Contusion, say doctors, but MOM says injury not work-related

Based on a review of case documents in early September 2019

In this story, we are going to describe a worker’s experience over an injury. There are many indicators that point to it being a valid workplace injury and within the scope of the Work Injury Compensation Act (WICA). Yet the initial decision of the Ministry of Manpower (MOM) was that it was unrelated to work. The matter remains pending as at the time of writing.

He continued to work until 7pm (putting in his usual overtime) as he did not feel so unwell that it prevented him from working. As a result, he did not inform the company or report the accident that day itself as he thought he would rest overnight and see how he felt the following day. He took some painkillers.

Tuesday 9 April 2019: He reported to work as usual and signed in, but by now the pain seemed worse. He phoned his safety supervisor – someone named Tuhin — and went over to see him about 9am, He showed him the injured area and described the accident, but Tuhin told him to carry on working and wait another day. On this day too, Anawrul finished work at 7pm.

Wednesday 10 April 2019: Once more, he signed in at work but with the pain becoming unbearable, some managers came to see him around 10am, including the main contractor’s safety officer and another representative of the main contractor. The safety officer instructed that Anawrul should be taken to a doctor immediately.

Safety supervisor Tuhin (not to be confused with the main contractor’s safety officer who gave the order) took Anawrul to a neighbourhood clinic where the doctor ordered an Xray to be done. It didn’t show any rib fracture. Specifically, the doctor wrote in a Work Injury Compensation report to the Ministry of Manpower (MOM):

The patient suffered contusion of the right chest wall. CXR (front and oblique view) on 10/4/19 >> no rib fracture seen.

What is a contusion? A simple dictionary meaning is that it’s “an injury, as from a blow with a blunt instrument, in which the subsurface tissue is injured but the skin is not broken; bruise.” In other words, a minor impact trauma.

Later, to a question on the MOM reporting form that asked “Are the employee’s injuries consistent with his/her description of the accident?”, the doctor answered “Yes”.

The doctor prescribed painkillers and medical leave. According to Anawrul, the doctor at first wanted to give him three days of medical leave but Tuhin objected. The doctor then insisted that Anawrul should get at least one day of medical leave, plus seven days of Light Duty.

Here’s the first question to consider: what motivated Tuhin to object to three days of medical leave? Already one wonders about motives.

Anawrul’s time card thus shows that he signed in for work on Thursday 10 April but worked only two hours – he was taken to the doctor. It also shows that he did not report for work on Friday 11 April. He probably took that as his medical leave day. He returned to work thereafter, as he had to, for Light Duty. If he didn’t, the employer would deduct $50 a day from his salary, said Anawrul.

But nothing in the documentation shows anything untoward on Monday 8 April – the day Anawrul said the injury occurred – since he made no report on that day itself.

On or around 18 April 2019, Anawrul reported the injury to the Ministry of Manpower, triggering a Work Injury Compensation claim.

He also went to Ng Teng Fong Hospital on his own for further medical follow-up. The report from this hospital also noted a contusion.

There would be several appointments at Ng Teng Fong hospital, with further X-rays and CT scans done, generating quite copious medical documentation. The long and short of it is that once again no fracture of the ribs was observed.

A liver specialist was brought in, and after some tests including an MRI, he found multiple hepatic lesions, “probably haemangiomas”. According to a Mayo Clinic website (link here) hepatic haemangiomas are noncancerous (benign) masses in the liver, made up of a tangle of blood vessels. In most cases, a liver haemangioma doesn’t cause any sign or symptom, but when it does, symptoms may include pain in the upper right abdomen, feeling full after eating only a small amount of food, nausea and vomiting.

Thus, the medical diagnosis is also clouded. What we do know is that there was contusion but no rib fracture. The pain might also have had a secondary cause in the haemangioma, which could have been pre-existing.

MOM’s decision

The Ministry of Manpower (MOM) issued a decision on 21 June 2019 saying “No compensation payable as employee’s injury was not caused by accident arising out of and in the course of employment.”

TWC2 helped Anawrul file an objection to that decision. We believe MOM made an error.

Interestingly, when TWC2 wrote to MOM to ask for a copy of the incident report that should have been filed by the employer, MOM replied that “Based on our records, Islam Md Anawrul’s employer did not file a report.” This suggests that the employer decided very early on not to acknowledge that an accident happened despite having been told by the main contractor’s safety officer to send Anawrul to a doctor.

Anawrul also has a short video in which he is speaking to someone in the company — from the context, it’s possibly Tuhin, the safety supervisor who took him to the doctor. The conversation is in Bengali so it’s pointless to embed the video. Instead, here is the transcript, in which Anawrul asked whether a report had been filed.

Anawrul: Did you make the report yet?

Company man: Yes, I already made the report. Whatever documents I had, I’ve submitted everything. Brought you to the hospital, submitted the reports and everything.

— long silence —

Anawrul: I’m have so many problems right now … I thought I would be able to get some doctor’s money (reimbursement?). With that I should be able to survive this month.

Company man: You would have gotten your accommodation money and also your treatment done … but you thought you were so smart … that’s why nothing happened.

Anawrul: Brother, now what am I to do?

Company man: No, no … your treatment and everything would have happened, but it did not – because of you, yourself. You went outside to inform them (MOM). And what’s the meaning of “law”, like you said? Don’t you want to stay and work in Singapore anymore?

The last statement by the company man is rather chilling. It suggests that the employer has taken a decision to inflict pain and punishment on Anawrul for reporting the matter to the Ministry of Manpower. It’s consistent with what happened when the first doctor proposed three days of medical leave and was met by an objection from the supervisor, raising a question about motive.

We learned from Anawrul that he had shown this video to MOM with the translation. We understand that MOM’s response was that the video shows nothing new and that it does not prove that an accident occurred (but see next paragraph). Given that the conversation touched on hospital and treatment, it may be hard to understand how MOM arrived at that conclusion. At the very least, the tone of the last part should have strongly flagged the possibility that the employer’s denial of an accident is grounded on something else other than fact, and therefore should be treated with grave suspicion.

It should also be noted that if MOM is expecting the worker to prove that an accident occurred, then MOM is misconstruing the law. The law creates three easy steps to demonstrate that an incident is a work accident (detailed below), and then it’s for the employer to prove that it is not.

Why we think MOM was wrong in its decision

Going forward, we think a recent High Court judgement (see High Court says MOM’s Assistant Commissioner had a “fundamental misunderstanding” of the work injury law) is likely to be helpful. In it, Justice Chan held that the death of a man who had a pre-existing heart condition, and a serious one at that, was within the ambit of the Work Injury Compensation Act (WICA) because he collapsed while he was at work, removing wheels from bins. It met the test of “in the course of employment”.

But let’s take a step back. In the same High Court decision, the court reiterated the tests for deciding whether a case falls within the Work Injury Compensation Act. The tests were:

1. Has the worker suffered an injury?

2. Was the injury caused by an accident?

3. Did the accident arise (a) in the course of, and (b) out of employment?

We believe there shouldn’t be any doubt about (1). The doctors’ finding that there was contusion should be sufficient to demonstrate that there was an injury to Anawrul.

As for (2), by its very definition, a contusion is caused by impact. Unless a worker chose to hit himself — and we doubt if anyone is even suggesting it (let alone be able to prove it) — the impact would be an unexpected, unintended event, and that counts as an accident.

Coming to (3a), if an accident occurred while an employee was at work, the law itself states that it should be presumed to be “in the course of employment”. Unfortunately, Anawrul did not inform his supervisor until the next morning, and didn’t get to see a doctor until the third day, creating an opportunity for the company to deny that it happened while at work on Monday 8 April. We don’t know if indeed the company is claiming this, but even if it was, it would almost surely need to demonstrate with evidence that it occurred at some other time, outside of work. As far as we know, based on Anawrul’s understanding of the matter, there has been no alternative explanation for the contusion put forward by the company. Then again, Anwarul may have been kept in the dark about the company’s counter-arguments.

In any case, as acknowledged by a judge in another case (see our write-up here) foreign workers do not have full control over when they can get to see a doctor. They depend to a large measure on their employers’ willingness to take them to a clinic or hospital, and it could be several days after an incident. Judges need to take this into consideration when hearing disputes over dates, that judge wrote.

As for (3b), if the employer wanted to argue that the accident did not arise out of work, the burden to demonstrate that would lie with the employer, the High Court said (see again High Court says MOM’s Assistant Commissioner had a “fundamental misunderstanding” of the work injury law). In that other case, where the worker had a serious pre-existing heart condition, the judge required the employer to “furnish evidence to prove” that there was absolutely no contributing factor from work. It’s not even for the claimant to prove that there WAS a contributing factor or a trigger event from work.

In Anawrul’s case, it appears that, regardless of whether he had a pre-existing liver condition, there was a trigger event – when he was hit by a pole.

The High Court judgement also reiterated that WICA is a piece of “social legislation which should be interpreted purposively in favour of employees who have suffered injury during their employment”.

All in all, we believe Anawrul has a good case. We shall see how it turns out.