Helen Shaw

The worker appealed a Case Manager decision regarding loss of earnings (LOE) benefits following a 2015 motor vehicle accident that resulted in permanent physical and psychotraumatic impairments.

The Appeals Resolution Officer found that the worker was completely unable to work due to the combined effects of his physical and psychological impairments, and that the identified suitable occupation of Cashier was not suitable.

The Officer upheld the decision to treat taxable dividends received in 2016 and 2017 as post-injury earnings, resulting in no LOE benefits for late 2016 and partial LOE benefits for 2017.

However, the worker was granted full LOE benefits from January 1, 2018 to the 72-month review date, and continuing to age 65.

The worker, a primary care paramedic, suffered a work-related mental stress injury (PTSD) and was completely unable to work as of May 6, 2024.

The Case Manager denied loss of earnings (LOE) benefits from May 8 to May 20, 2024, because the worker was on a pre-approved vacation and received vacation pay.

On appeal, the Appeals Resolution Officer found that under WSIB operational policy, a fully impaired worker may continue to receive full benefits during a vacation of up to three weeks if it does not interrupt treatment.

The worker had notified the WSIB of the vacation and actively participated in treatment without significant interruption.

The appeal was allowed, and full LOE benefits were granted for the disputed period.

The worker, who previously suffered a compensable neck injury and concussion from a fall at work, sought entitlement for new cervical spine diagnoses and a Non-Economic Loss (NEL) redetermination following a subsequent trip and fall at home.

The Appeals Resolution Officer denied the appeal, finding no causal link between the fall at home and the work-related injury.

The medical evidence did not establish a confirmed diagnosis of cervical spine instability or anterolisthesis, nor did it demonstrate a significant and permanent deterioration of the work-related cervical spine impairment to warrant a NEL redetermination.

The worker, a city bus driver, 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 verbal abuse and perceived threats of physical violence by two teenage passengers and an adult over a fare dispute.

The Appeals Resolution Officer found the incident was clearly and precisely identifiable and objectively traumatic, satisfying the criteria for TMS under WSIB operational policy 15-03-02.

The worker's objection was allowed, granting initial entitlement for TMS and full loss of earnings benefits for the period of lost time.

The worker appealed a Case Manager's decision denying entitlement for posttraumatic stress disorder (PTSD).

The worker had previously been granted entitlement for bilateral upper extremity injuries and Major Depressive Disorder resulting from extended disablement.

The worker argued that PTSD developed due to workplace harassment and the employer's failure to accommodate medical needs.

The Appeals Resolution Officer dismissed the appeal, finding that the worker's PTSD was not an indirect result of the physical injury or attributable to the extended disablement, and that general concerns regarding workplace harassment were outside the scope of the claim.

The employer appealed a decision granting the worker secondary entitlement for an infected burn on the left upper thigh and loss of earnings benefits.

The worker sustained a work-related thermal burn which subsequently became infected, causing the worker to miss work.

The employer argued the infection developed outside of work hours and was not work-related.

The Appeals Resolution Officer denied the employer's appeal, finding that the infection was causally linked to the work-related burn injury, as the worker would not have been subject to the risk of infection but for the initial work-related wound.

The worker, a correctional officer with a recognized permanent impairment for work-related posttraumatic stress disorder (PTSD), sought loss of earnings benefits for a recurrence of PTSD symptoms from July 21, 2022, to October 18, 2022.

The Case Manager initially denied the claim, finding that the worsening symptoms were caused by other factors, such as a toxic work environment.

On appeal, the Appeals Resolution Officer found that the worker experienced a significant deterioration in PTSD symptoms that was clinically compatible with the original injury, leaving them less capable of coping with usual occupational stressors.

The worker's objection was allowed, and full loss of earnings benefits were granted for the period in question.

The worker appealed a Case Manager's decision denying entitlement for a psychotraumatic disability following a 2018 workplace injury where they fell from a scaffold.

The worker argued they developed Major Depressive Disorder as an indirect result of the physical injury and extended disablement.

The Appeals Resolution Officer found that the worker's psychological condition did not manifest as an indirect result of the physical injury, noting that early stress was related to treatment delays rather than the injury itself.

Furthermore, the worker's ongoing stress was primarily attributed to financial constraints and disagreement with WSIB decisions, which do not satisfy the criteria for a psychotraumatic disability related to extended disablement.

The appeal was dismissed.

The worker appealed a Case Manager's decision denying entitlement for neck, mid-back, and shoulder injuries, and declining to consider secondary entitlement for psychotraumatic disability or chronic pain disability (CPD) following a workplace low back injury.

The Appeals Resolution Officer found no evidence to support initial or secondary entitlement for the neck, mid-back, or shoulders, as these were not reported at the time of the accident or causally linked to the low back injury.

However, the Officer found sufficient evidence of psychosocial barriers to warrant a formal decision on psychotraumatic disability and CPD.

The objection was allowed in part, with the matter remitted to the operating area to consider entitlement for the non-organic conditions.

The employer objected to a decision granting the worker initial entitlement for a left shoulder dislocation and loss of earnings (LOE) benefits.

The worker tripped and fell at work, initially receiving a diagnosis of a shoulder sprain.

A week later, the worker woke up in severe pain and was diagnosed with a shoulder dislocation.

The employer argued the dislocation occurred at home and was not work-related.

The Appeals Resolution Officer found it more likely than not that the dislocation occurred during the workplace fall but self-corrected before the initial medical assessment, leaving the shoulder vulnerable.

The ARO denied the employer's objection, confirming entitlement to healthcare and LOE benefits.

The worker objected to a decision denying coverage for a cervical pillow and noise-reducing ear plugs following a workplace injury.

The worker had sustained physical and psychological injuries after being assaulted by a student.

The Appeals Resolution Officer found that the requested items were not supported by the multidisciplinary treatment team at the Neurology Specialty Program.

The evidence did not establish that the items were necessary, appropriate, and sufficient health care treatment for the work injury.

The worker's objection was denied.

The worker suffered a workplace fall resulting in a left shoulder sprain and lower back contusion.

The WSIB initially allowed entitlement but later denied ongoing benefits, concluding the low back strain had resolved and the shoulder issues were related to a pre-existing condition.

The Appeals Resolution Officer allowed the worker's appeal, finding that the workplace fall aggravated the worker's pre-existing left shoulder glenohumeral osteoarthritis, necessitating total shoulder replacement surgery.

The Officer also found that the work-related lower back sprain/strain had not fully resolved.

Full loss of earnings benefits were restored.

The worker, a truck driver, suffered a workplace injury in November 2019 and was subsequently laid off due to a seasonal work shortage, which became a permanent work disruption in June 2020.

The Case Manager denied loss of earnings (LOE) benefits, determining the worker could restore their wage loss as a Light Delivery Driver.

The Appeals Resolution Officer allowed the worker's appeal, finding that the physical restrictions and psychological barriers prevented the worker from securing employment in the suggested suitable occupation without return to work assistance.

The worker was granted full LOE benefits from June 1, 2020, and a return to work assessment.

The worker appealed a Case Manager's decision denying entitlement for a recurrence of bilateral carpal tunnel syndrome and C7 nerve root compression.

The worker originally suffered the injury in 2011 and claimed a recurrence in October 2019 after a period of continuous flare-ups.

The Appeals Resolution Officer found that the original symptoms had largely resolved by August 2014 and that subsequent medical treatments were for various other physical complaints not compatible with the original injury.

The appeal was dismissed, with a direction to establish a new claim for the 2019 symptoms.

The worker, a personal support worker, suffered a work-related low back strain in 2016.

After initial loss of earnings benefits were terminated, the worker sought entitlement for chronic pain disability (CPD).

The Appeals Resolution Officer applied the five conditions under Operational Policy 15-04-03 and found that the worker's continuous, genuine pain was caused by the workplace injury, persisted beyond the usual healing time, was inconsistent with organic findings, and resulted in a marked life disruption.

The worker's appeal was allowed and entitlement for CPD was granted.

The employer objected to a decision denying relief under the Second Injury and Enhancement Fund (SIEF) for a worker's right shoulder injury.

The worker sustained full thickness rotator cuff tears while trying to catch a 100-pound cylinder.

The employer argued that pre-existing degenerative changes in the worker's shoulder prolonged the recovery and warranted 75% SIEF relief.

The Appeals Resolution Officer found the accident was moderate in severity and that the medical evidence did not establish that the pre-existing degenerative changes prolonged or enhanced the work-related disability.

The employer's objection was denied.

The worker and employer both objected to decisions of the WSIB.

The worker objected to the suitability of the Dispatcher suitable occupation (SO) and the payment of partial loss of earnings (LOE) benefits based on minimum wage.

The employer objected to the 25% relief granted under the Second Injury and Enhancement Fund (SIEF).

The Appeals Resolution Officer found the Dispatcher SO was suitable and available, and that partial LOE benefits were appropriately paid.

The employer's objection was allowed in part, with SIEF relief increased to 50% based on a minor accident and a minor pre-existing condition.

The worker sought loss of earnings (LOE) benefits following knee surgery for a work-related injury.

Benefits were denied under section 43(1)(b) of the Workplace Safety and Insurance Act because the worker was over 65 years of age at the time of the surgery.

The worker argued this provision violated section 5(1) of the Human Rights Code.

The Appeals Resolution Officer found that section 2.1(1) of the WSIA removed jurisdiction to consider a violation of the Code for a distinction based on age.

Alternatively, the Officer concluded that the age limitation did not result in substantive discrimination and could be justified as a bona fide requirement.

The objection was denied.

The worker, a delivery agent, sustained a muscle strain while lifting a parcel.

She appealed a decision denying her loss of earnings (LOE) benefits and sought to add an intercostal strain to her accepted diagnoses.

The Appeals Resolution Officer allowed the appeal in part, granting entitlement for the intercostal strain based on medical evidence.

However, the claim for LOE benefits was denied because the worker was not totally disabled from working and suitable modified duties were available without wage loss.

The worker, a plumber who suffered a right knee dislocation in 2009, objected to the denial of a non-economic loss (NEL) redetermination.

The Appeals Resolution Officer reviewed the medical evidence, including physiatrist reports, and compared the current objective findings to those from the last NEL assessment in 2012.

The Officer found that the worker's range of motion and clinical findings had not changed significantly, and in some respects had improved.

Consequently, the Officer concluded there was no evidence of a significant deterioration to warrant a NEL redetermination, and the objection was denied.