversarial meeting took place. It was during the latter meeting that the worker recounts experiencing his first inkling of “nausea and light-headedness” with difficulty breathing and chest discomfort. These are the early manifestations of a heart attack;
Stress is essentially a subjective phenomenon. Similarly, anxiety is a very individual and personal experience. While we cannot speculate on the precise role in a specific patient, there is very good evidence to postulate increasing vulnerability for acute coronary events under these circumstances;
It is highly likely, given the description of events, that elevated catecholamines, as well as other hormonal changes, played a causative role in the acute event. However, in the absence of direct measurement at the precise moment of coronary occlusion, we can only extrapolate from the clinical history. Predisposing risk factors were present – gender, age, nicotine usage, family history; however, the occurrence of high stress with the onset of his attack leads to a strong belief in cause and effect in this case.
It is my understanding that an acute myocardial infarction (MI) (also known as a heart attack) is a term used to describe a range of conditions associated with sudden, reduced blood flow to the heart. A MI usually results from the build-up of fatty deposits (plaques) in and on the walls of coronary arteries, the blood vessels delivering oxygen and nutrients to the heart muscles. When a plaque deposit ruptures or splits, a blood clot forms. This clot blocks the flow of blood to the heart muscles. When the supply of oxygen to cells is too low, cells of the heart muscles can die.
Symptoms of a heart attack (MI) most often include chest pain (angina), fatigue, nausea or stomach discomfort, heart palpitations, anxiety, sweating, feeling lightheaded, dizzy or passing out.
In this particular case, there is objective medical evidence, which confirms the worker had a number of well-established, classic risk factors for the condition including smoking, family history and multiple vessel coronary disease (coronary artery disease – CAD).
It is my understanding that CAD is a common heart condition. The major blood vessels that supply the heart (coronary arteries) struggle to send enough blood, oxygen and nutrients to the heart muscle. Cholesterol deposits (plaques) in the heart arteries and inflammation are usually the cause of coronary artery disease.
Similar to a heart attack, signs and symptoms of CAD occur when the heart does not get enough oxygen-rich blood. If one has CAD, reduced blood flow to the heart can cause chest pain (angina/chest pressure/tightness) and shortness of breath.
CAD often develops over decades. Symptoms may go unnoticed until a significant blockage causes problems, or a heart attack occurs. Therefore, while the worker stated that he did not have any pre-existing heart issues, the fact that significant CAD was identified, suggests otherwise.
While I acknowledge that the medical reports indicate that the worker is a smoker and has a family history of heart disease, there is no evidence that these conditions were uncontrolled at the time of the worker’s acute MI. In addition, while these are known risk factors in the development of cardiac complications there is an absence of evidence which supports that the worker did not have a work-related injury that contributed to his acute MI.
During the hearing I found the worker to be forthright and credible in his testimony. In addition, I find that while the evidence supports that the worker performed managing duties that were typically stressful as part of his regular job, the stress and acute emotional tone of the meetings that occurred on July 25, 2023, was stress that he was unaccustomed to experiencing, noting he was being blamed for the shortcomings of the crew due to decisions made by the mine owner. In addition, the worker was given an extraordinary and unusual task of having to explain the shortcomings. Further, the worker testified, and I accept, that during the second meeting his livelihood was being threatened and he was treated in a condescending and aggressive manner. I accept the worker’s testimony in that the stress he felt that day was much more aggressive, stronger and personal than anything he had experienced before and/or what he usually dealt with.
In considering all the available evidence, the worker’s testimony and the opinion of Dr. Vexler, I am satisfied that while the worker suffered from pre-existing factors that could have contributed to heart disease, I am persuaded on the balance of probabilities, that the work activities performed by the worker on July 25, 2023, caused an acute emotional stress of which he was not accustomed to at the time, and he developed an onset of symptoms with no significant delay.
In accordance with operational policy, entitlement can be accepted when a worker experiences an acute emotional stress with no significant delay in the onset of symptoms, which is the case here. Therefore, I find the activities performed by the worker on that day are causally related to a heart disorder which were a significant contributing factor in the development of the condition.
For these reasons, I find the worker’s cardiac condition arose out of his employment and as a result initial entitlement is allowed.
In the absence of any updated medical information, I remit the level and duration of benefits to the discretion of the operating area.
CONCLUSION
I conclude the worker’s cardiac condition arose out of his employment and as a result initial entitlement is allowed.
The level and duration of benefits is left to the discretion of the operating area.
The worker’s objection is therefore, allowed.
DATED December 19, 2024
L. Cirillo
Appeals Resolution Officer
Appeals Services Division