Decision #190/06 - Type: Workers Compensation

Preamble

This case deals with the relationship between the worker’s mental health problems and her workplace injury. The worker sustained a lower back injury and received benefits from the Workers Compensation Board (WCB). While recovering from this injury, she developed mental health problems. The WCB declined to pay for the worker’s psychotherapy treatments which were considered to be unrelated to the workplace injury. The worker appealed this determination.

A file review was held on October 11, 2006, at the worker’s request.

Issue

Whether or not the worker’s mental health problems, diagnosed as Panic Disorder and depressive features, are related to the compensable injury; and

Whether or not the worker is entitled to costs associated with psychotherapy treatment.

Decision

That the worker’s mental health problems, diagnosed as Panic Disorder and depressive features, are not related to the compensable injury; and

That the worker is not entitled to costs associated with psychotherapy treatment.

Decision: Unanimous

Background

During the course of her employment as a support worker on March 28, 2004, the worker injured her lower back region when she “yanked” to remove an area rug that became stuck in the vacuum cleaner she was using. At the time of the incident, the worker was in her first trimester of pregnancy.

During a discussion about a future return to work with the accident employer, the worker told her WCB case manager on May 12, 2004 that she was concerned about her pregnancy and the possibility of being assaulted in the workplace as this was a common occurrence.

On May 27, 2004, it was determined that the worker was capable of performing modified duties with restrictions starting at four hours per day where she would work as an extra person on shift. On June 4, 2004, the worker was provided with details of her return to work program that was to commence on June 4, 2004.

On June 7, 2004, the worker advised her WCB case manager that she returned to work as scheduled but experienced pain radiating down her leg. She also expressed concerns with the home setting and of a boy in the home that was considered to be violent.

The treating chiropractor told a WCB case management representative on June 8, 2004 that the worker was upset that her employer had placed her into a situation that was not safe and that she was not an extra person as was previously promised. The chiropractor noted that the worker’s back symptoms and findings were slightly flared but not significantly. He felt the worker could continue to participate with the return to work program once some of the return to work issues had been worked out.

On June 16, 2004, the worker was diagnosed with anxiety by her treating physician. She reported that the worker had low back pain and was feeling stressed. The worker was developing anxiety because of problems she had with communicating with her employer about suitable alternate duties. The physician commented that the worker was not able to handle her job because of the bending and was concerned that her unborn child might be at risk with possible exposure to physical violence at work.

A report was received from the treating physician dated October 7, 2005 which stated that the worker was being referred to a psychologist for treatment. It was noted that the worker had been willing to return to work on a part-time basis and she had a meeting with her employer requesting a safe environment due to her pregnancy. The worker felt there was a big risk of her being injured by the clients that she worked with. “As a result of the fear and difficulties communicating with her manager she developed severe anxiety and panic symptoms.” The physician concluded that the worker had not yet recovered from her back injury and that she required further treatment.

A report was received from the clinical psychologist dated February 16, 2006. The psychologist outlined her opinion that the worker’s disabling symptoms included chronic pain with some somatic discomfort and panic disorder. The worker’s panic episodes seemed to be situationally triggered and directly related to the work milieu, high risk and volatility.

A WCB psychiatric consultant reviewed the file information on April 3, 2006 and outlined her view that the worker’s anxiety was related to workplace issues and was not directly related to her compensable injury. She noted that the clinical psychologist on February 16, 2006 indicated a strong situational component to panic attacks. She stated that her diagnosis may have been adjustment disorder. Overall, the consultant thought that the worker’s psychological difficulties appeared to be multifactorial.

On April 11, 2006, the worker was advised by the WCB that the treatments provided by her clinical psychologist and her probable diagnosis was not, on a balance of probabilities, related to her compensable low back injury of March 28, 2004. In May 2006, the worker appealed the decision to Review Office.

In a May 19, 2006, decision, Review Office determined that the worker’s mental health problems, diagnosed as panic disorder and depressive features were not related to her compensable injury and that there was no entitlement to costs associated with psychotherapy treatment. Review Office accepted that the worker was frustrated in part, with circumstances around the return to work process regarding safety concerns, shifts, workplace issues, etc. and frustrations with continuous pain and finances. It felt that the worker’s response to these stressors was not a direct result of her compensable accident of ‘pulling a rug out from a vacuum’ but rather the result of ensuing events. It also accepted the WCB psychiatric consultant’s opinion that the worker’s diagnosis may have been an adjustment disorder and that her psychological problems were multifactorial. In June 2006, the worker appealed Review Office’s decision and a file review was arranged.

Reasons

Applicable Legislation

Subsection 60(2) of The Workers Compensation Act (the Act) provides that the WCB has exclusive jurisdiction to determine certain matters that are at the root of a workers compensation claim. This includes the authority under paragraphs (a) and (b) to determine whether an injury is caused by an accident and whether it arose out of or in the course of the worker’s employment. Subsection 60.8(2) provides that the Appeal Commission has all the powers conferred on the WCB under subsection 60(2). In relation to this appeal, these sections provide the Appeal Commission with authority to determine if the mental health problems are causally related to the workplace injury.

Where there is a compensable workplace injury, subsection 27(1) provides the WCB with authority to pay for medical expenses it considers necessary to cure and provide relief from a workplace injury.

Worker’s Position

In the worker’s application for appeal and attached letter dated June 20, 2006, the worker disputed the WCB conclusion that her anxiety was due to her reaction to the process and not related to the injury. She noted the following three topics were discussed prevalently during her psychotherapy sessions:

  1. Pain caused by workplace injury
  2. Financial burden of paying costs and going on maternity leave
  3. Anxiety that her back injury would not heal and concern about how she would look after her child with an injured back

The worker submitted that she did not have problems coping during the eight years of employment she had before the workplace injury and that her injury was the cause of her problems.

Analysis

The issues before the panel deal with the worker’s mental health problems that arose while the worker was recovering from her workplace injury. For the appeal to be successful, the panel must find that the mental health problems resulted from the workplace injury. The panel was not able to make this finding.

The panel has reviewed the claim file including medical information, considered the evidence and argument submitted by the worker, and finds, on a balance of probabilities, that the worker’s mental health problems, diagnosed as panic disorder and depressive features, did not result from the compensable injury and are not related to the injury.

In making this decision the panel places significant weight on the April 3, 2006 opinion of the WCB psychiatric consultant who reviewed the file and concluded that the worker’s anxiety appeared related to workplace issues and was not directly related to the workplace accident. The consultant commented further that the worker’s psychological difficulties appeared to be multifactoral.

As noted in the background, the reports of the worker’s treating physician and psychologist confirm the array of concerns identified by the worker which were causing stress and anxiety. Although pain from the back injury is noted, the reports identify many other factors which are not related to the workplace injury. The panel finds this supports the conclusion that the worker’s mental health problems did not, on a balance of probabilities, result from the workplace injury.

Given the panel’s findings on the first issue, the panel finds there is no entitlement to costs associated with the psychotherapy treatment.

The appeal is declined.

Panel Members

A. Scramstad, Presiding Officer
A. Finkel, Commissioner
M. Day, Commissioner

Recording Secretary, B. Kosc

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

Signed at Winnipeg this 29th day of November, 2006

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