Gap in continuity raised questions over causation but worker had psychological issues deserving of temporary entitlement starting soon after workplace injury
An Ontario worker has won entitlement to benefits for disabling depression that was diagnosed five years after a workplace accident that the worker claimed was the source for the depression.
The worker was involved in a motor vehicle accident around 2005, which led to back pain and headaches. She saw her doctor multiple times between 2005 and 2010, which her doctor noted were the result of an old car accident.
The worker began employment with a temporary employment agency in early 2010. A few months later, the agency assigned her to duties as a production worker for a company that manufactured retail displays. On July 6, the worker — who was 39 years old at the time — was working with a break press — a machine pressing tool for bending sheet and plate material such as sheet metal. Her hands got caught in the brake press, causing her to suffer lacerations and fractures to her right middle and ring fingers, as well as her left middle finger.
The worker’s hand injuries required treatment with sutures and splints. Over the next few months, the factures healed but the worker continued to feel pain and sensitivity in her two middle fingers. She remained off work while she experienced these symptoms.
In October 2010, the Ontario Workplace Safety and Insurance Board (WSIB) sent a return-to-work specialist to the workplace in which the worker had been working at the time of the accident. After discussion with the company, the worker was offered modified duties that involved placing labels onto packages and sending and receiving faxes. However, the worker didn’t believe she was capable of working yet due to ongoing symptoms in her hands, so she declined the offer.
Pain continued after healing
The worker had x-rays of her hands done in November and the medical report stated that her fractures had “completely healed.” However, the worker still felt pain and tenderness in her fingertips and had a reduced range of motion.
The return-to-work specialist determined in February 2011 that some of the modified duties that were originally offered in October weren’t suitable for the worker because they required fine finger dexterity. The employment agency continued to work with the manufacturing company in an attempt to find permanent modified duties.
One month later, the WSIB had the worker assessed through a hand and wrist program it ran. The assessment included reports by an orthopaedic surgeon, occupational therapist, and return-to-work co-ordinator, in which they all noted the worker had “significant hypersensitivity” in her hands along with anxiety, depression, and post-traumatic stress from the accident. This was followed by a psychological assessment which said the worker complained of depression, suicidal ideation, poor self-esteem, fatigue, poor appetite, irritability, and difficulty sleeping. The psychologist recommended 12 to 16 sessions with a reassessment before returning to work, but the worker didn’t proceed with it as she hadn’t yet received entitlement from the WSIB for coverage.
The hand and wrist program discharged the worker in July 2011 with a recommendation she could return to her pre-accident job duties on a graduated basis over three months. Her restrictions were to self-paced, sedentary or light-level work, lifting no more than 15 pounds. The worker returned to work with light packaging duties and full-time hours on Aug. 11, 2011.
A WSIB case manager granted entitlement to benefits covering the worker’s recommended psychological treatment, but the worker wasn’t made aware of this. As a result, she didn’t receive the treatment. On Dec. 12, the WSIB determined the worker had reached maximum medical recovery and had a mild residual impairment involving tenderness in her fingertips.
The worker underwent a functional abilities evaluation in January 2012, which determined she was capable of functioning at the “sedentary-light physical demands level.” The evaluators said she should have restrictions on “repetitive, sustained and forceful gripping and pinching should be self-paced,” but the worker’s focus on the pain she felt was a barrier to returning to work.
The manufacturing plant was closed on March 30, 2012, and the worker was laid off. She didn’t immediately start looking for other work, but in May the WSIB granted her a 10-per-cent non-economic loss award for her fingertips impairment.
Depression diagnosis 3 years after layoff
The worker saw a psychiatrist in August 2015 after complaining of headaches, stress, irritability, poor motivation, pain, and depression. The psychiatrist diagnosed her with major depression that made her unable to work. The worker then applied for workers’ compensation benefits for a psychotraumatic disability stemming from her July 2010 workplace accident.
The worker’s claim was denied by both the WSIB and an appeals resolution officer — finding no clinical documentation supporting a direct connection between the worker’s injury in 2010 and her diagnosis of depression five years later — so she appealed to the Ontario Workplace Safety and Insurance Appeals Tribunal.
The tribunal noted that the worker had pre-existing musculoskeletal pain in her back and headaches from a motor vehicle accident years before her workplace accident, but there was no indication through her doctor’s medical notes that she suffered from any significant psychological or psychiatric condition. In addition, the worker worked in the manufacturing plant for five months without missing any time from such a condition.
The tribunal also noted that the WSIB granted benefits covering psychological treatment in 2011 — though the worker didn’t receive the treatment — meaning at that point in time it believed the worker had psychological issues related to her workplace accident. There was a gap of a few years between then and the worker’s 2015 assessment, but there didn’t appear to be “any significant intervening event that might account for the diagnosis of depression.” In addition, the diagnosing psychiatrist linked the worker’s condition to the workplace accident, said the tribunal.
With some medical evidence indicating a link between the worker’s depression and her workplace accident and no medical evidence supporting a different cause, the tribunal determined the worker’s depression was directly linked to her 2010 workplace accident and as a result she was entitled to an assessment for entitlement for a psychotraumatic disability.
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