APPEALS RESOLUTION OFFICER DECISION
DECISION NUMBER:
20250070
OBJECTING PARTY:
employer
REPRESENTED by:
self represented
RESPONDENT PARTY:
worker (Not PARTICIPATING)
HEARING:
HEARING IN WRITING
HEARD by:
Brian Smith, appeals resolution officer
SEPTEMBER 24, 2025
ISSUE
The employer objects to the Eligibility Adjudicator’s January 11, 2024 decision that granted entitlement to benefits for a right knee strain.
BACKGROUND
On December 20, 2023, this worker reported to their employer that they were walking around a tractor doing a circle check when they felt a pop on the back of their left knee. The worker sought medical attention on December 1, 2023 and was diagnosed with left knee strain.
On January 12, 2024, an Eligibility Adjudicator accepted entitlement to health care benefits only for a left knee strain for a disablement as an unexpected result of work duties. The employer objected.
On March 19, 2024, an Eligibility Adjudicator reconsidered and upheld the January 12, 2024 decision. The Eligibility Adjudicator also denied entitlement to loss of earnings benefits for February 28, 2024 and March 4, 2024.
On May 10, 2024, a Case Manager determined that the worker had reached maximum medical recovery (MMR) with no ongoing impairment as of May 7, 2024.
The employer has objected to the January 12, 2024 decision, however, the decision remained unchanged and as a result, the matter was referred to the Appeals Services Division for further consideration.
AUTHORITY
Workplace Safety and Insurance Act, 1997 Section 13(2)
Operational Policy Manual
Published
11-01-01 Adjudicative Process
15-02-01 Definition of an Accident
November 3, 2008
October 12, 2014
ANALYSIS
I have carefully considered all of the available information, legislation and relevant operational policies in reaching this decision. I find that proof of accident is not met and the worker is not entitled to benefits for a left knee strain. My reason and analysis follow.
The employer contends that entitlement should not have been granted for a left knee sprain because the adjudicator failed to properly apply policy and legislation to the facts and evidence in this case. It is their position that the evidence does not support that the employee sustained an injury that arose out of their
employment.
The worker is not participating in the appeal.
Policy 15-02-01 Definition of an Accident states that an accident includes:
a willful 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
The definition of disablement includes
a condition that emerges gradually over time
an unexpected result of working duties.
The worker claims that they suffered an injury to their left knee as a result of their regular job. They submit that they were completing a circle inspection of a tractor when they felt a pop behind their knee. The worker did not identify a specific incident or a physical cause. Accordingly, I find that the worker’s accident would be classified as a disablement as an unexpected result of working duties. Thus, for entitlement to exist, it must be shown that an injury arose out of and in the course of the worker’s employment.
Section 13(2) of the Workplace Safety and Insurance Act (WSIA) states, that 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. However, the presumption contained within Section 13(2) does not apply to a disablement.
Policy 11-01-01 Adjudicative Process sets out what is necessary for a worker to establish initial entitlement to benefits. The policy states that all decision-makers use the same criteria for ruling on initial entitlement to benefits, namely, the “five point check system”. An allowable claim must have, among other things, an employer, a worker, a personal work-related injury, proof of accident, and compatibility of the diagnosis to the accident or disablement history.
I find no dispute over whether there is a worker or an employer. Proof of accident, a personal work-related injury, and compatibility of the diagnosis to the disablement history are in question.
Looking at proof of accident, policy 11-01-01 also states that 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?
I find that proof of accident is not met.
Considering whether an accident or disablement situation exists, I note in the worker’s initial statement, to the WSIB Customer Service Representative they stated that they were just walking around a tractor when they heard a pop in the back of their left knee. The worker also stated that they do not know if they had twisted their left knee, or if their footing slipped.
In my review of the case record, there is no indication of an external injuring process. In my view walking is a simple everyday activity and is not something specific to a working duty. I note that the Case Manager accepted that the worker could not recall what position they were in, however the contemporaneous reporting consistently indicated that the worker was only walking. There is no indication that the walking was prolonged, and there is no indication of a slip, a trip or of being in an awkward position. Consequently, I am not satisfied that an accident is evident.
With respect to witnesses, the case record makes no mention of a witness. However, I do not find the absence of a witness to a gradual onset injury unreasonable and therefore not fatal to entitlement.
Looking at whether there are discrepancies in the date of the accident and the date the worker stopped working, I note that the worker did not stop working as the employer offered suitable modified work. I have also considered whether there was any delay in the onset of symptoms or in seeking health care and I note that the worker sought medical attention the day after reporting the onset of pain.
In summary, I have found that an accident is not evident, the absence of a witness is not unreasonable, and I have found that there is no delay in the onset of symptoms or in seeking medical attention.
Since I have not found that an accident exists, proof of accident is not met.
Since I have found that proof of accident is not met. I am also not satisfied that a personal work-related injury exists. Accordingly, I find that the criteria in the five-point check have not been satisfied and the worker is entitled to benefits for left knee strain.
CONCLUSION
The employer’s objection is allowed.
The worker is not entitled to benefits for a left knee strain.
DATED September 24, 2025
Brian Smith
Appeals Resolution Officer
Appeals Services Division