APPEALS RESOLUTION OFFICER DECISION
DECISION NUMBER:
20250067
OBJECTING PARTY:
worker
REPRESENTED by:
WORKER REPRESENTATIVE
RESPONDENT PARTY:
employer (not participating)
HEARING:
HEARING IN WRITING
HEARD by:
L. Cirillo, appeals resolution officer
september 8, 2025
ISSUE
The worker objects to the Adjudicator’s decision dated March 25, 2024, which denied initial entitlement to benefits for an intracranial haemorrhage (stroke – left basal ganglia) sustained on December 16, 2023.
BACKGROUND
On December 16, 2023, the worker experienced a spontaneous intracranial bleed (stroke – left basal ganglia) while at work. At the time, they were working for the employer as a Sales Consultant, for 4 years. The worker attributed their stroke to chronic and acute workplace stress relating specifically to two sales that occurred on or around that date, which were unexpected and unusually stressful.
It was ultimately concluded that the workplace exposures were not a significant contributing factor in the development of the worker’s stroke and as a result, initial entitlement was denied. The decision was communicated to the worker in correspondence dated March 25, 2024.
The worker objected to the denial of initial entitlement. In support of their position, they submitted a detailed statement explaining their pre-injury job duties, how they had become more stressful over time, and that on or around the date of injury, they experienced a significant amount of unexpected stress, which led to their stroke. The worker also denied suffering from pre-existing hypertension.
In further support of their position, they submitted previous case law, referred to operational policy, and the WSIAT Medical Discussion Paper entitled “Stroke”.
The reconsideration decision letter dated October 28, 2024, upheld the decision to deny benefits on the basis that while the worker felt stressed as a result of their work duties, these did not meet the “acute emotional stress” causation as intended in Operational Policy 15-03-10. Further, it was concluded that the worker had not been exposed to an objectively traumatic event and that there was medical evidence of other likely risk factors. As such, it remained that the workplace exposures were not a significant contributing factor in the worker’s stroke.
The worker objected to the denial of initial entitlement; however, the decision remained unchanged and as a result, the matter was referred to the Appeals Services Division for further consideration.
Worker’s Position:
In correspondence dated June 11, 2025, the worker’s representative disagrees with the denial of initial entitlement for the worker’s stroke, which occurred on December 16, 2023. The representative provides a detailed claim background, summary of the worker’s pre-injury duties, and refers to operational policy and previous case law. This will not be repeated in its entirety.
Briefly, she argues the following in part:
- In over four years working with the employer, the worker had never encountered a circumstance as what unfolded on December 15/16, 2023 (i.e., two negotiated sales for the same vehicle fell through). This was extraordinary and profoundly destabilizing for the worker;
- This occurred when the worker was already experiencing significant workplace stress due to deteriorating economic conditions, increased customer demand, and the worker struggling to meet their sales targets (the worker was under mounting pressure from management and acutely aware of their declining performance – sales below target outlined at a meeting on the day of stroke);
- She submits that the unexpected collapse of two finalized transactions in a single day, was an acute psychological shock that far exceeded the normal stressors of the worker’s role;
- The representative also outlined that the worker was unexpectedly confronted by one of the customers at their workstation, which startled and unsettled the worker significantly;
- Immediately following this, the worker proceeded to their supervisor’s office to report the events of the previous day and while recounting the situation, amid elevated emotional stress, and in a state of shock, the worker suffered a sudden intracranial haemorrhage (stroke);
- In her view, the cumulative effect of these stressors created an acute and overwhelming emotional burden, far beyond anything the worker had previously experienced in the workplace;
- The representative also submits that there is no evidence that the worker had ever been diagnosed with, or treated for, hypertension or any other condition that could reasonably be said to have caused or contributed to the stroke. In support of this, she submitted a solicited letter (question/answers) from Dr. Kliman, the worker’s family doctor, dated March 22, 2025;
- In the alternative, she submits there was an aggravation of a latent pre-existing condition. In support of this position, she submitted a solicited letter from Dr. Santhiramohan, the worker’s treating Neurologist, dated January 24, 2025;
- Taken as a whole, she submits that the clinical and circumstantial evidence strongly supports the conclusion that the extraordinary and highly stressful work-related events the worker experienced in the 24 hours preceding their stroke were a significant contributing factor to the timing and occurrence of the injury;
- On a balance of probabilities, the stroke arose out of and in the course of employment. As such, she submits that the decision denying initial entitlement be set aside, and that the worker be granted retroactive entitlement to benefits.
Employer’s Position:
The employer is not participating in the worker’s appeal and therefore, did not provide a submission.
AUTHORITY
Workplace Safety & Insurance Act, 1997
Section 2 (1) & 15
Schedules 3 & 4
Operational Policy Manual
Published
11-01-01 – Adjudicative Process
11-01-03 – Merits and Justice
15-03-10 – Heart Conditions
November 3, 2008
October 12, 2004
October 12, 2004
Support Material
Workplace Safety & Insurance Appeals Tribunal (WSIAT) Medical Discussion Paper “Stroke” - February 2003 – Prepared by: Dr. J. David Spence - Stroke Prevention & Atherosclerosis Research Unit
Robarts Research Unit Professor of Neurology, University of Western Ontario
ANALYSIS
I have reviewed the record and considered the information, relevant legislation and operational policies in reaching this decision. In considering all of the evidence, including the medical reporting on file, and the arguments presented, I conclude the balance of evidence supports that the worker’s occupational exposures on/around December 16, 2023, were a significant contributing factor in the development of their stroke (i.e., spontaneous haemorrhage of the left basal ganglia).
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 these decisions, and each case is adjudicated based on its own merits.
In reviewing the record, including the worker’s detailed statement outlined in correspondence dated
July 9, 2024, and their representative’s letter dated June 11, 2025, I note the following pertinent information:
- The worker began working as a car salesman with the accident employer in June 2019. Their responsibilities included generating leads through email, phone, advertising, and walk-in traffic, as well as advising customers on vehicle availability, pricing, financing, and leasing options. When a customer expressed interest in purchasing a vehicle, the worker would present the offer to their supervisor and then return to the customer with the company’s final position. Upon acceptance, both parties would sign the sales agreement—constituting a final sales agreement under the Ontario Motor Vehicle Industry Council (OMVIC) framework—and the supervisor would provide final approval. The customer was then referred to a business manager for credit checks and financing approval. A few days prior to delivery, the worker would follow up to collect necessary insurance documentation. At the time of the accident, the worker worked on-site on Mondays, Tuesdays, Wednesdays, Fridays, and Saturdays;
- During the week of the accident, the worker missed their day off, Thursday, and worked on-site Monday to Saturday;
- On Friday, December 15, 2023, the worker finalized the sale of a used vehicle. A final sales agreement was signed by both the customer and the worker, approved by their supervisor, and financing was secured. Shortly thereafter, the customer unexpectedly contacted the worker seeking to cancel the sale and recover his deposit. The worker outlined that while cancellations may occur in preliminary discussions, it was highly unusual for a customer to withdraw after the execution of the final sales agreement and formal financing approval. They stated that cancellations are rare and were virtually unheard of in their experience;
- After consulting with their supervisor, the worker advised the customer that the transaction could be cancelled, and the deposit refunded. The customer stated he would return the following day, Saturday, to collect the deposit. The worker advised they would be unavailable and asked the customer to return on Monday;
- Later that same day, the worker negotiated a second sale for the same vehicle with a different customer. Again, a final sales agreement was signed and approved. However, that evening, the worker learned that the second customer also wished to cancel the deal;
- The worker stated that in over four years with the dealership, they had never encountered two customers executing final sales agreements for the same vehicle and then both seeking to cancel those agreements on the same day. To their knowledge, such a scenario had never occurred in the history of the dealership. The worker stated that this was extraordinary and profoundly destabilizing for them and it occurred at a time when they were already experiencing significant workplace stress;
- The worker claims that the unexpected collapse of two finalized transactions in a single day, an unprecedented occurrence, was an acute psychological shock that far exceeded the normal stressors of their role;
- The next morning, Saturday, December 16, 2023, the worker sent an email to their supervisor, detailing the prior day’s events. They then reported to work as usual and attended a mandatory sales meeting led by general manager. During the meeting, the general manager announced that sales for the month were significantly below target—further compounding the worker’s existing stress;
- In addition, contrary to the prior arrangement, the first customer arrived at the dealership seeking his deposit. The worker stated that the customer bypassed the main entrance and entered through a rear door, confronting them directly at their workstation, which was intrusive, and startled/unsettled the worker;
- They immediately proceeded to their supervisor’s office to report the events of the previous day and while recounting the situation, (reportedly amid elevated emotional distress and in a state of shock), the worker suffered a sudden intracranial haemorrhage (stroke);
I take particular note of the medical evidence on file as follows:
- The worker was transported to a hospital emergency room (ER) via ambulance suffering from right-sided weakness and language difficulty. They underwent CT investigation on December 16, 2023, which revealed the presence of an acute intracranial bleed centred in the left subinsular region and basal ganglia;
- Note is made that the worker suffered from pre-existing conditions and there was a family history of aneurysm and ischemic stroke;
- The ER notes reveal that the worker’s initial blood pressure was 199/122. It was further opined that the etiology of their stroke was due to hypertension given the location and blood pressure crisis at the ER, despite not being known for any significant hypertension, requiring medical intervention in the past.
The WSIB’s Operational Policy 11-01-01 Adjudicative Process states in part:
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.
The operating area determined that there was no entitlement for the worker’s stroke on the basis that the entitlement criteria under operational policy 15-03-10 had not been met. This policy 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.
The WSIB does not have a specific policy related to stroke. Therefore, as a matter of practice, operational policy 15-03-10 is regularly applied to stroke claims. While I concur that the entitlement criteria in this policy have not been met per se; this does not automatically equate to disentitlement. The policy clearly states that it is applicable to claims for entitlement for a cardiac condition, which is not the issue or medical condition in the current appeal. For these reasons, I find that operational policy 15-03-10 does not apply to this case. When the condition or disease claimed is not listed in the Schedules, and there is no specific WSIB policy, the decision is rendered based on the merits and justice of the individual case in accordance with the general provisions of the Act, as indicated in operational policy 11-01-03, Merits and Justice.
In order to consider granting entitlement, it must be established that it is more probable than not that the worker’s employment caused or significantly contributed to the development of the medical condition being claimed. In this case, the worker claims they developed an acute intracranial bleed (stroke) as a result, of unexpected and unaccustomed stress in the workplace.
As such, what needs to be determined is if the claimed unexpected/unaccustomed work-related stress caused or significantly contributed to the development of the worker’s stroke. If established, the above will generally be considered persuasive evidence that the employment made a significant contribution to the condition. A significant or material contributing factor is one of considerable effect or importance. To consider entitlement to benefits in this case, the evidence must show that on a balance of probabilities, that a causal or significant contributory relationship exists between the worker’s stroke and the employment related stress.
In reviewing the evidence on file, I accept that on or around December 16, 2023, the worker experienced a sudden onset of unexpected and unaccustomed stress due to multiple factors occurring at work including an unprecedented cancellation of two deals on the same vehicle, as well as a customer showing up unexpectedly confronting the worker at their workstation.
On page 12 of the WSIAT Medical Discussion Paper, Dr. Spence outlines the following [with various areas of my emphasis]:
Workplace stress and hypertension:
It can be expected that from time to time a claim will be made that stroke is due to stress at work. This would rarely be justified. One mechanism by which such a claim may be justified would be if the stroke were due to a marked rise in blood pressure during a particular stressful event, in which the worker experiences, literally, apoplexy. However, the kind of stroke that could be related to such an event would only be a hemorrhage due to rupture of a previously existing berry aneurysm, or a stroke due to hypertensive small vessel disease (either a hypertensive intracerebral hemorrhage, or a lacunar infarction), in the part of the brain in which such strokes commonly occur…
A rise from 140/80 to 194/107 (within the observed range described above) could be enough to cause a stroke.
While I acknowledge the medical evidence demonstrates the presence of pre-existing factors, which could predispose the worker to a stroke, I am persuaded by Dr. Santhiramohan’s uncontradicted opinion, which states, the worker suffered a left basal ganglia spontaneous haemorrhage due to a hypertensive crisis. He further notes that the worker may have had undiagnosed hypertension for some time, which was untreated and patients who have untreated hypertension and experience work-related stress can precipitate a hypertensive crisis.
In my view, the worker suffered a hypertensive crisis on December 16, 2023, which is supported by the fact that upon arrival at the ER, their blood pressure was measured to be 199/122, which is significantly outside of the norm and as outlined by Dr. Spence high enough to cause a stroke.
While I accept that hypertension is a know risk factor associated with strokes and that there is a family history, this does not discount the impact of the workplace stress on December 16, 2023, as a significant contributing factor. In order for entitlement to be established, the work-related stress need not be the sole contributing factor, but rather, a contributing factor.
In considering the evidence as a whole, on a balance of probabilities, I am persuaded that there is sufficient evidence, which supports that the unexpected/unaccustomed stress experienced by the worker on or around December 16, 2023, was a significant contributing factor in the development of the worker’s hypertensive crisis, which led to their stroke.
For these reasons, the worker is entitled to benefits for a left basal ganglia haemorrhage (stroke), which occurred on December 16, 2023.
The level and duration of benefits is left to the discretion of the operating area.
CONCLUSION
I conclude the balance of evidence supports that the worker’s occupational exposures on/around December 16, 2023, were a significant contributing factor in the development of their stroke (i.e., spontaneous haemorrhage of the left basal ganglia).
The level and duration of benefits is left to the discretion of the operating area.
The worker’s objection is allowed.
DATED September 8, 2025
L. Cirillo
Appeals Resolution Officer
Appeals Services Division