Decision based on reconfigured workstation without consideration of employee's condition
The rejection of a worker’s compensation claim was unreasonable because it wasn’t based on conditions at the time of injury and ignored medical opinions, the British Columba Supreme Court has ruled.
The worker was employed as a registered nurse. Her job initially involved filling out medical charts by hand, but changed in October 2012 when she started working at a mental health and addiction crisis centre and a psychiatric emergency department. Her new responsibilities involved extended periods of typing on a computer keyboard, using a computer mouse, and alternating these task with time on the telephone.
The worker initially worked in these positions two to three days per week, but this increased to four days per week in June 2013. About 80 per cent of her time was spent on the computer and 20 per cent on the telephone.
A short time later, the worker began to suffer pain her both of her wrists and hands, starting with a burning sensation and then becoming constant pain. In August 2013, her family doctor observed that the flexor tendons of her wrist were tender and recommended an ergonomic assessment of the worker’s work station.
Ergonomic modifications
The worker applied to WorkSafe BC for workers’ compensation benefits and her employer arranged for an ergonomic assessment of her workstation. The workstation was changed, with the keyboard lowered so she didn’t have to reach up and wrist supports installed.
A WorkSafe BC case manager reviewed the worker’s activities and recorded a video of her using the keyboard and telephone on the ergonomically modified workstation. The case manager issued a report noted a few wrist motions by each wrist each minute, but not in any awkward range or position. The report concluded that “no other awkward postures were observed.”
A WorkSafe BC medical advisor reviewed the file and case manager report, determining that there were no sufficient risk factors to cause the tendonitis and insufficient “forces or awkward postures to precipitate or aggravate carpal tunnel syndrome.”
However, the worker’s pain continued and a hand therapist believed that the worker had a form of tendonitis in the tendons on the thumb side of the wrist. The worker had to stop working on Sept. 24, 2013.
Diagnosis of workplace injury
The worker’s family doctor diagnosed her with bilateral tendinitis linked to her workplace activities and hours spent on those activities.
On Sept. 26, WorkSafe BC denied the worker’s application for benefits. The worker appealed, but the original decision was confirmed.
In July 2014, an occupational therapist and professional ergonomist reviewed the worker’s workstation as it had existed before the modifications and determined that it had been “ergonomically deficient” and straind her reached. The therapist concluded that the worker’s work activities “contributed to significant occupational risk factors to left and right thumbs, fingers, hands, wrists, and forearms.” He also noted that the WorkSafe BC case manager had assessed the worker’s modified workstation and only some of her activities.
The BC Workers’ Compensation Appeal Tribunal reviewed the original decision, including the videos taken of the worker, and found that the worker’s tendonitis was not due to the nature of the employment. It also found that reaching was not a risk factor for hand and wrist tendonitis under the WorkSafe BC policy for tendinitis claims, and the opinion of the worker’s doctor indicated that the work activities would have contributed to the worker’s symptoms, but not her actual diagnosed condition.
The worker applied for a judicial review of the decision on the ground that it was unreasonable.
Medical evidence
The court found that the tribunal’s reliance on the assessment report and WorkSafe BC medical opinion was unreasonable, as both were based on the reconfigured workstation, not the original set-up that the worker used when she developed the symptoms. It also found that the tribunal rejected the opinions of the worker’s doctor and occupational therapist, which were the only true medical opinions based on the conditions during which the worker developed her tendonitis.
The court noted that the tribunal referred to WorkSafe BC policies related to tendonitis claims, but it based its conclusion on “isolated anatomical movements” and the brief video recording of the worker rather than the medical opinions presented by the worker.
The court also noted that previous jurisprudence established that the tribunal is “not presumed to have medical expertise and is not equipped to reject a diagnosis “without an appropriate medical opinion to the contrary.” Here, the tribunal’s only medical opinion to the contrary was based on the reconfigured workstation and no in-person assessment of the worker’s condition and it arrived at its own medical diagnosis, said the court.
“The tribunal was not equipped to reject the [family doctor and occupational therapist’s] medical opinions, without an appropriate medical opinion to the contrary,” said the court. “Instead, it unreasonably relied upon its own ergonomic and medical observations and conclusions to contradict those medical experts’ conclusions…”
The court granted the worker’s appeal and remitted the matter back to the tribunal with the instruction that the tribunal use medical opinions based upon the actual work configuration and conditions in place at or immediately prior to the date of the worker’s disablement. See Rear v. British Columbia (Workers’ Compensation Appeal Tribunal), 2023 BCSC 1513.
