Decision No.: 2020-0274  
Page 1  
Appeals Commission for Alberta Workers’ Compensation  
Docket No.: AC0341-19-5  
Decision No.: 2020-0274  
Introduction  
[1]  
The worker appeals a February 15, 2019 Workers’ Compensation Board (WCB)  
Dispute Resolution and Decision Review Body (DRDRB) decision, which  
determined that WCB did not have additional responsibility for chronic pain or  
chronic pain syndrome on the worker’s claim under WCB Policy 03-01, Part II,  
Application 7.  
[2]  
[3]  
The worker filed her appeal within established time limits and elected to participate  
by way of documentary hearing. Notice of the appeal was provided to the employer  
and WCB, who did not respond, nor participate in the hearing.  
The worker’s representative (the representative) provided written submissions in  
support of the appeal and Appeals Commission decisions on the interpretation of  
the phrase “impaired earning capacity” within the context of WCB Policy 03-01, Part  
II, Application 7.  
Preliminary Matters  
Additional Documents and Issue of Appeal  
On May 27, 2020, the representative submitted:  
[4]  
[5]  
an Additional Documents List with 10 attachments (22 pages), and  
additional written submissions (15 pages).  
The panel noted the representative’s request in the additional written submissions,  
that an issue of appeal be added, specifically: “Should WCB arrange for a marked  
life disruption assessment?”. This was not an issue per se decided upon by the  
WCB/DRDRB and properly appealed to the Appeals Commission. The panel  
considered the marked life disruption provision in its analysis of WCB Policy criteria,  
not as a separate issue of appeal, and addressed this under Evidentiary Findings  
and Reasons.  
[6]  
The single issue of appeal appropriately before the Appeals Commission is stated  
below.  
Classification: Protected A  
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Subsequent Matters  
Medical Reporting and the Issue of Appeal  
[7]  
By letter dated June 30, 2020 this panel directed the WCB/DRDRB to further  
investigate the matter of Chronic Pain/Chronic Pain Syndrome, pursuant to the  
Workers’ Compensation Act, RSA 2000, c W15 (WCA) section 13.2(6)(f).  
Specifically, there was insufficient information to determine:  
whether the worker’s complaints of pain and pain behaviour with respect to her  
compensable injuries were consistent with organic findings;  
whether there was a psychological/psychiatric basis for the worker’s pain;  
if the worker’s pain was inconsistent with organic findings and there was no  
psychological/psychiatric basis for the worker’s pain, whether the weight of  
evidence satisfied the remaining criteria in WCB Policy 03-01, Part II,  
Application 7.  
[8]  
The panel requested reported findings, in the form of a Comprehensive  
Psychological Assessment (CPA) and Independent Medical Examinations (IMEs)  
from a Psychologist, Psychiatrist, Orthopedic Specialist, and a Neurologist, on the  
following:  
the worker’s diagnosis(es);  
whether the confirmed diagnosis(es) was attributable to the worker’s May 17,  
2013 accident and/or associated surgeries; and  
whether the worker’s complaints of pain and pain behaviours were attributable  
to a psychiatric diagnosis; or  
whether the worker’s complaints of pain and pain behaviours were completely  
consistent with organic findings as defined in WCB Policy.  
[9]  
The CPA, 3 IMEs, updated Magnetic Resonance Imaging (MRI) scan and  
Electromyography (EMG) conducted over the period July 2020 to April 2022,  
resulted in the following reports returned directly to this panel for consideration:  
[9.1]  
[9.2]  
[9.3]  
[9.4]  
[9.5]  
[9.6]  
November 24, 2020, CPA Report;  
December 6, 2021, Psychiatric IME Report;  
December 6, 2021, Orthopedic IME Report;  
December 6, 2021, Neurology (IME) Report;  
January 25, 2022, requisition for EMG studies and MRI;  
February 12, 2022, Neurology IME Addendum Report following updated  
EMG studies and MRI.  
Classification: Protected A  
Decision No.: 2020-0274  
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[10]  
The representative provided further written submissions on February 11 and  
April 21, 2022, in response to the medical evidence and criteria specific to the issue  
of appeal.  
[11]  
[12]  
The panel reconvened on May 18, 2022 to finalize its decision.  
The single issue of appeal appropriately before the Appeals Commission is whether  
the worker has an acceptable claim for chronic pain or chronic pain syndrome  
under WCB Policy 03-01, Part II, Application 7. The panel notes the WCB/DRDRB  
posed several additional questions to the CPA and 3 IME physicians separate and  
apart from those directed by this panel and also introduced the issue of the  
worker’s fitness for work. The panel must determine the relevance and weight  
attributable to the medical evidence received. Given the issue of fitness for work is  
not before us, we make no findings with respect to this or any issue(s) beyond the  
single issue set out in this decision.  
Issue  
[13]  
Does the Workers’ Compensation Board have additional responsibility for  
Chronic Pain or for Chronic Pain Syndrome in accordance with WCB Policy  
03-01, Part II, Application 7?  
Analysis  
Legislation and Policy  
[14]  
[15]  
[16]  
In deciding this appeal, the panel considered:  
The WCA, sections 1(1)(a), 13.1(1), 13.2(6), 24(1);  
WCB Policies 02-01, Part II, Application 7; 03-01, Part I, Part II, Application 1  
and 7 (Issue date August 26, 2015).  
Excerpts of the applicable WCA sections and WCB Policies appear in Appendix “A”  
and “B”. The panel is bound by the WCB Policies in effect at the time of the  
February 7, 2018 WCB decision.  
Background and Questions to be Answered  
It is undisputed that:  
[16.1]  
The worker, a mine equipment operator, injured her left elbow in the course  
of her work duties for the employer on May 17, 2013.  
[16.2]  
WCB accepted the following injuries and surgeries on the worker’s claim:  
left elbow avulsion fracture,  
left tricep tear,  
Classification: Protected A  
Decision No.: 2020-0274  
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left cubital tunnel syndrome,  
left upper extremity skin infection, and  
surgical procedures completed on:  
o October 24, 2013 (arthroscopic debridement of the left elbow,  
olecranon bursectomy, tricep debridement and repair);  
o January 23, 2015 (left submuscular anterior ulnar nerve  
transposition for the postoperative diagnosis of left cubital tunnel  
syndrome);  
o February 12, 2016 (neurolysis ulnar nerve from submuscular  
position and transposition to a subcutaneous position).  
[16.3]  
WCB determined the worker had permanent work restrictions and was  
assessed with a 5.5% Permanent Clinical Impairment (PCI) (May 18 and  
November 14, 2018).  
[17]  
[18]  
The DRDRB’s February 15, 2019 decision upheld the WCB Case Manager’s  
February 7, 2018 denial of additional responsibility for chronic pain or chronic pain  
syndrome on the claim under WCB Policy 03-01, Part II, Application 7. The worker  
appealed.  
By letter dated June 30, 2020 this panel directed the WCB/DRDRB to further  
investigate whether the worker’s complaints of pain and pain behaviours were  
inconsistent with organic findings. We made initial findings (discussed below) that  
the weight of medical and other evidence supported that the worker’s:  
pain and related symptoms developed as a consequence of a compensable  
injury and/or surgeries,  
pain persisted beyond the usual healing time for the injury, and  
pain impaired her earning capacity.  
[19]  
To decide the issue of appeal, the panel must determine if the worker meets the  
criteria pursuant to WCB Policy 03-01, Part II, Application 7:  
for entitlement to treatment of chronic pain:  
o has pain and related symptoms developed as a consequence of a  
compensable injury or condition?  
o has the pain persisted beyond the usual healing time for the injury?  
o are complaints of pain and pain behaviours inconsistent with organic  
findings?  
Classification: Protected A  
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o has pain impaired earning capacity?  
for acceptance of chronic pain syndrome as compensable on the claim:  
o have all physical medical investigations and rehabilitation treatments  
been concluded?  
o has pain resulted in marked life disruption?  
o has pain and related symptoms developed as a consequence of a  
compensable injury or condition?  
o has the pain persisted for six months or more beyond the usual healing  
time for the injury?  
o are complaints of pain and pain behaviours inconsistent with organic  
findings?  
o has pain impaired earning capacity?  
Key Submissions  
The Worker’s Representative  
[20]  
The representative filed written submissions along with the Notice of Appeal on  
October 2, 2019, and additional written submissions on May 27, 2020, February 11  
and April 21, 2022. The written submissions are not repeated here in their entirety.  
Key submissions relevant to the issue of appeal are summarized as follows:  
[20.1]  
The worker seeks additional entitlement for chronic pain and chronic pain  
syndrome as compensable on the claim, given she meets all WCB Policy  
03-01, Part II, Application 7, criteria.  
The worker’s pain and related symptoms developed as a consequence of  
a compensable injury or condition  
[20.2]  
[20.3]  
The worker, a mine equipment operator, suffered an avulsion fracture and  
other injuries when she hit her left elbow on a broken arm rest (exposed  
wood, bolt) in the truck she was driving. She had no prior left elbow injury or  
pain condition, which was confirmed by a consulting Neurologist who noted  
no “Past Medical History”.  
The weight of medical reporting by treating and consulting physicians  
confirmed the worker’s presentation was valid and provided a chronic pain  
diagnosis as a result of her compensable left elbow work related  
injury/accident and/or surgeries. No other intervening cause or event was  
identified.  
Classification: Protected A  
Decision No.: 2020-0274  
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[20.4]  
[20.5]  
A WCB Medical Consultant recommended that the worker undergo an IME  
to determine if she had developed chronic pain.  
The May 9 and June 30, 2017 reporting by WCB referred Neurologist,  
Orthopedic Specialist, and Neuropsychologist indicated invalid  
examination(s), or inability to confirm chronic pain/chronic pain syndrome.  
The worker argues a finding of chronic pain/chronic pain syndrome given  
they offered no definitive organic explanation for her left elbow complaints of  
pain and pain behavior, or alternatively that no weight be given to their  
opinion(s) as it was outside their area of expertise.  
[20.6]  
The worker relies upon the CPA and IMEs directed by the Appeals  
Commission. The CPA and IME reporting confirms the worker’s  
presentation was valid. In particular, the worker relies upon the IME  
Neurologist as the most qualified to diagnose and treat chronic pain and who  
opined in the December 6, 2021 Report and February 12, 2022 Addendum  
Report that the worker satisfied the criteria for chronic pain/chronic pain  
syndrome.  
[20.7]  
The IME Neurologist relied upon MRI and EMG studies and stated in the  
February 12, 2022 Addendum:  
the January 25, 2022 MRI of the left elbow showed:  
o previous anterior transposition of the ulnar nerve that is stable  
with no new mass, thickening, or inflammation;  
o stable intact tricep tendon repair;  
o resolution of previously noted mild bone marrow edema within the  
radial head. A cluster of new tiny sub-1cm anterior subchondral  
cysts are likely related to remote micro-trauma;  
o new mild joint effusion.  
upon review of the January 25, 2022 EMG study, that his original  
recommendations and diagnosis had not changed. Specifically, “In my  
view, [the worker] fulfills criteria for the WCB definition of chronic pain  
syndrome,” in that:  
o her pain resulted from a workplace injury;  
o her pain persisted beyond the usual healing time for the injury;  
o there were no clear organic findings to explain the worker’s  
elbow pain, the worker’s pain was not “completely  
consistent with organic findings”;  
Classification: Protected A  
Decision No.: 2020-0274  
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o her pain clearly impaired her earnings.  
The worker’s pain persisted beyond the usual healing time for the injury  
[20.8]  
[20.9]  
The worker experienced continuous left elbow pain, swelling and numbness  
following the 2013 work place accident/injury and the 2013, 2015 and 2016  
corrective surgeries (left elbow debridement, olecranon bursectomy, tricep  
tear repair, ulnar nerve transposition, etc.).  
WCB’s Disability Duration Guidelines stated that a reasonable period of  
recovery for an upper extremity fracture was several weeks. The worker  
sustained a permanent injury. Her left elbow pain symptoms and permanent  
restrictions were a consequence of the work place accident/injury. They  
persisted for years beyond the usual healing time.  
[20.10] Medical reporting by treating and consulting physicians showed that the  
worker’s pain had persisted beyond the usual healing time. This was also  
confirmed by a WCB Medical Consultant.  
The worker’s complaints of pain and pain behaviour were inconsistent with  
organic findings  
[20.11] The weight of medical opinion, from treating and consulting physicians,  
supports that there was no organic explanation for the worker’s complaints  
of left elbow pain and pain behaviour.  
[20.12] The worker’s chronic elbow pain commenced after the work related accident  
and has continued uninterrupted since then.  
[20.13] The treating Orthopedic Surgeons were uncertain as to why the worker had  
not improved following surgery (2013 to 2016). They could not explain the  
worker’s symptoms and ongoing restrictions from an organic standpoint.  
They were unable to offer any additional treatment or further surgical  
intervention to assist the worker with chronic and significant left elbow pain  
and swelling.  
[20.14] A consulting Neurologist assessed the worker’s ulnar nerve function (EMG  
studies) on December 9, 2015 and diagnosed post traumatic left elbow pain  
with no clinical or electrophysiological evidence of ulnar nerve dysfunction  
(ulnar neuropathy).  
[20.15] An IME/PCI Orthopedic Surgeon described ongoing ulnar nerve irritation,  
but was unable to explain what caused the worker’s left elbow pain  
symptoms.  
Classification: Protected A  
Decision No.: 2020-0274  
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[20.16] The weight of medical reporting (CPA, IMEs) directed by the Appeals  
Commission could not explain the worker’s symptoms and ongoing  
restrictions from an organic standpoint.  
The worker’s pain impaired her earning capacity  
[20.17] Due to permanent work restrictions and pain limitations, the worker was  
unable to resume pre-accident employment and earn a pre-accident living.  
The financial impact on the worker was significant.  
[20.18] The worker’s treating Orthopedic Surgeons, who performed three surgeries  
and provided follow-up care, stated that the worker’s left elbow restrictions  
were permanent. The worker’s Family Physicians requested that WCB  
assess the worker for permanent impairment and reported that the worker  
was unable to work due to chronic pain.  
[20.19] The WCB/DRDRB concluded the worker did not meet Policy 03-01, Part II,  
Application 7 criteria, on the basis that she was not totally unemployable as  
a result of chronic pain. The worker disputes the WCB/DRDRB’s  
interpretation of the phrase “pain impairs earning capacity” to mean that the  
worker must be totally disabled/unemployable as a result of chronic pain.  
[20.20] The worker relies upon several Appeals Commission decisions (2008-610,  
2012-83, 2015-0445, 2015-0623, 2017-0047, 2011-030, 2009-729), which  
interpreted “pain impairs earning capacity” to mean that the pain need only  
diminish the worker’s earning capacity or reduce the worker’s earning  
capacity from pre-accident levels. Where the worker’s earning capacity had  
been impaired or diminished by the work accident and chronic pain, the  
worker was entitled to a marked life disruption assessment. Total inability to  
work was not a criterion.  
Classification: Protected A  
Decision No.: 2020-0274  
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All physical medical investigation and rehabilitation treatment had  
concluded  
[20.21] The worker submits that the treating and consulting physicians completed all  
investigations and recommended no further treatment or surgical  
intervention.  
[20.22] While the Family Physician’s November 9, 2017 report recommended a pain  
program to help the worker cope with left elbow pain and improve quality of  
life, an April 30, 2020 report noted the chronicity of symptoms and failure to  
respond to treatment rendered improvement unlikely.  
[20.23] A WCB Medical Consultant reported that attendance at a complex pain  
program was not supported.  
[20.24] An IME/PCI Orthopedic Surgeon indicated that maximum medical  
improvement had been achieved and no further treatment was  
recommended.  
[20.25] The weight of medical reporting directed by the Appeals Commission  
completed their medical investigations and recommended no further  
treatment.  
The worker’s pain resulted in marked life disruption  
[20.26] The worker suffered significant marked life disruption since her 2013 work  
place accident/injury.  
[20.27] Prior to the 2013 work place accident/injury the worker:  
maintained consistent employment;  
worked full time;  
had no left elbow/arm pain symptoms;  
did not take medication;  
rarely saw a doctor;  
was physically active and able to play with, lift and carry her  
grandchildren; and  
participated in recreational activities such as swimming, horseback  
riding, baseball, and hoped to renew her lifeguard certification.  
Classification: Protected A  
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[20.28] Following the 2013 work place accident/injury the worker:  
suffered daily from pain and swelling and despite barely using her left  
arm, it remained symptomatic;  
was restricted from using her left arm effectively for daily living activities  
and hired someone to do tasks such as washing her hair;  
iced her left arm every 40 minutes and elevated it to alleviate symptoms;  
was impacted vocationally, socially, emotionally, and recreationally. She  
was unable to work. Her participation in activities and personal  
relationships were impacted. She was unable to swim, horseback ride,  
play baseball, certify as a lifeguard, or pick up her grandchildren. She  
became depressed.  
[20.29] The worker requests a Marked Life Disruption (MLD) assessment given  
difficulty, or dysfunction in the following areas:  
physical functioning;  
affective state;  
cognitive aspects;  
vocational aspects;  
family relationships;  
social/recreational activities; and  
behaviour/daily activities.  
[21]  
[22]  
Given the above, the worker argues that she meets the criteria of Policy 03-01, Part  
II, Application 7. She seeks entitlement to WCB supported treatment for chronic  
pain and acceptance of chronic pain syndrome on her claim.  
Evidentiary Findings and Reasons  
We find the weight of medical evidence supports:  
that the worker’s pain and related symptoms developed as a consequence of a  
compensable injury or condition;  
that the worker’s pain persisted beyond the usual healing time for the injury;  
that the worker’s complaints of pain and pain behaviour are inconsistent with  
organic findings;  
Classification: Protected A  
Decision No.: 2020-0274  
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that the worker’s pain impaired earning capacity.  
[23]  
[24]  
[25]  
Based on the weight of medical evidence before the panel, we are persuaded that  
the worker meets the criteria for a finding of chronic pain under WCB Policy 03-01,  
Part II, Application 7, Question 2. We are not persuaded that the worker meets all  
criteria necessary for acceptance of chronic pain syndrome under WCB Policy  
03-01, Part II, Application 7, Question 3 and direct WCB, pursuant to WCA section  
13.2(6)(f), to ensure all rehabilitation treatments recommended by the IME  
Neurologist have been concluded. Our findings, analysis and reasons are set out  
below.  
WCB Policy 03-01, outlines three ways that persistent, lingering pain may result in  
chronic pain being accepted by the WCB as a compensable condition: 1.) The pain  
and pain behaviour are related to an organic finding where the physical cause of  
the pain can be medically identified (WCB Policy 03-01, Part II, Application 1).  
2.) The pain and pain behaviour are the result of a psychiatric condition (WCB  
Policy 03-01, Part II, Application 6). 3.) The pain and pain behaviour meet the  
criteria of Chronic Pain/Chronic Pain Syndrome (WCB Policy 03-01, Part II,  
Application 7).  
In this case, the DRDRB decision was limited to the compensability of chronic pain  
and chronic pain syndrome under WCB Policy 03-01, Part II, Application 7.  
Submissions by the representative confirmed the worker was seeking acceptance  
under Application 7. To decide the worker’s appeal, the panel considered whether  
the worker satisfied the requirements for acceptance under the Chronic Pain and  
the Chronic Pain Syndrome policy.  
[26]  
[27]  
Chronic pain and chronic pain syndrome are defined by WCB Policy 03-01, Part II,  
Application 7, Question 1. In order to be compensated, the worker must meet all  
criteria set out in Question 2 for Chronic Pain and all criteria set out in Question 3  
for Chronic Pain Syndrome.  
According to Question 1, WCB Policy 03-01, Part II, Application 7, applies when  
pain and pain behaviour is inconsistent with organic findings. It does not apply to  
cases of persistent, lingering pain due to discernible organic diagnosis or a  
psychiatric condition. Such cases are considered for entitlement under WCB’s  
policies relevant to the specific diagnosis or condition.  
[28]  
According to Question 2, the following criteria must be met before a finding of  
Chronic Pain can be made under WCB Policy 03-01, Part II, Application 7:  
pain and related symptoms develop as a consequence of a compensable injury  
or condition,  
the pain persists beyond the usual healing time for the injury,  
Classification: Protected A  
Decision No.: 2020-0274  
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complaints of pain and pain behaviour are inconsistent with organic findings,  
and  
pain impairs earning capacity  
[29]  
According to Question 3, the following criteria must be met before a finding of  
Chronic Pain Syndrome can be made under WCB Policy 03-01, Part II, Application  
7:  
all physical medical investigation and rehabilitation treatment have been  
concluded,  
pain results in marked life disruption,  
pain and related symptoms develop as a consequence of a compensable injury  
or condition,  
the pain persists for six months or more beyond the usual healing time for the  
injury,  
complaints of pain and pain behaviour are inconsistent with organic findings,  
and  
pain impairs earning capacity  
[30]  
[31]  
According to Question 4, MLD is determined under WCB Policy 03-01, Part II,  
Application 7, by psychological assessment, interviews, standardized testing and  
refers to difficulty or dysfunction in specified areas (see Appendix B).  
According to Question 5, pain disorders are categorized under a number of different  
labels and cases of Somatoform Pain Disorder may be entitled to compensation  
under WCB Policy 03-01, Part II, Application 7, if they meet the requirements for  
chronic pain or chronic pain syndrome.  
The worker’s pain and related symptoms developed as a consequence of a  
compensable injury or condition  
[32]  
We find the weight of medical evidence supports that the worker’s pain and related  
symptoms developed as a consequence of her compensable injury or condition.  
While not a complete listing of the extensive medical evidence pertaining to this  
criteria, we rely upon the findings in medical reporting by the Consulting  
Neurosurgeon (November 20, 2014) contemporaneous to the date of accident,  
Treating Family Physicians who reported the worker’s chronic left elbow pain  
complaints, swelling and noted permanent restrictions, Treating Orthopedic  
Surgeons, Neurologist (December 9, 2015), and an IME/PCI Orthopedic Surgeon  
who documented continuity of the worker’s pain complaints and symptoms dating  
from the compensable accident and who causally connected the worker’s chronic  
pain and symptoms to the date of accident.  
Classification: Protected A  
Decision No.: 2020-0274  
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[33]  
[34]  
We note the worker had no prior left elbow injury or pain condition. This was  
confirmed by the Neurologist in December 9, 2015 reporting as “Past Medical  
History: None”.  
We also note the WCB Medical Consultant initially recommended that the worker  
undergo an IME to determine if she had developed “chronic pain versus CRPS  
[chronic regional pain syndrome]” and that she may benefit from a complex pain  
program. We interpreted this to mean that upon the WCB Medical Consultant’s  
documentary file review of the treating and consulting physicians’ reports, he was of  
the view the worker’s pain and related symptoms developed as a consequence of a  
compensable injury or condition. The WCB Medical Consultant’s August 29, 2017  
Memo was less definitive on this criteria following the review of two Consulting  
IMEs. This is discussed further below.  
[35]  
We rely upon and place significant weight on the following reporting as it pertains to  
the criteria of the worker’s pain and related symptoms, which developed as a  
consequence of her compensable injury or condition. Specifically:  
[35.1]  
The November 24, 2020, CPA documented a diagnosis as follows:  
“Based on her responses to the objective measures as well as the interview,  
and consistency with the medical file, this assessment is considered to be  
valid.  
. . .  
. . . [the worker] appears to meet the criteria for the following according to  
the DSM-5:  
300. 82 - Somatic symptom disorder with predominant pain, moderate.  
. . .  
As such, it appears the DOA [date of accident] incident was required as well  
as the ongoing investigations and surgeries to ultimately result in her current  
presentation of somatic symptom disorder with predominant pain.”  
[35.2]  
The December 6, 2021, Psychiatric IME Report documented a diagnosis as  
follows:  
“2. Please express an opinion as to the diagnosis of the injury  
sustained under this claim.  
Somatic symptom disorder with predominant pain.  
3. Was the work injury/exposure necessary to cause the current (or  
above) diagnosis and the injuries sustained under this claim?  
Please provide rationale.  
The work injury was necessary for the development of the above  
diagnosis.”  
Classification: Protected A  
Decision No.: 2020-0274  
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[35.3]  
The December 6, 2021, Neurologist’s IME Report and February 12, 2022  
Addendum Report relied upon MRI and EMG studies and documented that  
the worker satisfied the criteria for chronic pain as follows:  
“The main diagnosis currently is a neuropathic pain syndrome related to  
trauma suffered at the left elbow during the accident of May 17, 2013, and  
possibly also related to some extent to the subsequent surgeries.  
. . .  
. . . In my view, she fulfils criteria for the WCB definition of a chronic pain  
syndrome, in that:  
A. She has pain as a consequence of a work injury  
B. The pain has persisted far beyond the usual healing time for the injury.  
C. We have no clear organic findings to explain the severe pain around the  
elbow - my concerns that it is neuropathic pain from damage to small nerve  
branches is speculative.  
D. Her pain clearly impairs her earning capacity.  
. .  
Yes. The diagnoses listed are attributable to [the worker’s]  
May 17, 2013, accident and associated surgeries.”  
[36]  
We prefer and rely upon the medical opinion expressed in the above three Reports.  
We interpret the above three Reports, directed to specifically address the issue of  
chronic pain and chronic pain syndrome, to confirm the worker’s presentation to be  
valid and to provide a chronic pain and/or “Somatic symptom disorder with  
predominant pain” diagnosis, as a result of the worker’s compensable left elbow  
work related injury/accident and/or surgeries.  
[37]  
[38]  
Based on the above medical reporting, we find the somatoform pain disorder  
labelled “Somatic symptom disorder with predominant pain” falls within the  
provisions of WCB Policy 03-01, Part II, Application 7, Question 5, and entitles the  
worker to consideration under the Chronic Pain/Chronic Pain Syndrome WCB  
Policy.  
The panel accepts and places the greatest weight on the diagnosis and analysis  
provided in the above three Reports, given their expertise and credentials in  
neurology, psychiatry and psychology, the benefit of reviewing all medical reporting  
available, the ability to conduct in-person examinations, interviews, testing and  
noted no validity concerns.  
The worker’s pain persisted beyond the usual healing time for the injury  
[39]  
We find persuasive medical evidence to support that the worker’s pain persisted  
beyond the usual healing time for the injury.  
Classification: Protected A  
Decision No.: 2020-0274  
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[40]  
While not a complete listing of the extensive medical evidence on this criteria, we  
rely upon the following:  
[40.1]  
Treating Family Physicians documented the worker’s pain traceable back to  
the 2013 compensable injury and supported that the worker experienced  
pain that persisted beyond the usual period of healing.  
[40.2]  
[40.3]  
[40.4]  
The IME/PCI Orthopedic Surgeon indicated that eight years later, the  
worker’s pain still related back to the 2013 compensable injury.  
The WCB Medical Consultant stated the worker’s pain persisted well beyond  
the usual healing time for the 2013 date of accident injury.  
The IME Neurologist confirmed his December 6, 2021 findings in a February  
12, 2022 Addendum Report that the worker’s pain had persisted far beyond  
the usual healing time for the injury.  
[41]  
We are satisfied the worker meets this WCB Policy criteria as the weight of medical  
reporting by treating and consulting physicians, and a WCB Medical Consultant  
confirmed that the worker’s pain had persisted beyond the usual healing time.  
The worker’s complaints of pain and pain behaviour were inconsistent with  
organic findings  
[42]  
[43]  
We are persuaded, following the completion of the CPA and IME reports directed  
by this panel and the weight of medical opinion on the ADP, that the worker’s  
complaints of pain and pain behaviour were inconsistent with organic findings and  
we are satisfied that the worker meets this WCB Policy criteria.  
By letter dated June 30, 2020, this panel directed the WCB/DRDRB to further  
investigate the matter of Chronic Pain/Chronic Pain Syndrome, pursuant to WCA  
section 13.2(6)(f). Specifically, to address conflicting and insufficient information  
pertaining to:  
whether the worker’s complaints of pain and pain behaviour with respect to her  
compensable injuries were consistent with organic findings,  
whether there was a psychological/psychiatric basis for the worker’s pain,  
if the worker’s pain was inconsistent with organic findings and there was no  
psychological/psychiatric basis for the worker’s pain, whether the weight of  
evidence satisfied the remaining criteria in WCB Policy 03-01, Part II,  
Application 7.  
[44]  
We initially noted the following:  
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[44.1]  
The treating Orthopedic Surgeons were unsure why the worker’s persistent  
pain symptoms continued to recur and were uncertain as to the etiology of  
the painful swelling.  
[44.2]  
[44.3]  
[44.4]  
The treating Family Physicians consistently reported the worker’s pain  
complaints and recommended follow-up with a pain specialist.  
The WCB Medical Consultant indicated the worker’s complaints of left elbow  
pain and pain behaviour were probably not organic.  
2017 Neurology Reports concluded no neurological diagnosis, in particular  
no ulnar nerve dysfunction and suggested follow-up on musculoskeletal  
pathology at the left elbow was required to account for the worker’s  
symptom presentation.  
[44.5]  
[44.6]  
[44.7]  
A 2017 consulting Orthopedic Specialist was unable to provide a diagnosis  
based on the worker’s symptoms. He was of the view that there were likely  
multiple non-orthopedic factors contributing to her presentation and whether  
they were related to the compensable injuries would have to be determined  
by a Psychiatrist and/or Neurologist;  
A consulting Psychologist indicated validity issues with the psychological  
evaluation conducted and recommended the worker undergo a repeat  
psychological assessment. WCB Psychology Consultants reviewed the  
worker’s psychological/psychiatric history and recommended that the worker  
repeat the CPA.  
An IME/ PCI Orthopedic Surgeon attributed ongoing ulnar nerve irritation as  
secondary to the contusion and perhaps aggravated by two surgeries.  
Maximum medical improvement had been achieved.  
[45]  
Given the inconsistencies, the panel directed the WCB/DRDRB to further  
investigate this criteria. We relied upon the medical opinion expressed in two IMEs  
and CPA as they specifically addressed whether the worker’s complaints of pain  
and pain behaviour were inconsistent with organic findings. Examinations were  
considered valid and supported the interpretation that the “complaints of pain and  
pain behaviour were inconsistent with organic findings” as defined under WCB  
Policy 03-01, Part II, Application 7, Questions 2 and 3.  
[46]  
The IME Neurologist reported December 6, 2021 that there were no clear organic  
findings to explain the worker’s pain, specifically:  
“Her pain appears severe and very real but is not completely consistent with  
organic findings. . . She is now some eight years after her injury. . . She  
certainly has chronic pain, and major disability from this.”  
[47]  
We interpret the IME Neurologist to mean that the worker’s complaints of pain and  
pain behaviour were inconsistent with organic findings.  
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Decision No.: 2020-0274  
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[48]  
The IME Psychiatrist documented on December 6, 2021 that there was no clear  
physical etiology for the worker’s current complaints and no evidence that the  
worker’s complaints of pain or pain behaviours were “attributable to a psychiatric  
diagnosis”.  
[49]  
[50]  
We interpreted the IME Psychiatrist to mean that the worker’s complaints of pain  
and pain behaviour were inconsistent with organic findings and no psychiatric  
diagnosis was provided.  
The Psychologist’s November 24, 2020 CPA Report provided a “Somatic symptom  
disorder with predominant pain” diagnosis as a result of the worker’s compensable  
left elbow work related injury/accident and/or surgeries, but did not specifically  
address the remaining questions posed by the Appeals Commission panel. The  
remainder of the report appears to address the questions posed by WCB/DRDRB,  
which are not before this panel.  
[51]  
The panel accepts and places the greatest weight on the diagnosis and analysis  
provided in the two noted IMEs, given their expertise and credentials in neurology  
and psychiatry, the benefit of reviewing all medical reporting available, the ability to  
conduct in-person examinations, interviews, testing and noted no validity concerns.  
[52]  
[53]  
We are persuaded the weight of medical evidence before the panel supports the  
conclusion that the “complaints of pain and pain behaviour are inconsistent with  
organic findings” as required under WCB Policy 03-01, Part II, Application 7.  
We acknowledge other medical opinion evidence to the contrary. We place less  
weight on this evidence and find it is less persuasive for the following reasons:  
[53.1]  
While the consulting Orthopedic Surgeon’s December 6, 2021 IME Report  
stated that the worker’s pain was attributable to an organic condition, we  
note this was contrary to both treating Orthopedic Surgeons who were  
unsure why the worker’s persistent pain symptoms continued to recur and  
were uncertain as to the etiology of the painful swelling.  
[53.2]  
We prefer and are persuaded by both treating Orthopedic Surgeons given  
they initially consulted with the worker, performed three surgeries and  
provided follow-up care to the worker. We attribute greater weight to their  
medical opinion evidence, which was supported by second opinion and  
further review. The weight of medical reporting could not explain the  
worker’s pain and pain behaviours from an organic perspective. This was  
reinforced by EMG testing, which showed no ulnar dysfunction.  
[53.3]  
We note a 2017 Orthopedic IME Report was unable to confirm a chronic  
pain/chronic pain syndrome finding from an orthopedic standpoint and the  
Orthopedic Specialist deferred to other multi/non-orthopedic possibilities  
better addressed by a Psychiatrist and/or Neurologist.  
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[53.4]  
We note the IME/PCI Orthopedic Surgeon attributed ongoing ulnar nerve  
irritation as secondary to the contusion and perhaps aggravated by two  
surgeries. His medical opinion related the worker’s pain to the date of  
accident/injury and was relied upon to support that the worker’s pain was  
organic.  
[53.5]  
We are not persuaded that the IME/PCI Orthopedic Surgeon addressed  
“organic” versus “inconsistent with organic” under WCB’s Chronic  
Pain/Chronic Pain Syndrome Policy 03-01, Part II, Application 7. We  
understand the IME/PCI Orthopedic Surgeon was tasked with and focused  
on a PCI assessment of the worker (2.5% recognized for elbow range of  
motion, 3% recognized for ulnar nerve compression). We therefore find the  
medical opinion of the IME/PCI Orthopedic Surgeon to be of less probative  
value on chronic pain/chronic pain syndrome. We are satisfied that chronic  
pain/chronic pain syndrome is better addressed by the Psychiatrist and/or  
Neurologist.  
The worker’s pain impaired earning capacity  
[54]  
The panel finds, based on the evidence before us and our interpretation of WCB  
Policy 03-01, Part II, Application 7, Questions 2 and 3, that the worker’s pain has  
impaired her earning capacity. We rely upon the following to make these findings:  
[54.1]  
Medical reporting, WCB correspondence, and Return To Work (RTW)  
reporting on the appeal documents package (ADP) supports that the worker  
suffered a diminished or impaired earning capacity and was in receipt of  
WCB wage benefits (temporary partial disability (TPD), economic loss  
payment (ELP)). WCB deemed the worker into the position of dentistry  
receptionist, given permanent work restrictions and inability to return to her  
date of accident employment as a heavy equipment operator. In this case,  
we understand the worker’s deemed position and receipt of an ELP, to  
indicate a diminished/impairment of earning capacity.  
[54.2]  
[54.3]  
We acknowledge the cited Appeals Commission decisions relied upon by  
the representative to support the interpretation of the phrase in WCB Policy  
“impairment of earning capacity” to mean diminished earning capacity, not  
total incapacity or unemployment (see citations listed above).  
We interpret the wording of WCB Policy 03-01, Part II, Application 7, broadly  
and liberally within the context of WCB Policy. We align with the cited  
Appeals Commission decisions to consistently interpret and define  
“impairment” in this WCB Policy provision to mean “diminished”, not total  
incapacity.  
[54.4]  
In Appeal Commission Decision 2008-610, the panel found that the chronic  
pain/chronic pain syndrome Policy did not require that the worker’s pain  
result in the “elimination of earning capacity”. Rather, WCB Policy speaks of  
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Decision No.: 2020-0274  
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“impairment of earning capacity”, which the panel interpreted to mean that  
pain need only diminish the worker’s earning capacity. Decision 2008-610  
referred to the definition of “impairment” in both the Canadian Oxford  
Paperback Dictionary and Black’s Law Dictionary and the panel determined  
that the worker’s earning capacity had been diminished by his chronic pain.  
[54.5]  
In Appeals Commission Decision 2017-0047, the WCB had determined that  
the worker remained fit for some level of employment, and therefore  
declined to arrange an MLD assessment. Decision 2017-0047 stated:  
“[21] As stated above the WCB interprets this aspect of policy to mean  
that a worker must be unemployable. We disagree with that  
interpretation. We find that impairment of earning capacity means  
that a worker’s earning capacity is reduced from pre-accident levels,  
not that there is total inability to work. In this case the worker has an  
impairment of earning capacity as she is in receipt of an earning loss  
supplement to reflect the fact that she has diminished or impaired  
earning capacity as compared to before the compensable accident  
. . .”  
[55]  
[56]  
We conclude that WCB Policy 03-01, Part II, Application 7, does not require that the  
worker’s pain result in total elimination of earning capacity in order to meet the  
criteria. We interpreted WCB Policy wording “impairment of earning capacity” to  
mean that the pain need only diminish the worker’s earning capacity.  
We find based on the above, that the worker meets the four criteria set in WCB  
Policy 03-01, Part II, Application 7 , Question 2, for chronic pain. Below, we  
consider whether the worker also meets the criteria for chronic pain syndrome  
pursuant to WCB Policy 03-01, Part II, Application 7, Question 3.  
Physical medical investigation and rehabilitation treatment not concluded  
[57]  
[58]  
[59]  
We find, according to the CPA and IME Reports directed by this panel, that all  
physical medical investigation was completed pursuant to WCB Policy 03-01, Part  
II, Application 7, Question 3. However, the IME Neurologist noted in his December  
6, 2021 Report that the worker might benefit from treatment, specifically  
assessment and follow-up in a Chronic Pain Program.  
We noted that past medical reporting was inconsistent in its support for a Chronic  
Pain Program. The worker’s Family Physician recommended participation in a  
Chronic Pain Program, whereas the WCB Medical Consultant did not support a  
Pain Program. It does not appear that the worker was ever enrolled in such  
programming.  
The panel is of the view that in order for the worker to meet all criteria in WCB  
Policy 03-01, Part II, Application 7, Question 3, she must follow through with the  
treatment as recommended by the IME Neurologist.  
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Decision No.: 2020-0274  
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[60]  
[61]  
The matter of treatment in a Chronic Pain Program is returned to the WCB/DRDRB  
pursuant to WCA section 13.2(6)(f) to make arrangements for the worker’s  
participation and coverage.  
Any decision by WCB/DRDRB arising from the adjudication of the worker’s  
treatment in a Chronic Pain Program is subject to the usual appeal process.  
The worker’s marked life disruption (MLD) assessment  
[62]  
[63]  
We find completion of rehabilitation treatment is a pre-requisite to the direction of a  
MLD assessment according to WCB Policy 03-01, Part II, Application 7, Question  
3. This criteria has not been met.  
As discussed above, the worker meets the WCB Policy criteria for chronic pain.  
The criteria for chronic pain syndrome requires that the worker conclude  
rehabilitation treatment before a MLD assessment is directed. The worker has  
yet to satisfy this criteria. We acknowledge the representative’s detailed  
submissions in support of a MLD assessment direction and with regard to the  
worker’s efforts to comply with WCB Policy 03-01, Part II, Application 7, Question  
3 criteria.  
[64]  
We are persuaded that the worker should be given the opportunity to undergo a  
Chronic Pain Program that follows the treatment recommendations by the IME  
Neurologist. There are sufficient reasons to support the direction that the worker  
undergo an MLD assessment (see paragraphs 20(28) to 20(29)) pursuant to  
WCA section 13.2(6)(f).  
[65]  
[66]  
We return this matter to WCB pursuant to WCA section 13.2(6)(f) for the  
purposes of referral into and treatment in a Chronic Pain Program (discussed  
above) and direct the WCB/DRDRB to complete a MLD assessment.  
Any decision by WCB/DRDRB arising from the adjudication of the worker’s  
entitlement to a MLD assessment is subject to the usual appeal process.  
Conclusion  
[67]  
Based on the weight of medical evidence, we conclude:  
that the worker’s pain and related symptoms developed as a consequence of a  
compensable injury or condition;  
that the worker’s pain persisted beyond the usual healing time for the injury;  
that the worker’s complaints of pain and pain behaviour are inconsistent with  
organic findings;  
that the worker’s pain impaired earning capacity.  
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Decision No.: 2020-0274  
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[68]  
[69]  
It follows that the worker meets the criteria of WCB Policy 03-01, Part II, Application  
7, with regard to chronic pain and is entitled to treatment.  
As discussed, the worker has not met the criteria of WCB Policy 03-01, Part II,  
Application 7 criteria, with regard to completion of rehabilitative treatment (Chronic  
Pain Program) and a MLD assessment. It follows that the worker must complete  
the criteria of WCB Policy 03-01, Part II, Application 7, as directed under WCA  
section 13.2(6)(f) before chronic pain syndrome may be accepted on the claim.  
[70]  
[71]  
Any decisions by WCB/DRDRB arising from the adjudication of the worker’s  
completion of rehabilitative treatment and entitlement to a MLD assessment are  
subject to the usual appeal process.  
Decision  
The Workers’ Compensation Board has additional responsibility for chronic pain in  
accordance with WCB Policy 03-01, Part II, Application 7. Additional responsibility  
for chronic pain syndrome in accordance with WCB Policy 03-01, Part II,  
Application 7 is returned to WCB pursuant to WCA section 13.2(6)(f) and requires  
the worker’s completion of rehabilitative treatment (Chronic Pain Program) and a  
MLD (Marked Life Disruption) assessment as directed above.  
[72]  
The worker’s appeal is granted in part and the February 15, 2019 decision of the  
Dispute Resolution and Decision Review Body is reversed.  
This decision is made with the full agreement of the hearing panel.  
Decision signed in Edmonton, Alberta on June 21, 2022.  
S. Yanitski  
Hearing Chair  
(on behalf of the panel)  
Hearing Panel:  
S. Yanitski  
D. Boissonneault  
T. Axworthy  
– Hearing Chair  
– Commissioner  
– Commissioner  
Typed by: ab  
DEC07D (20191203)  
Classification: Protected A  
Decision No.: 2020-0274  
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Appendix A  
Workers’ Compensation Act, RSA 2000, c W-15 (WCA)  
Excerpts and/or a summary of the applicable WCA sections are noted below. The  
current WCA version is applicable unless otherwise stipulated:  
[A1]  
Section 1(1)(a) of the WCA defines “accident” as meaning:  
“. . . an accident that arises out of and occurs in the course of  
employment in an industry to which this Act applies. . .”  
[A2]  
Section 13.1(1) of the WCA establishes the exclusive jurisdiction of the Appeals  
Commission to hear appeals and to examine, inquire into, hear and determine all  
matters and questions arising under the WCA and the regulations in respect of  
appeals from decisions under section 46 made by a review body appointed under  
section 45 of the WCA.  
[A3]  
[A4]  
Section 13.2(6) of the WCA provides that the Appeals Commission is bound by  
the WCB policies relating to the matter under appeal.  
Section 24(1) of the WCA establishes the authority to pay compensation:  
“. . .  
(a) to a worker who suffers personal injury by an accident. . .”  
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Decision No.: 2020-0274  
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Appendix B  
Workers’ Compensation Board Policy  
[B1]  
[B2]  
The panel is bound by the WCB Policies in effect at the time of the February 7,  
2018 WCB decision. Excerpts and/or a summary of the applicable WCB Policies  
are noted below.  
WCB Policy 02-01, Part I: Arises Out of and Occurs in the Course of  
Employment:  
“POLICY:  
To be considered compensable, an accident must meet two conditions: it  
must arise out of and occur in the course of employment. When WCB is  
notified of an accident, it initiates inquiries to obtain all relevant evidence,  
and adjudicates the eligibility of the claim based on the weight of that  
evidence.  
If, after gathering all the available evidence, it is clear that one of the  
conditions is met but there is insufficient evidence on which to base a  
decision regarding the second condition, the statutory presumptions  
contained in [section] 24 of the Workers’ Compensation Act (WCA) will  
apply.  
. . .  
INTERPRETATION  
1.0  
Accident  
‘Accident’ is used in the usual and ordinary sense, and means an  
unexpected mishap or event. For the purposes of workers’  
compensation, ‘accident’ also includes the circumstances defined in the  
four subclauses of s. [section] 1(1)(a) of the WCA.  
2.0  
Arises out of Employment  
An accident arises out of employment when it is caused by some  
employment hazard. An employment hazard is defined as an  
employment circumstance which presents a risk of injury. The hazard  
may be directly related to the industry or occupation (for example,  
machinery, chemicals, worksite ergonomics), or may be incidental (for  
example, weather conditions, insect bites, third-party vehicles).  
. . .  
3.0  
Occurs in the Course of Employment  
An accident occurs in the course of employment when it happens at a  
time and place consistent with the obligations and expectations of  
employment. Time and place are not strictly limited to normal hours of  
work or the employer’s premises, however, there must be a relationship  
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Decision No.: 2020-0274  
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between employment expectations and the time and place the accident  
occurs (see Part II, Applications 2 and 3).  
4.0  
Evidence  
Evidence includes accident reports, witness reports, medical information,  
and accepted medical opinion, as well as any other facts relevant to the  
accident.  
If the information received on the required reports is not sufficient to  
adjudicate the claim, WCB is responsible for gathering additional  
evidence relevant to the claim.”  
[B3]  
WCB Policy 02-01, Part II, Application 1: Employment Hazards:  
“1.  
What factors are considered when determining if an injury  
resulted from an employment hazard?  
The employment must have contributed to the accident so that, if it were  
not for the employment, the accident would not have occurred at that time  
(see Application 7 – Causation). The hazard may arise directly from the  
occupation or industry itself, or it may arise from positional risk. The  
following conditions apply when determining whether an employment  
hazard caused or contributed to an accident:  
the hazard must be related to the worker’s employment  
. . .”  
[B4]  
WCB Policy 02-01, Part II, Application 2: Time and Place:  
“1.  
What is the relationship between employment hazard and  
time and place?  
The two conditions are very closely linked, but are not identical.  
Employment hazard deals with how the injury occurs, while time and  
place considers when and where.  
For example, a worker at an employer-provided campsite falls and is hurt  
when a railing gives way. The broken railing is a hazard of the premises  
and therefore an employment hazard; however, WCB must also consider  
why the worker was at the campsite at that time, and if the reason is  
consistent with the worker’s employment.  
2.  
What factors are considered when determining whether the  
time and place of injury are consistent with employment?  
The following factors may be considered, together with any other facts  
relevant to a specific claim:  
did the injury occur on the employer’s premises?  
was the worker in the process of doing something form the benefit of  
the employer?  
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Decision No.: 2020-0274  
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did it occur during a time period for which the worker was being paid?  
was the worker in that time and place for employment reasons (for  
example, in a hotel because of an overnight business trip)?  
did it occur in the course of using equipment or materials supplied by  
the employer?  
Compensation coverage generally begins when the worker enters the  
employer’s premises to start the work shift, and terminates on the worker  
leaving the premises at the end of the shift. Coverage may begin with the  
journey to work if travelling is required as a condition of employment (see  
Application 3, Travel). Coverage may also be extended beyond normal  
work hours to workers who are staying in residential facilities such as  
bunkhouses or campsites.”  
[B5]  
WCB Policy 02-01, Part II, Application 7: Causation:  
“4. What standard of causation does WCB apply?  
The standard of causation used by WCB is the ‘but for’ test, except when  
specifically stated otherwise.  
5.  
What is the ‘but for’ test?  
The ‘but for’ test is a finding of fact – the work exposures were necessary  
for the accident and injury to occur. In other words, if not for the work  
exposures, the injury or disease would not have happened.  
In some cases there may be several causes that meet the ‘but for’ test  
that work in combination to cause an injury. Work does not have to be  
the only factor, or even the primary one, for the injury to be compensable.  
It must, however, be a necessary factor; if the injury or disability would  
have happened anyway, regardless of the work factor, it is not  
compensable.  
The finding of fact is based on the evidence and accepted medical  
knowledge, not on a speculative connection.”  
[B6]  
[B7]  
This provision must be read in conjunction with the criteria set out in Policy  
03-01, Injuries; Policy 03-02, Aggravation of a Pre-existing Condition and the  
other provisions in Policy 02-01.  
WCB Policy 03-01, Part I:  
“POLICY:  
WCB will determine whether an injury has occurred as the result of a  
compensable accident, and will adjudicate appropriate compensation and  
services from the date of accident. . .  
. . .  
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INTERPRETATION  
. . .  
2.0  
Date of Accident  
When there is a specific incident which results in injury, the date of  
accident is the date on which the incident occurred.  
When the compensable condition or disease is progressive (i.e., there is  
no specific incident), the date of accident is normally the first date on  
which medical treatment is provided. If, however, the worker experienced  
earlier lay-offs or loss of earnings which medical evidence indicates were  
caused by the compensable condition, the date of accident will be the first  
day of that earnings loss.  
The date of accident for cases of potential disablement due to  
occupational disease is the date the potential disablement comes to  
WCB’s attention.”  
[B8]  
WCB Policy 03-01, Part II, Application 1: Relationship to Compensable Accident:  
“1.  
Why is the relationship of injury to compensable accident  
important?  
To be compensable, an injury must be the result of an accident as  
defined under Policy 02-01, Arises Out of and Occurs in the Course of  
Employment. Therefore, when adjudicating the eligibility of a claim, WCB  
looks at the nature of the injury and its relationship to the compensable  
accident.  
Often there is an obvious relationship between the nature of the injury  
and the compensable accident (e.g., a firefighter is burned when fighting  
a fire). However, the relationship is not always obvious. In these cases,  
there is a need for additional information, especially medical information,  
to establish the relationship to the compensable accident. For example,  
many occupational diseases have a long latency period. WCB’s inquiries  
must establish whether the work-related exposure was sufficient to cause  
the condition (see Application 3, Occupational Disease).”  
[B9]  
WCB Policy 03-01, Part II, Application 7 (issue date August 26, 2015): addresses  
the compensability of chronic pain and chronic pain syndrome as follows:  
1. When does WCB apply the provisions of this application?  
This application applies only to chronic pain and chronic pain syndrome  
when pain and pain behaviour is inconsistent with organic findings (see  
Questions 2 and 3). It does not apply to cases of persistent, lingering pain  
due to discernible organic diagnosis or a psychiatric condition. Such  
cases are considered for entitlement under WCB's policies relevant to the  
specific diagnosis or condition.  
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Decision No.: 2020-0274  
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2. When does WCB consider sponsoring treatment for chronic  
pain?  
WCB may consider treatment for chronic pain when the chronic pain has  
the following characteristics:  
pain and related symptoms develop as a consequence of a  
compensable injury or condition,  
the pain persists beyond the usual healing time for the injury,  
complaints of pain and pain behaviour are inconsistent with organic  
findings, and  
pain impairs earning capacity.  
3. When doe WCB consider chronic pain syndrome a compensable  
condition?  
This policy question is effective January 1, 1992 and applies to all claims  
regardless of date of accident  
BoD Resolution 2001/05/28  
Chronic pain syndrome may be compensable when the following  
conditions are met:  
all physical medical investigation and rehabilitation treatment have  
been concluded,  
pain results in marked life disruption,  
pain and related symptoms develop as a consequence of a  
compensable injury or condition,  
the pain persists for six months or more beyond the usual healing time  
for the injury,  
complaints of pain and pain behaviour are inconsistent with organic  
findings, and  
pain impairs earning capacity.  
4. How does WCB determine marked life disruption?  
Marked life disruption is determined by psychological assessment,  
interviews, and standardized testing; and refers to difficulty or dysfunction  
in the following areas:  
physical/vegetative functioning  
affective state  
cognitive aspects  
vocational aspects  
family relationships  
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social/recreational activities  
behaviour/daily activities  
5. Are cases of somatoform pain disorder entitled to compensation  
under this policy?  
Pain disorders are categorized under a number of different labels, e.g.,  
somatoform pain disorder, fibromyalgia, etc. Individuals diagnosed with  
such disorders may be compensated under this policy, but only if they  
meet the requirements for chronic pain or chronic pain syndrome.”  
Classification: Protected A  


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