WORKPLACE SAFETY AND INSURANCE APPEALS ...wsiat.on.ca/decisions/2015/531 12.pdfREASONS (i)...

Workplace Safety and Insurance Tribunal d’appel de la sécurité professionnelle

Appeals Tribunal et de l’assurance contre les accidents du travail

505 University Avenue 7th Floor 505, avenue University, 7e étage

Toronto ON M5G 2P2 Toronto ON M5G 2P2

WORKPLACE SAFETY AND INSURANCE

APPEALS TRIBUNAL

DECISION NO. 531/12

BEFORE: R. McCutcheon : Vice-Chair

J. Blogg : Member Representative of Employers

A. Grande : Member Representative of Workers

HEARING: March 27, 2014; October 22-23, 2014 at Hamilton

Oral hearing

DATE OF DECISION: March 11, 2015

NEUTRAL CITATION: 2015 ONWSIAT 553

DECISIONS UNDER APPEAL: WSIB Appeals Resolution Officer (ARO) D.M. Shepherd dated

August 12, 2011;

ARO D. DeRose dated March 18, 2014 (Request for

reconsideration denied May 20, 2014);

ARO D. DeRose dated March 19, 2014

APPEARANCES:

For the worker: Self represented

For the employer: R. Boswell, Lawyer

Tribunal counsel: A. Wong, student-at-law (March 27, 2014)

L. Ostrom, student-at-law (October 22-23, 2014)

Interpreter: Not applicable

Decision No. 531/12

REASONS

(i) Introduction to the appeal

[1] The now 56-year-old worker started as a customer service representative with the

accident employer, a large retail establishment, in 1990. She started as a casual employee, and

later became a full-time employee. She stopped working for the employer in 2003-2004. The

WSIB established eight claims in relation to the worker’s injuries, although there is some overlap

between the claims. Many of her claims are related to the nature of her job duties generally. The

worker takes the position that her job involved prolonged standing in one position at the cash

register for hours at a time as well as heavy lifting to stock shelves. She submits that she

complained to co-workers and managers and asked for more opportunity to move in her job. On

the other hand, the employer submits that the worker’s job duties were varied and would not be

associated with repetitive strain injuries.

[2] The worker appeals three ARO decisions, giving rise to seven issues in this appeal. The

worker also sought to appeal a fourth ARO decision, a decision of ARO P. Puhl, dated

December 14, 2009. The worker’s appeal from that decision was not filed within the statutory

time limit. The worker’s request for a time extension was denied in Decision No. 531/12E.

[3] The worker testified at the Tribunal hearing and made submissions on her own behalf.

The worker filed a written submission, which she reviewed during her testimony. Counsel for

the employer had indicated the intention to call a witness to testify, but subsequently decided not

to call that witness. Both parties had an opportunity to make submissions. Tribunal counsel

attended the hearings and assisted the Panel with questioning the worker. Ms. Ostrom also made

legal submissions which the Panel relied upon in considering the jurisdictional issue raised by

the employer, discussed below.

(ii) Procedural and jurisdictional issues

[4] After the first day of hearing, the Panel directed the employer to produce documentation

in its possession that was potentially relevant to the understanding of the worker’s job duties

during the period in question. Counsel for the employer subsequently advised the Tribunal that

the documentation was no longer available. Therefore, the Panel has proceeded on the basis of

the available evidence, which included the written record and the worker’s testimony.

[5] The employer raised a jurisdictional issue regarding the worker’s appeal from the

decision of ARO DeRose dated March 18, 2014. The employer submitted that the Tribunal

ought to decline jurisdiction to hear the worker’s appeal from that decision. The parties were

given an opportunity to file written submissions on this issue following the first day of hearing.

In a memorandum dated October 2, 2014, the Panel set out its reasons for denying the employer's

representative’s request and taking jurisdiction over the decision. Those reasons are set out in

Appendix “A” to this decision.

(iii) Overview of the worker’s WSIB claims

[6] As noted above, the WSIB established eight claims in relation to the worker’s injuries.

These claims are summarized below.

Page: 2 Decision No. 531/12

1. “Claim #1”

- On April 27, 1996, the worker cut her right index finger while changing a blade on box cutter.

- She was assigned to modified work, not on cash, for three weeks.

- She went to the doctor on September 19, 1996 and was diagnosed with tendon strain.

- The WSIB granted entitlement for health care benefits only.

2. “Claim #2”

- This claim was established when Dr. D. Choi, family physician, submitted a Physician’s First

Report (Form 8), on May 19, 1999. Dr. Choi described on and off right wrist pain for several

years, which had increased in the previous two months. The worker had pain over the right

wrist, forearm and shoulder. The diagnosis was repetitive strain injury. NSAIDs and

physiotherapy were prescribed. It was expected that this problem would need on and off

management in the future. Dr. Choi also referred to the ergonomics of the work station.

- According to the Employer’s Report of Injury (Form 7), the worker reported a gradual onset of

right hand/arm/shoulder pain attributed to her duties as cashier in July 1999. Her symptoms

included swelling and pain in the right upper extremity from the right hand to the shoulder. The

employer took the position that the worker’s job duties were not repetitive and she performed a

wide variety of job duties.

- No further was action was taken because the worker did not return the Worker’s Report of Injury

(Form 6). When the worker did file the form in 2000, the WSIB opened a new claim (See

Claim #4, below).

- This file was re-opened when the worker pursued the claim again in 2009.

3. “Claim #3”

- On June 8, 1999, the worker cut her right index finger when a knife slipped.

- The laceration was sutured and the worker returned to work on June 12, 1999.

4. “Claim #4”

- This claim was established with an accident date of September 6, 2000. The worker reported a

gradual onset of pain in the upper extremities, low back and hips attributed to heavy lifting and

operating cash register.

- A Form 8 was filed by Dr. Bowler, physiatrist, in August 2000. Dr. Bowler noted that the

worker had a two-year history of fingertip tingling, shoulder pain, and giving way of the left hip;

exams were normal. She had myofascial pain. Vioxx, physiotherapy, and anti-depressants were

prescribed.

- The claim was denied on the basis of the opinion of the medical advisor that myofascial

discomfort with a completely normal physical examination is not related to the nature of the

worker as a customer service representative (CSR).

5. “Claim #5”

- On August 29, 2002, the worker dropped a bottle of liquor on her left foot which was

immediately reported to employer.

- The worker sought medical treatment on September 19, 2002; x-ray showed fracture of the

middle phalanx of the second toe.

- Initial entitlement was granted pursuant to the 2011 ARO decision, but the worker’s claims for

permanent impairment and loss of earnings (LOE) were denied.


6. “Claim #6”

- In a Worker’s Report of Injury (Form 6) dated March 19, 2003, the worker reported that standing

in one spot for an extended period of time caused pain to her low back, legs, and torso.

- The Form 8 dated February 20, 2003, described a flare-up of pain at work attributed to prolonged

standing at cash. The diagnosis was muscle spasm.

- The WSIB denied initial entitlement; this decision was confirmed in the ARO decision of

March 19, 2014.

7. “Claim #7”

- In April 2003, the WSIB established a separate claim for the worker’s claim for fibromyalgia.

- The claim was denied on the basis that the worker’s symptoms had been present for 10 years and

there was no precipitating work event. The worker’s objection was denied in the ARO decision

of August 12, 2011.

8. “Claim #8”

- In November 2010, the worker submitted a claim that she sustained injuries to the low back,

arms, and shoulder in an accident in November 1996 when shelving fell on a co-worker.

- She stated that she had no discomfort at that time but submitted a report in case problems arose.

- The claim was denied as there was no evidence that injuries occurred due to an accident in

November 1996. This decision was upheld in the ARO decision of August 12, 2011.

[7] The Panel notes that the worker underwent surgery to remove a ganglion from the right

wrist in January 1998, but entitlement for this surgery has not been specifically addressed under

any of the claims. This issue is not before the Tribunal in this appeal.

[8] It should be noted that there is some overlap among the claims, particularly Claim #2 and

Claim #4, which were established relatively close in time (May 1999 and September 2000,

respectively) for disablement injuries. It is apparent from the materials that the worker became

confused by the number of claims. Claim #2 was established by a Physician’s First Report dated

May 19, 1999, which noted that the worker had pain in the right wrist and hand, right forearm

and right shoulder. The diagnosis was repetitive strain injury. As noted above, the WSIB closed

the claim on the basis that the worker had not returned the Form 6, but it does not appear that the

WSIB made telephone contact with the worker prior to closing her file. In September 1999, the

worker left a voice mail message stating that she did not receive any forms for her claim.

According to a memorandum dated September 17, 1999, the claims adjudicator re-issued another

Form 6.

[9] According to a memorandum filed under Claim #4, on October 10, 2000, the worker

called and asked if the adjudicator had received her Form 6. The worker described that she felt

that her injury was definitely caused by the repetitive nature of her job and heavy lifting. The

worker stated that she began feeling pain in her arms and shoulders and upper back

approximately three years earlier, but she just thought it would go away. Instead it got worse.

She started physiotherapy. The claims adjudicator asked the worker about her “previous gradual

onset injury.” In response, the worker stated that she had no previous gradual onset injury, only

a claim for a cut hand. In her numerous subsequent letters to the WSIB and various other

agencies she has chosen to copy on her correspondence, the worker subsequently took issue with

the way in which the WSIB established multiple claims. Nevertheless, there is no final decision


of the WSIB on the issue of the amalgamation of these claims and this is not an issue in this

appeal.

[10] This procedural history is relevant to the employer’s jurisdictional argument, particularly

in that it was submitted that ARO DeRose’s decision of March 18, 2014 addressed substantially

the same issues as ARO P. Puhl’s decision of 2009, for which the worker missed the appeal time

limit. As we noted previously, however, the Tribunal has jurisdiction over final decisions

rendered by the WSIB. Although the parties may have questioned the WSIB’s decisions to

establish claims in the manner that they did, there was no final decision of the WSIB on that

issue, and the worker was entitled to pursue legitimate avenues of appeal created by the WSIB’s

adjudication. For the reasons set out in Appendix A to this decision, we decided that we have

jurisdiction over the worker’s appeal from ARO DeRose’s decision of March 18, 2014.

(iv) Issues

[11] In summary, the following issues are before the Tribunal in this appeal, as identified in

the Tribunal’s hearing-ready letter:

1. Entitlement for repetitive strain injury of the right upper extremity, under Claim #2

(ARO DeRose, March 18, 2014);

2. Initial entitlement for a neck condition under Claim #4 (ARO Shepherd,

August 12, 2011);

3. Initial entitlement for low back and upper torso pain attributed to prolonged

standing, under Claim #6 (ARO DeRose, March 19, 2014);

4. Entitlement for fibromyalgia/chronic pain disability (CPD) under Claim #7, or in

the alternative, under Claim #1, Claim #3, Claim #4, and/or Claim #5

(ARO Shepherd, August 12, 2011);

5. Initial entitlement for the low back and right shoulder under Claim #8

(ARO Shepherd, August 12, 2011);

6. LOE benefits from September 2002, under Claim #5 (ARO Shepherd,

August 12, 2011);

7. Permanent impairment assessment for the left toe under Claim #5 (ARO Shepherd,

August 12, 2011).

[12] Issue #1 listed above requires further clarification. The employer's representative

submits that this issue does not include entitlement for carpal tunnel syndrome (CTS), since this

was addressed in ARO Puhl’s decision, for which the worker missed the statutory time limit.

The Panel agrees with that submission. The worker had not been diagnosed with CTS at the time

that the worker filed the claim relevant to this issue. Also, we note that ARO Puhl specifically

referred to the diagnosis of CTS, whereas ARO De Rose did not. We also agree with the

employer's representative’s submission that the worker’s CTS was not significant in any event.

This is demonstrated in the medical reporting, discussed in more detail, below.

(v) Tribunal Discussion Papers

[13] The issues in this appeal include claims for the low back, neck, upper extremity and

fibromyalgia. The file includes Tribunal Discussion Papers on these topics and relevant


discussion papers were included in the record for this appeal. The Tribunal’s medical discussion

papers deal with medical topics which frequently arise in appeals. They are written by

independent experts who are recognized in their fields of specialization. The papers are not peer-

reviewed publications, but are rather intended to provide parties and representatives with a

broad, general overview of medical topics. A discussion paper is included in the case materials

for an appeal when it appears that the paper may provide some relevant background to an issue

in dispute. Medical discussion papers are also available on the Tribunal’s website and in its

Library. A Vice-Chair/Panel is not bound by any information or opinion expressed in a

discussion paper, but may consider and rely on the general medical information provided by the

paper. Every Tribunal decision must be based upon the facts of the particular appeal. It is

always open to the parties to rely upon a discussion paper, or to distinguish or challenge it with

other evidence.

[14] The Panel has referred to the Tribunal Discussion Papers, as relevant, in the analysis of

the issues.

(vi) Summary of the medical evidence

[15] The following summary of the medical evidence is not a complete review of every report

on file, but refers to the highlights of the significant reports, which also provide insight into the

chronology of the worker’s complaints.

Date

Health

Professional

Summary

1996-09-30

Dr. Huang, family

physician

Form 8

The worker was changing the blade of a cutter when it flew off and cut her

right second finger. She bandaged it and kept working. She was assigned

away from the cash register for three weeks. When she went back on the cash

register in May, the pain recurred and she sought medical treatment. The

diagnosis was right D2 tendon strain. Physiotherapy was prescribed and “no

cash register duty.”

1998-01-28

Dr. McLean,

plastic surgeon

Excision of ganglion from right wrist.

1998-08-27 Leave of Absence without pay, for six to 12 months.

1999-05-19

Dr. Choi, Form 8

Dr. Choi described on and off right wrist pain for several years, which had

increased in the previous two months. The worker had pain over the right

wrist, forearm and shoulder. The diagnosis was repetitive strain injury.

NSAIDs and physiotherapy were prescribed. It was expected that this problem

would need on and off management in the future. Dr. Choi also referred to the

ergonomics of the work station.

1999-07-17

Employer Health

and Safety

Incident Report

(Worker)

The worker describes an injury brought on by repetitive motion at work, not an

isolated incident. The worker described swelling of the right hand and up

through the right arm and shoulder. The worker described the activities

involved in the work being performed as “Cashiering.” The area of injury was

the right shoulder, upper arm, elbow, wrist, and hand. She stated that she

believed the cause of accident was performing the standard job without


Date

Health

Professional

Summary

rotation to other work areas over the years.

2000-06-06

X-ray of cervical

spine

Showed “subtle mid level degenerative change,” as documented in Dr. Hart’s

report (see below). (CR 62)

2000-08-31

Dr. Bowler,

physiatrist,

Form 8

Dr. Bowler attached a narrative report to the Form 8, noting that the worker

reported a two-year history of fingertip tingling, shoulder pain, and giving way

of the left hip. Any overhead work seemed to aggravate her discomfort and

she reported that the cash registers were mounted quite high, given her height.

As a result, she tended to be reaching upwards and she found this quite

discomforting. She reported right and left shoulder pain. Nerve conduction

studies for the right and left upper extremities for the radial, median, and ulnar

nerves, sensory motor fibres were within normal limits. There was no

evidence of any peripheral entrapment neuropathies. Needle

electromyography of the right upper extremity was also conducted

representing C5 through T1; there was no evidence of any acute deinnervation

or chronic reinnervation phenomenon.

Dr. Bowler concluded: “In essence, we have normal studies.” Since the

worker did have myofascial discomfort, Dr. Bowler recommended a course of

exercise therapy in combination with some massage therapy. Dr. Bowler also

noted that “much of her discomfort is positional in nature but we were unable

to tease that out completely today.” Dr. Bowler prescribed Vioxx to see if it

would facilitate improved sleep patterns. The worker was crying during the

examination and Dr. Bowler suggested that the worker may be started on a trial

of antidepressants to see if it improved her overall pain perception and

behaviours. Dr. Bowler described the physical examination. The worker

demonstrated full strength and most tests were negative. She demonstrated full

range of motion in the cervical, thoracic, and lumbar regions and had normal

gait analysis for heel, toe, and squat patterns.

2000-09-16

P. McNamara,

physiotherapist

The worker had right upper traps/shoulder pain, central low back and tail bone

pain, decreased range of motion lumbar spine, especially flexion; multiple

tight/tender points in upper traps, suboccipitalis, pectorals; positive neural

tension signs right greater than left; positive painful arc syndrome.

2000-09-18

Physiotherapist

Extension Request

The worker had a gradual onset of neck, low back, tailbone and upper

extremity pains. The family doctor referred to Dr. Bowler and the worker was

referred to physiotherapy. The worker had decreased ranges of motion in the

lumbar spine particularly flexion and trunk rotation. There was positive

painful arc of the right shoulder. There were positive neural tension signs

through the pectorals. The working diagnosis was chronic myofascial strains.

The restrictions were no repeated bending or lifting.

2000-10-16

Dr. Ho, Medical

Dr. Ho refers to Claim #2 and the PDA submitted by the employer. The

worker saw Dr. Kwong in September 1996 and September 15, 1999, but no


Date

Health

Professional

Summary

Consultant reports were submitted. Dr. Ho reviews Dr. Bowler’s report. Dr. Ho gave the

opinion that myofascial discomfort with a completely normal physical

examination is not related to the nature of the worker as a CSR.

2000-11-01

Physiotherapist

The worker attended for therapy including a combination of heat, acupuncture,

and myofascial and neural tension stretches. She responded positively to

treatment, unfortunately, the repetitive/heavy nature of her work aggravated

her pain, and driving one hour to work did not help.

2001-03-29

Dr. R. Stein,

internal medicine,

IME at employer’s

request

History was obtained from Dr. Kwong, who had been the worker’s family

physician since September 1999. In September 1999, the worker had pain in

the right shoulder diagnosed as possible tendinitis or rotator cuff syndrome.

There was no specific injury although she had been lifting boxes at work. The

worker’s main complaint appeared to be discomfort in her back associated

with standing or sitting for periods of 30 minutes or longer. She complained of

pain in her right wrist and elbow as well. In June 2002, her symptoms became

worse, associated with numbness of her hands and pain on lifting her arms

above her head. EMG was normal. The worker complained of back pain on

sitting or standing for 30 minutes or more.

2002-02-18

Dr. T. Scocchia,

rheumatologist

The worker described a 10-year history of gradual onset of pain. She

described pain in the lower lumbar and sacral region as well as in the lateral

hip area. She said the pain was much worse with prolonged standing. Bending

and lifting aggravated her pain to some degree. Her pain changed dramatically

depending on weather changes. Dr. Kwong had noted symptoms suggestive of

anxiety and depression. The worker’s left sided hip and back pain may

represent myofascial pain or possibly some mild dural sleeve irritation,

possibly from a herniated disc. Some of the symptoms could be related to soft

tissue pain and there may be an element of underlying depression, but her

symptoms appeared to be quite consistent in the one area.

2002-02-19

X-ray of the SI

joints, left hip, and

lumbar spine

There were some early degenerative disc and facet changes but no fractures.

2002-02-24

After Hours clinic

The worker had chronic back pain and query fibromyalgia. The worker had

trouble sleeping. Amitriptyline was prescribed.

2002-03-12

After Hours Clinic

The worker requested a doctor’s note for work and medication for

fibromyalgia. Elavil was prescribed.

2002-03-25

Dr. Scocchia,

Employer Health

Care Provider’s

report

The worker was seen for back and hip pain. It was recommended that the

worker avoid prolonged standing and sitting, which aggravated her problems.

The worker should be allowed to change position at least every 20 minutes.


Date

Health

Professional

Summary

2002-03-25

Dr. Scocchia

The worker was seen for back, hip and buttock pain. The worker stated that

she had to work with standing of half an hour at a time with only a five-minute

rest period. She had been experiencing an increase in pain and had missed a

couple of days of work. On examination, straight leg raise on the left appeared

to be positive in both supine and sitting with increase in posterior calf and back

pain. Lumbar range of motion was restricted.

2002-04-07

After Hours Clinic

The worker had a flare-up of fibromyalgia that had been ongoing for years.

She had some arthralgia recently. She returned to work the previous day and

needed a note. Weather related.

2002-06-07

CT report –

lumbar spine

Impression: mild acquired central spinal stenosis at the L4-5 level mainly due

to degenerative facet changes, but no disc herniation present.

2002-06-25

Dr. Scocchia

The worker was seen following a CT scan. There was mild spinal stenosis that

might explain some of the symptoms and problems, but they seemed somewhat

out of proportion to the findings on the CT scan. Her symptoms remained

essentially the same. The worker had 10 year history of lower back pain

radiating to the lateral hip. It was much worse with prolonged standing

especially after about half an hour. She noted that that sitting in her car for

more than about 20 minutes at a time also aggravated the symptoms. Bending

and lifting aggravated it to some degree, but nearly as much. It was reasonable

for the worker to have restrictions in her work. On examination, the lumbar

spine range of motion was restricted and there was lower back pain on flexion

and extension and with left side flexion. The CT scan showed mild acquired

central spinal stenosis at L4-5 mainly due to degenerative facet changes and no

disc herniation was present.

2002-06-30

MRI report –

lumbar spine

There was no focal disc herniation or foraminal stenosis identified throughout

the lumbar spine. There was no definite neural compression. There was

minimal narrowing of the canal at the L4-5 level due to a small diffuse annular

bulge and very mild prominence of the ligamentum flavum that were not felt to

be of any clinical significance.

2002-07-08

Dr. Scocchia

The worker was evaluated for her back and iliac crest pain. There was very

mild degenerative pathology shown on previous x-rays and CT scans.

Restrictions were to avoid standing in one position for length periods of time;

standing for more than 30 minutes should be restricted. She could walk or sit

to change positions. Repetitive and heavy bending and lifting would also

likely aggravate her back symptoms. She should take breaks when the

commute was longer during bad traffic and use an Obus Forme in the car.

Medications at that time consistent of Elavil 10 to 20 mg o.d. MRI scan

showed very mild bulge at L4-5 with no evidence of significant herniation or

foraminal stenosis. There was mild thickening of the ligamentum flavum

posteriorly. L5-S1 and L3-4 were essentially normal.


Date

Health

Professional

Summary

2002-07-19

Dr. P. Robert,

orthopaedic

surgeon, IME (at

employer’s

request)

Dr. Robert stated that the examination failed to demonstrate any objective

findings pertaining to the neuro-musculoskeletal system. Dr. Robert gave the

opinion that the worker was capable of performing the duties of her

employment as a customer service representative with no restrictions or

limitations.

2002-09-27

Dr. Robert, IME

Addendum

Dr. Robert reviewed CT scans and MRI reports which identified mild

degenerative changes at the L4-5 level. Dr. Robert stated that the clinical

examination failed to demonstrate any symptoms in keeping with degenerative

disc disease. Dr. Robert stated that degenerative changes of the lumbar spine

are a common phenomenon and are often asymptomatic not requiring changes

of lifestyle or specific treatment.

2002-10-22

Dr. C. Ballyk,

Physical Medicine

and Rehabilitation

The worker was complaining of aching in her hands but also in her arms,

shoulders, neck, low back, and hip. She was also having problems with

dropping things. Her hands would fall asleep while driving and Dr. Wells

wondered if she had carpal tunnel syndrome. The EMG and nerve conduction

study were abnormal, showing very mild median nerve entrapment mainly

affecting sensory myelin. This could account for the hand numbness when

driving and using her hands in a prolonged position, but likely did not account

for all of her symptoms. Dr. Ballyk recommended blood work. If this was

normal, then Dr. Ballyk suggested a fibromyalgia program.

2002-10-22

Dr. Wells, family

physician

The worker fractured her toe in late August. It was not healing well and the

worker would be off for several weeks.

2003-02-24

McMaster

Emergency Dept.

The worker was seen for back pain, but a note indicates that the emergency

record could not be located. Another note refers to visits between January

2003 and June 2003.

2003-02-20

Dr. Katarey, Form

8

Dr. Katarey reports longstanding backache which flared up at work on that

date. The diagnosis was low back muscle spasms.

2003-03-16

Dr. Loka

The worker complained of severe back pain after standing on her feet for

hours. She had similar episodes of low back pain in the past. The diagnosis

was low back pain/muscle strain. Tylenol #2 was prescribed. It was noted that

the worker was to see the specialist the following week.

2003-03-31

Dr. Ballyk

The worker complained of pain in her shoulder, neck, low back, and hips,

which had been longstanding for about 10 years. Her job duties involved

lifting and carrying objects, which she found very difficult, but she was still

doing her job. She had been followed by Dr. Scocchia. It was felt that her

back pain was more mechanical and myofascial pain as well. Laboratory tests

were normal. An MRI of June 2002 showed minimal narrowing at the L4-5

level due to a small diffuse annular bulge. The worker was complaining of


Date

Health

Professional

Summary

pain and was quite distressed. She took Tylenol #2 occasionally Arthrotec and

a number of supplements. Dr. Ballyk concluded that the worker had

myofibrositis as well as chronic pain. The EMG showed very mild medial

nerve entrapment but mostly this was within normal limits. There was no

evidence of myositis or significant neuropathy. No significant pathology was

shown on MRI or blood tests. Other than a pain management program,

Dr. Ballyk had nothing further to offer.

2003-04-23

ER, Dr. Francis,

Form 8

The diagnosis was chronic fibromyalgia. Dr. Francis described recurrent pain

exacerbated by position at work. Toradol was prescribed.

2003-04-23

Emergency Triage

Record and

Emergency

Record

The worker presented with body ache and shakes. The worker stated she had

fibromyalgia diagnosed four to five years earlier. She needed to work and had

been standing all day and body had stiffened up. Medications included

Tylenol (#2 and #3), amitriptyline, Toradol. The form noted that the worker

had been working at the cash register. On examination, the worker was crying.

2003-05-06

Dr. P. Varey,

physical medicine

The worker described a history of whole body pain which had been an issue

for at least 10 years. Her worse discomfort was in the low back and hip

girdles. She had tightness through the entire spine with aching in the

shoulders, elbows, wrists, and lower extremities. She denied any consistent

numbness or tingling, but some sporadic sensory complaints in her hands. The

worker was working shifts at that time. Medications included Toradol,

Tylenol #2, and Tylenol #3. Neurological examination was normal. The

worker had widespread tenderness with the fibromyalgia tender point count 18

of 18. Dr. Varey had copies of past investigations indicating an element of

mild degenerative disc disease not out of keeping with the worker’s age and of

questionable clinical relevance. Dr. Varey counselled the worker on the need

for consistent use of Amitriptyline. Dr. Varey recommended participation in a

multi-disciplinary fibromyalgia program.

2003-05-23

Dr. Ballyk

The worker had longstanding chronic pain. Extensive blood work and lab

testing was normal. Dr. Scocchia stated that an MRI showed a mild bulge at

L4-5 with mild ligamentum flavum thickening. Dr. Ballyk did not suggest any

further interventions. The worker was still working and Dr. Ballyk encouraged

working over attending the Fibromyalgia Pain Program.

2003-06-11

Urgent Care

Centre,

Physician’s

Report of Re-

Opened Claim

Diagnosis of fibromyalgia with tender areas in the neck and shoulders. The

worker could not do regular or modified work. The recurrence was caused by

weather and increased work. The worker was referred to Dr. Varey.

2004-01-20

Dr. W.J.

The worker reported experiencing pain symptoms that began in 1996. She

developed symptoms first in her back and leg, then over a few months her


Date

Health

Professional

Summary

Reynolds,

rheumatologist

discomfort became widespread involving her trunk and all of her limbs. Her

pain was constant and tended to be more severe on the right. There were

prominent myofascial pains, particular in her low back region, which were

severe with repetitive activities and any prolonged posture. She had cervical

headaches, dyspepsia, and disturbed sleep. On examination, there was a

decreased range of movement of neck, back, shoulders, and hips and all tender

points were painful. Grip strength was reduced. Dr. Reynolds diagnosed

fibromyalgia that developed out of her back and leg pain that developed in the

context of her work activities. Her fibromyalgia includes sleep deprivation and

autonomic symptoms.

2006-03-08

Dr. R. Dost,

neurologist and

electromyographer

The worker described a long history of chronic low back pain. For the past

several years she also described pain in the arms worse on the right with

tingling of the right arm and left hand along with occasional electrical shock

sensations radiating from the cervical spine. Physical examination was

normal. Electrophysiological studies in both upper limbs were normal. MRI

of the head and cervical spine was arranged.

2006-06-29

Dr. Dost

MRI showed C5/C6 on the right which was described as moderate. Dr. Dost

noted that this may be affecting exiting nerve root and causing numbness in the

arm with radicular symptoms. She required several months of physiotherapy

including strengthening, conditioning, and traction. If this fails, surgical

opinion may be obtained. (There is no indication that a surgical option was

pursued).

2006-07-04

Dr. L.E. Hart,

rheumatologist,

Medico-legal

report

Dr. Hart examined the worker and reviewed the medical records in detail. The

worker described that she was in good health until about 10 years earlier, when

she began experiencing pain in her right hand, and became aware of pain

involving her right shoulder and arm as well. Later, she began experiencing

pain in her low back. Sometime in 1999, her pain became more generalized in

nature, involving her upper and lower back and also both of her upper and

lower limbs. Dr. Hart reviewed the diagnostic criteria for fibromyalgia and

determined that the worker met the diagnosis. The diagnoses were chronic

myofascial (soft tissue pain) – fibromyalgia; headaches; anxiety; degenerative

disc and joint disease (osteoarthritis).

(vii) Law and policy

[16] The pre-1997 Workers’ Compensation Act applies to the worker’s claims with an

accident date between January 2, 1990 and January 1, 1998. The hearing of the appeal

commenced after January 1, 1998; therefore, certain provisions of the WSIA also apply to the

appeal. The Workplace Safety and Insurance Act, 1997 (the “WSIA”) applies to the worker’s

claims with accident dates occurring on or after January 1, 1998.

[17] Workplace insurance is a no-fault system. Accordingly, it is usually not necessary to

consider blameworthiness in determining initial entitlement.


[18] Tribunal jurisprudence applies the test of significant contribution to questions of

causation. A significant contributing factor is one of considerable effect or importance. It need

not be the sole contributing factor. See, for example, Decision No. 280.

[19] Section 13 of the WSIA provides that a worker is entitled to benefits for a personal injury

by accident arising out of and in the course of employment. The definition of accident includes a

disablement, which in turn includes a condition that emerges gradually over time or an

unexpected result of working duties (Operational Policy Manual (OPM)

Document No. 15-02-01). Section 13 provides that an injury occurring in the course of

employment is presumed to have arisen out of the employment, but this presumption does not

apply to disablement injuries: see, for example, Decision No. 1672/04 (2009), 88 W.S.I.A.T.R.

(online).

[20] The standard of proof in workers’ compensation proceedings is the balance of

probabilities. Pursuant to subsection 124(2) of the WSIA, the benefit of the doubt is resolved in

favour of the claimant where it is impracticable to decide an issue because the evidence for and

against the issue is approximately equal in weight.

[21] Pursuant to section 126 of the WSIA, the Board provided a statement of applicable

policy. The Panel has considered these policies, as applicable, in the analysis of the issues

below.

(viii) Conclusions and analysis

[22] The appeal is allowed in part for the reasons set out below.

(a) Overview of the Panel’s findings

[23] The worker’s claims with the WSIB now have a long and somewhat convoluted history.

Nevertheless, most of the claims turn on the worker’s simple contention that her work was

repetitive, in particular, that she was assigned to the cash register for hours at a time. She has

said this repeatedly to the WSIB and in her various written statements. The worker maintained

that position in her testimony. The employer challenged that contention, relying on previous

statements that the work was varied, but did not call any witnesses to refute the worker’s

testimony. The employer's representative suggested that the employer was at a disadvantage

presenting evidence due to the passage of time. The Panel notes, however, that the employer had

identified a witness who in fact was present at the hearing location, but chose not to call that

witness to testify.

[24] In these circumstances, the Panel accepts the worker’s testimony that she was assigned to

work on the cash register in a static position for prolonged periods of time. Due to her short

stature, she was required to reach up to the cash register. Although questioning of the worker

focused on alleged inconsistencies in her statements over time, we find that she has been

generally consistent in asserting her primary complaint about prolonged assignment to the cash

register. In the Panel’s view, it does not undermine her credibility that she also referred to heavy

lifting at times; it is undisputed that this would also be performed as part of her job duties. The

fact that she worked prolonged hours on the cash register does not preclude performing some

heavy lifting at times in other tasks. For example, an emergency record dated April 23, 2003

indicates that the worker stated that she was working on the cash register for six hours. Given

that her shift was seven to eight hours, the worker still would have had time to perform stocking

duties, although she was also on the cash register for six hours.


[25] The worker’s description of the onset of her injuries is summarized in a WSIB

investigation report dated July 10, 2003. In that report, the worker noted that she is 5’1” tall and

had no outside hobbies or activities. She began employment with the accident employer in 1990

and became full-time in 1999. She worked 40 hours per week. The worker provided a list of

five store locations where she had been employed over the years. The worker described her job

duties as follows:

She worked mainly as a cashier for the first seven years. From 1997 on, she spent 80%

of time on case [sic: cash], and the other 20% putting away stock or pulling shelves. This

means pulling the stock on the shelves to the front for easier access.

All the cash register movements are done with her right hand, and the bagging of product

with her left hand. If she does put stock away, all cases are piled on carts, and she would

put the bottles on the shelves one at a time.

She said she is very fast running the cash, and feels she was placed on cash during the

busiest times for this reason. She would be relieved for breaks and lunches.

[26] According to the investigation report, the worker described the onset of her symptoms as

follows:

When the symptoms initially started, [they] were very sporadic, 3-4 times per week.

They would last for hours, especially if she was experiencing muscle spasms.

Her hands have always been achy. She described lower back and hip pain, with pain

radiating down both legs. The areas of injury seem to depend on her stress levels. She

will also experience pain in her neck and up into her head causing headaches. Her feet

have been affected and her legs have given out, causing her to fall. She has also

developed shaking all over her body. Some days she has to use a cane.

[27] The worker gave the names of four assistant managers to whom she made complaints, as

well as a corporate manager at the corporate office. The worker noted that she did not have a

family doctor for a period of time, and often visited a walk-in clinic. At that time, she was

receiving EI sick benefits. She said that she had lost time over the years due to her pain, but did

not keep track of it. She had been reprimanded for her attendance.

[28] In a statement that is consistent with her testimony, the investigation report notes that the

worker attributed a lot of her problems to a contract agreement where casual staff members were

required to work 7 ½ hours per day with only one 15-minute break. The worker has provided

further information that this lasted from 1997 to 2000. She would find that her right hand would

swell severely during these shifts.

[29] The Panel finds that the worker has been consistent in the basic information that she has

provided regarding the onset of her condition. Any discrepancies have been primarily in minor

details.

[30] As noted by the employer's representative, the Panel also notes that the worker’s written

statements and testimony reflect some misapprehensions of legal concepts and medical facts, but

we will only address those points as they are necessary to the disposition of this appeal. The fact

that the worker has misapprehensions of certain facts and legal concepts does not undermine her

credibility generally nor does it negate all of her testimony.

[31] The investigation report and the worker’s testimony also reflect that there were labour

relations issues at play for many years. For example, the worker was not happy that the

employer had refused her repeated requests for re-assignment to a location closer to her home.


The Panel recognizes that various labour relations issues have likely played some role in the

worker’s animosity towards her employer and her perception of events, but these factors do not

undermine our acceptance of the worker’s description of the repetitive nature of her job duties.

[32] Although the worker’s claims became protracted and seemingly complex, it began simply

with her report of upper extremity pain that she attributed to repetitive work. A claim was

initially established in 1999 (Claim #2) and then re-opened under another claim in 2000

(Claim #4). Regardless of the WSIB’s procedural decisions in the establishment of these claims,

this Tribunal has the jurisdiction to consider the issues arising from the ARO decisions on their

merits and justice. In deciding the issues before us, we have considered all of the evidence that

is relevant to the issues.

[33] The employer's representative also submitted that an “adverse inference” should be

drawn against the worker in relation to the records that are not available because the worker did

not pursue her claims in a timely way. We are unable to give effect to this submission. The

principle of drawing an adverse interest has been defined as follows: if a party fails to produce a

witness who is within its power to produce, and who should have been produced, the judge may

instruct the jury to infer that the witness’s evidence is unfavourable to the party’s case. Notice

ought to be provided before an adverse interest is drawn.1 In this case, Claim #2 was established

in 1999, and we do have records from that time period. The worker was not given notice of the

potential for drawing an adverse inference against her, nor did the employer's representative

identify specific evidence within the worker’s power to produce that she failed to produce. It

would be no more appropriate to draw an adverse inference against the worker in this regard,

than it would be to draw an adverse inference against the employer based upon the employer's

late decision not to call its witness to testify.

[34] The employer's representative also relied upon the reasoning employed by ARO Puhl in

2009 regarding the worker’s credibility. In the course of that adjudication, the worker stated that

she required a leave of absence in 1998 due to her symptoms. Since she could not take the time

off, she told the employer that she had to tend to a sick relative. On the basis of this information,

the employer granted the worker an unpaid leave of absence for up to 12 months. The

employer's representative argues that this was a gross misrepresentation that undermines the

worker’s credibility as a whole. The Panel does not agree that this situation warrants a wholesale

dismissal of the worker’s testimony or credibility. We note that the leave of absence was unpaid,

significantly lessening the seriousness of the misrepresentation. If we accept the worker’s

explanation of this leave, as the employer's representative submits that we ought, then it in fact

supports her claim that she had worsening symptoms due to the nature of her work, leading her

to leave work without pay for an extended period of time.

[35] That is not to say, however, that the Panel accepts all of the worker’s perceptions or her

portrayal of her employer’s actions, but it is necessary to separate these issues from the relevant

evidence at hand in this appeal.

(b) The Panel’s assessment of the issues in this appeal

(1) Entitlement for repetitive strain injury of the right upper extremity,

under Claim #2 (ARO DeRose, March 18, 2014)

[36] The worker’s appeal is allowed on this issue.

1 See, for example, Decision No. 340/13.


[37] As noted above, this claim was established when the worker reported a gradual onset of

right hand/arm/shoulder pain attributed to her duties as cashier.

[38] The WSIB established a date of accident of May 19, 1999, date of the worker’s treatment

by Dr. Choi, who completed the Form 8 of that date. Dr. Choi noted that the worker had a

longstanding history of intermittent right wrist pain, worse over the preceding months. On

examination, she had pain in the right wrist, especially the right metacarpal, right forearm, and

right shoulder. The diagnosis was repetitive strain injury. NSAIDS and physiotherapy were

prescribed. Although Dr. Choi check “yes” in response to whether complete recovery was

expected, it was also a problem that will need on and off management in the future. Restrictions

referred to the ergonomics of the cashier desk.

[39] The employer confirmed that in July 1999, the worker reported to the employer that she

had swelling and pain in the right upper extremity from the right hand to the shoulder attributed

to cashier demands as CSR. The worker’s incident report is included in the personnel file. The

employer submitted a physical demands analysis (PDA) and the claims adjudicator accepted the

employer’s contention that the job duties were varied and non-repetitive.

[40] The WSIB closed this claim on the basis that the worker did not provide additional

information. The worker pursued this claim again in 2009, although the worker had pursued

other claims in the meantime.

[41] In the decision under appeal, the ARO found that there was “no proof the worker spent

prolonged periods of time performing cashier duties.” Also, the ARO found that the worker had

a progressing degenerative cervical spine condition which was responsible for her symptoms. In

this regard, the ARO appears to be referring to findings on a MRI of the cervical spine in 2006.

[42] In this appeal, we have had the benefit of the worker’s testimony. As noted above, the

Panel accepts the worker’s testimony that she worked on the cash register for prolonged periods,

including a period during which she worked for seven hours with one 15-minute break. When

she was not on the cash register, she was stocking shelves or facing up merchandise, which could

involve heavy lifting and/or reaching.

[43] Furthermore, the medical evidence, outlined above, does not support a conclusion that the

worker has a serious degenerative condition that would have been responsible for her upper

extremity symptoms. In June 2000, an x-ray of the cervical spine showed “subtle mid level

degenerative change.” The medical reporting during this period indicates that the worker’s pain

was myofascial. The worker was thoroughly assessed by a number of different specialists during

this period who did not attribute her right upper extremity symptoms to degenerative changes. In

June 2006, Dr. Dost reviewed an MRI of the cervical spine, which showed moderate narrowing

at C5-6. Dr. Dost noted that “this may be affecting exiting nerve root and causing numbness in

the arm with radicular symptoms.” Dr. Dost raised the possibility of surgery, but there is no

evidence it was pursued. Furthermore, the Panel notes that Dr. Bowler conducted needle EMG

of the right upper extremity, representing the nerve roots C5 through T1 in August 2000; this

testing showed no evidence of acute deinnervation or chronic reinnervation phenomenon. In the

Panel’s view, Dr. Bowler’s findings in 2000 seriously undermine the speculation that the 2006

MRI findings in the cervical spine were responsible for the worker’s symptoms which formed

the basis of her claim in 1999.


[44] In the Panel’s view, it is evident that the worker consistently reported an injury to her

right upper extremity that she attributed to repetitive work on the cash register, awkward

ergonomics of the cash register due to her short stature, and a period of time during which she

was limited to one 15-minute break over a 7 ½ hour shift. The contemporaneous medical

evidence is entirely consistent with this. The confusion arose because the worker continued

working and may not have filed forms in a timely manner; however, this does not undermine the

merit of the claim on the evidence.

[45] The Panel notes that, in Claim #4, the medical consultant provided the opinion that

“myofascial discomfort with a completely normal physical examination is not related to the

nature of the worker as a CSR.” We note that Dr. Ho relied upon the PDA provided by the

employer; we have preferred the worker’s evidence regarding the worker’s job duties.

Furthermore, Dr. Bowler filed a Form 8 in this regard, suggesting that Dr. Bowler considered the

myofascial (muscular) strain to be the injury. Furthermore, the physiotherapy reports during this

period confirm the worker’s gradual onset of pain and findings of painful arc of the right

shoulder. The diagnosis was chronic myofascial strains.

[46] In summary, the Panel finds that the worker has initial entitlement for soft tissue injuries

to the right hand/arm/shoulder under this claim. The worker’s entitlement to specific benefits

under this claim is remitted to the WSIB for consideration.

(2) Initial entitlement for a neck condition under Claim #4

(ARO Shepherd, August 12, 2011)

[47] This claim was established with an accident date of September 6, 2000. The worker filed

a Worker’s Report of Injury (Form 6), dated September 29, 2000. The worker described her

injury as follows:

Repetitive cashiering, in addition to pulling stock for the floor. Off loading trucks (hand

bombing). The average case weighs approximately 45 to 50 pounds – in [store number]

staff has to set cases on racks and at times climb to put away and retrieve such cases

anywhere up to 7’ to 8’ in height. I always complained about the safety issue.

[48] In answer to the question of when she first noticed the pain and whether there were any

changes to her job duties, the worker stated as follows in the Form 6:

Late 1995, respectively to every area of my upper body. My work hours have always

been approx. 40 hrs per week increasing to 48 hours – voluntarily cut back to 40 hrs.

[49] In the Form 6, the worker also stated that she “complained to every supervisor/manager

and co-workers in every store I have worked.” She stated that her complaints started as early as

1996.

[50] The claims adjudicator called the worker to obtain her statement about the injury

(Memo #3). The worker stated that “it is definitely caused by the repetitive nature of her job,

and heavy lifting. She advised that she doesn’t lift anything at home, so it was from working.”

The worker stated that she began feeling pain in her arms and shoulders and upper extremity

approximately three years earlier, but she just thought that it would go away, but instead, got

worse. Based upon the information available, the Claims Adjudicator felt that the wrist, shoulder

and upper back injury were related to the worker’s job duties, but not the low back or hip. In

response, the Dr. Ho gave the opinion that myofascial discomfort with a completely normal

physical examination is not related to the nature of the work as a CSR. The worker’s claim was

denied.


[51] As noted above, the worker’s entitlement under this claim was also addressed by

ARO Puhl in a decision of December 14, 2009. The worker was denied an extension of the time

limit to appeal that decision; therefore, the issue before the Tribunal in this appeal relates only to

the worker’s entitlement for the neck under this claim. In the decision under appeal

(ARO Shepherd, dated August 12, 2011), the ARO summarized the worker’s testimony, which

was similar to the worker’s testimony in this appeal. The worker testified that she was assigned

exclusively to cashier duties from the date of hire until she began to experience neck symptoms.

She described having to operate a manual cash register which was positioned too high, and she

described prolonged standing in one place. The worker stated that she performed these duties for

extended periods with few breaks. The ARO felt that this description was not entirely consistent

with the early file documentation. In this regard, the ARO referred to a physical demands

analysis from 2003, which indicated that the worker was involved in cash, customer service, and

stocking duties. The ARO accepted that the worker likely spent most of her time on cash duties.

[52] The ARO concluded that the worker’s history of emerging neck symptoms was consistent

with the natural progression of the worker’s degenerative arthritis and degenerative disc

processes as shown on MRI (2006). The ARO noted that the worker’s job duties of the operation

of a cash register, prolonged standing, and lifting of liquor bottles were not sufficiently heavy or

forceful to affect the natural course of the worker’s degenerative condition.

[53] The employer submitted that there was no evidence of any diagnostic imaging of the neck

until May 2006, which was an MRI of the cervical spine. The Panel notes, however, that the

July 2006 report of Dr. Hart refers to an x-ray of the cervical spine taken on June 6, 2000,

contemporaneously with the worker’s complaints. That x-ray reportedly showed “subtle,

mid-level degenerative change” in the cervical spine. It is not clear that the x-ray report is

contained in the file, but it appears that it is referred to in Memorandum #7, dated

October 12, 2000, in Claim #4. That memorandum documents a call from the employer’s

Human Resources manager. According to the Human Resources Manager, the worker advised

her of two x-rays, “one to her upper spine and one to her lower spine.” This is consistent with

Dr. Hart’s description of an x-ray of the cervical spine in June 2000.

[54] Similar to ARO DeRose’s decision, ARO Shepherd relies upon moderate degenerative

changes shown on the MRI in 2006 to find that the worker’s symptoms in 2000, six years earlier,

were related to degenerative change. The Panel notes that none of the contemporaneous medical

evidence in 2000 cites degenerative change as a primary cause of the worker’s neck symptoms.

The contemporaneous medical evidence suggests that the worker sustained myofascial/muscular

strain of the neck at work in 2000.

[55] The file includes a report dated August 31, 2000, from Dr. Bowler, physiatrist.

Dr. Bowler noted that the worker reported a two-year history of fingertip tingling, shoulder pain,

and giving way of the left hip. Nerve conduction studies for the right and left upper extremities

for the radial, median, and ulnar nerves, sensory motor fibres were within normal limits. There

was no evidence of any peripheral entrapment neuropathies. Needle electromyography of the

right upper extremity was also conducted representing C5 through T1; there was no evidence of

any acute deinnervation or chronic reinnervation phenomenon. Dr. Bowler concluded: “In

essence, we have normal studies.” Dr. Bowler also noted that “much of her discomfort is

positional in nature but we were unable to tease that out completely today.” Dr. Bowler

prescribed Vioxx to see if it would facilitate improved sleep patterns. The worker was crying

during the examination and Dr. Bowler suggested that the worker may be started on a trial of


antidepressants to see if it improved her overall pain perception and behaviours. Dr. Bowler

described the physical examination. The worker demonstrated full strength and most tests were

negative. She demonstrated full range of motion in the cervical, thoracic, and lumbar regions

and had normal gait analysis for heel, toe, and squat patterns. Dr. Bowler’s findings do not

suggest that the worker’s neck complaints were due to DDD or a lesion of the spine, but rather,

that she had myofascial pain. It was “positional” in nature, which suggests that it was related to

her positioning. Later, the worker’s pain was also described as “mechanical.”

[56] The record also includes a physiotherapy report dated September 18, 2000. According to

that report, the worker reported a gradual onset of neck, low back, tailbone and upper extremity

pains. The physiotherapist found decreased range of motion in the lumbar spine on examination.

There was a painful arc of the right shoulder and a reference to findings through the pectoral

muscles. The working diagnosis was “chronic myofascial strains,” which appears to include the

neck as well as the other areas listed.

[57] In summary, based upon Dr. Bowler’s report and the physiotherapy report, there is

evidence of a myofascial strain of the worker’s neck related to her job duties. Dr. Bowler

described the worker’s difficulty as being “positional” in nature. The subsequent medical reports

indicate that the worker’s neck was not a focus of significant ongoing medical attention until

approximately 2006. The extent of the worker’s entitlement to benefits under this claim is

remitted to WSIB for determination.

(3) Initial entitlement for low back and upper torso pain attributed to

prolonged standing, under Claim #6 (ARO De Rose,

March 19, 2014)

[58] The worker’s appeal is allowed in part. The Panel finds that the worker has entitlement

for the lower back and torso pain on an aggravation basis.

[59] OPM Document No. 11-01-10, “Aggravation Basis,” states:

In cases where the worker has a pre-accident impairment and suffers a minor work-

related injury or illness to the same body part or system, the WSIB considers entitlement

to benefits on an aggravation basis.

Generally, entitlement is considered for the acute episode only and benefits continue until

the worker returns to the pre-accident state.

[60] The policy stipulates that entitlement is not limited in cases where there is no

pre-accident impairment, or the severity of the accident/exposure on its own would have resulted

in additional impairment.

[61] According to the policy, a pre-accident impairment is a condition, which has produced

periods of impairment/illness requiring health care and has caused a disruption in employment.

(Although the period of time cannot be defined, a decision-maker may use a one to two year

timeframe as a guide.) The policy goes on to provide further guidance for determining whether

there is a pre-accident impairment:

Before the allowance on an aggravation basis is considered, decision-makers must

determine if a pre-accident impairment exists. Evidence of this includes, but is not

limited to, a worker having


a previously identified and symptomatic medical condition/impairment,

medical precautions/restrictions and performing modified work prior to the

accident,

receiving regular health care treatments prior to the accident,

lost time from work prior to the accident.

This information can be obtained by reviewing

prior health care documentation (e.g., x-rays, hospital records, operative reports)

prior claim(s)

statements from the worker, the employer, or co-workers

employment records.

[62] This claim was established pursuant to the worker’s Form 6, dated March 19, 2003. The

worker reported standing in one spot for an extended period of time caused pain to her low back,

legs, and torso. The worker indicated that the pain was steady through her back, legs, feet, and

upper torso. She attributed her pain to “stress from standing planted in one spot, for an extended

period of time.”

[63] It must be noted that there is overlap between this issue and the decision of ARO Puhl,

which is not before the Tribunal in this appeal. Under Claim #4, established in 2000, ARO Puhl

addressed the worker’s entitlement for the hands arms, shoulders, back and hips. Therefore, to

the extent that the worker had a low back condition prior to 2003, it must be considered

non-work-related. That does not preclude consideration on an aggravation basis, however.

[64] The Panel finds that the contemporaneous medical reporting provides persuasive

evidence of a work-related exacerbation of her low back condition. The worker sought treatment

from Dr. H. Katarey, who filed a Form 8 dated February 20, 2003. Dr. Katarey noted that the

worker had a longstanding back ache. She had had similar episodes in the past. On examination,

the worker had tender lower back muscles and sacroiliac joints bilaterally. Leg raising was

positive bilaterally at 30 to 40 degrees. There is also a reference to the worker’s gait, but the

comment is unclear. Rest was prescribed for two days, followed by a trial of duties. It was

recommended that the worker avoid working standing in one spot. The diagnosis was low back

muscle spasm. Dr. Loka, of the same medical office, filed a Form 8 dated March 26, 2003. It

noted that the worker had severe back pain after standing at work for hours. The diagnosis was

lower back pain/muscle strain.

[65] A medical report dated February 20, 2003 indicated that the worker experienced a

flare-up of pain at work attributed to prolonged standing at cash. The worker attributed the

symptoms to walking, standing, and lifting.

[66] It is documented that the worker was assigned to modified work prior to this flare-up and

had prior lower back complaints for which entitlement was denied by ARO Puhl. Therefore it is

appropriate to limit entitlement in this claim on an aggravation basis. The Panel leaves it to the

WSIB to determine the date that the aggravation ceased.


(4) Entitlement for fibromyalgia/chronic pain disability under

Claim #7, or in the alternative, #1, 2, 4, and/or 5

[67] The WSIB established Claim #7 to address the worker’s condition of fibromyalgia under

the CPD policy. Since entitlement under the CPD policy is established in relation to a specific

allowed claim, Claim #7 must be meant to address the worker’s entitlement with respect to the

workplace injury claims for which she has entitlement. The Panel finds that the worker has

entitlement for fibromyalgia pursuant to the CPD policy under Claim #7.

[68] OPM Document No. 15-04-03 provides that the following eligibility criteria must be met

before entitlement is recognized for Chronic Pain Disability:

1. A work-related injury occurred;

2. Chronic pain is caused by the injury;

3. The pain persists six or more months beyond the usual healing time of the injury;

4. The degree of pain is inconsistent with organic findings;

5. The chronic pain impairs earning capacity and causes a marked life disruption.

[69] The policy also sets out the type of evidence usually required to establish that the criteria

have been met.

[70] OPM Document 15-04-03 addresses entitlement for fibromyalgia as follows:

Fibromyalgia syndrome

Workers diagnosed with fibromyalgia syndrome will be considered for compensation

benefits under the CPD policy.

Characteristics include

chronic diffuse pain of unknown aetiology attributable to either undetected

organic condition or psychogenic sources

the presence of "tender points" in predictable, and usually symmetrical,

locations

fatigue and sleep disorders.

With the exception of the "tender points", these characteristics are those usually seen in

individuals with CPD, and the recommended treatment is identical to that recommended

for individuals with CPD. Because of this, fibromyalgia syndrome is recognized as a

variant of CPD and workers who are disabled/impaired by fibromyalgia may be eligible

for benefits under the CPD policy or the psychotraumatic disability policy, see 15-04-02,

Psychotraumatic Disability, as follows.

Effective dates

Workers diagnosed as having fibromyalgia or fibrositis (resulting from a work-related

injury) for periods between November 30, 1976 and March 26, 1986 are considered

for benefits in accordance with the WSIB's policy for psychotraumatic disability.

Workers diagnosed with fibromyalgia syndrome for periods before March 27, 1986, and

extending beyond March 27, 1986 may choose one of two options:

- continue to receive benefits under the psychotraumatic disability policy for periods after

March 27, 1986, OR

- be considered for benefits under the CPD policy for periods after March 27, 1986.


Workers diagnosed with fibromyalgia syndrome or fibrositis on or after March 27, 1986

are considered for benefits under the CPD policy.

The retroactivity date of March 26, 1986 applies only to that portion of the whole-person

pension that is attributable to the CPD. A worker's impairment of earning capacity arising

from the organic condition and/or the psychiatric conditions of post-traumatic stress

disorder or conversion disorder is fully retroactive to the date of the accident or onset of

the disability, whichever is later, see 15-04-04, Chronic Pain Disability Rating Schedule.

[71] The Panel finds that the worker is entitled to benefits for fibromyalgia under Claim #7

pursuant to terms of the CPD policy. The causation of the worker’s CPD overlaps between

different claims and the WSIB established Claim #7 to separately address the worker’s claim for

fibromyalgia/CPD. The establishment of a separate claim for CPD permits the worker’s claim

for CPD to encompass the workplace injuries for which she was granted entitlement. In this

decision, the Panel has granted entitlement for a repetitive strain injury of the right upper

extremity under Claim #2 and a neck injury under Claim #4. The evidence indicates that the

worker’s chronic pain originated with the repetitive strain injury to the right upper extremity

under Claim #2, but was aggravated by her subsequent workplace injury to the neck and the fact

that she continued employment for several years in job duties that involved prolonged

positioning and awkward postures.

[72] Turning to the entitlement criteria for CPD, the Panel has accepted that a work-related

injury occurred, specifically, a myofascial strain of the right upper extremity under Claim #2 and

a neck injury under Claim #4.

[73] A major point of contention in the WSIB’s adjudication has been whether the degree of

pain is inconsistent with the organic findings. In particular, the WSIB has pointed to findings of

mild to moderate degenerative changes in the cervical and lumbar spine. At the same time,

however, the worker has clearly been diagnosed with fibromyalgia. This diagnosis was

confirmed by several specialists, including Dr. Ballyk (who used the term fibromyositis),

Dr. Reynolds, and Dr. Hart. Most of these specialists concluded that the physical findings did

not explain the extent of the worker’s symptoms. While there were some physical findings on

diagnostic tests, they did not explain the extent of the worker’s symptoms. One example is the

diagnosis of CTS. Dr. Ballyk found signs of CTS on EMG in 2002, but they were mild and did

not explain her symptoms. As the employer's representative noted in his submissions, the

Tribunal’s Discussion Paper on CTS indicates that EMG is not determinative, particularly where

clinical tests are negative. In this case, Dr. Bowler documented negative Tinel’s and Phalen’s

sign in 2000. Also as noted by the employer's representative, a later EMG by Dr. Ballyk was

negative. Therefore, to the extent that the medical evidence indicates that the worker had CTS, it

does not preclude entitlement for CPD.

[74] Later, in 2006, Dr. Dost referred to the findings documented on the MRI of the cervical

spine, commenting that the findings at C5-6 “may” be responsible for the worker’s right arm

symptoms. Although surgery was raised as a possibility, there is no evidence it took place,

thereby undermining the suggestion that this was indeed primarily responsible for the worker’s

symptoms. In the Panel’s view, it is clear that the predominant theme of the medical reports is

that the worker’s symptoms were not explained by the physical findings and there was a general

medical consensus confirming the diagnosis of fibromyalgia.


[75] Board policy requires evidence that the chronic pain was caused by the injury, through

subjective or objective medical or non-medical evidence of the worker's continuous, consistent,

and genuine pain since the time of the injury. In this appeal, the Panel has accepted the worker’s

subjective evidence of her continuous and genuine pain since the onset of her injury. The nature

of the worker’s pain is also well-documented in the medical reporting. The Panel acknowledges

that it is arguable that the worker’s pain has not been entirely consistent over the years, but this is

explained by two factors. First, the worker sustained a gradual onset injury and continued to

work for most of the time after her injuries. Due to the nature of a gradual onset injury, it is

more difficult to pinpoint and identify the areas of pain, and the areas and level of pain may

fluctuate. The fact that the worker continued to work also affected the areas of pain, and there

were times when the nature of her work aggravated her lower back more than her upper

extremity. As noted above, we have accepted that the worker sustained a work-related

aggravation of her low back in 2003.

[76] The second consideration is that the worker developed fibromyalgia that was diagnosed

by approximately 2002. As noted in Board policy, fibromyalgia, by its very nature, involves

“chronic diffuse pain of unknown aetiology attributable to either undetected organic condition or

psychogenic sources.” As such, the fact that the worker described widespread pain is entirely

consistent with the eventual diagnosis of fibromyalgia, which is characterized by “diffuse pain.”

[77] The Panel finds that the worker’s compensable right upper extremity injury and neck

injury were significant contributing factors in her development of fibromyalgia. Although other

non-compensable conditions may have played a role, they did not overwhelm the causal role of

the compensable right upper extremity injury and the neck injury. She continued to complain

about the right arm and shoulder throughout the medical reporting, and we find that it was a

significant causal factor in the fibromyalgia that subsequently arose.

[78] It is evident to the Panel that the worker did experience a marked life disruption. She

eventually had to stop working and she described the changes in her social and home life in her

testimony.

[79] Accordingly, the worker is granted entitlement for fibromyalgia under the CPD policy

under Claim #7. Her entitlement is effective from 2002, when the diagnosis of fibromyalgia was

confirmed.

(5) Initial entitlement for the low back and right shoulder under

Claim #8 (ARO Shepherd, August 12, 2011)

[80] Although the hearing-ready letter referred to the left shoulder on this issue, it was

clarified at the hearing that this issue pertains to the right shoulder.

[81] The worker’s appeal is denied on this issue. This claim was established in

November 2010, when the worker notified the WSIB of an incident in November 1996 when

shelving fell on a co-worker. The date of the incident is unclear since the worker submitted

pages from her day timer which noted an incident in December 1996. The worker stated that she

sustained injuries to low back, arms, and shoulder in this incident. The worker stated that there

was no discomfort at that time but submitted a report in case problems arose. The WSIB denied

this claim, finding that there was no evidence that injuries occurred due to an accident in

November 1996.


[82] The worker described in her testimony an incident in which a shelving unit fell on a

young co-worker in or about November 1996. The shelving unit did not fall on her. She and

another co-worker were involved in lifting the shelf off of the co-worker.

[83] The Panel notes that there was a lengthy delay between this incident in 1996 and the

worker’s reporting of the incident approximately 14 years later. This delay alone suggests that

the worker did not sustain an injury in this accident. As the Panel understands it, the worker

believes that later diagnostic imaging reveals “damage” that was done to her spine in this

incident. Our attention was not drawn to any medical opinion which directly supports this theory

of the case. The worker appears to be relying upon the notion that a traumatic injury to the spine

may cause post-traumatic degenerative changes that will not appear on diagnostic imaging for

several years. Nevertheless, the initial injury must be a traumatic one: an insignificant injury that

did not warrant any immediate medical treatment is not the type of trauma to the spine which is

associated with changes in the spine. In this regard, the Panel refers to the Tribunal Discussion

Paper on Back Pain, prepared for WSIAT by Dr. W.R. Harris and Dr. J.F.R. Fleming

(March 1997, revised February 2003). The Discussion Paper states in part:

Can an injury precipitate aging change?

Rarely. However, a severe injury, such as a fall from a height (as opposed to a lifting

strain) may result in the appearance (within a year) of narrowing of a single disc with

bony overgrowth (spurs or osteophytes) at the adjacent vertebral margins.

[84] The Panel is not persuaded that the worker sustained any injury in this incident. Even if

she did sustain an injury in that incident, it would not have been a severe injury analogous to that

described in the Discussion Paper. If it had been such an injury, there would have been evidence

of medical treatment at or about the time of the injury. There is no such evidence. Furthermore,

the worker did not mention this incident to the WSIB for many years, despite frequent and

ongoing communication with the WSIB during the relevant time period.

[85] In support of her position regarding this incident, the worker cited the WSIB

investigation report of July 2003. That investigation was conducted in relation to the worker’s

claim for fibromyalgia, which the WSIB established as Claim #7. The WSIB investigator spoke

to the employer Human Resources Manager, who stated that she was advised by the adjudicator

not to submit a Form 7. The worker takes the position that this establishes a conspiracy between

the adjudicator and the employer. The Panel is unable to give effect to this argument, as the

investigation was conducted in relation to the fibromyalgia claim, not the claim established for

the incident of November 1996. The investigation took place in 2003, six years after the

incident, but four years prior to the worker filing a claim for this incident in 2010. In advising

the employer that a Form 7 was not required, it is evident that the claims adjudicator was

referring to the fibromyalgia claim, not the incident of 1996. This is also consistent with the HR

Manager’s memorandum in the personnel file, dated May 30, 2003. The timing of the

memorandum makes it clear that it was not related to the incident of November/December 1996,

which was not reported to the WSIB until 2010.

[86] While the Panel accepts the worker’s testimony that some type of incident occurred in

November/December 1996, in which a shelf fell on a co-worker, there is insufficient evidence to

find that the worker sustained any injury in this incident.


(6) LOE benefits from September 2002, under Claim #5

[87] The worker’s appeal is allowed in part on this issue. The worker is entitled to LOE

benefits from September 2002 to December 9, 2002.

[88] Section 43 of the WSIA provides that workers are entitled to benefits for the loss of

earnings that arises from the injury.

[89] The 2011 decision of ARO Shepherd granted initial entitlement for the fracture of the

worker’s left toe, which occurred at work on August 29, 2002. The employer's representative

did not dispute that the medical evidence supported the worker’s entitlement to LOE benefits for

a period of time following this injury. The employer's representative conceded that the evidence

supported that the worker was unable to work for a period of time as a result of this accident.

[90] In October 2002, Dr. Wells reported that the worker fractured her toe in late August. It

was not healing well and the worker would be off for several weeks. The records support that

the inability to work due to the left toe injury continued until December 2002. The Panel accepts

the employer's representative’s review of the documentation, indicating that the worker had

returned to work following this injury by December 9, 2002. She is therefore entitled to LOE

benefits to that date under this claim.

(7) Permanent impairment assessment for the left toe under Claim #5

(ARO Shepherd, August 12, 2011)

[91] The Panel finds that the worker is not entitled to a permanent impairment/NEL

assessment for the left toe.

[92] Section 46 of the Workplace Safety and Insurance Act, 1997 and section 42 of the

pre-1997 Workers’ Compensation Act, as amended, provide that if a worker’s injury results in

permanent impairment, the worker is entitled to compensation for non-economic loss.

[93] “Impairment” means a physical or functional abnormality or loss (including

disfigurement) which results from an injury and any psychological damage arising from the

abnormality or loss. “Permanent impairment” means impairment that continues to exist after the

worker reaches maximum medical recovery.

[94] The worker testified that she has no ongoing impairment related to her toe and does not

receive any specific medical treatment for her toe. Our attention was not drawn to any medical

evidence supporting that the worker has a permanent impairment of the left toe resulting from

the workplace accident of August 29, 2002.


DISPOSITION

[95] The appeal is allowed in part as follows:

1. Entitlement is granted for a disablement soft tissue injury of the right upper extremity

(including the wrist, forearm, and shoulder) under Claim #2 (ARO DeRose,

March 18, 2014). The nature and duration of benefits flowing from this decision will be

returned to the WSIB for further adjudication, subject to the usual rights of appeal.

2. Initial entitlement is granted for a neck condition under Claim #4 (ARO Shepherd,

August 12, 2011). The nature and duration of benefits flowing from this decision will be

returned to the WSIB for further adjudication, subject to the usual rights of appeal.

3. Initial entitlement is granted on an aggravation basis for low back and upper torso pain

attributed to prolonged standing, under Claim #6 (ARO DeRose, March 19, 2014). The

nature and duration of benefits flowing from this decision will be returned to the WSIB

for further adjudication, subject to the usual rights of appeal.

4. Entitlement is granted for fibromyalgia and CPD under Claim #7, effective from 2002

(ARO Shepherd, August 12, 2011). The nature and duration of benefits flowing from

this decision will be returned to the WSIB for further adjudication, subject to the usual

rights of appeal.

5. Initial entitlement is denied for the low back and right shoulder under Claim #8

(ARO Shepherd, August 12, 2011).

6. The worker is granted LOE benefits from September 2002 to December 9, 2002, under

Claim #5 (ARO Shepherd, August 12, 2011).

7. Permanent impairment assessment for the left toe is denied under Claim #5

(ARO Shepherd, August 12, 2011).

DATED: March 11, 2015

SIGNED: R. McCutcheon, J. Blogg, A. Grande

WORKPLACE SAFETY AND INSURANCE

APPEALS TRIBUNAL

DECISION NO. 531/12

APPENDIX “A”

The Panel’s reasons for decision on preliminary issues raised by the

employer, as set out in a memorandum dated October 2, 2013

The purpose of this memorandum is to set out the Panel’s rulings on two issues, pending the

reconvened hearing of this appeal:

1. The jurisdictional argument raised by the employer's representative with respect to the

worker’s appeal from the decision of ARO D. DeRose, dated March 18, 2014;

2. The employer's representative’s comments regarding the worker’s capacity to represent

herself in this appeal.

The Panel has concluded as follows:

1. The Tribunal has jurisdiction to hear the worker’s appeal from the decision of

ARO D. DeRose, dated March 18, 2014, and there is no reason to decline to exercise that

jurisdiction;

2. There is no reason at this stage to make any inquiry into the worker’s capacity.

In reaching our conclusions, we have carefully considered the written submissions of

Mr. Boswell on behalf of the employer; Ms. Ostrom, Tribunal counsel; and [the worker], on her

own behalf. We will set out brief reasons for our decision in this memorandum.

1. The worker’s appeal from the decision of ARO DeRose March 18, 2014

Relevant background:

Decision of ARO P. Puhl December 2009

- In a decision dated December 14, 2009, ARO P. Puhl addressed the worker’s claim for

entitlement under [Claim #4].

- According to that decision, this claim was established when the worker completed a

Form 6 on September 29, 2000, for pain to every area of her upper body, which she

attributed to repetitive, heavy work. She indicated that she had reported the injury to the

employer on September 20, 1996.

- In that decision, ARO Puhl denied entitlement in the claim, finding that there was no

medical evidence of an impairment and no evidence of an accident by way of

disablement. The ARO found that the worker’s job duties were varied and not repetitive.


- The worker did not file an appeal to the Tribunal within the statutory time limit. The

worker’s application for an extension of the time limit was denied in

Decision No. 531/12E.

Decision of ARO D. DeRose, March 18, 2014

- This decision addressed the worker’s claim for a repetitive strain injury of the right upper

extremity under [Claim #2]. The worker reported a gradual onset of right

hand/arm/shoulder pain that she attributed to her job duties as a cashier.

- The date of accident was May 19, 1999, the date of first medical treatment. The

diagnosis was right wrist/thumb, forearm, and shoulder repetitive strain.

- ARO DeRose denied the worker’s appeal, finding that there was no proof the worker

spent prolonged periods performing cashier duties and there was a lack of a workplace

connection between the worker’s job duties and her upper extremity symptoms in 1999.

- Following the first day of hearing at the Tribunal, the employer's representative requested

that ARO De Rose reconsider the decision to take jurisdiction over the issue, arguing that

the substance of the matter had already been addressed by ARO Puhl. The ARO denied

the employer's representative’s reconsideration request.

The employer's representative’s submission is well-documented in the record. It is the

employer's representative’s position that ARO DeRose ought not to have taken jurisdiction over

the worker’s objection, arguing that it does not reflect a new decision when compared to the

decision of ARO Puhl. The employer's representative submits that it decides the same issue and

constitutes an abuse of process.

There are two sub-issues to consider: first, the Tribunal’s jurisdiction over the worker’s appeal

from the decision of ARO DeRose; secondly, whether the Tribunal ought to decline to exercise

its jurisdiction based upon a finding of abuse of process.

On the first issue, the Panel finds that the Tribunal has jurisdiction over the worker’s appeal from

the decision of ARO DeRose. The decision of ARO DeRose is a final decision of the WSIB and

the worker filed the appeal within the statutory time limit. Accordingly, the Tribunal has

jurisdiction over this appeal pursuant to section 123 of the WSIA. As noted by Tribunal counsel

in her written submission, the Tribunal has consistently held that the Tribunal does not have

jurisdiction over the WSIB’s process and procedure. The cases in which the Tribunal has looked

at the WSIB’s process in reaching a final decision involve situations in which precisely the same

issue had been determined by this Tribunal, the final level of appeal (for example,

Decision Nos. 1019/14I and 1928/03). In this case, while there may be some overlap between

the two decisions at issue, the nature of the claims are not the same; the Panel finds that the

Tribunal’s decision to deny the time extension request does not address identical issues to those

subsequently addressed by ARO DeRose. The time periods at issue were different and the areas

of injury were different.

The second issue is whether to the Tribunal ought to decline jurisdiction over the appeal on the

basis that it constitutes an abuse of process. The doctrine of abuse of process is applied to

preclude relitigation in circumstances where the strict requirements of issue estoppel are not met,

but where allowing the litigation to proceed would nonetheless violate such principles as judicial


economy, consistency, finality, and the integrity of the administration of justice (Toronto (City)

v. C.U.P.E. Local 79, [2003] 3 S.C.R. 77, per Arbour J. at paragraph 37).

As noted in Tribunal counsel’s submission, there are two preconditions to establish an abuse of

process:

1. The proceedings are oppressive or vexatious; and

2. It violates the fundamental principles of justice underlying the community’s sense of fair

play and decency.

In considering delay and abuse of process, it is necessary to consider the full context, including

the nature of the case, its complexity, the rights at stake, and the purpose and nature of the

proceedings. In this case, the Panel notes that the case has become complex over time and the

worker has a significant interest at stake. The Panel is not satisfied that prejudice to the

employer has been established that outweighs the worker’s interests at stake. The Tribunal’s

decisions have established a high threshold to dismiss matters for excessive delay outside of

circumstances where the statutory time limit has not been met. Although the events at issue in

this appeal did occur many years in the past, the delay is not unusually excessive when

considered in comparison to other appeals that come before the Tribunal. The worker did file an

appeal from ARO DeRose’s decision in a timely manner.

With regard to re-arguing the same issue, the Panel finds that the worker has not chosen an

improper method of relitigation. She has followed the route of appeal available to her at the

WSIB, pursuant to the claims established by the WSIB. As the employer's representative

pointed out, the worker suggested that the claims were related, but the WSIB determined that

separate claims were appropriate. This is not an uncommon situation; often the WSIB may

establish separate claims where either an employer or a worker may perceive that a new claim is

not required. Nevertheless, that should not deprive either party from pursuing legitimate avenues

of appeal that are available due to the WSIB’s adjudicative decisions to establish claims in a

certain manner. The Panel finds that it is not oppressive or vexatious for the worker to follow a

legitimate route of appeal created by the WSIB’s decision-making.

Turning then to the Tribunal’s jurisprudence, we note that it is rare for this Tribunal to decline

jurisdiction on the basis of an abuse of process. Decision No. 525/07 provides one such

example, but in that case, the worker had been given multiple opportunities to proceed with the

appeal, and had advised the Tribunal that he did not want to proceed with the appeal. We agree

with Tribunal counsel that the circumstances of this case are not analogous to

Decision No. 525/07. Weighing the relevant factors set out above, we find that it is preferable to

permit the worker’s appeal to proceed.

In summary, the Tribunal has jurisdiction to consider the worker’s appeal from the decision of

ARO D. DeRose dated March 18, 2014; the Panel will exercise that jurisdiction as we find that

an abuse of process has not been established.


2. The employer's representative’s comments regarding the worker’s capacity

The Panel finds that there is a lack of substantial evidence to support an inquiry into the worker’s

capacity to participate in this appeal. The fact that the employer's representative and the

employer find it “challenging” to deal with the worker is not sufficient. The first day of hearing

proceeded without any major difficulties. There is no medical evidence suggesting that the

worker lacks capacity. Tribunal counsel will be present at the reconvened hearing to provide

assistance as needed.

Please provide a copy of this memorandum to the parties. The hearing will reconvene for two

days of hearing as scheduled, in Hamilton.

Thank you for your assistance.

WORKPLACE SAFETY AND INSURANCE APPEALS ...wsiat.on.ca/decisions/2015/531 12.pdfREASONS (i)...

Documents

Transcript of WORKPLACE SAFETY AND INSURANCE APPEALS ...wsiat.on.ca/decisions/2015/531 12.pdfREASONS (i)...