Worker’s changing description, symptoms, and medical history made causal link unlikely
An Ontario worker has had her claim for workers’ compensation benefits for tennis elbow and fibromyalgia denied because her symptoms were more consistent with pre-existing conditions and not the workplace accident for which she was filing her claim.
The worker was employed at a hospital in a position that involved preparing and delivering food for patients. In 1994, she had surgery for carpal tunnel syndrome that had been causing numbness in her hands, which she said fixed the problem going forward. She also had shoulder pain for some time that restricted her arm movement but it didn’t significantly affect her ability to work and live an active lifestyle. However, she did receive workers’ compensation benefits for aggravation of her carpal tunnel syndrome and a non-economic loss award for minor impairment in her shoulder. Medical reports at the time indicated she had a history of low back pain, neck pain, headaches, right shoulder pain, and right arm pain stemming from a 1993 work-related injury that were suggestive of reflex sympathetic dystrophy (RSD) — a condition of the extremities causing pain and swelling — but there was no confirmed diagnosis.
On Sept. 15, 2009, the worker was asked to come in to do a shift in housekeeping rather than her regular work at the hospital. During the shift, she had to do a garbage run in the cancer unit, which required emptying a large cast iron cart of garbage. The cart also contained liquids that were hazardous materials.
The worker began pushing the cart on its rollers out of the room with the intention of taking it to garbage bins outside the facility. However, when she grabbed the cart, its doors weren’t locked as they were supposed to be. She put her hands in the door to make sure it didn’t open while she moved the cart, but this caused the cart to start tipping. As the cart tipped, the worker’s right hand got stuck in the door, cutting her fingers. In addition, the contents of the cart began falling out and onto the worker and she was worried the hazardous liquids were leaking onto the floor.
A hospital contractor entered the room and helped the worker get the cart upright and her hand out of the door. The worker then had a shower and cleaned herself up. By the time she was finished, her shift was over and she couldn’t find anyone to whom she could report the accident. She also thought about going to the emergency room, but when she discovered the wait there was more than 15 hours, she went home.
The worker came to the hospital the next day. Her hand was wrapped with tape — no stitches were necessary — and she was sent home. She soon returned to work but had to wear gloves and wasn’t able to do any lifting. She also complained of ongoing swelling and other problems with her wrists, elbows, and shoulders.
The worker reported the accident and the hospital completed a report of injury for the Ontario Workplace Safety and Insurance Board (WSIB) on Sept. 22, one week after the accident. The report stated that the worker injured her right hand, forearm, and elbow after getting caught in the cart’s doors and her attempt to open them.
The worker soon began experiencing burning and shooting pain and difficulty moving her hands, and they sometimes appeared discoloured. She also wasn’t able to drive or do anything that involved heavy use of her hands. She was diagnosed with tennis elbow and carpal tunnel syndrome.
Inconsistent accounts of accident and symptoms
The worker completed another injury report form for the WSIB in January 2010 so she could file a claim for the tennis elbow and carpal tunnel syndrome injuries. The report stated she had noticed liquid on the floor in the room near the garbage cart. She said the cart doors were jammed because the cart was overfilled and her hand got caught in the door when she tried to open it. When she finally did open the door, the worker said liquid spilled on her. This second report made no mention of the cart tipping over or another worker coming to her assistance.
The WSIB interviewed the worker and she described garbage bags falling on her but not the cart. She said both hands were initially caught in the cart door but she was able to free her left hand easily and her right hand was injured. The WSIB told her the mechanics of the injury weren’t consistent with carpal tunnel syndrome and the worker said the swelling in her hands was related to other work she had done in the past.
The worker saw a chiropractor who diagnosed her with tennis elbow but made no observations regarding cuts or other injury to her right hand. A doctor assessed her soon after and noted evidence of carpal tunnel syndrome and RSD in her right hand, but no hand injury warranting entitlement to benefits.
The WSIB denied the worker’s claim and she appealed to the Workplace Safety and Insurance Appeals Tribunal. However, she withdrew her appeal so she could pursue entitlement for RSD and fibromyalgia. The WSIB denied her second claim and the worker appealed to the tribunal.
The tribunal noted the inconsistencies between the worker’s different reports of the 2009 accident. She initially said the cart tipped over, but her second report and interview made no mention of tipping or someone helping her. She also added that liquid was on the floor, when she made no reference to it in her initial report. As a result, the tribunal found it couldn’t rely on any of the worker’s reports that the cart tipped and could only rely on the documented evidence.
The tribunal also noted inconsistencies in the worker’s account of her pre-existing conditions. Though medical evidence showed she had ongoing issues with carpal tunnel syndrome and possibly RSD following an accident and surgery in the 1990s, the worker insisted she was symptom-free by 2009. However, the symptoms she displayed once her cuts healed were more consistent with her pre-injury conditions and not the 2009 accident.
The tribunal determined there was no medical evidence that indicated the worker’s diagnoses of RSD and fibromyalgia — with which a doctor linked her symptoms in a March 2014 assessment — and the 2009 workplace injury that cut the worker’s right hand. The tribunal found that any medical reports that linked the worker’s conditions with the 2009 accident were based on “an incorrect injuring process” and the worker’s inconsistent description of the accident. Since the tribunal didn’t believe the cart tipped, any reports of symptoms from a “crushing injury” were likely the result of the worker’s pre-existing conditions, it said. Since the hand lacerations weren’t referred to in any assessments from 2010 onwards, the injury had resolved by then, said the tribunal.
“The worker may have ongoing issues which have led to the diagnosis of RSD and fibromyalgia but I find that these ongoing issues cannot be attributed to her injuries in 2009,” said the tribunal in denying the worker’s claim. “I find that I do not have any reliable evidence of significance that persuades me on a balance of probabilities that the worker’s 2009 injury caused or significantly contributed to the worker’s diagnosis of RSD and fibromyalgia.”
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