The Appeal CommissionThe Workers Compensation Act of Manitoba

Preamble

The worker is appealing the decision made by the Workers Compensation Board ("WCB") that his claim was not acceptable. A hearing was held on March 15, 2018 to consider the worker's appeal.

Issue

Whether or not the claim is acceptable.

Decision

That the claim is not acceptable.

Background

The worker filed a Worker Incident Report on December 5, 2016, where he reported that he suffered from an incident of high blood pressure on October 19, 2016. The worker described the incident as follows:

My job is inside sales, working with clients.

We had a meeting regarding a client and how the business is doing.

During the meeting, I was asked details about things, what I did, how I did it, who I talked to. I was struggling to remember and was so stressed and sweating.

My blood pressure went so high I almost blacked out.

After that I noticed problems with speaking to clients and started to get things mixed up. This was not normal. I was afraid I might have had a stroke or something else wrong.

I went to the doctor.

The worker further reported that he believed "the way he was treated at the meeting caused him to have a stroke."

On October 24, 2016, the worker saw his family physician who noted that the worker's active problems were hypertension, diabetes and obesity. The physician set out the worker's complaints, in part, as "not feeling ok..., felt like slurring of speech, find difficultto (sic) get the word and speech…" Clinical findings included "not in acute distress, anxious, Speech - normal" and "BP [blood pressure] Left Arm Sitting: 180/100 Pulse 72." The physician provided a diagnosis of hypertension/slurring of speech, rule out transient ischemic attack, with the treatment plan being to send the worker to emergency and provide a sick note for one week.

Later that same day, the worker attended a hospital emergency department, where it was noted:

Patient sent in by family doctor to rule out TIA. Presents with 4/7 days of slurred speech and word finding difficulty. He denies H/A, N/V or focal unilateral neuro deficits. No fever, chills or sweats. He denies vision changes or double vision. He has no chest pain or SOB.

His main issue as per patient is he is having difficulty articulating and getting his words out.

A CT scan of the brain conducted on October 24, 2016 showed the following:

There is an ovoid area of decreased attenuation at the superior aspect of the left basal ganglia extending into the left frontal lobe white matter, in keeping with an acute area of infarction. There is no significant mass effect. There is no hemorrhage. Ventricles are normal in size. No other acute abnormalities identified.

The worker was provided with a referral to an outpatient stroke clinic.

On December 15, 2016, the worker's family physician provided the WCB with his complete charts for visits from December 2014 to November 2016, which were placed on the worker's claim file.

On February 1, 2017, a WCB medical advisor reviewed the worker's claim and opined, in part, as follows:

1. The diagnosis reported in an October 24, 2016 hospital discharge summary is acute stroke (in the left basal ganglia region of the brain). 

… 

3. Hospital and doctors reports have indicated that [the worker] has the following pre-existing risk factors for stroke: 

• Male sex 

• Hypertension 

• Diabetes 

• Smoker (quit 3 years ago) 

• Morbid obesity

The pre-existing risk factors are the dominant cause of his stroke. I am unable to establish a relationship between his workplace activities and the stroke.

4. The medical findings do not support total disability.

On February 13, 2017, Compensation Services advised the worker that his claim was not acceptable. Compensation Services found they were unable to establish that the worker's job duties were the dominant cause of his stroke. They noted that the worker's pre-existing conditions of cigarette smoking and past medical history of hypertension were considered risk factors for a stroke and would have had a combined causative effect. Based on these factors, Compensation Services was unable to establish a probable relationship between the worker's occupational exposure and the diagnosis of his stroke.

On February 17, 2017, the worker requested reconsideration of the WCB's decision by Review Office.

On March 10, 2017, Review Office determined that the worker's claim was not acceptable. Review Office found that although the worker reported he became symptomatic while at work, they were unable to establish that the dominant cause of his condition met the criteria of an accident as defined in The Workers Compensation Act (the "Act") and policies.

On March 25, 2017, the worker appealed the Review Office decision to the Appeal Commission, and an oral hearing was arranged.

Reasons

Applicable Legislation and Policy

The Appeal Commission and its panels are bound by the Act, regulations and policies of the WCB's Board of Directors.

Subsection 4(1) of the Act provides that where a worker suffers personal injury by accident arising out of and in the course of employment, compensation shall be paid to the worker.

"Accident" is defined in subsection 1(1) of the Act as follows:

"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.

"Occupational disease" is defined as follows:

"occupational disease" means a disease arising out of and in the course of employment and resulting from causes and conditions 

(a) peculiar to or characteristic of a particular trade or occupation; 

(b) peculiar to the particular employment; or 

(b.1) that trigger post-traumatic stress disorder; but does not include 

(c) an ordinary disease of life; and 

(d) stress, other than an acute reaction to a traumatic event.

WCB Policy 44.05, Arising Out of and in the Course of Employment, provides information on the interpretation of the phrase arising out of and in the course of employment, and states, in part:

Generally, an injury or illness is said to have "arisen out of employment" if the activity giving rise to it is causally connected to the employment -- that is, if it is caused by some hazard which results from the nature, conditions or obligations of the employment. To have occurred "in the course of employment," an injury or illness must have occurred within the time of employment, at a location where the worker may reasonably be, and while performing work duties or an activity incidental to employment.

A "pre-existing condition" is defined in WCB Policy 44.10.20.10, Pre-existing Conditions, as "a medical condition that existed prior to the compensable injury."

Worker's Position

The worker was self-represented. The worker made a presentation at the hearing and responded to questions from the panel.

The worker’s position was that his job and the environment in which he worked caused or contributed tremendously to his health issue.

He stated that he had worked in sales all his working life, and had never had problems like this. He started working for the employer at the beginning of June 2016 as an inside salesperson. This position was different from what he had done previously and was particularly difficult to do. He was required to sit down all day and conduct business over the phone, without the ability to stretch and relieve pressure.

The worker said that in the five or six months leading up to his injury, he was subjected to more and more pressure from management, which caused his blood pressure to keep going up and led to his stroke. He had to attend sales meetings every week with his manager, where he was pressured to remember details about clients, procedures and other things. The meeting on October 19, 2016 was the straw that broke the camel’s back. He felt that something was happening to him in that meeting, and he was basically not able to remember anything.

The worker did not agree that his stroke was caused by a pre-existing condition or conditions. He said that none of his symptoms were present prior to his injury. He had quit smoking three years earlier and had never been a heavy smoker. He did not agree that he was obese. He said that as a result of his injury, he is no longer able to work in his field. He cannot remember things, cannot communicate with clients and becomes exhausted quickly.

Employer's Position

The employer was represented by its Branch Manager, who advised that the employer supported the decision to deny the claim.

In response to questions from the panel, the employer's representative provided information with respect to the employer's business and operations, as well as the nature and expectations of the worker's position.

Analysis

The issue before the panel is claim acceptability. For the worker's appeal to be successful, the panel must find that the worker suffered an injury by accident arising out of and in the course of his employment. The panel is unable to make that finding, for the reasons that follow.

In order for a claim to be acceptable, the Act requires that an accident arises both "out of" and "in the course of" a worker's employment.

Based on the information which is before us, the panel accepts that the worker suffered a stroke and that this happened at work. The panel is therefore satisfied that the worker's injury arose in the course of his employment.

The panel is unable to find, however, that the worker's injury arose "out of" his employment.

The panel notes that the worker is attributing his stroke to the demands and duties of his job generally, with the meeting on October 19, 2016 having been the triggering incident or the "straw that broke the camel's back."

At the hearing, the panel carefully reviewed with the worker the nature of his job duties and activities over the course of his employment and on October 19, 2016.

The panel finds that there was no major confrontation or acute event on October 19, 2016 or any other date that would have caused or led to a stroke. The panel notes that in his evidence at the hearing, the worker described the sales meeting on October 19 as being "just our sales meeting that he conducted with me every week."

The panel is further unable to find any evidence that the conditions of the worker's employment caused or contributed to his injury or stroke, such as to fall within the definition of an "occupational disease" under the Act.

In this regard, the panel notes that the worker interpreted his difficulties with his blood pressure as a manifestation of his difficulties and stress with his work. The panel is unable to make that connection. The panel finds that medical information on file, including the worker's charts for two years prior to the event, show that the worker had a history of high blood pressure or hypertension which significantly pre-dated his employment with the employer and was being treated with medications. Medical reports further indicate that even though the worker was being monitored and counselled on his medications, both his hypertension and diabetes were suboptimal and uncontrolled.

The panel notes that there is no evidence on file from any medical practitioner stating that the worker's stroke was caused by his job or by an acute event at work. The panel also notes that there was no evidence to support an event that was significantly forceful as to cause a stroke from massive increase in blood pressure.

In summary, the panel finds that although the worker's injury arose in the course of his employment, it did not arise out of his employment, and the definition of an accident under the Act has therefore not been met. Accordingly, the worker's claim is not acceptable.   The worker's appeal is dismissed.

Panel Members

M. L. Harrison, Presiding Officer
A. Finkel, Commissioner
P. Walker, Commissioner

Recording Secretary, J. Lee

M. L. Harrison - Presiding Officer
(on behalf of the panel)

Signed at Winnipeg this 14th day of May, 2018