Decision at the Appeal Branch to Overturn an Entitlement

Abstract: It is not unusual for the WSIB to grant entitlement to benefits for a workplace injury where the employer questions whether a workplace accident occurred or not.

This appeal focused on the probability a workplace accident occurred versus pre-existing conditions:

A: the initial incident was not a workplace accident but a physical condition this worker dealt with for many years.

B: the secondary (compensating) injury was also a result of the pre-existing condition and was not impacted by the worker’s sedentary modified work duties

The appeal resulted in a complete reversal of the original decision. Entitlement to benefits was overturned and this file was removed from the client’s experience rating statements.

Nature of the Workplace Accident: While repositioning a resident the PSW felt immediate pain in her left wrist and arm. Entitlement was granted for a left wrist strain and the worker began performing modified duties.

The worker’s hours of work and income level were maintained.

The modified work plan, signed by the worker, was limited to the following duties: Distributing Linens and Returning Laundry to residents, answering the call bell, singing and checking all lists, inventory of the stock room and performing safety checks.

The worker underwent an X-ray and Ultrasound within 30 days of the date of the accident and it was found she had Carpal Tunnel Syndrome (CTS).

Later she underwent an assessment at the Musculoskeletal Program of Care (POC) where she was diagnosed with a right triceps strain, and a repetitive strain to the right shoulder due to overcompensating for the left wrist strain.

Entitlement was granted for the following reasons:

• The Medical Consultant (MC) concluded:
  • The worker suffered a triangular fibrocartilage complex (TFCC) tear that is not usually attributable to the work-related injury
  • The worker returned to the strenuous duties of resident care
    • As resident care is normally a two-handed job overcompensating with the opposite arm is a plausible outcome

Conclusion: the workplace accident caused an EXACEBERATION of both the pre-existing CTS and the pre-existing right shoulder cuff tendinopathy.

A letter for reconsideration of this decision was denied.

Basis of the Appeal: Initial Entitlement should not have been granted for either the initial wrist injury of the secondary shoulder injury.

The worker had undergone an MRI as part of their treatment. The MRI findings include severe thinning of the TFCC articular disc with possible central perforation, mild lunate chondromalacia, subluxation of the exterior carpi ulnaris tendon with complete disruption of the ECU sheath, a mild increase of fluid in the fourth extensor compartment tendon sheath consistent with mild tenosynovitis.

The MC concluded the finding of mild lunate chondromalacia is unlikely compatible with the work injury.

The MC also concluded that CTS is a chronic condition and is not generally related to acute injury. “The reported presence of CTS symptoms on the contralateral side would suggest that this condition is not directly related to the work injury.”

The appeal also included a request to overturn the decision to grant entitlement for the secondary right shoulder injuries as a result, which were granted on the grounds the worker had to overcompensate to provide patient care.

The Appeals Officer reviewed the initial and subsequent offers of modified work and agreed that the assigned duties were clerical/administrative and any patient care did not include lifting.

The appeal was successful and both entitlement decisions were overturned.

This decision was granted in March 2020. All costs of this claim will be removed from the client’s 2018 NEER charges. Further, this decision will reduce the client’s 2020 premium rate under the rate framework model, and will continue to do so every year into the future.