Worker v. Employer, 2025 CanLII 144149

20260011

VIDEOCONFERENCE – OCTOBER 27, 2025

HEARD by:

DATED:

OCTOBER 29, 2025

ISSUE

The worker is objecting to the decision dated January 9, 2024, in which the Case Manager (CM) denied initial entitlement to benefits for a low back, neck, left shoulder and left knee injury.

BACKGROUND

On October 6, 2023, the worker was carrying a carpet with their colleagues up the stairs when they lost their balance and fell to the ground. Initial entitlement to benefits was granted for a right 5th metatarsal fracture, along with full loss of earnings (LOE) benefits from October 7, 2023, to October 6, 2025. The worker reached maximum medical recovery (MMR) on August 2, 2024. They received a 2 percent non-economic loss (NEL) benefit for their permanent right foot impairment.

On October 7, 2023, the worker went to the hospital. They reported pain and swelling to their right foot and bruising to their left arm and right side following a fall at work. The doctor ordered an x-ray of the right foot and subsequently diagnosed a 5^th metatarsal fracture.

On November 11, 2023, the family doctor assessed the worker at their clinic. The doctor noted that the worker had a history of low back issues, specifically a slipped disc at L4-L5, and was now reporting a flare-up. The doctor diagnosed a musculoskeletal strain of the neck, back, and shoulder, and recommended therapy and the use of paracetamol.

On November 17, 2023, the worker advised the WSIB that they had injured their low back and left hand in the accident. Approximately one month later, on December 5, 2023, the worker asked the physiotherapist to treat their neck, low back, and left knee. The physiotherapist refused to treat these additional areas, as the worker did not have entitlement for injuries to the low back, neck, left shoulder, or left knee.

On December 7, 2023, during a conversation with the CM, the worker attributed their neck and low back pain to the performance of their regular duties, but also emphasized, that the pain in those areas worsened after the work-related accident. The worker further clarified that they only began to feel pain in their back, neck, and knee once the pain medication wore off following the fracture of their foot.

In their decision dated January 9, 2024, the CM determined that the worker did not have initial entitlement to benefits for injuries to the lower back, neck, left shoulder, or left knee, as they were unable to establish compatibility and continuity. The worker objected to this decision. As a result, the issue of initial entitlement to benefits for injuries to the lower back, neck, left shoulder, and left knee is now before me in this appeal.

AUTHORITY

Operational Policy Manual

Published

11-01-01, Adjudicative Process

November 3, 2008

ANALYSIS

After carefully considering all of the available information, applicable legislation, and relevant operational policies, I find that the worker does not have initial entitlement to benefits for a low back, neck, or left shoulder strain, or for a left knee injury.

Worker’s position

The worker is seeking initial entitlement to benefits for low back, neck, left shoulder and left knee injuries.

Worker’s testimony

The worker advised that they were unable to recall the details of their accident with precision, but indicated a willingness to share what they could remember in a transparent and forthcoming manner.

The worker recalled that, on the day of the accident, they were carrying a heavy carpet with two co-workers. While ascending the stairs and leading the way, the worker lost their footing upon reaching the third or fourth step and fell to the ground. The worker was unable to recall the specifics of how they fell or how they landed. They do remember being disoriented and unaware of their surroundings immediately after the fall. After a few minutes, the worker got up and completed their shift.

The worker recalled attending the hospital the day following the accident. When asked what type of injury they reported to the attending physician, the worker indicated that they reported a right foot injury. When questioned as to why no other injuries were reported at that time, the worker explained that the right foot injury was their primary concern, as the pain was predominantly localized to that area.

The worker recalled that the doctor recommended the use of an air boot for several weeks, as well as pain medication. When asked to specify the type of medication was prescribed, the worker was unable to recall. Similarly, the worker could not remember the duration for which they took the pain medication.

When questioned about the onset of pain in areas other than the right foot, the worker advised that this pain began after they stopped taking the prescribed pain medication.

The worker stated that they reported their low back, neck, left shoulder, and left knee injuries as soon as they began to experience pain in those areas. When asked to clarify the approximate time of reporting these injuries, the worker was unable to recall. Similarly, the worker was unable to specify to whom they

reported the injuries. The worker testified that, although they reported their injuries, “no one was listening.”

The worker testified that they had never experienced any issues with their neck, back, knee, or shoulder prior to the accident. When presented with a memo dated December 7, 2023, the worker was unable to recall having this specific conversation with the CM. When questioned regarding any pre-existing low back disc issues, the worker acknowledged having experienced some low back pain in the past.

However, they emphasized that the severity of their low back pain was significantly greater following the work-related accident.

The worker testified that they had never taken any time off work due to a medical condition prior to the workplace accident. They also stated that, before the accident, they were not attending any assessments or treatments for any injury or condition, nor were they taking any medication.

The worker confirmed that they recently underwent imaging of their shoulder, back, neck, and knee. During the testimony, I observed the worker pointing at their right shoulder when discussing shoulder pain, and when asked which shoulder was causing ongoing issues, the worker confirmed it was their right shoulder. They also confirmed that they were attending massage therapy for their shoulder, had not received any treatment for their neck or back so far but planned to pursue treatment in the future, and clarified that they were unable to bend or sit in certain positions due to their knee issues. Upon review of the recent imaging reports, the worker stated that their doctor informed them they have arthritis in their shoulder and lower back.

Employer’s position

The employer is not participating in this appeal.

Assessment of evidence

Policy 11-01-01, Adjudicative Process says that 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”, and it says that 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.

Entitlement in this case has already been accepted for a right foot injury. In determining whether the worker also sustained a low back, neck, left shoulder, and left knee injury, the appeal turns primarily on the last three criteria.

In this appeal, the main issue is that the worker delayed reporting their neck, low back, left shoulder, and left knee injuries by approximately five weeks. The worker submits that they did not experience any pain in these areas until they stopped using pain medication prescribed for their right foot injury, suggesting that the delay in reporting was due to the pain medication masking their symptoms.

I do not find it significant that the worker did not experience immediate pain in their neck, low back, left shoulder, or left knee on the day of the accident. In my view, it is common to experience delayed pain following an acute sprain or strain, which can be explained by a combination of the body’s initial hormonal response and the gradual development of inflammation. I accept the worker’s statement that their neck, low back, left shoulder, and left knee pain started developing after October 6, 2023.

I accept that the worker was on pain medication following their workplace accident. While I am unable to corroborate the worker’s statement with the hospital records due to issues with illegibility, I find there is

no reason not to trust the worker’s sworn statement on this matter. The worker suffered a fracture to their right foot, and it is reasonable to expect that a doctor would prescribe pain medication during the acute recovery period. As such, I accept that the worker was on some type of pain medication as of October 7, 2023.

I accept that the worker was on pain medication for approximately two weeks. I place significant weight on the contemporaneous information documented in memo #22, dated December 7, 2023, in which the worker informed the CM that they were on pain medication for 10 to 15 days. In the absence of any other evidence to the contrary, I accept that the worker was on pain medication up to, or around,

October 21, 2023.

I accept the worker’s statement that they began experiencing pain in their neck, low back, left shoulder, and left knee as soon as they stopped taking pain medication prescribed for their right foot injury. As established in my assessment, the worker discontinued the use of pain medication on or around October 21, 2023. Therefore, I conclude that the worker became aware of the pain and injuries in their neck, low back, left shoulder, and left knee on or around October 21, 2023.

I find that the worker did not report injuries to their neck, low back, left shoulder, or left knee on or around October 21, 2023. While the worker submits that they reported these injuries around this time, I find that the preponderance of evidence does not support their submission. Specifically, memos dated October 31, 2023, November 15, 2023, and November 28, 2023, indicate that the worker did not report any pain or injury to their neck, low back, left shoulder, or left knee.

I acknowledge the worker’s suggestion that the CM failed to properly document their concerns on or around October 21, 2023. Upon reviewing the memos on file, I observed that the CM conducted several lengthy conversations with the worker, with the assistance of an interpreter, and documented detailed information regarding the worker’s recovery and return-to-work (RTW) status. In the absence of any concrete evidence, I am unable to accept the worker’s suggestion on this matter.

I find that the worker first reported their low back pain to their doctor on November 11, 2023, which was approximately three weeks after they stopped using pain medication and became aware of their symptoms. At that time, the worker reported a flare-up of pre-existing low back pain. Upon reviewing the clinical note dated November 11, 2023, I found no evidence that the worker attributed their worsening low back symptoms to the workplace accident

I also find that the worker first reported their neck and shoulder pain to their doctor on November 11, 2023, which was approximately three weeks after they stopped using pain medication and became aware of their symptoms. When reviewing the clinical note from that date, I found no evidence to suggest that the worker complained of any new neck or left shoulder pain, that the doctor assessed the worker’s neck or left shoulder, or that the doctor related the worker’s neck and left shoulder injuries to the workplace accident. The doctor’s note simply indicated that the worker had a strain in their neck and shoulder.

I find that the worker did not report a left knee injury to any health care provider. Upon reviewing the clinical information on file, including the legible hospital records, clinical notes, and specialty clinic reports, I found no indication that the worker ever complained of left knee issues to any health care provider, nor that the worker received any diagnosis related to the left knee. In light of this, I am not able to conclude that the worker sustained a personal left knee injury.

Even if I were to accept the worker’s position that pain medication was masking their pain in the neck, low back, left shoulder, and left knee—thereby causing delays in the reporting of those injuries—I find that this explanation does not adequately justify the additional delays in reporting. As outlined above, the evidence indicates that the worker became aware of neck, low back, left shoulder, and left knee pain on or around October 21, 2023, but did not report these injuries until November 11, 2023, approximately three weeks later. Furthermore, when the injuries were reported, the doctor did not relate them to the workplace accident.

Considering the evidence as a whole, I find it difficult to establish a causal relationship between the workplace accident and the reported neck, low back and left shoulder strains, or a left knee injury. As all five criteria outlined in policy 11-01-01, Adjudicative Process, are not met, I find that the worker does not have initial entitlement to benefits for a strain of the neck, low back, or left shoulder, or for an injury to the left knee.

CONCLUSION

The worker’s objection is denied.

I conclude that the worker does not have initial entitlement to benefits for a strain of the low back, neck, or left shoulder, or for a left knee injury.

DATED OCTOBER 29, 2025

Mila Vrdoljak

Appeals Resolution Officer Appeals Services Division