C. Goegan

The worker, an educational assistant, appealed a Case Manager's decision denying initial entitlement for traumatic mental stress (TMS) and chronic mental stress (CMS).

The worker had been subjected to multiple incidents of physical violence by special needs students over her career, culminating in a May 2022 incident where she was punched in the face by a 14-year-old student.

The Appeals Resolution Officer found that being the object of physical violence constituted an objectively traumatic event under WSIB Policy 15-03-02, regardless of the worker's occupation or training.

Relying on psychiatric evidence, the Officer concluded that the cumulative traumatic exposures significantly contributed to the worker's diagnosis of post-traumatic stress disorder (PTSD).

The worker's objection was allowed, and initial entitlement for PTSD was granted.

The worker objected to a Case Manager's decision that they had reached maximum medical recovery (MMR) by July 23, 2024, with no permanent impairment resulting from a work-related left ankle/foot injury.

The Appeals Resolution Officer reviewed the medical evidence, including reports from a WSIB Lower Extremity Specialty Clinic, which indicated the ankle fracture had fully healed with full range of motion and no residual impairment.

Applying the AMA Guides, the Appeals Resolution Officer confirmed the range of motion measurements did not result in a measurable impairment rating.

The worker's objection was denied, and the Case Manager's decision was upheld.

The worker appealed a Case Manager's decision concluding they had reached maximum medical recovery (MMR) by July 23, 2024, with no permanent impairment resulting from a work-related left ankle/foot injury.

The Appeals Resolution Officer reviewed the medical evidence, including reports from a WSIB Lower Extremity Specialty Clinic, which indicated the fracture had fully healed with full range of motion and no residual impairment.

The appeal was denied, confirming the worker reached MMR with no permanent impairment.

The worker appealed a Case Manager's decision denying a Non-Economic Loss (NEL) redetermination for a mild traumatic brain injury and neck injury sustained at work.

The Appeals Resolution Officer reviewed the medical evidence, including reports from a physical medicine specialist and a family doctor, against the American Medical Association's Guides to the Evaluation of Permanent Impairment.

The Officer concluded that the evidence did not establish a permanent and significant deterioration in the worker's condition since the previous 23% combined NEL rating.

The appeal was dismissed.

The worker's estate objected to a decision limiting the Loss of Retirement Income (LRI) pre-retirement death benefit to the mandatory contributions made by the WSIB and accumulated investment income.

The worker had elected to make voluntary 5% contributions from their loss of earnings benefits, but due to an administrative error, the WSIB never deducted these amounts.

The Appeals Resolution Officer denied the objection, finding that because the voluntary contributions were paid directly to the worker as part of their benefits and never invested into the LRI fund, they did not generate accumulated investment income.

Therefore, the estate was not entitled to any supplementary pre-retirement death benefit.

The worker, a paramedic, developed PTSD following a traumatic call and was granted entitlement.

After a period of accommodated work, the Case Manager determined the pre-injury job was unsuitable and denied further loss of earnings (LOE) benefits and entitlement for an adjustment disorder.

On appeal, the Appeals Resolution Officer found that the pre-injury job of paramedic was suitable with accommodations, as the worker had successfully returned to accommodated duties.

The final LOE benefit review date was adjusted to June 10, 2020, with partial LOE benefits payable based on the worker's actual accommodated earnings.

However, entitlement for an adjustment disorder and additional LOE benefits for claimed recurrences in 2022 were denied, as the worker's psychological deterioration was caused by a significant new incident—grief over the perceived loss of her career—rather than the original workplace injury.

The worker, an educational assistant, was head-butted by a special needs student, sustaining a concussion and psychological injuries.

The worker appealed the Case Manager's decisions denying entitlement for post-traumatic stress disorder (PTSD) and post-traumatic vision syndrome.

The Appeals Resolution Officer allowed the appeal in part, granting entitlement for PTSD based on the WSIB Mental Health Specialty Clinic's assessment, finding the accident was objectively traumatic.

However, the claim for post-traumatic vision syndrome was denied, as multiple neurological assessments found no organic basis for a visual system impairment.

The worker appealed a Case Manager's decision to offset 100% of their Canada Pension Plan Disability (CPP-D) benefits from their loss of earnings (LOE) benefits starting February 26, 2021.

The worker had sustained work-related injuries including an L1 burst fracture, neurogenic bladder, and left shoulder injury.

The Appeals Resolution Officer found that the worker's application for CPP-D benefits and the accompanying medical report listed only the work-related injuries as the basis for the disability.

Therefore, under WSIB Policy 18-01-13, the CPP-D benefits were paid solely because of the work-related injuries, and a 100% offset from the LOE benefits was appropriate.

The worker's objection was denied.

The worker, a cabinet-maker, suffered severe injuries to the fourth and fifth fingers of his left hand from a table saw, resulting in partial amputation of the fifth finger.

The WSIB initially granted a 4% Non-Economic Loss (NEL) award for the fifth finger but did not include the fourth finger.

Upon reconsideration, the NEL Clinical Specialist maintained the 4% rating.

The worker appealed.

The Appeals Resolution Officer applied the AMA Guides to evaluate the impairments of both fingers, including amputation, abnormal motion, and sensory loss.

The Officer determined the combined impairment of the left hand equated to an 11% upper extremity impairment, resulting in a 7% whole person impairment.

The appeal was allowed, and the NEL award was increased to 7%.

The worker, a communications operator, suffered a work-related mental stress injury (PTSD) in August 2019 and received loss of earnings (LOE) benefits.

After participating in a graduated return to work plan, the worker stopped working in October 2022 due to a deterioration in psychological symptoms.

The Case Manager denied entitlement to a recurrence of the work-related PTSD and LOE benefits, finding the deterioration was caused by significant non-work-related life stressors.

The worker objected to this decision and a subsequent decision denying partial LOE benefits during a March 2023 return to work plan.

The Appeals Resolution Officer dismissed the appeal, concluding that the worker's significant deterioration was due to a confluence of non-work-related life stressors, which equated to a significant new incident, and therefore the worker was not entitled to LOE benefits for a recurrence or partial LOE benefits during the subsequent return to work plan.

The worker objected to a Case Manager's decision denying entitlement to benefits for a psychotraumatic disability following a 2018 workplace accident where she sustained soft tissue injuries.

The Appeals Resolution Officer found that the worker did not meet any of the three circumstances outlined in WSIB Policy 15-04-02.

The evidence did not establish that the psychological condition was an indirect result of the physical injury or related to an extended disablement, as the worker reached maximum medical recovery with no ongoing impairment shortly after the accident.

The worker's objection was denied.

The employer objected to a Case Manager's decision that the worker reached maximum medical recovery (MMR) by December 16, 2022, with a permanent low back impairment.

The worker, a personal support worker, suffered a low back strain and exacerbation of pre-existing spondylolisthesis after assisting a patient.

The Appeals Resolution Officer reviewed the medical evidence, including reports from a specialty clinic, and found that the worker had reached a plateau in recovery with no further significant improvement likely.

The Officer concluded that the worker continued to have an ongoing work-related impairment at the time of MMR, confirming the permanent impairment.

The employer's objection was denied.

The worker objected to a Case Manager's decision denying entitlement to a recurrence of work-related forehead, neck, and trapezius injuries originally sustained in 2014 when struck by a jig.

The worker sought benefits for neck and shoulder symptoms reported in 2019 and 2020.

The Appeals Resolution Officer found that the original injuries had resolved and that the new diagnoses of rotator cuff pathology, tendinosis, and lateral epicondylitis were not clinically compatible with the original soft tissue injuries.

The appeal was dismissed, and entitlement to a recurrence was denied.

The worker objected to a Case Manager's decision denying ongoing entitlement to chronic mental stress and loss of earnings (LOE) benefits following a workplace harassment incident.

The Appeals Resolution Officer found that the worker had not reached maximum medical recovery by September 2006, but did so by November 2007 with no ongoing compensable impairment.

The Officer also determined that the worker was entitled to full LOE benefits from November 2005 until their return to work in 2006, as they had reasonably co-operated in the return-to-work process.

The objection was allowed in part.

The worker appealed a Case Manager's decision reducing their loss of earnings (LOE) benefits from full to partial as of April 1, 2022.

The worker had sustained a right knee injury requiring surgery and subsequently developed a psychotraumatic disability.

The Appeals Resolution Officer found that although the worker was not totally disabled, they had made reasonable efforts to secure suitable employment and engaged in health care measures aimed at improving their employability.

As suitable work was not available from the employer, the worker met the criteria for full LOE benefits.

The appeal was allowed, granting full LOE benefits from April 1, 2022 to March 10, 2023.

The worker, a truck driver, appealed a decision denying initial entitlement for multiple injuries sustained after falling from a ladder while repairing a trailer roof.

The Eligibility Adjudicator had denied the claim on the basis that the accident occurred outside working hours and after the worker consumed alcohol.

The Appeals Resolution Officer allowed the appeal, finding that the accident occurred on the employer's premises, during paid working hours, and while the worker was performing a work-related activity assigned by his supervisor.

The worker's testimony was found to be credible and outweighed contradictory witness statements.

The consumption of one beer was not found to be a significant contributing factor to the fall.

The worker appealed a Case Manager's decision denying initial entitlement to benefits for chronic mental stress (CMS).

The worker alleged that a verbal warning for lateness and subsequent heated exchanges with their supervisor, which included yelling and profanity, constituted workplace harassment and caused their anxiety.

The Appeals Resolution Officer found that while the interactions were unprofessional, they amounted to interpersonal conflict over a disciplinary matter and did not rise to the level of a substantial workplace stressor as required by WSIB Policy 15-03-14.

The employer's decision to issue a one-day suspension to the supervisor was also deemed a normal employment function.

The worker's objection was denied.

The worker appealed several decisions regarding their Workplace Safety and Insurance Board (WSIB) claim following a left ankle fracture.

The Appeals Resolution Officer determined that the Non-Economic Loss (NEL) quantum for the left ankle impairment was 8%, but this did not increase the worker's overall 49% NEL award.

The Officer also found that the worker's psychotraumatic disability was temporary and did not warrant a permanent impairment award.

Finally, the Officer concluded that the worker was capable of part-time suitable work, adjusting the Loss of Earnings (LOE) benefits based on a part-time entry-level wage rather than a full-time wage.

The employer appealed a decision granting the worker initial entitlement to health care and loss of earnings benefits for a left knee strain.

The worker alleged they injured their knee while walking up stairs and later re-injured it stepping into a truck.

The Appeals Resolution Officer reviewed video surveillance which contradicted the worker's claims of slipping or tripping.

The Officer concluded the injury was a disablement rather than a chance event, and that there was no workplace injuring process that could reasonably explain the onset of symptoms.

The employer's appeal was allowed and initial entitlement was rescinded.

The employer objected to a Case Manager's decision granting a police officer initial entitlement to post-traumatic stress disorder (PTSD) and loss of earnings (LOE) benefits.

The worker had been exposed to multiple traumatic events during their employment.

The Appeals Resolution Officer found that the worker met the criteria for the first responder PTSD presumption under Policy 15-03-13.

The employer failed to rebut the presumption, as the evidence showed the worker's employment as a police officer significantly contributed to the PTSD diagnosis.

The worker was also found entitled to full LOE benefits because the psychological injury prevented a return to any type of work.

The employer's objection was denied.