The Appeal CommissionThe Workers Compensation Act of Manitoba

Preamble

The worker appealed the Workers Compensation Board ("WCB") decision that they are not entitled to further benefits. A hearing took place on January 13, 2026 to consider the appeal.

Issue

Is the worker entitled to further benefits?

Decision

The worker is not entitled to further benefits.

Background

The employer submitted an Employer's Accident Report to the WCB on April 7, 2021, reporting the worker injured their head, neck, and right hip as the result of an incident that occurred on March 31, 2021 when the worker slipped and fell while walking down a set of stairs. The worker provided a Worker Incident Report to the WCB on April 9, 2021, outlining that they "…slipped on the steps and fell about 3 steps down onto laminate flooring" on March 31, 2021. The worker noted they believed their injuries were not "that bad" and described going to their office to drop off paperwork later the same day. The worker described that by the time they returned home, they felt "…a fullness in my head and I couldn't hear well with my left ear. I was also having vertigo. I was feeling nauseated and was dry heaving on April 2." The worker reported that they believed they did not hit their head but also indicated they found bruising on the right side of their head and right arm a few days later, with swelling at the base of their neck near their skull.

On April 1, 2021, the worker sought chiropractic treatment, reporting pain to their lower back and neck, ringing in their ear, vertigo, nausea, and head pressure/headache after falling down some stairs while working. The treating chiropractor found decreased cervical range of motion both globally and segmentally, with pain and decreased hearing in the left ear and diagnosed concussion, whiplash, and lumbar strain. The worker attended a local emergency department on April 2, 2021, reporting ringing and echoing in both ears, decreased balance, and hearing, with cervical spine tenderness from C2 to C6. The emergency room physician noted the worker may be experiencing symptoms related to their fall on March 31, 2021 and ordered a brain and cervical spine CT scan, which was taken April 3, 2021 and noted normal findings.

The worker saw their family physician on April 8, 2021, who diagnosed concussion and sensorineural hearing loss. The family physician noted decreased hearing on the left side, headache and soft tissue pain to the right arm and hip, and referred the worker to an Ear, Nose and Throat (ENT) specialist on an urgent basis, noting "Both tympanic membranes appear normal but hearing test indicative of severe sensorineural hearing loss. No sign of fracture." On April 8, 2021, the worker saw an audiologist for hearing testing which indicated hearing within normal limits on the right and moderately severe sensorineural hearing loss on the left. The audiologist noted the treating family physician had started the worker on a course of steroids for 5 days, beginning that day. The worker saw an ENT specialist on April 9, 2021 who found "The tympanic membrane, mesotympanic space, and external auditory canals are normal bilaterally" and recommended a steroid injection, performed that day. The specialist recommended follow-up in one week and a repeat audiogram in six months.

On April 12, 2021, the worked confirmed the details of their injury to the WCB, stating their belief they did not lose consciousness when they fell and could not recall hitting their head. The worker recalled driving to their office approximately 15 minutes after the incident, working there for two hours and then returning home. The worker noted they immediately felt pain to their right hip, and a few hours later, their left ear began to get muffled and feel “weird.” The next morning, the worker reported feeling vertigo, balance issues, ringing in both ears and a muffled, swelling feeling in their left ear. They described current symptoms of constant ringing in their right ear, no hearing in their left ear with ringing as well, dizziness, vertigo, intermittent nausea, and soreness in their head and neck. The worker advised they reported the injury to the employer the day after it occurred and completed an injury report on April 6, 2021. The WCB accepted the worker’s claim on April 13, 2021 and began providing benefits to the worker.

At follow-up on May 13, 2021, the treating family physician recorded the worker’s complaints of decreased hearing on the left side with constant ringing, vertigo and neck stiffness and pain with forward flexion and headaches exacerbated with screen time. On examining the worker, the physician found decreased range of motion in their neck, with testing indicating the worker was neurologically intact. The physician recommended the worker could return to work on May 17, 2021 at reduced hours. The employer confirmed the worker returned to work at reduced hours on May 17, 2021.

A WCB medical advisor reviewed the worker's file on May 26, 2021 and concluded that the worker did not sustain a concussion resulting from the accident, noting the initial diagnosis of a mild neck strain. The medical advisor noted recovery for such a strain typically occurred in a few days to a few weeks. On June 1, 2021, a WCB ENT specialist reviewed the worker's file and provided an opinion that "… the worker likely sustained a cochlear or inner ear concussion."

On June 8, 2021, at an initial physiotherapy assessment, the worker reported headaches, hearing loss, difficulty focusing, dizziness, pain to their right lateral head, behind their eyes and tightness to their neck bilaterally. The treating physiotherapist diagnosed a concussion and upper cervical strain and recommended ongoing treatment. On July 15, 2021, the treating physiotherapist advised the WCB physiotherapy consultant that the worker did not have “…true vestibular signs/symptoms and most of [the] findings are likely related to [their] neck.” The WCB consultant recommended holding off on vestibular treatments but approved twelve sessions of regular physiotherapy.

A September 15, 2021 MRI study of the worker's ear canals indicated normal findings. After following up with the worker on October 21, 2021, the treating ENT specialist noted the worker’s treatment and that the diagnostic imaging and testing indicated the worker’s hearing had returned to normal. The WCB received a discharge report from the treating physiotherapist on February 8, 2022.

On March 2, 2022, the WCB advised the worker as they had returned to their full regular duties and were no longer receiving treatment for their workplace injuries, their claim would be closed.

On August 28, 2024, the worker contacted the WCB, providing a detailed chronology of their difficulties and treatment since the claim closed in March 2022. The worker stated that approximately 6 months after the accident, they developed double vision, and their treating optometrist recommended waiting to see if it would resolve. The worker noted a referral to a neuro-ophthalmologist the previous year, with a follow-up referral in March 2024, due to their ongoing complaints. The worker also reported attending a local emergency department in April 2024, due to symptoms of double vision, dizziness, headache, sweating and feeling like they were going to pass out. They underwent a CT scan and again received a referral to neuro-ophthalmology. The worker requested the WCB provide further benefits.

The WCB obtained further medical reports from the treating healthcare providers, and a WCB medical advisor reviewed these along with the worker’s file on February 13, 2025. The medical advisor noted the WCB accepted the claim based on diagnoses of mild neck strain and cochlear concussion, and that the evidence indicated both injuries resolved by early 2022. The WCB medical advisor provided that the worker's current symptoms, including convergence insufficiency, were not related to the March 31, 2021 workplace accident. On February 27, 2025, the WCB advised the worker by letter that it determined their current difficulties were not medically related to the March 31, 2021 workplace accident and as such, they are not entitled to further benefits.

On March 10, 2025, the worker requested Review Office reconsider the WCB’s decision. In their submission, the worker noted their treating healthcare providers diagnosed post-concussion syndrome, which included diagnoses of convergence insufficiency and peripheral motion sensitivity and related the worker's symptoms to the workplace accident. On June 20, 2025, the employer provided a submission in support of the WCB’s decision, and the worker provided a further submission in response on June 23, 2025.

On June 25, 2025, Review Office determined the worker is not entitled to further benefits. The worker appealed that decision to the Appeal Commission on October 6, 2025 and a hearing was arranged. After the hearing, the panel requested additional medical information which it shared with the parties before meeting on April 28, 2026 to render its decision.

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 and WCB policies in effect as of the date accident apply.

A worker is entitled to benefits under s 4(1) of the Act when it is established that a worker sustained injury as a result of an accident at work. Under s 4(2), a worker injured in an accident is entitled to wage loss benefits for the loss of earning capacity resulting from the accident, but no wage loss benefits are payable where the injury does not result in a loss of earning capacity during any period after the day on which the accident happens. When a worker has a loss of earning capacity, an impairment or requires medical aid because of a workplace accident, compensation is payable under s 37 of the Act. Section 39(2) 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. Section 27 of the Act outlines 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 appeared in the hearing on their own behalf, offering testimony and making an oral submission, and provided a further submission in writing upon reviewing the additional information obtained by the appeal panel following the hearing.

The worker's position is that their current medical condition is the result of the injuries sustained in the workplace accident of March 31, 2021. The worker submits that as a result of that accident, they sustained a concussion and that their current diagnoses of post-concussion syndrome, convergence insufficiency and peripheral motion sensitivity is related to that injury. The worker relied on the reporting by the concussion clinic physician and the concussion clinic optometrist as supporting this position, noting that no other non-occupational cause explains their ongoing issues. The worker noted they did not experience their current symptoms, including double vision, headache, and dizziness, before the accident but that these symptoms have persisted after the accident. The worker confirmed that they have complied with all treatment recommendations from the various specialists seen and continue to have functional limitations in relation to their work.

The worker submits that considering the accepted claim, the absence of pre-injury symptoms, their continuous medical care, and ongoing diagnoses by their treatment providers, it is reasonable to conclude that their current condition is an ongoing result of the injury sustained in the workplace accident. For these reasons, the worker submits they are entitled to further benefits.

Employer's Position

The employer was represented in the appeal by its workers compensation coordinator. The employer representative made oral submissions in the hearing and provided a further written submission in response to the additional information obtained by the appeal panel following the hearing.

The employer's position is that the evidence does not support a finding that there is a causal relationship between the worker's current and ongoing medical condition and the injury they sustained on March 31, 2021. The employer representative noted the medical reporting following the injury indicates at that time the worker had no visual symptoms, was recovered from the neck strain injury, and had fully regained their hearing. The employer representative noted that the medical reporting indicated the worker developed double vision symptoms at least six months after the injury, or their post-accident return to work.

The employer representative reviewed the medical reporting in support of the employer's position and relied on the opinions provided by the WCB medical advisors, with respect to the lack of evidence that the worker sustained a concussion and with respect to the development of new symptoms more than six months after the accident occurred.

Analysis

The worker’s appeal requires the panel to consider if the worker is entitled to further benefits in relation to the workplace accident of March 31, 2021. For the appeal to succeed, the panel would have to find the worker continued to require medical aid or sustained a further loss of earning capacity as a result of the injuries sustained in that accident. As detailed in the reasons that follow, the panel did not make such findings and therefore the worker’s appeal is denied.

The worker's position is that they are entitled to further benefits because they continue to experience the effects and require treatment for the injuries sustained in the workplace accident. The panel therefore considered the medical reporting in relation to the injuries sustained by the worker in the accident and the treatment received. We noted the initial diagnosis by the emergency room physician of head injury with mild concussion, and the subsequent diagnosis by the treating family physician of concussion and sensorineural hearing loss. We further noted the diagnosis by the treating chiropractor of concussion, whiplash and lumbar strain. The panel noted the treating physiotherapist who treated the worker's neck strain over the course of more than six months, outlined in their discharge report of February 8, 2022 that the worker recovered satisfactorily and required only a home exercise program ongoing. The panel further noted the physiotherapist noted in their October 14, 2021 report that the worker had a "resolved concussion" and their reports also document an improvement in the worker's headache symptoms with treatment of their cervical spine. The panel also considered that the ENT specialist who treated the worker in relation to their cochlear concussion and related hearing loss reported in October 2021 that the worker's hearing indicated return to normal function. Based on this reporting, we are satisfied that the evidence confirms the worker recovered from these conditions by the time the WCB discontinued the worker's benefits in March 2022.

In relation to the worker's vision-related diagnoses, the panel considered that the first evidence of any visual-related symptoms is from early 2022, more than nine months after the accident occurred. On January 21, 2022, the treating optometrist noted the worker's report of vertical diplopia over the previous month. When the worker reported those symptoms continued, the optometrist initiated a referral to a concussion clinic, which confirms the worker "recently reports vertical diplopia within the last month". The panel noted that the initial assessment by the concussion clinic physician did not occur until June 2024 and resulted in a further assessment by a neuro-ophthalmologist which took place in August 2024. The panel also considered that these symptoms were not previously reported to any of the worker's treatment providers after the accident. The evidence confirms testing related to the worker's vision upon the initial emergency room visit of April 3, 2021, upon physiotherapy assessment on June 8, 2021 and again at physiotherapy on October 14, 2021, none of which indicate any visual concerns. The worker's own report to their treating optometrist indicated they began to experience symptoms in the month before January 21, 2022. As such, and despite the differing opinions offered by the concussion clinic treatment providers in 2024, the panel is unable to make a finding that these symptoms are related to the workplace accident. We find the appearance of visual symptoms some nine months after the accident to be too remote from the injury to suggest a causal relationship, particularly when coupled with medical reporting indicating resolution of the conditions that did arise soon after the accident.

The panel noted the worker's submission that in addition to the WCB accepted diagnoses of mild neck strain and cochlear (inner ear) concussion in relation to the accident, they also sustained a cerebral concussion. The file documents that the WCB did not accept this diagnosis, relying upon the opinion of the WCB medical advisor of May 26, 2021, and the opinion of the WCB sport medicine consultant of February 13, 2025. Having determined that the worker recovered from the accepted neck strain and cochlear concussion injuries, and that the onset of new visual symptoms is not related to the workplace accident, we are satisfied that even if the worker did sustain a cerebral concussion as a result of the accident, the evidence does not support a finding that the worker's current need for treatment and any related loss of earning capacity is a result of the workplace accident. Based on the totality of the evidence before us, and on the standard of a balance of probabilities, we are satisfied that the worker's need for treatment and related loss of earning capacity, if any, is not causally related to the injuries sustained in the workplace accident of March 31, 2021. Therefore, the worker is not entitled to further benefits and the appeal is denied.

Panel Members

K. Dyck, Presiding Officer
J. Peterson, Commissioner
M. Kernaghan, Commissioner

Recording Secretary, J. Lee

K. Dyck - Presiding Officer
(on behalf of the panel)

Signed at Winnipeg this 14th day of May, 2026