Case snapshot
At a glance
- Case
- Can a Work-Caused Hernia Surgery Be Covered Under WSIB in Ontario?
- Court / Tribunal
- Workplace Safety and Insurance Appeals Tribunal
- Citation
- 2026 ONWSIAT 931 ↗
- Date
- August 14, 2026
- Area of law
- Employment Law
- Key issue
- Whether the WSIB emergency-surgery requirement in the hernia policy applies when the hernia itself was caused by a workplace accident, not merely aggravated by one, and whether the worker was owed full loss-of-earnings benefits while recovering from surgery.
- Outcome
- The employer's appeal was denied. The worker is entitled to benefits for the November 1, 2018 umbilical hernia repair surgery and to full loss-of-earnings benefits from November 1 to November 25, 2018 inclusive, with the nature and duration of further benefits returned to the WSIB.
- Why it matters
- Employers may argue that hernia surgery is elective unless it meets the emergency criteria in the WSIB hernia policy. This decision shows the Tribunal reading those criteria as limited to pre-existing, non-work-related hernias aggravated by work, so surgery for a hernia caused by a workplace accident was compensable.
Legal principle
The rule from this case
WSIB Policy 15-04-08 says that if a worker's pre-existing, non-work-related hernia is aggravated through work and the worker elects to have it repaired, benefits for the surgery and related lost time are not allowed unless emergency criteria are met: the hernia is incarcerated, strangulated, or associated with or apt to cause rupture of the bowel wall. In this decision, the Vice-Chair found that the emergency-surgery requirement relates only to that pre-existing, aggravated situation. Where a hernia is caused by a workplace accident, treatment, including surgery, and lost time arising from the treatment are compensable. On loss of earnings, Policy 18-03-02 provides that a worker is generally entitled to full LOE benefits if the injury completely prevents a return to any type of work, or if no suitable work is available, provided the worker co-operated in health care and return to work. Relying on the surgeon's report of total disability, the Vice-Chair confirmed full LOE under section 43(1) of the Workplace Safety and Insurance Act, 1997 for the recovery period.
Important limits
What this does not mean
This decision does not mean every hernia surgery is covered. The emergency criteria in the hernia policy still apply when a pre-existing, non-work-related hernia is aggravated by work and the worker elects surgery. The result here rested on the record: initial entitlement for a work-caused hernia was no longer contested, the worker had no history of hernia, and the surgeon and clinical notes linked the surgery to the August 16, 2018 accident. It is also a single Vice-Chair's decision on a written record in which the worker did not participate. It decided only the surgery and full LOE from November 1 to November 25, 2018; the nature and duration of any further benefits went back to the WSIB for adjudication, subject to the usual appeal rights.
Can WSIB Cover Hernia Surgery If the Injury Happened at Work?
In this case, yes. In Decision No. 412/26, 2026 ONWSIAT 931 (CanLII), a Workplace Safety and Insurance Appeals Tribunal (WSIAT) Vice-Chair found that surgery to repair a hernia caused by a workplace accident was compensable even though the medical notes did not describe it as an emergency. The appeal was decided on a written hearing, and the decision was released on August 14, 2026.
The worker, a Rear Fill Team Member, was injured on August 16, 2018 while forcefully and quickly pulling an ergonomic arm and welding gun to reach the weld location. He felt sharp abdominal pain, sought medical attention the same day, and was diagnosed with an umbilical hernia. He returned to modified work without losing time. He had hernia repair surgery on November 1, 2018, returned to modified work on November 26, and resumed regular duties without restrictions on December 20, 2018.
The WSIB allowed the hernia, the surgery and full loss-of-earnings (LOE) benefits for the recovery period, and an Appeals Resolution Officer upheld those decisions. The employer appealed to the Tribunal. Before the hearing it withdrew its challenge to initial entitlement, leaving only the surgery and LOE issues. The worker did not participate in the Tribunal appeal.
If you have questions about a workplace injury claim, our Ontario employment lawyers can help you understand your options.
What Does the WSIB Hernia Policy Say About Emergency Surgery?
WSIB Policy 15-04-08 says that if a worker’s pre-existing, non-work-related hernia is aggravated through work and the worker elects to have it repaired, benefits for surgery and related lost time are not allowed unless the emergency criteria are met. Those criteria cover a hernia that is incarcerated (irreducible), strangulated, or associated with or apt to cause rupture of the bowel wall.
The employer argued that the objective medical evidence showed no such emergency and that the surgery reflected the worker’s personal preference. The CT scan on the day of the injury showed a small para-umbilical herniation with no bowel herniation or incarceration, and the Vice-Chair accepted that the medical notes did not indicate an emergency surgery.
Why Did the Emergency-Surgery Rule Not Apply?
The Vice-Chair found that the policy’s emergency-surgery requirement relates only to a pre-existing, non-work-related hernia that is aggravated through work. That was not this worker’s situation. Nothing in the medical evidence suggested his hernia was pre-existing, he told his case manager he had never been treated for a similar condition, and his entitlement was for a hernia caused by the August 16, 2018 accident.
The Vice-Chair also relied on the surgeon’s November 1, 2018 operative report, which said the hernia was work-related and symptomatic and that the worker wanted it repaired. Clinical notes between the injury and the surgery showed ongoing functional limitations, and the surgery was being planned: the worker signed his consent form on October 3, 2018, and an October 17 surgical consultation confirmed the November 1 repair. The Vice-Chair found the surgery sufficiently proximate in time to the injury and attributed to it by the treating professionals, not an elective surgery resulting from a pre-existing condition or other cause.
Why Were Full Loss-of-Earnings Benefits Confirmed?
Under section 43(1) of the Workplace Safety and Insurance Act, 1997, a worker who has a loss of earnings as a result of a compensable injury is entitled to LOE benefits. Policy 18-03-02 provides that full LOE is generally payable when the injury completely prevents a return to any type of work, or when no suitable work is available, provided the worker co-operated in health care and return to work.
The surgeon reported on the day of surgery that the worker was totally disabled and unable to work in any capacity from November 1 to November 25, 2018. Given the surgeon’s specialization, the Vice-Chair accepted that opinion and noted that the period was consistent with the hernia policy, which indicates recovery may take up to eight weeks for an uncomplicated repair. Full LOE for November 1 to November 25, 2018 inclusive was confirmed.
What Happens After the Decision?
The appeal was denied. The nature and duration of any further benefits flowing from the decision were returned to the WSIB for adjudication, subject to the usual rights of appeal.
Questions and Records to Discuss With a Lawyer
- Has the WSIB accepted your hernia as caused by a workplace accident, or as a pre-existing hernia aggravated by work?
- Do your medical records from the day of injury onward document the hernia and your symptoms?
- Does your surgeon’s operative report or other record say whether the hernia was work-related?
- What does your surgeon say about your ability to work during recovery?
- Has your employer objected to or appealed your benefits, and have you received notice of the appeal?
If you are dealing with a WSIB decision about hernia surgery or loss-of-earnings benefits, reach out to UL Lawyers through /connect to discuss your circumstances.
This article is automated commentary on a public court decision and is for general information only — not legal advice. Decisions rely on facts unique to each case. If you are affected by a similar issue, contact a lawyer for advice specific to your situation.
FAQ
Frequently asked questions
Not in this case. The Vice-Chair read the emergency-surgery criteria in WSIB Policy 15-04-08 as applying to a pre-existing, non-work-related hernia that is aggravated by work. Because this worker's hernia was accepted as caused by a workplace accident and he had no history of hernia, the surgery did not have to be an emergency to be covered.
Yes. Here the employer appealed to the Workplace Safety and Insurance Appeals Tribunal (WSIAT) after an Appeals Resolution Officer upheld the worker's benefits. It withdrew its challenge to initial entitlement before the hearing, leaving the surgery and loss-of-earnings issues. The worker did not participate in the written hearing, and the employer's appeal was denied.
From November 1 to November 25, 2018 inclusive. The surgeon reported on the day of surgery that the worker was totally disabled and unable to work in any capacity for that period, and the Vice-Chair noted that the hernia policy indicates recovery may take up to eight weeks for an uncomplicated repair. The worker returned to modified work on November 26 and regular duties on December 20, 2018.