Decision #83/99 - Type: Workers Compensation


An Appeal Panel hearing was held on January 22, 1999, at the request of a worker advisor, acting on behalf of the claimant. The Panel discussed this appeal on January 22, 1999, and May 18, 1999.


Whether the claim is acceptable; and

Whether the claimant is entitled to benefits.


That the claim is acceptable.


On August 26, 1997, the claimant submitted an application for compensation benefits as a result of her employment activities as a telecommunications operator. The claimant indicated that on or about April 4, 1997, she thought that the damage to her vocal cords was caused from a bout of laryngitis. She later found out that her vocal cords were damaged/aggravated from continuously using her voice due to occupational demands.

Initial medical reports indicate that the claimant was examined by a specialist on April 4, 1997. Subjectively, the claimant had a severe sore throat with major loss of voice. Objectively, the claimant had "sl fauces; TM ok; no midline tenderness". The diagnosis was chronic occupational laryngitis.

On May 21, 1997, an otolaryngologist reported that the claimant had been troubled by hoarseness for an extended period of time and required some time off work. The claimant was described as being markedly hoarse, a non-smoker, no good history of reflux, an asthmatic on a number of inhalers and a history of high blood pressure. Examination revealed markedly inflammed vocal cords with hyperemia and evidence of some fungal over growth.

On August 20, 1997, the otolaryngologist wrote to the Municipal Employees Benefits Board reporting that the claimant was still troubled by hoarseness and that her vocal quality was improving on rest. Work was believed to be aggravating the problem and the claimant was being referred to a speech pathologist for assessment, evaluation and treatment.

The case was reviewed by an Ear, Nose and Throat (ENT) medical advisor from the Workers Compensation Board (WCB) on October 17, 1997. The medical advisor was of the opinion that the diagnosis of the claimant's condition was laryngitis. It was felt that the claimant's condition was not directly related to employment but was aggravated by the continuous use of her voice as a telecommunications officer. With regard to pre-existing conditions, the medical advisor indicated the claimant was an asthmatic on steroid inhalers and that this can cause irritation of the vocal cords along with fungal infection. It was further noted that the claimant improved on medication which suggested the possibility of G.E. reflux but she had not been investigated for that condition.

On September 18, 1997, the family physician reported that the claimant was seen for laryngitis on February 17, April 4, April 8, April 15, May 1, and May 13, 1997.

On October 28, 1997, a WCB adjudication supervisor spoke with the ENT medical advisor regarding his comments of October 17, 1997. The medical advisor was asked whether there were any studies that supported the fact that workers who use their voice a lot were at a higher risk of developing laryngitis. The medical advisor responded that there were several studies which supported the fact that people who use their voice a lot for work are susceptible to laryngitis. This would include singers, teachers, telephone operators, etc. The common finding in all these cases, however, would suggest that the workers have developed vocal chord nodules which led to the largyngitis. The medical advisor commented that there was no evidence to support the fact that the worker had vocal chord nodules. As the chords were reported as being red this suggested they were inflamed. The medical advisor believed there was some other process at work and suggested that the most likely cause of the laryngitis was the worker's taking of inhaled steroids which can cause irritation of the vocal chords and result in fungal infection. The claimant's duties simply irritated the chords when they vibrate suggesting an aggravation.

On November 19, 1997, the claimant and employer were notified by Claims Services that the claim for compensation was not acceptable. Claims Services determined that the claimant's laryngitis condition was most likely related to inhaled steroids. It was therefore not substantiated that the claimant suffered a personal injury due to an accident arising out of and in the course of her employment.

A worker advisor appealed Claims Services decision on April 16, 1998. The worker advisor contended that the claimant's employment duties either caused her condition or exacerbated her pre-existing asthmatic condition to the point that she was disabled from work. A medical report dated March 25, 1998, was submitted in connection with the appeal.

On May 8, 1998, the Review Office determined that the claimant was not entitled to benefits for the effects of vocal cord damage about April 1997. According to Review Office, the medical evidence showed that the claimant's laryngitis and associated vocal cord damage more likely than not was a consequence of her pre-existing asthma and the related use of steroid inhalers. Systemic factors were more likely to contribute to the cause of the worker's problem than was the overuse of her vocal cords at work. Review Office noted the absence of vocal cord nodules which most often accompany laryngitis caused by excessive use of the vocal cords. Review Office found that the historical information in the case did not support a significant causal connection between the claimant's injury and the hazards of her employment.

The worker advisor appealed the Review Office's decision on October 15, 1998, and an Appeal Panel hearing was held on January 22, 1999.

Subsequent to the hearing, the Appeal Panel requested additional medical information prior to rendering a decision. On May 3, 1999, all parties were provided with the new and additional medical information which was obtained from three of the claimant's attending physicians, the treating speech pathologist and from the Municipal Employee Benefits Board. On May 18, 1999, the Panel met to render its final decision.


The issues in this appeal are whether or not the claim is acceptable and whether or not the claimant is entitled to benefits. The relevant subsections of The Workers Compensation Act (the Act) are subsections 1(1) which defines accident and 4(1) which provides for the payment of compensation benefits to a worker where he or she sustains personal injury by accident arising out of and in the course of employment.

In accordance with subsection 1(1) the panel must initially be satisfied that there has been an accident within the meaning of the Act.

Subsection 1(1) states:


1(1) In this Act, "accident" means a chance event occasioned by a physical or natural cause; and includes

    (a) a wilful and intentional act that is not the act of the worker,

    (b) any

      (i) event arising out of, and in the course of employment, or

      (ii) thing that is done and the doing of which arises out of, and in the course of employment, and

    (c) an occupational disease.

and as a result of which a worker is injured.

Subsection 4(1) states:

Compensation payable out of accident fund

4(1) Where , in any industry within the scope of this Part, personal injury by accident arising out of and in the course of employment is caused to a worker, compensation as provided by this Part shall be paid by the board out of the accident fund, subject to the following conditions.

Relevant Workers Compensation Board (WCB) Policies are Section 44.05, Arising Out of and in the Course of Employment and Section, Pre-Existing Conditions.

In determining this appeal, we reviewed all the evidence on file and given during the hearing process. We find that the weight of the evidence, on a balance of probabilities, supports a finding that a non specific accident as per sub clause 1(1)(b)(ii) of the Act occurred. We find that the claimant had a pre-existing condition which was aggravated by her employment activities which meets the requirements of WCB policy and therefore the claim is acceptable. In arriving at this conclusion we placed weight on the following evidence:

  • a progress note dated April 4, 1997 from an attending physician indicates that the claimant is a dispatcher who talks all day as part of her employment activities and makes a diagnosis of chronic occupational laryngitis;
  • the Employer's Report of Injury dated August 29, 1997 reveals that the claimant did not work from April 4, 1997 due to problems with her voice; that she was a telecommunications officer and that all related duties required the use of her voice;
  • a narrative report from an attending otolaryngologist dated May 21, 1997 indicates that the claimant is an asthmatic requiring a number of inhalers;
  • in a narrative report dated August 20, 1997 the attending otolaryngologist indicates that the claimant's work still seems to aggravate the problem;
  • in a WCB memorandum to file dated October 8, 1997 from adjudication to a WCB medical advisor, the WCB medical advisor diagnoses laryngitis and that the claimant has an asthmatic condition treated by steroid inhalers as a pre-existing condition and when asked if the claimant's diagnosis would be directly related to her employment activities responds:

    " Not directly related to employment but aggravated by continuous voice use as a telecommunications officer."

  • in a WCB memorandum to file dated October 28, 1997 from adjudication to a WCB ENT consultant, the consultant indicates that people who use their voice a lot are at a higher risk of laryngitis; a common finding is the development of vocal cord nodules and there was no evidence that the claimant had vocal cord nodules. He indicates that the claimant's problems were probably caused by the use of inhaled steroids. However, the ENT specialist further states:

    " The claimant's duties simply irritate the cords when they vibrate. This would be an aggrevation (sic)."

  • in a narrative report dated March 25, 1998 the attending otolaryngologist indicates that the claimant has chronic recurrent laryngitis, exacerbated by her employment at certain points and that the claimant has a pre-existing asthmatic condition requiring steroid inhalers which have also exacerbated the problem because of secondary fungal overgrowth. The otolaryngologist, when asked if the claimant's duties as a telecommunications officer contributed in a material way to the chronic laryngeal condition, further indicates:

    "It would appear that her work is an ongoing irritant and significantly contributes to her problem."

In summary, we find from the weight of the evidence that this claim is acceptable as an aggravation of a pre-existing asthmatic condition and the sequelae of its treatment with steroid inhalers which led to the development of fungal overgrowth and laryngitis. We find that the claimant's employment activities as a dispatcher requiring the constant use of her voice aggravated her laryngitis. We find that the claim is acceptable as outlined and therefore the claimant's appeal on this issue is allowed.

On the second issue as to whether or not the claimant is entitled to benefits and the duration of those benefits, taking into account all of the factors in this claim, we find that this issue has never been adjudicated at the initial level and therefore the file will be referred to the WCB for consideration and determination.

Panel Members

D. A. Vivian, Presiding Officer
A. Finkel, Commissioner
R. Frisken, Commissioner

Recording Secretary, B. Miller

D. A. Vivian - Presiding Officer
(on behalf of the panel)

Signed at Winnipeg this 1st day of June, 1999