The Appeal CommissionThe Workers Compensation Act of Manitoba

Preamble

The worker filed an appeal with the Appeal Commissionstating that he disagreed with the decision made by the Workers Compensation Board ("WCB") that his current bilateralknee problems were not the result of his compensable accident.  A hearing was held on January 15, 2015via teleconference to consider the matter.  

Issue

Whether or not the worker is entitled to wage loss andmedical aid benefits.

Decision

That the worker is entitled to wage loss and medical aidbenefits.

Decision: Unanimous

Background

On February 5, 2014, the worker filed a claim with the WCB for injury to his knees that he related to a work incident that occurred on May 16, 2013. The worker described the incident as follows:

...I was walking up a set of concrete stairs...as I turned to go up the stairs, I rolled my ankle and came straight down landing on both of my knees. I fell about 2.5 feet...

The worker stated that he delayed in reporting the injury to the WCB as he hoped his knee condition would get better. When he returned to work after taking holidays during the summer months, both knees became aggravated and he sought medical attention in August 2013.

The Employer's Accident Report dated February 5, 2014 indicated that the worker injured his knees on May 16, 2013 while going up some steps. The worker advised the employer that "I rolled my ankle and came down on my knees on the edge of the concrete riser of the steps."

A Doctor First Report dated August 1, 2013 indicated that the worker injured his knees three months ago from "fall with weight on hands direct impact on both flexed knees on floor." An MRI was recommended to confirm a diagnosis. The MRI results are on file dated January 25, 2014 which showed bilateral menisci tears in both knees and a bone contusion of the posterior tibia in the right knee.

In a decision dated February 18, 2014, the WCB advised the worker that his claim had been denied as it was unable to establish a causal link between the medical attention he received on August 1, 2013 and the incident which occurred on May 16, 2013. It was noted in the decision that the WCB must have prompt medical information which validated the injury at the time of the incident and the only medical reports on the claim file were 60 days post incident.

On February 28, 2014, the worker filed an appeal with Review Office regarding the February 18, 2014 decision. The worker noted that he was injured at work and didn't realize how serious his injury was at the time. He said he made a doctor's appointment which ended up being rescheduled. When he finally saw the doctor, an MRI was suggested and the results confirmed damage to both knees.

On March 3, 2014, the employer provided Review Office with two witness statements along with an Incident Investigation Report related to the May 16 accident.

On March 4, 2014, Review Office determined that it was premature for it to consider the worker's appeal after a preliminary review of the file information. The case was referred back to initial adjudication to further investigate the claim.

Following a meeting with the worker on March 7, 2014, the WCB case manager accepted the worker's claim for contusions to his knees resulting from the May 16, 2013 accident. The case manager also determined that the worker was not entitled to wage loss or medical aid benefits as she was unable to establish a causal link between the MRI findings and the May 16, 2013 fall. On May 5, 2014, the worker appealed the decision to Review Office.

On July 11, 2014, Review Office determined that the worker was not entitled to wage loss or medical aid benefits. Review Office referred to the MRI findings of January 25, 2014 and stated that horizontal tears were generally considered degenerative in nature and not the result of a traumatic event. As such, Review Office felt that the file evidence did not support a causal relationship between the May 16, 2013 workplace incident and the worker's current bilateral knee difficulties. On November 8, 2014, the worker appealed Review Office's decision to the Appeal Commission and an oral hearing was held on January 15, 2015.

Following the hearing, the appeal panel requested medical chart notes from the clinic that the worker attended for treatment. The requested information was later received and was forwarded to the interested parties for comment, following which the panel met further to discuss the case and rendered its decision on the issue under appeal.

Reasons

Applicable Legislation

The Appeal Commission and its panels are bound by The Workers Compensation Act (the “Act”), regulations and policies of the Board of Directors.

The worker has an accepted claim for contusions to his knees resulting from a fall at work. He is seeking wage loss and medical aid benefits on this claim.

Under subsection 4(1) of the Act, where a worker suffers personal injury by accident arising out of and in the course of employment, compensation shall be paid to the worker by the WCB. Subsection 39(1) of the Act provides that wage loss benefits will be paid: “…where an injury to a worker results in a loss of earning capacity…” Subsection 39(2) of the Act provides that the WCB will pay wage loss benefits until such a time as the worker’s loss of earning capacity ends, or the worker attains the age of 65 years. Subsection 27(1) of the Act provides that the WCB "...may provide a worker with such medical aid as the board considers necessary to cure and provide relief from an injury resulting from an accident."

Worker's Position

The worker was self-represented. He explained his reasons for appealing and answered questions from the panel.

The worker advised that he was injured on the job when he fell at work. He said "... when I did injure myself, it was, I fell in an awkward way. It was very fast. I rolled my ankle, and I came down, it just happened so quickly."

In answer to questions about the fall the worker advised that:

· "I was proceeding to go up to the stairs. I was turning left to go up the set of stairs, and I rolled my ankle."

· "And I just turned, I was just turning left to go up the set of stairs, and that’s when I rolled my ankle, and I came down on both of my knees, right on the edge of the riser...

· "... I was turning left, so all my weight was basically, my first step was my right ankle onto the first step. And then, as I lifted up my second, my left foot, and that’s when my ankle rolled, and I came down on the riser of the next step with both my knees."

· his knees hit right on the edge of the riser, on raw concrete.

The worker advised that he does a lot of walking and that his work is very physical. After the injury he was very limited in his knee motions. He was scared of walking on a decline. He advised that he missed very little work and said that "...I plugged through, pushed through..." He advised that he was assigned a different job which was less strenuous physically. He also advised that he did not seek medical attention immediately because he thought his condition would improve and that it takes time to get medical attention in his community.

The worker advised that he was referred to an orthopedic surgeon, had surgery to both knees and is recovering well.

Employer's Position

The employer was represented by its Safe Operations Manager. The employer representative advised the employer does not question that the incident occurred. She advised that there was a witness who saw the worker after the incident. She also said the supervisor confirmed that something happened. She advised that the employer supports the worker's appeal.

With respect to medical treatment, she noted that the worker did not get the treatment injured workers usually get and he had to navigate the public system.

Analysis

The worker is appealing the WCB decision that he is not entitled to wage loss and medical aid benefits. For the worker's appeal to be successful, the panel must find that the worker sustained a loss of earning capacity and required medical aid as a result of the workplace injury. The panel was able to make this finding.

The panel finds that when the worker fell at work on May 16, 2013 he injured his knees and enhanced his pre-existing degenerative condition. In this regard, the panel notes that the MRI, clinical findings and operative report note the presence of a combination of acute and degenerative tears to the menisci of both knees. In reviewing the mechanism of injury, the worker's body was rotating to the left as he turned to go up the stairs. This rotation would have led his upper body (above the knees) to continue to rotate during the fall and after his knees contacted the stairs, this would have resulted in rotational forces to both knees that are consistent with meniscal injuries, especially in the presence of pre-existing meniscal tears. Accordingly, the panel finds that the worker sustained an acute injury and that the surgery was required as a result of the fall and enhancement of his pre-existing meniscal condition.

With respect to the condition of the worker's knees, the panel finds that the worker had significant degeneration prior to the fall but that the fall enhanced his condition requiring the surgery. The evidence noted in the surgery report suggests both acute and degenerative conditions.

The panel accepts the worker's and employer's representative's evidence that the worker was able to perform his regular duties without problems prior to the injury but could not continue after the injury. The loss in functionality is evidence of the extent of the injury caused by the accident which was more than simple contusions to the worker's knees.

The worker's appeal is approved.

Panel Members

A. Scramstad, Presiding Officer
A. Finkel, Commissioner
P. Walker, Commissioner

Recording Secretary, B. Kosc

A. Scramstad - Presiding Officer

Signed at Winnipeg this 12th day of March, 2015