The Appeal CommissionThe Workers Compensation Act of Manitoba

Preamble

The worker is appealing the decision made by the Workers Compensation Board ("WCB") that they are not entitled to wage loss or medical aid benefits after February 28, 2025. A hearing was held by videoconference on May 26, 2025 to consider the worker's appeal.

Issue

Whether or not the worker is entitled to wage loss or medical aid benefits after February 28, 2025.

Decision

The worker is not entitled to wage loss or medical aid benefits after February 28, 2025.

Background

This claim has been the subject of a previous appeal. Please see Appeal Commission Decision No. 32/24, dated April 8, 2024. The background will therefore not be repeated in its entirety.

The worker has an accepted WCB claim for a psychological injury that occurred at work on July 29, 2022. The worker’s claim was initially denied by the WCB, however, pursuant to Appeal Commission Decision No. 32/24, that decision was overturned and the claim was accepted but a specific psychological diagnosis was not determined. The worker’s file was returned to the WCB’s Compensation Services for further adjudication.

On April 18, 2024, the WCB contacted the worker to gather further information. The WCB also spoke with the employer on April 25, 2024 and was provided with employment and wage information from both the employer and the worker’s subsequent employers. On April 29, 2024, the WCB provided the worker with wage loss benefits for the period of July 30, 2022 to August 20, 2022. The worker’s claim was accepted as an acute stress reaction. A May 1, 2024 report from the worker’s treating counsellor was received by the WCB on May 10, 2024. The report noted the worker had a pre-existing diagnosis dated April 4, 2022 of Post-Traumatic Stress Disorder (PTSD), and after a further assessment on September 27, 2023, met the criteria for Complex Post-Traumatic Stress Disorder. The counsellor noted the worker had contacted them after the July 29, 2022 workplace accident reporting symptoms of anxiety due to the accident and on February 1, 2023, was contacted by the worker again who reported trying to cope with their PTSD symptoms and anxiety but was having difficulties. Again, on March 15, 2023, the counsellor reported the worker contacted them due to their difficulties with PTSD symptoms and paranoia, which had been preventing them from leaving the house. The counsellor advised that the worker continued to report distress with their mental health and provided their prognosis being moderate if the worker continued to attend for treatment. As the WCB received further income information from the worker and the employer, wage loss benefits were paid to the worker.

The WCB referred the worker to a psychologist on August 19, 2024. A report from the worker’s appointment on that date was received by the WCB on October 15, 2024. The treating physician with a mental health program noted the worker had been referred due to reporting increased anxiety symptoms in addition to depressed mood. The physician further noted the worker was also experiencing “…significant preoccupation and rumination…” about their WCB claim, which was resulting in poor sleep. It was also noted that the worker reported longstanding paranoia with fears of being attacked by people from their former workplace or drug dealers living in their neighbourhood. The worker reported keeping a weapon close to their bedside as a result. The worker further indicated that they were unable to leave the house alone and only did so when accompanied by their spouse and at a time of day they would encounter fewer people outside. The treating physician recorded the medications the worker was taking, noting the worker acknowledged not taking their prescription medications consistently. The physician provided the worker had a history of PTSD, and presented with worsening anxiety symptoms, in the context of some ongoing stressful life events. The physician recommended the worker adhere fully to their medication “…for optimal response and improvement…” in symptoms. The physician again noted the worker’s paranoia was longstanding and “…felt to be more of ideations instead of a delusional belief, and may respond to constant reassurance at this time.” The physician noted that if the worker’s paranoid ideations worsened, a low dose of antipsychotic medication could be considered. The treating physician recommended supportive psychotherapy and cognitive behavioural therapy, in addition to learning problem solving and stress management skills.

At the request of the worker, the WCB referred the worker to a psychologist. Background information on the worker was provided to the psychologist by the WCB on November 6, 2024 and 4 treatment sessions were authorized. On November 7, 2024, the WCB received copies of chart notes from the worker's treating healthcare provider from August 9, 2022 to July 26, 2024. The notes indicated that the worker's reporting on symptoms of anxiety, poor sleep and other symptoms related to a non-compensable injury. The physician noted the worker was not compliant with taking their medications and had recommended different doses to help the worker with this issue. The WCB met with the worker and their counsellor on November 26, 2024, at which time the worker advised that they had attended 3 sessions with the psychologist and noted their belief that they found the sessions helpful. The worker advised the WCB they were providing permission to their counsellor to provide the treating psychologist with an assessment report from their previous psychologist. It was also noted that the worker’s treating physician had made some adjustments to their medications that appeared to be helping the worker. On December 10, 2024, the WCB received a copy of the April 23, 2024 assessment by the worker's previous psychologist. The assessment provided a diagnosis of Complex Post-Traumatic Stress Disorder (CPTSD) and Persistent Dehumanizing Trauma for the worker and noted the CPTSD appeared to have developed from the worker's exposure to traumatic events in childhood and throughout their adulthood, and the Persistent Dehumanizing Trauma developed from past and present chronic exposure to racialized trauma and prejudice. The assessment went on to list the worker's symptoms and recommend the worker remain off work and receive treatment. It was then recommended that return to work planning may be possible after the worker had an improvement in their symptoms, possibly after 6 to 8 weeks of treatment, with a slow, gradual return. A copy of the assessment was provided to the worker's treating psychologist on December 11, 2024.

The worker's treating psychologist provided their assessment to the WCB on December 12, 2024. The psychologist opined the worker had symptoms consistent with a diagnosis of Adjustment Disorder, with mixed anxiety and depressed mood, and noted the testing indicated the worker's scores measured "Extreme" for anxiety and depression. The psychologist further provided that due to the severity of the worker's symptoms, they were currently not fit to return to work. It was noted the worker had advised the psychologist they wished to continue treatment with their counsellor and would not be interested in further psychological treatment at this time.

The worker's file was reviewed by a WCB psychiatric consultant on February 10, 2025. The consultant provided a detailed review of the medical reports on the worker's file and opined the worker's diagnosis was Paranoid Personality Disorder, which was a longstanding pre-existing condition. In addition, the consultant provided there were no medications specifically for the diagnoses of Adjustment Disorder or Paranoid Personality Disorder and the worker's current medications were prescribed for their pre-existing, not related PTSD diagnosis. The WCB psychiatric consultant did make note of the report indicating the worker may benefit from the introduction of an antipsychotic medication in an attempt to manage their long standing and pre-existing paranoid ideations. With respect to treatment, the consultant indicated their belief that there was no treatment that would lead to a sustained improvement in function for the worker. It was noted the worker had a good relationship with their counsellor and would likely benefit from ongoing treatment with them. The consultant further noted that "…ongoing contact with WCB or WCB-related mental health providers would only serve to perpetuate paranoid ideations…and contribute to increased stress."

On February 14, 2025, the WCB advised the worker by way of a formal decision letter, their entitlement to wage loss and medical aid benefits would be ending on February 28, 2025, as it had been determined there was no evidence to support the July 29, 2022 workplace accident continued to aggravate their pre-existing mental health conditions. The worker requested reconsideration of the WCB's decision to the Review Office noting their treating healthcare providers all supported the workplace accident increased their PTSD symptoms, which they continued to suffer from and as such, they required further benefits.

The Review Office determined that the worker was not entitled to benefits after February 28, 2025 on April 1, 2025. The Review Office accepted and agreed with the opinion of the WCB psychiatric consultant and noted the worker's treating psychologist also supported the opinion the worker's ongoing difficulties are related to their pre-existing mental health difficulties and not the July 29, 2022 workplace accident. In addition, the Review Office found the worker was focused on issues and difficulties they perceived they were experiencing with the WCB and the management of their claim, which are not difficulties covered for compensation by the WCB.

The worker filed an appeal with the Appeal Commission on April 10, 2025 and a hearing was arranged.

Reasons

Applicable Legislation and Policy

The Appeal Commission and its panels are bound by the provisions of The Workers Compensation Act (the “Act”), regulations under the Act and the policies established by the WCB's Board of Directors. The provisions of the Act in effect as of the date of the worker’s accident apply.

Pursuant to Section 4(1) of the Act compensation is to be paid by the WCB where a worker has sustained personal injury by accident arising out of and in the course of employment. Section 4(2) outlines that a worker injured in an accident is entitled to wage loss benefits for the loss of earning capacity resulting from the accident. When the WCB determines that a worker has sustained a loss of earning capacity, an impairment or requires medical aid because of an accident, compensation is payable under Section 37 of the Act.

The Act provides at Section 27 that the WCB may provide any medical aid necessary or advisable to cure or give relief to the worker.

Section 39 of the Act sets out that wage loss benefits are payable until the worker's loss of earning capacity ends or the worker attains the age of 65 years.

Worker’s Position

The worker was present at the hearing and was supported by their spouse. The worker made an oral submission in support of their appeal and answered questions posed by members of the appeal panel.

The worker’s position is that the assessment completed by the WCB’s psychiatrist is not correct and should be given little weight by the panel as it was conducted improperly since it was done over the phone. The worker therefore states that the assessment, that the worker has Adjustment Disorder, is not accurate. The worker states that their pre-existing diagnosis of PTSD is accurate. The worker also argues that the opinion from the WCB’s psychiatrist was not reviewed by their treating psychiatrist.

The worker’s evidence is that they were the subject of very malicious gossip in their workplace and that this has caused embarrassment and hurt. The worker submits that this affected their PTSD symptoms. The worker states that the workplace injury has caused them to be isolated and has destroyed their confidence.

The worker is seeking that their entitlement to wage loss benefits and medical aid be extended after February 28, 2025.

Employer’s Position

The employer did not participate in the hearing.

Analysis

The question before the panel is whether or not the worker is entitled to wage loss benefits or medical aid after February 28, 2025. For the worker’s appeal to succeed, the panel would have to determine that the worker sustained a loss of earning capacity or continued to require medical aid after February 28, 2025 as a result of the injuries sustained in the workplace accident of July 29, 2022. As detailed in the reasons that follow, based on the evidence before the panel, we were unable to make such a finding and therefore, the worker’s appeal is denied.

The panel considered the evidence of the worker and the medical evidence on file and finds that there is no clinical evidence to support that the worker’s continued loss of earning or need for further medical aid is connected to the workplace incident.

The panel acknowledges that the worker continues to report feelings of embarrassment from the workplace incident, however the panel relies on the Healthcare Service Request of the WCB psychiatric consultant dated February 10, 2025 which outlines that the worker’s ongoing symptoms relate to the worker’s pre-existing paranoia and a tendency to hyper focus on an incident. The psychiatric consultant’s opinion is that ongoing contact with the WCB or WCB related mental health providers would only “serve to perpetuate paranoid ideations about the [incident] and contribute to increased stress”. The panel does not have evidence before it of the worker’s continued symptoms beyond February 28, 2024 in relation to the July 2022 incident, other than the evidence that the worker has concerns about how the file has been managed and feels they have been treated unfairly. The panel is of the view that any ongoing difficulties the worker is experiencing are a result of the worker’s longstanding pre-existing paranoid ideation.

Based on the evidence before the panel, and on the standard of a balance of probabilities, we are not satisfied that the worker sustained a loss of earning capacity or continued to require medical beyond February 28, 2025 as a result of the workplace incident on July 29, 2022. Therefore, the worker is not entitled to wage loss benefits beyond that date. The worker’s appeal is denied.

Panel Members

R. Lemieux Howard, Presiding Officer
J. Witiuk, Commissioner
P. Kraychuk, Commissioner

Recording Secretary, J. Lee

R. Lemieux Howard - Presiding Officer
(on behalf of the panel)

Signed at Winnipeg this 24th day of July, 2025