Worker v. Employer, 2025 CanLII 144152

DECISION NUMBER:

20260008

OBJECTING PARTY:

REPRESENTED by:

RESPONDENT PARTY:

REPRESENTED by:

HEARING:

HEARING IN WRITING – OCTOBER 23, 2025

HEARD by:

DATED:

OCTOBER 23, 2025

ISSUE

The worker objects to the Case Manager’s (CM) decisions of March 21, 2025 and May 9, 2025. These decisions determined that the worker had reached maximum medical recovery (MMR) for the work-related adjustment disorder, with mixed anxiety and depressed mood, with no permanent impairment (PI) evident.

The worker seeks:

A finding that he sustained a PI arising from the work-related adjustment disorder, with mixed anxiety and depressed mood.

BACKGROUND

The Appeals Resolution Officers’ (ARO) July 11, 2019, November 28, 2021, and November 2, 2023 decisions, as well as the December 15, 2020 and February 9, 2023 decisions of the Workplace Safety and Insurance Appeals Tribunal (WSIAT), provide a thorough history of the case file. Therefore, I will not repeat it all here.

On July 29, 2018, the worker injured his right knee when the wheel of a heavy dolly of English muffins he was pulling became stuck, causing him to have to forcefully push the dolly, while in a confined area. He had worked with the employer as a General Labourer/Boxer in a bakery for three months at the time.

The WSIB granted initial entitlement to a right knee sprain/strain injury, an exacerbation of pre-existing chondrosis in the patellofemoral compartment, and edema of the Hoffa’s fat pad.

On February 9, 2023, the WSIAT found that the worker sustained a right knee PI for a permanent exacerbation of the pre-existing chondrosis of the patellofemoral compartment and the edema of the Hoffa’s fat pad in the right knee. The worker subsequently received a 13% non-economic loss (NEL) award in recognition of the right knee PI on April 14, 2023, with February 22, 2023 as the date of MMR.

The worker representative then contacted the WSIB on May 1, 2023, requesting secondary entitlement under operational policy 15-04-02, Psychotraumatic Disability (PTD).

On October 13, 2023, the CM granted secondary entitlement to an adjustment disorder, with mixed anxiety and a depressed mood, under operational policy 15-04-02, PTD, finding that the condition manifested on July 30, 2020, when Dr. E. Light, Psychologist, first assessed the worker.

The worker representative then contacted the WSIB on July 24, 2024, requesting entitlement to a PTD PI. Upon receipt of the worker representative’s request, the CM wrote to Dr. Light, requesting an updated progress report outlining, in part, the worker’s response to treatment. Dr. Light did not respond to the CM’s request.

On March 20, 2025, the worker representative contacted the WSIB, insisting on a decision with respect to the worker’s entitlement to a PTD PI.

The Decisions Under Appeal: On March 21, 2025, the CM found that the worker had reached MMR for the work-related PTD, with no PI evident, on the basis that there had been no continuity of psychological complaint and/or mental health attention for almost two years, since May 12, 2023.

Dr. Light then assessed the worker again on March 24, 2025, at the worker representative’s request. Upon receipt of Dr. Light’s report, the CM reconsidered and upheld the March 21, 2025 decision on May 9, 2025, for the same reason.

The Worker’s Position: The worker representative relies on the evidence on record to support the worker’s position.

The Employer’s Position: The employer is not participating in the worker’s appeal.

AUTHORITY

Operational Policy Manual

Published

11-01-05: Determining Permanent Impairment

November 3, 2014

ANALYSIS

I have carefully considered all of the available information and relevant operational policy in reaching this decision. Having done so, I find that:

The worker reached MMR for the work-related PTD on May 12, 2023, with a PI evident. Therefore, entitlement to a NEL award determination for the same is in order.

Operational policy 11-01-05, Determining Permanent Impairment, states that a person reaches MMR when a plateau in recovery has been reached and it is not likely that there will be any further significant improvement in the work-related injury. Furthermore, it defines “significant improvement” as a marked degree of improvement in the work-related injury that is demonstrated by a measurable change in clinical findings.

On July 30, 2020, the date of the work-related PTD manifestation, as determined by the CM, the worker informed Dr. Light that he suffered from right knee pain, causing sleep disturbance and mental stress. He reported feeling stressed most of the time and that his social life had suffered because of his pain.

Dr. Light found that the worker had full abilities, from a psychological perspective, diagnosing him with an adjustment disorder, with mixed anxiety and depressed mood, as well as a pain disorder, recommending three blocks of mental health treatment.

At the time, the WSIB had determined that the worker had reached MMR for his right knee injury, with no PI evident, and did not adjudicate secondary entitlement under the PTD policy. However, there is no indication in the clinical record of any ongoing complaints or medical attention for mental health issues over the next nearly three years.

Subsequent to the February 9, 2023 WSIAT decision granting the worker a right knee PI, the worker returned to Dr. Light, who assessed him again on May 12, 2023. On that date, the worker reported suffering with pain in both knees and severe depression. He stated that he had not been able to work and had been separated from his wife for three years, had lost everything and felt lonely. Dr. Light opined that his symptoms were not fully exhibited and were skewed towards depression, self-dislike, and inadequacy. Furthermore, Dr. Light opined that the worker was not able to return to safe and sustainable employment at that time because of his pain syndrome and mental health status. He also pointed out that the worker only had a Grade 9 education and might benefit from completing English as a Second Language and General Educational Development programs. Dr. Light maintained diagnoses of an adjustment disorder, with mixed anxiety and depressed mood, as well as a pain disorder, recommending three blocks of cognitive behavioural therapy to address his pain and mental health issues.

As previously noted, on October 13, 2023, the CM granted secondary entitlement to an adjustment disorder, with mixed anxiety and a depressed mood, under operational policy 15-04-02, PTD, finding that the condition manifested on July 30, 2020, when Dr. Light first assessed the worker. The case record does not show that the WSIB approved and communicated the approval of funding for the treatment recommended by Dr. Light.

The medical record then documents a number of consultations with different health care providers over the next two years. However, there are no documented mental health complaints or mental health attention until March 21, 2025, when the CM found that the worker had reached MMR for the

work-related PTD, with no PI evident. Three days later, the worker returned to Dr. Light, an assessment arranged by the worker representative.

On March 24, 2025, the worker described ongoing physical difficulties that interfered with his ability to perform daily tasks. He reported limited mobility and the need for assistance with activities such as bathing and getting up from seated positions. He stated that he spent most of his time in his room and noted that he was no longer able to participate in previous social or recreational activities. He expressed a strong sense of isolation, sharing that he had lost contact with friends over the years.

The worker described feelings of sadness, helplessness, and a diminished sense of purpose. He also reported disturbed sleep and a reliance on alcohol in the evenings to cope. He stated that he often felt emotionally numb and disconnected. He expressed a sense of loss over the changes in his life since the injury. Although not directly stated, he did note spending most of his time in his room and expressed ongoing concentration difficulties and emotional distress, which might suggest that sustained focus on

activities like reading or watching films could be challenging for him. Despite these challenges, he maintained close contact with his immediate family, especially his children and grandchildren.

Dr. Light noted that the worker reported significant impairment across various areas of functioning. Socially, he expressed a deep sense of isolation, noting the loss of friendships due to his inability to participate in shared activities. He spent most of his time alone at home and no longer engaged in social outings. Occupationally, he had not returned to work since the incident and did not engage in structured daily activities. He also experienced difficulty with personal care tasks such as dressing and bathing, occasionally requiring assistance from his son, particularly when fatigued. He described struggling with memory and concentration and noted that emotional distress often affected his ability to focus. He expressed a diminished sense of purpose and emotional numbness. He acknowledged spending most of his time in his room, and his cognitive and emotional challenges limited his ability to read or watch films.

Dr. Light added that the worker expressed emotional distress and passive thoughts related to hopelessness and wishing life were different. He noted that the worker mentioned thoughts like "I don't love this life" and alluded to drinking nightly to cope. While he did express that sometimes he had thoughts of self-harm, there was no indication of a specific plan, intent, or immediate risk to himself or others.

Dr. Light opined that the worker faced multiple barriers to returning to occupational function. Physically, he continued to experience limitations in mobility and endurance, which restricted his ability to perform job-related tasks. Psychologically, he reported ongoing emotional distress, low motivation, and social withdrawal, all of which impacted his readiness for work. The worker also noted a lack of support or contact from his previous employer regarding potential accommodations. This combination of physical, emotional, and systemic factors had contributed to prolonged disengagement from the workforce.

From a psychological perspective, Dr. Light stated that the worker was currently unable to return to safe and sustainable occupational function due to significant emotional distress, low mood, and reduced coping capacity. His sense of hopelessness, social isolation, and lack of daily structure interfered with motivation and engagement in work-related tasks. He also reported concentration difficulties, which impaired his ability to focus and follow through on tasks consistently. Dr. Light stressed that, without addressing these psychological barriers, a return to work would likely be unstable and unsustainable.

In conclusion, Dr. Light maintained diagnoses of an adjustment disorder, with mixed anxiety and depressed mood, as well as a pain disorder, recommending three blocks of mental health treatment, involving cognitive restructuring, problem-solving, and psychoeducation.

The facts and circumstances lead me to find that, after almost three years from the date of manifestation, the worker’s PTD remained symptomatic. This is thoroughly corroborated not just by Dr. Light’s reports of July 30, 2020 and May 12, 2023, but by the CM’s decision of October 13, 2023, which confirmed a nexus between the worker’s deteriorated mental health state on May 12, 2023 and the onset of the same on July 30, 2020. This is a significant amount of time for one to be struggling with a psychological condition, especially an adjustment disorder. If one has not psychologically adjusted to one’s permanent circumstances within a three-year period, it is highly unlikely that that failure to adjust is not itself a permanent impairment. Therefore, I find that the worker reached MMR for the work-related adjustment disorder, with mixed anxiety and depressed mood, on May 12, 2023, with a PI evident. Therefore, entitlement to a NEL award determination for the same is in order.

Furthermore, the Operating Area has not adjudicated entitlement to a March 24, 2025 recurrence based on Dr. Light’s findings of the same date. Therefore, I do not have the jurisdiction to consider and address the issue. The Operating Area is, therefore, directed to do so.

CONCLUSION

I find that:

The worker reached maximum medical recovery for the work-related adjustment disorder, with mixed anxiety and depressed mood, on May 12, 2023, with a permanent impairment evident. Therefore, entitlement to a non-economic loss award determination for the same is in order.

Furthermore, the Operating Area is directed to adjudicate entitlement to a March 24, 2025 recurrence of the work-related psychotraumatic disability.

The worker’s objection is, therefore, allowed.

DATED OCTOBER 23, 2025

C. da Cunha

Appeals Resolution Officer Appeals Services Division