Medical Evidence Ignored in Appeal Tribunal Decision

Written by Daniel Standing LL.B., Content Editor, First Reference Inc.

The recent Supreme Court of British Columbia case 2023 BCSC 1513 (CanLII) concerns the appropriate decision-making process of the Workers’ Compensation Appeal Tribunal when it must make a compensation decision in the face of multiple medical reports.


A registered nurse developed tendonitis in her wrist and claimed it was caused by her use of a computer and phone in a poorly configured workstation. The employer assessed the workstation and made some important ergonomic changes. Unfortunately, the nurse’s condition worsened to the point she had to stop working.

Just days before, a WCB case manager did a 20-minute review of the work area. He took a five-minute video of the nurse at her computer and phone in the modified workstation, later writing a report noting no awkward postures. A WCB medical advisor’s report on the same day cast doubt on the link between the condition and the nurse’s work activities even though the advisor never personally met with the nurse. Three days later, the Board denied the nurse’s application for benefits, a decision that was maintained on internal review.

However, in what would ultimately prove to be a sage move, the nurse obtained two further medical reports: one from a physician diagnosing her with bilateral tendinitis linked to her workplace activities, and one from an occupational therapist and professional ergonomist who looked at the original workstation and concluded it was markedly ergonomically deficient.

When the matter ended up before the Appeal Tribunal, the Tribunal confirmed the original decision, essentially dispelling the idea there was any link between the condition and the workplace. Critically, it didn’t consider it necessary to seek any further medical opinions, preferring instead to rely on the evidence at hand.

What the Supreme Court of British Columbia decided

The Supreme Court of British Columbia began by setting out the standard of review, or the legal test that the decision must meet if it is to stand. In this case, the decision had to be found patently unreasonable before it could be set aside.

One way a WCAT decision could be patently unreasonable, said the court, is if it ignores a medical opinion, preferring its own diagnosis in the absence of supporting evidence. That is what happened in this case, when the Tribunal rejected two expert opinions and made its decision based on inferences and conclusions that it reached based on watching a few anatomical movements from a five-minute video.

The issue of causation in this case (that is, whether certain body movements and postures caused strain to specific tendons) was a medical one, and the hearing panel of the Appeal Tribunal wasn’t equipped to reject a diagnosis in an evidentiary vacuum since it lacks that type of expertise.

Key takeaways

This case shows that even expert tribunals are fallible when it comes to evaluating claims for workers compensation, and there is a hidden lesson for employers, one that is most likely to crop up in accommodation situations. Medical evidence pertaining to a worker’s restrictions can be complicated, lacking or contradictory, in which case, an employer would do well to fully exhaust its questions and analysis of such evidence before proceeding. Perhaps if the Appeal Tribunal had done that, it would have reached a different result.


  1. Appeal board decision makers often side with Workers Compensation staff’s negative decisions so as to save money for the WCB. They know many dissatisfied injured claimants will not fight the decision in the provincial Superior Court.

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