APPEALS RESOLUTION OFFICER DECISION
DECISION NUMBER: 20260017
OBJECTING PARTY: employer
REPRESENTED by: SELF
RESPONDENT PARTY: worker
REPRESENTED by: WORKER REPRESENTATIVE
HEARING: VIDEOCONFERENCE – january 27, 2026
HEARD by: L. Cirillo, appeals resolution officer
ADDITIONAL ATTENDEES: 3 OBSERVERs FOR THE EMPLOYER WITNESS FOR THE EMPLOYER
ISSUES
The employer objects to the Eligibility Adjudicator’s (EA’s) and Case Manager’s (CM’s) decisions dated July 15, 2024, and October 25, 2024, which:
- Granted initial entitlement for a left-hand injury;
- Granted entitlement to psychotraumatic disability.
It must be noted that the worker was originally scheduled to appear at the oral hearing; however, as outlined in memo A0110, dated December 23, 2025, the worker’s representative reported that they could not attend the hearing due to mental health issues. This was supported by Dr. Pilowsky, Psychologist, in her report dated January 13, 2025.
As a result, it was determined that the worker was not able to participate and therefore, they did not appear at the oral hearing.
BACKGROUND
On July 11, 2024, the worker was using a table saw to cut a small piece of wood. While cutting, the worker’s right hand was using a push stick to push the material through; however, they used their left hand to catch the wood on the other side. In doing so, there was kickback, which caught the worker’s left hand causing lacerations, and fractures. At the time, the worker had been working for the employer, a stair and railing manufacturer, as a General Labourer for 8 years.
The worker was transported to the emergency room and diagnosed with amputations of the left third and fourth digits with fractures of the middle phalangeal remnants. There was also an oblique fracture through the midshaft of the index phalanx and a hairline fracture through the fifth terminal phalangeal base. The worker later underwent a revision amputation surgery on July 22, 2024.
Initial entitlement was e-adjudicated and allowed for a left-hand injury. The decision was communicated to the workplace parties in correspondence dated July 15, 2024, and August 26, 2024.
In correspondence dated September 17, 2024, the employer objected to the allowance of initial entitlement. They argued that the worker’s injury did not arise out of or in the course of their employment. In support of their position, the employer argued the following:
- At the time of the incident, the worker was using company equipment to cut four pieces of walnut wood measuring 1.5 inches x 1.5 inches x 18 inches (legs of a chair or table), which is not a standard size used in their manufacturing processes – as follows:
o The employer maintained that the wood being cut by the worker had improper dimensions - their company does not produce or work with wood pieces of the dimensions they were using for any of their products;
o In their view, the pieces being cut were legs for a personal furniture project;
o At the scene of the accident, the worker had a 5th piece measuring 10”x10”x1” with sanded and finished edges, indicating that it was a tabletop or stool seat;
o The smallest wood size they commonly use is 8" by 48" for stair risers. It is nowhere near the size or dimensions of what the worker was handling at the time.
In their view, this strongly suggested that the worker was working on a personal project, (4 legs with 1 tabletop/seat piece) and the work they were doing was not authorized or related to their job duties. The employer provided a still photograph of the worker (later identified on video surveillance), which they stated depicted the pieces described above;
At the time of the accident, the employee was handling walnut wood, which is typically high-end and costly. The employer maintained that at that time, there were no ongoing projects or orders involving walnut wood;
The employer argued that as walnut wood was being used without any related work orders, this strongly suggested that the activity in question was unrelated to the job duties at their facility;
At the time of the incident, the worker was not involved in any duties relevant to their employment. They stated that this is clearly affirmed by the employer, management, and the worker’s direct supervisor, who all agreed that the worker’s actions were not authorized;
The items the worker was crafting were not representative of anything produced by their company. Further, the saw the worker used is specifically for cutting larger pieces, like stair risers, which are significantly bigger than the small wood pieces the worker had;
The employer maintained that the use of company property, specifically the walnut wood, for personal projects was considered unauthorized use or theft. While they sympathized with the worker’s injury, they stated this was a breach of company policy;
They state that it appears that the worker, knowing they were using company materials without authorization, was rushing to finish their project discreetly. This haste could explain why someone with over 20 years of experience operating the saw, and who serves as a safety trainer for new hires, including instructing them on proper saw usage, made the critical misstep of disregarding safety protocols by improperly operating the saw (reaching in at the other end of the saw);
The employer submitted various witness statements from management and staff, which they argued supported that the worker was working on a personal project and not within the course of their employment at the time of the incident. These included: AB, Head Manager; CD, Plant Manager; EF, Shipping Office; GH, Direct Supervisor; IJ, Safety Manager, Floor Supervisor; KL, First Aider; MN, co-worker; and OP, co-worker;
Given all of the above, the employer requested that initial entitlement be rescinded as the worker’s actions were not in the scope of their employment and were not sanctioned by the employer.
Following receipt of the above, the operating area contacted the worker (with the assistance of a Spanish interpreter) and obtained further details. The worker maintained that they were not working on a personal project, and they only did what their employer told them to do. The worker further explained that 80% of the work they are told to do is outside of the manufacturer and they go to various houses, and they perform the work they are assigned. The worker maintained that they were cutting that wood to prepare for a job they had the following week, which was assigned to them.
It was ultimately concluded that at the time of the incident, the worker was at their place of employment, during their fixed working hours. Further, the worker’s pre-injury job was a General Labourer, whose regular duties involved assembling stairs, as well as other various tasks assigned by the employer. It was determined that using a table saw was a daily activity required by the worker and noting the nature of the activity, which caused the injury, and the work environment it occurred in, the decision maker could not establish that the task deviated from the worker’s regular employment activities. As a result, the decision to allow initial entitlement remained upheld. Further, it was noted that the Presumption Clause, under s. 13 (2) of the Workplace Safety & Insurance Act applied. The reconsideration decision was communicated to the workplace parties in correspondence dated September 23, 2024.
In October 2024, entitlement was expanded to include psychotraumatic disability for the diagnoses of Post-Traumatic Stress Disorder (PTSD), and Adjustment Disorder with depressed mood. The decision was communicated to the workplace parties in correspondence dated October 25, 2024.
The employer submitted video surveillance of the incident which occurred on July 11, 2024, and once again requested reconsideration of the initial entitlement decision. Despite this, it was once again concluded that there would be no change in the initial entitlement decision as the decision maker was unable to establish that the worker had removed themselves from the course of their employment. The reconsideration decision was communicated to the workplace parties in correspondence dated September 2, 2025.
The employer objected to the allowance of initial entitlement and psychotraumatic disability; however, the decisions remained unchanged and as a result, these matters were referred to the Appeals Services Division for further consideration.
Employer’s Position:
At the oral hearing the employer argued the following in part:
While the worker’s injury occurred in the workplace, it did not arise due to the work;
The employer maintains that the worker took themself out of the course of their employment and performed unauthorized, personal activities using company equipment;
The employer argued that the evidence shows that the actions performed by the worker on July 11, 2024, had nothing to do with manufacturing stairs. This is supported by the material that was used, and the dimensions of the wood, which was completely inconsistent with the work they did there;
Instead, the employer maintains that at the time, the worker was cutting small pieces of wood that were for a small chair or table, which the company does not produce;
Further, they had no orders during that time that called for that type of wood or dimensions;
In addition, the employer maintained that personal projects were not authorized by the employer and the worker, who had extensive experience, would have known that that those pieces of wood were too small to cut with the large saw;
The employer stated that the incident resulted in a catastrophic injury; however, it arose due to the worker’s decision to use industrial equipment to fabricate personal furniture pieces;
The employer referred to the video surveillance and witness statements (on file);
For these reasons, he argued that the initial entitlement criteria had not been met and as a result, initial entitlement and expanded entitled for psychotraumatic disability ought to be rescinded.
Testimony of Employer Witness – CD (in part):
He is the Plant Manager and is responsible for all employees on the floor. He is accountable for all orders and has the authority to assign speciality tasks and align job orders with specific materials. He stated that most of the time, when it comes to speciality jobs, the staff answers to him, but other times he has floor supervisors that allocate production work for him;
He stated that in a typical day the staff is assigned to a specific station (they have 130 employees);
CD noted that he would send the worker to perform speciality orders offsite and it depended on how busy they were. At the end of 2023/beginning of 2024, the worker spent 50% of their time on site;
CD stated that the worker would need approval before starting any job;
CD provided great detail with respect to the product that the company manufactures (staircases), and he had samples of each of the components used to build them (stringers, treads, and risers);
He outlined the cutting process and noted that in general, they use about 70% Oak wood. The other 30% is considered paint grade material (i.e., side white). He noted that they may also carry approximately 10% exotic type wood;
CD stated that the only wood that needed to be trimmed for the staircase is 1/8th of an inch of the backing and the risers. He stated that all other parts of the staircase are premade;
CD testified that stair production only involves the pieces he demonstrated, i.e., the risers, the backing, etc. and there are no small pieces;
CD testified that at the time of the incident, the worker was cutting a walnut grade material, which is an exotic wood. In his experience, the piece the worker was cutting would not be involved in staircase making. Further, they do not make chair pieces there;
CD stated that no one assigned the worker work that involved cutting small walnut pieces nor did the worker ask for approval to cut any walnut wood on the day of incident and this was documented on the work orders for that day;
CD outlined that none of his employees are allowed to work on any personal items in the plant and the worker was not given permission to do this during work time;
After the accident they looked at the workstation and based on the items that were there, it looked like the worker was building a small type of table, which was not tracked to any job;
CD referred to the video of the worker and noted that they were cutting 4 or 5 pieces, which they pushed through the blade with a stick and tried to grab from the back with their left hand. In doing so, the saw kicked back and pulled their hand in. He stated that the worker had more experience than him and he never saw them do anything like that before. In fact, the worker was the one who trained others on how to use the saw properly. He stated that those pieces are not cut with that saw;
In his perspective, the worker looked like they were rushing to finish what they were doing, so that no one would see them;
CD stated that stair production is the worker’s activity but at the time of the incident there was no stair production happening. They were not doing anything that benefited the employer or that the employer required, and they were not authorized by the employer to cut that type of wood. Instead, the worker stepped away from their work duties and engaged in a personal activity, which was outside of their employment;
CD reiterated that none of his supervisors instructed the worker to do this and if such an order existed there would be paperwork/specifications to support it, which there is not;
CD clarified that while the company also manufactures railings, this is completely separate from the stair department and the employees from each department do not work together or share tasks.
Worker’s Position:
In her closing statement, the worker’s representative argued the following in part:
The worker’s injury occurred on the employer’s premises, during work hours, and while using equipment normally used during their job duties;
She referred to operational policy 15-02-02 “Accident in the Course of Employment”, and the presumption clause;
She noted that while the employer argues the worker’s activity was personal in nature, the WSIB already considered this evidence and could not rebut the presumption;
She argued that there is no direct evidence that the wood was not from the workplace, and this is merely speculation by the employer;
With respect to psychotraumatic disability, the worker sustained a sudden and traumatic injury, and therefore, entitlement for PTSD was correctly allowed;
In conclusion, she is agreement with the WSIB and states that initial entitlement and all resulting benefits were correctly allowed, and this should be upheld.
AUTHORITY
Sections 13 & 17 - Workplace Safety & Insurance Act (WSIA), 1997
Operational Policy Manual
Published
11-01-01 – Adjudicative Process 15-02-01 – Definition of an Accident 15-03-08 – Personal Activities/Removing Self From Employment 15-04-02 – Psychotraumatic Disability
November 3, 2008 October 12, 2004 October 12, 2004 September 7, 2018
ANALYSIS
I have reviewed the record and considered the information and relevant legislation and operational policies in reaching this decision. In considering all of the evidence, including the witness statements on file, the testimony provided at the oral hearing, and the arguments presented, I find the following:
The worker’s actions on July 11, 2024, amounted to serious and willful misconduct;
The worker’s injury is solely attributable to their serious and willful misconduct; however, the injuries sustained by the worker resulted in serious impairment and accordingly, entitlement for their injuries under s. 17 of the WSIA is allowed;
The decision, which allowed psychotraumatic disability for the diagnoses of PTSD and Adjustment Disorder with depressed mood was correct.
The rationale for my decision is as follows.
- Initial Entitlement
The Workplace Safety & Insurance Board’s (WSIB) policy for the Adjudicative Process states in part:
A claim created by the WSIB for a workplace accident/disease is adjudicated based on entitlement principles and the facts of the case.
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
Proof of accident
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?
Diagnosis
If it is not clear that the (injury or disablement) diagnosis provided is the result of the accident or disablement history described, a decision-maker may consult with the WSIB's clinical staff to assist in making this determination.
Operational Policy 15-02-01 states the following in part:
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.
Chance event
A chance event is defined as an identifiable unintended event, which causes an injury. An injury itself is not a chance event.
Disablement
The definition of disablement includes
a condition that emerges gradually over time
an unexpected result of working duties.
On the Form 7, Employer’s Report of Injury, the employer outlines that on July 11, 2024, while cutting a piece of wood, the worker used their left hand on the opposite side of the blade, which caused their fingers to be cut by the saw.
Subsequent to this, the employer submitted additional evidence and argued that the wood the worker was cutting was not a species that was typically used in the production of staircases (their usual business activity). In addition, the size of the pieces being cut did not align with the usual staircase pieces used in the production activities.
A Form 6, Worker’s Report of Injury does not appear on record; however, the worker provided a statement to the CM on September 20, 2024. At that time, they explained that on the date of injury, they were only doing work they were assigned to do, and it was not a personal activity.
According to the evidence provided by the workplace parties, the worker claims to have suffered a left-hand injury as a result of a chance event type accident that occurred on July 11, 2024. Under these circumstances, the worker has the benefit of the presumption clause under s. 13(2) of the WSIA, which states in part:
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. [my emphasis added]
It is my understanding that the employer is a stair and railing manufacturer. I note that the assembly of stairs involves components such as stringers, treads, and risers, which are often assembled in a factory setting.
In reviewing the various witness statements (dated September 3 & 4, 2024) on file, I note the following (in part):
AB, Head Manager – after the worker’s injury, he noted that the worker was cutting 4 squares approximately 2” x 2” x 18” of walnut – he questioned GH and CD why the worker was cutting these pieces as they were not part of any stair parts;
EF, Shipping Office – stated she schedules customer orders for manufacturing and installation. At the time of the worker’s injury there were no orders for walnut wood being manufactured;
GH, Direct Supervisor – worker was working on a personal project – after the incident he saw small pieces of walnut wood at the saw where the worker was cutting;
IJ, Safety Manager, Floor Supervisor - On the day of incident, the worker came to the first aid office holding their left hand. They noticed the tips of their left hand were cut. He instructed the first aider to contact emergency services. He then went over to the table saw where the worker was working and saw small pieces of walnut wood;
KL, First Aider – outlined the worker’s injuries and the first aid given;
MN, co-worker – stated he saw the worker on the day of injury, and they had a piece of walnut hardwood in their hand and started cutting it on the table saw;
OP, co-worker – was working near the table saw where the injury occurred. The worker came to him after they were injured, and he told them to go to first aid. Afterwards, he went to the worker’s table saw and noticed small lengths of walnut, which they were cutting.
I have also viewed the video footage of the worker contained in the claim file. The video depicts the worker cutting small pieces of wood using a table saw. The wood pieces in the video appear to be in line with the descriptions identified by the witness statements and the testimony provided at the oral hearing. Further, from the video it appears that the wood pieces were small and not consistent with the typical pieces used in the assembly of staircases (i.e., stringers, treads, and risers), which were demonstrated at the oral hearing.
Operational policy 15-03-08 states in part:
An accident shall be considered to occur in the course of the employment when it happens on the employer's premises as defined, unless at the time of the happening of the accident the worker is performing an act not incidental to the work or employment obligations.
Compensation benefits are not payable to a worker who is voluntarily out of the course of the employment. Such situations may include
doing something outside the worker's normal duties, such as transacting personal business, or
going places having nothing to do with the worker's employment or doing something not reasonably expected of the worker.
While I acknowledge that a worker and employer relationship exists, and that at the time of the injury the worker was on the employer’s premises, during their usual working hours, and using the employer’s equipment, I find that the items the worker was cutting did not form part of their normal job duties. Instead, the evidence demonstrates that the worker was participating in a personal project and they therefore, removed themselves from the course of their employment. Therefore, I find that the contrary has been demonstrated and the presumption does not apply.
That being said, s. 17 of the WSIA states:
If an injury is attributable solely to the serious and wilful misconduct of the worker, no benefits shall be provided under the insurance plan unless the injury results in the worker’s death or serious impairment [my emphasis added].
It is my understanding that serious and wilful misconduct refers to intentional, deliberate, or pre-planned wrongful behavior by an employee that violates workplace policies, safety standards, or the employment contract.
It is also my understanding that serious impairment has been found to mean more than six weeks of temporary total disability or permanent disability.
Further, s. 17 must be interpreted to mean that, when a worker who has taken themself out of the course of employment suffers an injury that results in death or serious impairment, the worker is nevertheless deemed entitled to benefits and, therefore, must be deemed to be in the course of employment.
Based on the evidence, including the robust arguments presented by the employer, it is clear that the worker’s injury is solely attributable to their serious and wilful misconduct, noting it has been determined that they intentionally participated in actions which were not condoned by the employer or part of their employment contract. However, the evidence also supports that the worker suffered a life altering injury, which was also described by the employer as being catastrophic.
In considering that the worker suffered a partial amputation of their left hand, I find that they suffered a serious impairment and that, in accordance with s. 17 of the WSIA, entitlement for the injuries the worker sustained on July 11, 2024, is in order.
- Psychotraumatic Disability
Operational Policy 15-04-02 states in part:
General rule
If it is evident that a diagnosis of a psychotraumatic disability/impairment is attributable to a work-related injury or a condition resulting from a work-related injury, entitlement is granted providing the psychotraumatic disability/impairment became manifest within 5 years of the injury, or within 5 years of the last surgical procedure.
Psychotraumatic disability/impairment is considered to be a temporary condition. Only in exceptional circumstances is this type of disability/impairment accepted as a permanent condition.
Psychotraumatic disability/impairment resulting from organic brain damage is assessed as a permanent disability/impairment.
Psychotraumatic disability entitlement
Entitlement for psychotraumatic disability may be established when the following circumstances exist or develop
- Organic brain syndrome secondary to
o traumatic head injury
o toxic chemicals including gases
o hypoxic conditions, or
o conditions related to decompression sickness.
- As an indirect result of a physical injury
o emotional reaction to the accident or injury
o severe physical disability/impairment, or
o reaction to the treatment process.
- The psychotraumatic disability is shown to be related to extended disablement and to non-medical, socioeconomic factors, the majority of which can be directly and clearly related to the work-related injury.
As is outlined above, the worker suffered a traumatic partial hand amputation while using a table saw on July 11, 2024. The worker also underwent revision surgery of the amputation on July 22, 2024.
The record reveals that in August 2024, the worker was seen at Hospital A for a follow-up and to have their stitches removed. The report noted that the worker was having psychological issues with respect to the injury.
As a result, the worker was assessed by Dr. Judith Pilowsky, Psychologist, on August 19, 2024, and was diagnosed with PTSD and Adjustment Disorder with depressed mood.
In her report, Dr. Pilowsky noted the following in part:
The worker reported a persistent low mood characterized by mood swings, crying bouts, irritability, impatience, and frustration, compounded by the physical pain they endured;
They found it challenging to discuss the details of their accident with friends, as they had not yet come to terms with their injury;
Although they considered themself strong, they acknowledged that this experience has been overwhelming;
The worker’s difficulty sleeping was exacerbated by pain and constant rumination about their circumstances, including financial difficulties, and further disturbed by nightmares of their injury that awaken them startled and tense;
The worker also expressed resentment towards their employer, feeling unsupported and perceiving that they may blame them for the incident, despite their belief that they were not at fault;
Their physical limitations have led to a loss of interest and motivation in activities they once enjoyed, and they are troubled by the impact their irritability has on their family, particularly their daughter;
The worker worries about the long-term effects of their behaviour on her and their spouse. Additionally, the worker reports a reduced appetite and pervasive anxiety about their recovery and future, which preoccupies their thoughts daily;
They are concerned about the lack of financial benefits as they were still waiting for payment and the potential impact on their family's well-being;
They experience somatic symptoms, including heart palpitations, uneasiness, and an inability to relax. Cognitive difficulties, such as short-term memory issues, trouble focusing, and problems with concentration, have made previously manageable tasks more challenging;
While the worker seeks solace in their faith and the Bible, they struggle with intrusive negative thoughts that hinder their efforts;
They also experience intrusive thoughts about the accident, feelings of worthlessness, and agitation, though they deny any suicidal ideation, paranoid thoughts, or self-harming behaviours. Despite trying to avoid thinking about their health and recovery, these concerns remain at the forefront of their mind;
Their relationship with their spouse has been strained due to the tension caused by their injury and the additional caregiving responsibilities they have assumed, particularly with their young child;
They have flashbacks of the accident but avoids thoughts of the accident whenever possible. When these thoughts do arise, they often shudder, close their eyes, and take deep breaths to cope, sometimes feeling nauseous when the thoughts persist. They also report an automatic response of quickly pulling their left hand away when objects or even their children come too close to it, a reaction likely linked to the trauma of the accident;
They have frequent ruminations as well;
The worker underwent psychodiagnostic testing, which was noted to be valid;
The DSM-IV diagnosis was determined to be PTSD and Adjustment Disorder with depressed mood
The employer did not provide any specific argument with respect to the allowance of psychotraumatic disability. Rather, their objection stemmed from their disagreement with the allowance of initial entitlement.
The Diagnostic and Statistical Manual of Mental Disorder, fifth edition (DSM-V), outlines the criteria necessary to diagnose PTSD. For a diagnosis of PTSD, certain criteria must be met. There must be evidence of an exposure to a traumatic incident (which includes exposure to actual or threatened death, serious injury or sexual violence) resulting in intrusive symptoms, avoidance, negative alterations in cognitions and mood, alterations in arousal and reactivity. There must be evidence that the duration of symptoms is greater than a month and the symptoms have created distress or functional impairment (e.g., social, occupational).
In considering the accident history, I am in agreement with the operating area and find that the accident was traumatic in nature and that it resulted in a significant, life-altering injury. In my view, the worker developed an emotional reaction to the accident and its sequelae and for these reasons, I find entitlement to psychotraumatic disability for the diagnosis of PTSD was appropriately allowed.
Regarding the third policy criterion for allowance, it must be shown that the psychotraumatic disability is related to extended disablement and to non-medical, socioeconomic factors, the majority of which can be directly and clearly related to the work-related injury. For entitlement to exist there must be clear and convincing evidence the physical work injury significantly contributed to the resulting extended disablement and is not primarily attributable to any other factors.
The worker was also diagnosed with an Adjustment Disorder with depressed mood. The medical evidence supports that the worker is dealing with an extended disablement noting the nature and severity of their injury. This is supported by the fact that the worker’s day to day life has been impacted and their ability to participate in tasks they did prior to the injury has been altered. Further, the worker outlined that they are dependent on their family, which is a significant source of distress. In addition, they noted difficulty engaging in activities they previously enjoyed.
For these reasons, I find the worker also developed an Adjustment Disorder with depressed mood due to their extended disablement and non-medical socioeconomic factors, the majority of which are attributable to the workplace injury.
CONCLUSION
I conclude the following:
The worker’s actions on July 11, 2024, amounted to serious and willful misconduct;
The worker’s injury is solely attributable to their serious and willful misconduct; however, the injuries sustained by the worker resulted in serious impairment and accordingly, entitlement for their injuries under s. 17 of the WSIA is allowed;
The decision, which allowed psychotraumatic disability for the diagnoses of PTSD and Adjustment Disorder with depressed mood was correct.
The employer’s objection is therefore, denied.
DATED February 13, 2026
L. Cirillo Appeals Resolution Officer Appeals Services Division