Worker claimed lingering psychological effects from accident when original claim expired
An Ontario worker’s claim for a psychotraumatic injury in addition to a physical injury following a workplace accident has been denied by the Ontario Workplace Safety and Insurance Appeals Tribunal.
The worker was a truck driver. On Oct. 14, 2008, he was directing another driver backing up a truck to a trailer. The worker slipped and fell, becoming trapped between the truck and the trailer. He suffered a serious injury to his neck, which was categorized as a “combined penetrating and blunt type injury” that caused a “deep neck laceration” and fracture.
The Ontario Workplace Safety and Insurance Board (WSIB) granted the worker full loss-of-earnings benefits for a four-year period in which he could not work, until Dec. 7, 2012. By then, he was considered to be fully recovered.
However, after the worker was initially granted benefits for his neck injury, he claimed entitlement to additional benefits for a right shoulder injury and a psychotraumatic disability, which he claimed were both caused by the workplace accident.
A WSIB case manager denied both claims, as did an appeals resolution officer. The latter indicated the matter could be reviewed again if more information could be provided, including an assessment for the psychotraumatic injury by the WSIB’s psychological trauma program.
After the assessment, a case manager once again denied both claims. The worker appealed to the tribunal.
A psychiatrist diagnosed the worker with “severe major depression with pseudo dementia” and post-traumatic stress disorder, chronic pain syndrome and a driving phobia. However, the WSIB assessment determined the worker exhibited “consistent evidence of symptom amplification and/or fabrication based on extensive psychometric testing.” The report’s conclusion was that the worker’s symptoms indicated malingering, as he didn’t display the symptoms to such an extent outside of the assessment.
The tribunal found the evidence supported the fact that the worker exaggerated his symptoms and it couldn’t go against the assessment of the psychological trauma program, which included a psychiatrist, clinical psychologist and a psychometrist. There was also no evidence the worker’s own psychiatrist — who diagnosed him — actually assessed him rather than took the worker’s word for his symptoms.
The tribunal also found the worker didn’t mention any pyschotraumatic issues to his family doctor or anyone else in the wake of the workplace accident. The worker only claimed of the symptoms when he was told his benefits for the neck injury would be ending. As a result, it found the worker was being untruthful regarding his claim for psychotraumatic injury and was not credible.
The tribunal took a different view of the claim for a right shoulder injury. The evidence showed that following the accident, the worker was diagnosed with a right shoulder condition. This condition, said the tribunal, was likely related to the compensable neck injury. The reason it wasn’t initially documented was likely due to the seriousness of the neck injury, which “was the main focus of medical attention and treatment that the worker received in the immediate aftermath of the injury.”
The tribunal also found the shoulder injury was in the same region of the body where he was struck in the accident and all his medical assessments attributed it to the accident. In addition, there was no other cause or reason for the development of shoulder problems in the time between the workplace accident and the diagnosis of the shoulder injury, said the tribunal.
