Appeals Resolution Officer Decision
Decision Number: 20250071
Objecting Party: Worker
Represented by: Self-represented
Respondent Party: Employer (Not Participating)
Hearing: Hearing in Writing
Heard by: S. Johnson, Appeals Resolution Officer
Dated: August 8, 2025
Issue
The worker objects to the Case Manager’s decision letter dated January 4, 2024 and reconsideration decision letter dated May 9, 2024 that concluded the worker did not meet the six-month time limit to file a claim for a mental stress injury due to the work incident in March 2001 that required medical treatment on March 12, 2001.
Background
In the Worker’s Report of Injury/Disease (Form 6) dated January 2, 2024, this part-time store assistant filed a claim for a mental stress injury dating back to a work incident that happened in March 2001. In this report, the worker documented a co-worker showed the worker a video camera that was monitoring the worker’s work area. The co-worker suggested to the worker that they were being monitored by the employer. The worker felt extremely paranoid and received medical treatment at the Hospital A on March 12, 2001.
In the Hospital A Discharge Summary Report dated March 22, 2001, the psychiatrist documented the worker was admitted to the hospital on March 12, 2001 with complaints of paranoid delusions, increasing paranoia for several months, decreased sleep and concentration, speeding thoughts, fear and irritability arising from being monitored by an insurance company attempting to defame them. The psychiatrist diagnosed depression with psychosis and admitted the worker to the hospital. They were discharged on March 20, 2001 and advised to see their family doctor for psychiatric medications and attend the Day Treatment Program.
In the Employer’s Report of Injury/Disease (Form 7) dated February 21, 2025, the employer documented they have no record of the worker reporting a mental stress injury in March 2001.
In a decision letter decision letter dated January 4, 2024 and in a reconsideration decision letter dated May 9, 2024, the Case Manager concluded the worker did not meet the six-month time limit to file a claim for a mental stress injury due to the work incident in March 2001 that required first medical treatment on March 12, 2001.
This is the issue for my review and determination.
Authority
Operational Policy Manual
Published
15-01-03 Workers’ Requirement to Claim and Consent
April 9, 2021
Analysis
I have carefully considered all the available information, legislation and relevant operational policies in reaching this decision.
I find entitlement to an extension of time to file a claim for a mental stress injury that occurred some time in March 2001 is denied.
The Operational Policy Manual (OPM) Document No. 15-01-03 – Workers’ Requirement to Claim and Consent – states a claim must be filed within six months of an injury or, in the case of an occupational disease, within six months of the worker learning of the disease. The Workplace Safety and Insurance Board (WSIB) may extend the six-month deadline, or waive the dual requirement altogether if in the WSIB's opinion it is just to do so. If the worker does not file the claim for benefits, or consent to the disclosure of functional abilities information within the six-month deadline, the WSIB does not provide benefits unless, in its opinion, it is just to do so.
This policy states, that, if a worker fails to file a claim by the respective deadline, the WSIB allows the claim to be filed at a later date if the worker can show that exceptional circumstances existed at the deadline. Exceptional circumstances can include:
- compelling personal reasons, such as serious health problems or injuries (experienced by the party or the party's immediate family), or the party leaving the province/country due to the ill health or death of a family member
- the worker's ability to understand the time limit requirements and consequences of not meeting them (e.g., was the worker made aware at the workplace of the requirement to claim and consent; were language difficulties a factor?), and
- whether the worker reported the accident to the employer, health care professional, or co-workers.
Worker Submissions
In the Appeal Readiness Form dated January 31, 2025, the worker had no further information to add.
In the Intent to Object Forms dated April 23, 2024, May 5, 2024 and January 31, 2025, the worker relied on a previous letter dated April 11, 2024 and additional evidence in support of the position they were under major stress and paranoid when they found out they were being monitored by video at work. The worker submitted additional information summarized below:
- In a letter dated February 22, 2018, the employer confirmed the worker was hired as a part-time store assistant with the bookstore from February 5, 2001 to February 28, 2001 and from June 5, 2001 to December 31, 2001.
- In the Hospital A Discharge Report dated March 22, 2001, the psychiatrist documented the worker was admitted to the hospital on March 12, 2001 with paranoid delusions and acute psychosis that has been increasing for several months. The worker reported they believed that an insurance company was trying to defame them and monitoring their bank account. They have been recently acting on their delusions and misperceptions. They have become anxious, suspicious and hypervigilant with some psychotic symptoms such as auditory hallucinations. They are still planning to separate from their wife which may have also caused significant stress.
In a letter dated March 24, 2025, the worker documented they were hired by Company A to work at the employer’s bookstore. After they viewed the video camera and television on their workstation, they became extremely paranoid to the extent they were hospitalized a few days later.
The worker contends they received medical treatment at the hospital within a few days following the work incident in March 2001. This medical evidence supports their claim for entitlement to a mental stress injury arising from work in March 2001.
The worker requests they should be awarded benefits because their mental stress injury is due to being monitored and recorded by the employer.
Employer Participation
The employer is not participating in the worker’s appeal.
In a letter dated May 24, 2024, the employer was advised of the worker’s intention to appeal the Case Manager’s decision letter dated January 4, 2024 at the Appeals Services Division. The employer was instructed to complete and return the Employer Participant Form to the WSIB within 30 days if they wish to participate in the Appeals Services Division process.
The Employer Participant Form was not completed and returned to the WSIB at the time I received the worker’s appeal for my review and determination.
Findings
The worker does not dispute the 23 year delay in filing this claim. Where the worker disagrees is this should not prevent them from claiming entitlement to benefits and services under the insurance plan because the medical information supports their mental stress injury is work-related. I am unable to agree with this position.
I find a 23 year delay in filing a claim is lengthy to the extent the evidence is so stale that the claim cannot reasonably be adjudicated on its merits. The employer has no record about the work incident occurring some time in 2001 and the worker is unable to recall the exact date of the event. In the absence of an exact date, I note the worker relied on the Hospital A report dated March 22, 2001 that documented the admission on March 12, 2001. Based on this evidence, the work incident would have occurred in the days prior to March 12, 2001.
In reconciling the issue concerning when the work incident happened in March 2001, I relied on the employer’s evidence. In a letter dated February 22, 2018, the employer confirmed the worker was hired as a part-time store assistant with the bookstore from February 5, 2001 to February 28, 2001 and from June 5, 2001 to December 31, 2001.
I accord the greatest amount of weight to the employer’s evidence since it is the best evidence that I have before me that supports the worker was not employed or working with the employer beyond February 28, 2001. The employer’s evidence is consistent with the medical evidence that supports the worker’s hospitalization on March 12, 2001 happened at a point in time the worker was not employed with the employer.
I find it significant the worker’s evidence about what happened at work in March 2001 that led to their hospitalization is not consistent with the medical evidence. In the Hospital A Report dated March 22, 2001, the worker did not report their mental stress condition was due to a work event that happened just prior to their admission to the hospital on March 12, 2001. In this report, the psychiatrist documented the worker was admitted to the hospital on March 12, 2001 with paranoid delusions and acute psychosis that has been increasing for several months. The worker reported they believed that an insurance company was trying to defame them and monitoring their bank account. They have been recently acting on their delusions and misperceptions. They have become anxious, suspicious and hypervigilant with some psychotic symptoms such as auditory hallucinations. They are still planning to separate from their wife which may have also caused significant stress.
The psychiatrist did not document any information about the worker’s mental stress condition requiring hospitalization on March 12, 2001 was due to a work-related incident. The psychiatrist is in the best position to provide a medical opinion about the worker’s mental health status and the need for admission to the hospital. They had the opportunity to conduct an in-person interview with the worker, obtain their history and onset of their psychological symptoms, assess the worker and record the clinical objective findings. The medical report is complete and based on an accurate understanding about the facts and circumstances of this worker’s mental health status at the time they received first medical treatment on March 12, 2001. There is nothing in this report that suggests the worker’s psychological condition arose from a work-related incident.
I had regard for the fact that other records and witnesses may no longer be available and these potential witnesses may no longer recall the event in question accurately due to the length of time that has passed. There is also no record of any medical evidence from the worker’s family physician.
I considered whether there were exceptional circumstances set out in the OPM Document No. 15-01-03 – Workers’ Requirement to Claim and Consent – that existed in this worker’s case to consider an extension of the time limit to file a claim. In a telephone conversation with the Case Manager on January 4, 2024, the worker advised they were too paranoid to file the incident report with the employer on the day that it happened. I find this does not reasonably explain or justify a 23 year delay in filing a claim until January 2, 2024. The case record documents the worker returned to work with the employer performing their part-time store assistant job until December 31, 2001. In my view, the worker could have reported the work incident to the employer.
I find there are no exceptional circumstances that reasonably explains the 23 year delay in filing a claim for the same reasons that I have found the worker has not provided a reasonable explanation for this lengthy delay. The worker’s paranoia arising from their concerns about being defamed by an insurance company is not in dispute and captured in the Hospital A Report dated March 22, 2001. The worker’s hospitalization and medical treatment from March 12, 2001 to March 22, 2001 does not explain the absence of reporting a work-related incident to either the psychiatrist or to the employer.
I had regard for whether there is prejudice to the employer caused by the 23 year delay in filing a claim. In the Employer’s Report of Injury/Disease (Form 7), the employer documented they were not aware of any work incident until they received first notice of the claim being registered with the WSIB in a letter dated January 3, 2024. I find the employer’s ability to respond to the worker’s claim for entitlement to a mental stress injury dating back to March 2001 is prejudiced. In my view, relevant witnesses, such as co-workers or the worker’s supervisor, and other relevant personnel records dating back 23 years ago may not be available. The memories of any potential witnesses whom the employer may be able to locate, if available, have likely faded as a result of the 23 year delay in filing a claim. The employer has been deprived of the ability to collect timely and contemporaneous information about the accident that happened in March 2001 and any injury resulting from this accident.
I examined the worker’s appeal to determine whether they may have an arguable case based on the merits of their claim. I find this condition has not been met. The facts and evidence in this case weigh against granting entitlement to an extension of time to file a claim for a mental stress injury that happened in March 2001. I find the delay of 23 years has rendered the evidence relevant to the worker’s claim so stale that it cannot be reasonably adjudicated on its merits. The worker’s evidence about what happened in March 2001 is not supported by the contemporaneous medical evidence and the employer’s evidence. I find it significant the worker clearly confirmed they had no intention to file a claim within the six-month time period and I have found no reasonable or appropriate explanation for the 23 year delay in filing the claim. There is no evidence to support there were exceptional circumstances that existed to justify the 23 year delay in filing the claim. The worker did not provide additional evidence to suggest they made an intent to file a claim. I note the worker was discharged to the care of their family physician on March 22, 2001 for medication management. The worker confirmed there is no further medical information and there is nothing submitted to the case record from their family physician to suggest the worker’s mental stress injury was work-related. In my view, if the worker received further medical treatment with their family physician after discharge from the hospital on March 22, 2001 and reported their mental stress injury was work-related, then it is reasonable to expect this would be documented in the physician’s clinic notes. Even if I accept this as a bona fide intent to file a claim, it does not mitigate the fact that the worker failed to take the next step which is to actually file the claim within the six-month time frame.
I find there are significant evidentiary difficulties that do not weigh in favour of granting entitlement to an extension of time to file a claim that include the lengthy 23 year delay, the relevant records and witnesses that may no longer be available, the memories of any potential witnesses may have likely faded and the employer’s ability to prepare a response to the worker’s claim is prejudiced. All these factors will impair the Board’s ability to adjudicate this worker’s case on its merits. Even if I accept the worker’s psychological condition may constitute an exceptional circumstance as defined in the OPM Document No. 15-01-03 – Workers’ Requirement to Claim and Consent – I find it is outweighed by the worker’s self-reported decision to not file the claim when they should have done. There is nothing in the case record to suggest the worker’s psychological condition affected their ability to file a claim in a timely manner or their ability to understand the six-month time limit to file a claim.
I conclude entitlement to an extension of time to file a claim for a mental stress injury that happened some time in March 2001 is denied because the worker failed to meet the time limit to claim and consent and they do not meet the listed exceptions set out in the OPM Document No. 15-01-03 – Workers’ Requirement to Claim and Consent.
Conclusion
I conclude entitlement to an extension of time to file a claim for a work-related mental stress injury that happened in March 2001 is denied.
The objection is denied.
DATED August 8, 2025
S. Johnson
Appeals Resolution Officer
Appeals Services Division