APPEALS RESOLUTION OFFICER DECISION
DECISION NUMBER: 20250059
OBJECTING PARTY: WORKER
REPRESENTED by: WORKER REPRESENTATIVE
RESPONDENT PARTY: EMPLOYER
HEARING: HEARING IN WRITING
HEARD by: Kelly Gordon, appeals resolution officer
DATED: APRIL 21, 2025
ISSUE
The worker, through their representative is objecting to the Occupational Disease (OD) Adjudicator’s decision dated July 26, 2024, and their reconsideration decision dated January 23, 2025. Specifically, the worker objects to the denial of their diagnosed palmar psoriasis, contact dermatitis, and allergic contact dermatitis.
BACKGROUND
On June 12, 2024, this housekeeping aide developed cracking on the skin of their hands, and their hands became sore. The worker reported their hand condition to the employer the same day, and they related their hand condition to the cleaning products, and gloves used to perform their regular job duties. The worker sought medical attention on June 13, 2024, and Dr. Eason submitted a Health Professional’s Report of Injury, Form 8 that provides a diagnosis of chemical dermatitis. The worker lost sporadic days from work between June 13, 2024 and July 12, 2024. The employer then advised the worker they cannot accommodate their restrictions, and on July 12, 2024, the worker stopped working.
The OD Adjudicator reviewed the evidence on file, including the worker’s statement, the Material Safety Data Sheets (MSDS) for the cleaning products, and a Functional Ability Form (FAF) dated July 23, 2024, that provides a different diagnosis of palmer psoriasis. The OD Adjudicator then issued a decision dated July 26, 2024, stating that due to the new diagnosis of palmer psoriasis, they are unable to establish compatibility between the palmer psoriasis and the workplace exposures. As such, they denied initial entitlement to the bilateral hand conditions being claimed.
The worker submitted a telemedical dermatology consultation report dated October 7, 2024, in which the dermatologist questions whether the worker has irritant contact dermatitis or allergic contact dermatitis. In addition, the worker submitted a Health Professional’s Statement Report in which the doctor states the worker’s top diagnosis is contact dermatitis, and their differential diagnosis is palmer psoriasis.
The OD Adjudicator referred the claim to an Occupational Medical Consultant (OMC) who reviewed the evidence and recommended a referral to the Occupational Disease Specialty Program (ODSP) Dermatology Stream to confirm the diagnosis. However, the worker advised they could not attend the ODSP assessment as they were not able to leave home for a week to travel to City A for the assessment. The OD Adjudicator issued reconsideration decisions dated December 5, 2024, and January 23, 2025, stating they are upholding the decision to deny initial entitlement as they could not confirm the diagnosis without the ODSP assessment.
The worker representative submitted the Appeal Readiness Form (ARF) dated December 23, 2024, confirming the worker’s objection to the July 26, 2024, decision, and the reconsideration decisions that denied initial entitlement to the worker’s bilateral hand condition.
The worker’s objection to the denial of initial entitlement to their bilateral hand condition forms the basis of this appeal.
AUTHORITY
Section 2(1) and 15 and Regulations 3 and 4 of the Workplace Safety and Insurance Act, 1997 (the Act)
Operational Policy Manual
Published
11-01-01 Adjudicative Process
November 3, 2008
18-03-02 Payment and Reviewing LOE Benefits (Prior to Final Review)
September 1, 2021
ANALYSIS
For the reasons that follow, I find the worker does have entitlement to contact dermatitis. I also find the worker has entitlement to loss of earning (LOE) benefits for their lost time from work starting
June 13, 2024. In reaching this decision, I have carefully considered all the available information on file, the worker representative’s submission, the legislation, and the relevant operational policies.
Attached to the ARF dated December 23, 2024, the worker representative provided a submission. In this submission, the representative refers to the medical review in which the OMC recognized a temporal relationship between the worker’s rash and their workplace chemical exposure. Although the OMC could not confirm if the diagnosis is irritant contact dermatitis or allergic contact dermatitis, they argue that regardless of the type of dermatitis, the workplace exposures to gloves and chemicals were a significant contributing factor to the onset of the dermatitis. In addition, the representative states the medical evidence supports the worker’s hand condition improved when they were away from work, and their hand condition flared up when they returned to work. In terms of the ODSP assessment, the representative states the worker declined the assessment as they have ongoing compensable low back issues, and they find it extremely difficult to travel long distances. Although the worker has been trying to get an appointment with an in-person dermatologist in their area, there is a six to 12 month wait. Included with their submission are pictures of the worker’s hands, and a copy of the Workplace Safety and Insurance Appeals Tribunal (WSIAT) discussion paper titled: Allergic Contact Dermatitis versus Irritant Contact Dermatitis. The representative notes that the discussion paper relates dermatitis to possible irritants, such as cleaners, disinfectants and bleach. They argue the preponderance of the evidence supports the conclusion that the worker’s diagnosed contact dermatitis is more likely than not from their workplace exposure to chemicals and gloves. Therefore, they are requesting initial entitlement be accepted for contact dermatitis, and any other benefits that flow from that decision.
The employer is not participating in this appeal, and no submissions have been provided for my review.
Occupational disease cases are adjudicated under section 2 (1) and section 15 of the Act and by regulation in Schedules 3 & 4 of the Act. If the disease is not listed in the Schedules and a relevant policy has not been developed, entitlement to benefits and services is determined based on the merits and justice of the case. It must be established that it is more probable than not that the circumstances of the worker’s employment and exposure history significantly contributed to the development of the medical condition being claimed.
In this case, the worker is claiming entitlement to either irritant or allergic contact dermatitis due to occupational exposures while working with this employer. Allergic contact dermatitis is listed under Schedule 3 of the Act. Within Schedule 3, a presumption of work-relatedness is applied, unless the contrary can be shown. Therefore, in cases where an injured worker has been diagnosed with allergic contact dermatitis, and is employed in a process exposing them to a skin allergen, entitlement is granted, unless the employer can rebut the presumption. The worker’s diagnosed irritant contact dermatitis and diagnosed palmer psoriasis are not listed under Schedule 3 or 4 of the Act, and there is no specific WSIB policy for either of these conditions. As such, entitlement to irritant contact dermatitis or entitlement to palmer psoriasis is based on the merits and justice of the individual case. To support entitlement to irritant contact dermatitis or palmer psoriasis, the evidence must show that the workplace exposures contributed significantly to the development of the condition.
In this appeal, I also refer to Policy 11-01-01 that states a five point check system is used to adjudicate initial entitlement claims. Each point must be satisfied for initial entitlement to be allowed. There must be an employer, a worker, a personal work-related injury, proof of an accident, and compatibility of the diagnosis to the accident or disablement. As this is an occupational disease claim, what needs to be established is compatibility between the diagnosed allergic, or irritant contact dermatitis or palmer psoriasis and the worker’s occupational exposures. I find all other criteria in Policy 11-01-01 have been met.
In this appeal, I have considered the evidence pertaining to the worker’s occupational exposures, the worker’s personal protective equipment (PPE), as well as all medical evidence.
Occupational Exposures
The employer submitted the MSDS for all cleaners that the worker has exposure to while performing their regular job duties. I have reviewed the MSDS for each cleaner, and as noted below, I have identified risks for skin exposures.
- Prominence Heavy Duty Floor Cleaner
o Undiluted - causes skin irritation – avoid contact with skin and clothing, PPE to include chemical resistant gloves
o Diluted – no PPE required under normal use conditions
o Delayed, immediate, or chronic effects and symptoms from short and long-term exposure: Skin contact: causes skin irritation, symptoms may include pain (which may be delayed), redness, and/or discomfort.
- Crew Bathroom Cleaner & Scale Remover
o Undiluted – causes skin irritation – avoid contact with skin and clothing, PPE to include chemical resistant gloves
o Diluted - PPE to include chemical-resistant gloves
o Delayed, immediate, or chronic effects and symptoms from short and long-term exposure: Skin contact: causes skin irritation, symptoms may include pain (which may be delayed), redness, and/or discomfort
- BreakDown XC Odor Eliminator & Cleaner Concentrate – Fresh
o Undiluted – avoid contact with skin and clothing, PPE to include chemical resistant gloves
o Diluted – no PPE required under normal use conditions
o Delayed, immediate, or chronic effects and symptoms from short and long-term exposure: Skin contact: causes skin irritation, symptoms may include pain (which may be delayed), redness, and/or discomfort
- Oxivir Plus (Canada) Disinfectant Cleaner Concentrate
o Undiluted – no hazard for skin in normal use conditions
o Diluted – no hazard for skin in normal use conditions
o Delayed, immediate, or chronic effects and symptoms from short and long-term exposure: Skin contact: unlikely to be irritant in normal use
- Glance NA Glass & Multi-Surface Cleaner
o Undiluted – avoid contact with skin and clothing, PPE to include chemical resistant gloves
o Diluted – no hazard for skin in normal use conditions
o Delayed, immediate, or chronic effects and symptoms from short and long-term exposure:
Skin contact - may be mildly irritating to skin, symptoms may include redness and/or transient discomfort
- GOJO Clear & Mild Foam Handwash
o No special measures necessary provided when product is used correctly
- Alliance Vinyl Powder-Free Gloves / Sure Touch Power-Free Blue Nitrile Disposable Gloves
Medical evidence
As per the memorandum dated July 9, 2024, the worker confirmed their family doctor retired. Since they do not have a new family doctor, they have been seeking medical attention at Hospital A.
June 13, 2024 – Dr. Eason completed a Health Professional’s Report of Injury, Form 8 that states the worker has had ongoing exposures to chemicals at work. The date of symptom onset is April 1, 2024, and they provide a diagnosis of chemical dermatitis. The worker was referred to dermatology.
July 11, 2023 – Dr. Comam completed an FAF stating the worker has restrictions due to a chemical exposure.
July 23, 2024 – Dr. Quirt completed an FAF stating the worker was seen for palmar psoriasis.
October 7, 2024 – a telemedical dermatologist (doctor name not on report) submitted a consultation report stating that since the worker’s hands improve while away from work, and that they flare up when they return to work their diagnosis is consistent with contact dermatitis. However, without seeing the worker in person they could not comment on whether the worker has irritant contact dermatitis or allergic contact dermatitis.
October 15, 2024 – Dr. Christinck submitted a Health Professional’s Report of Injury confirming the worker’s hands were exposed to chemicals and gloves, the diagnosis provided is contact dermatitis.
November 5, 2024 – Dr. Ersr completed an FAF stating the worker was not to be exposed to chemical cleaners or gloves.
On November 29, 2024, Dr. McGoveran from the Occupational Health Hub (OHUB) conducted a claim review. After considering all the evidence on file, they provide the opinion that there is a temporal relationship between the worker’s bilateral hand rash and their workplace exposures.
Dr. McGoveran refers to the evidence that confirms the worker regularly washes their hands while working, and while at work, they use GOHO Clear and Mild Foam Handwash. Dr. McGoveran states this handwash contains sodium laureth sulfate, which is a potential irritant as per the MSDS. Dr. McGoveran provides the opinion that the evidence suggests a diagnosis of irritant contact dermatitis. However, they could not confirm whether the worker has a primary diagnosis of allergic contact dermatitis with a possible irritant component from handwashing, or if the worker has irritant contact dermatitis. To confirm the diagnosis, Dr. McGoveran strongly suggests a referral to the ODSP Dermatology stream.
Following Dr. McGoveran’s medical claim review, Dr. Maden completed a Health Professional Statement dated December 4, 2024. Dr. Maden provides a top diagnosis of contact dermatitis, and a differential diagnosis of palmer psoriasis.
On February 6, 2025, Dr. Langley, Dermatologist submitted a Health Professional Statement, and a consultation report. Dr. Langley states the worker was seen for chronic hand dermatitis that they relate to their work in housekeeping. Their condition has become worse since they went from part-time work to full-time work. Although the worker has used different gloves to prevent the reactions, none have been helpful. In terms of the worker’s physical examination, they note the worker has ill-defined erythematous scaly thin patches on their palms, and photos provided to Dr. Langley show more severe thickening plaques with lichenification and fissuring. No signs of eczema, psoriasis, or other skin disorders are noted. Under impression, Dr. Langley provides a diagnosis of chronic hand dermatitis, presenting as contact dermatitis, most in keeping with irritant contact dermatitis from longstanding cleaning/wet work in their occupation. They go on to state that it is less likely the worker has allergic contact dermatitis, but they referred the worker for patch testing to ensure no true allergies.
In the report dated March 28, 2025, Dr. Langley confirms the worker underwent patch testing during the week of March 28, 2025. The results support occupationally related chronic hand dermatitis. Although the patch testing results support an allergic component to cetrimonium bromide which is used in lice kits, cosmetics, conditioners, and hair products, Dr. Langley provides the opinion that this allergy is not a relevant exposure to explain the worker’s symptoms. Instead, Dr. Langley states the worker’s presentation is in keeping with irritant contact dermatitis of the hands, which they feel is occupational in nature given the strong chemicals used while working, and their inability to wear protective gloves that fully cover the hands/forearms.
Entitlement to palmar psoriasis
Having considered the medical evidence, I note the only medical reports that provide a diagnosis of palmar psoriasis include Dr. Quirt’s July 23, 2024, FAF and Dr. Maden’s December 4, 2024, Health Professional Statement. The medical evidence supports the worker underwent multiple assessments after these reports, and no other medical report provides this diagnosis. I also find it important to note that Dr. Langley who is a dermatologist specializing in skin conditions, confirms in their report dated February 6, 2025, that there were no signs of psoriasis or other skin conditions. As I find no other dermatology report that argues the findings as provided by Dr. Langley, I have accepted their opinion, and I find the worker’s hand condition is not a result of psoriasis. Therefore, I find the worker does not have entitlement to psoriasis.
Entitlement to allergic contact dermatitis
As previously noted, allergic contact dermatitis is listed under Schedule 3 of the Act. Within Schedule 3, a presumption of work-relatedness is applied, unless the contrary can be shown. In this case, I find the contrary has been shown, and the presumption clause has been rebutted. In stating this, I note that although the patch testing results confirm the worker has an allergy to cetrimonium bromide, Dr. Langley reviewed the MSDS for the cleaners the worker had exposure to in the workplace, and they confirm these cleaners do not contain cetrimonium bromide. In addition, Dr. Langley provides the opinion that the worker’s symptoms are not in keeping with allergic dermatitis. As I accept the opinion as provided by
Dr. Langley and noting the MSDS do not support the worker had an occupational exposure to cetrimonium bromide, I find the presumption has been rebutted. Therefore, I find the worker does not have entitlement to allergic contact dermatitis.
Entitlement to irritant contact dermatitis
Based on my review of the information on file, I find the weight of the medical evidence supports the worker’s diagnosis of irritant contact dermatitis. In making this determination, I have placed significant weight on the opinions as provided by Dr. McGoveran, and Dr. Langley.
In terms of Dr. McGoveran’s medical claim review, I find it significant that Dr. McGoveran confirms there is a temporal relationship between the worker’s hand condition and their occupational exposures. In addition, Dr. McGoveran provides the opinion that the evidence supports the worker does have some form of work-related contact dermatitis, and they confirm one of the cleaning chemicals the worker is regularly exposed to contains a potential irritant. Dr. McGoveran only questions whether the worker has a primary diagnosis of allergic contact dermatitis or irritant contact dermatitis. Following Dr. McGoveran’s review, the worker underwent an assessment with Dr. Langley who specializes in dermatology.
Dr. Langley had the benefit of physically examining the worker, and they reviewed photos of the worker’s hands during a flare up. Dr. Langley confirms there are no signs of eczema, psoriasis, or other skin disorders, and they provide the opinion that the worker’s presentation is consistent with a diagnosis of contact dermatitis, most in keeping with an irritant form of contact dermatitis from longstanding cleaning/wet work in their occupation. Following the worker’s patch testing, Dr. Langley considered the results, and confirmed their prior opinion that the diagnosis is irritant contact dermatitis of the hands.
Dr. Langley considered the MSDS, and they also provide the opinion that the worker’s irritant contact dermatitis is related to their occupational exposure to cleaning chemicals. As there are no other dermatologist opinions on file that argue the findings provided by Dr. Langley, I accept Dr. Langley’s opinion that the worker’s diagnosis is irritant contact dermatitis due to their occupational exposure to cleaning chemicals. For the reasons provided above, I accept the medical evidence supports it is more probable than not that the worker’s workplace exposures significantly contributed to the development of the worker’s diagnosed irritant contact dermatitis. Therefore, I find the worker does have initial entitlement to irritant contact dermatitis.
Loss of earning benefits
Policy 18-03-02 states that if the nature or seriousness of the injury/disease completely prevents a worker from returning to any type of work, or if the worker is able to return to some form of work, but the WSIB determines no suitable work is available, the worker is generally entitled to full LOE benefits providing the worker co-operates in health care measures and all aspects of the return-to-work (RTW) process.
As confirmed in the memorandum dated July 9, 2024, the worker lost time from work on the following days:
June 13, 2024 - 8 hours
July 2, 2024 - 8 hours
July 8, 2024 - 8 hours
July 11, 2024 – 8 hours
In the memorandum dated July 9, 2024, the employer confirms that as of July 12, 2024, they are unable to accommodate the worker with modified duties based on their restriction of limited handwashing. I also note that as per the employer’s submission, the worker has remained off work, and no offer of modified duties have been made until at least November 30, 2024.
As the employer has not been able to accommodate the worker with suitable modified duties, and noting the employer has confirmed the worker’s lost time from work, I find the worker does have entitlement to LOE benefits for their lost time from work as of July 13, 2024. As there is no information on file confirming the worker’s lost time from work following November 30, 2024, I ask the operating area to confirm the worker’s lost time from work and determine the worker’s entitlement to ongoing LOE benefits.
CONCLUSION
I find the worker does have initial entitlement to irritant contact dermatitis.
I find the worker does have entitlement to LOE benefits for their lost time from work from June 13, 2024, up to November 30, 2024 at the earliest.
I ask the operating area to review entitlement to LOE benefits from November 30, 2024 and ongoing.
The objection is allowed.
DATED April 21, 2025
Kelly Gordon
Appeals Resolution Officer
Appeals Services Division