Special fund compensates employers for losses from accidents caused by employee's existing condition
An Ontario employer is entitled to 100 per cent cost relief for a worker’s compensation claim because the accident was caused by the worker’s pre-existing medical condition, the Ontario Workplace Safety and Insurance Board has ruled.
The worker was a truck driver for a waste management company in Ontario, hired in June 2006. He had no history of fainting or other medical conditions that caused him to lose consciousness.
On April 13, 2015, the worker was driving a truck as part of his regular duties. At one point, he lost control of the vehicle and struck several posts, another vehicle, and several trees before ending up in a ditch. After an ambulance took him to the hospital, he was diagnosed with a fractured spine and other injuries.
The worker couldn’t remember events leading up to the accident and it became evident he had lost consciousness while driving. Doctors investigated for epilepsy but tests came back negative. However, they found he suffered from severe obstructive sleep apnea, and the worker indicated he also suffered from severe insomnia.
The worker filed a claim for workers’ compensation for the injuries and was granted benefits.
The employer then filed a request for full relief of the costs of this claim from the Ontario Workplace Safety and Insurance Board’s (WSIB) second injury and enhancement fund. The fund is a “special reserve fund” established under the province's Workplace Safety and Insurance Act that is designed to “meet losses that may arise from a disaster or other circumstance that, in the opinion of the board, would unfairly burden the employers in any class.”
The fund was also governed by a WSIB policy manual document that stipulated “if a prior disability caused or contributed to the compensable accident, or if the period resulting from an accident becomes prolonged or enhanced due to a pre-existing condition, all or part of the compensation and health care costs may be transferred from the accident employer …to the (second injury and enhancement fund).”
An appeals resolution officer denied the employer’s claim, finding there was no evidence of a pre-existing condition that caused or contributed to the accident. The employer appealed to the tribunal.
The tribunal noted one of the purposes of the fund was to encourage employers to hire workers with disabilities, since they would be provided with financial relief if a pre-existing condition aggravated or prolonged a worker’s disability. The policy document governing the fund defined “pre-existing disability” as “an underlying or asymptomatic condition which only becomes manifest post-accident.”
The tribunal also pointed out that the policy manual document allowed full relief of a claim’s cost when “a prior non-work-related condition is the cause of the accident.”
The tribunal’s medical liaison office provided a paper on obstructive sleep apnea, which outlined details of the condition and stated that patients with it were two to three times more likely to be in motor vehicle accidents, as it caused or exacerbated cognitive deficits.
The tribunal mentioned the difference between an underlying condition affecting the severity of an injury and one affecting the injury-causing accident itself. In the former circumstances, relief for the employer would not be warranted. But in the latter, under the policy, the employer is entitled to relief.
The tribunal found it was likely that the worker’s accident was caused by his obstructive sleep apnea. The condition itself wasn’t compensable, but the injuries the worker suffered while working were. As a result, the employer was entitled to 100 per cent cost relief for the worker’s claim from the second injury and enhancement fund.
