H. Mohamed

The worker appealed several decisions by the WSIB operating area, including the creation of a $76,647.48 recoverable overpayment, denial of psychotraumatic disability, denial of a NEL redetermination, termination of supplementary benefits, rescission of an organic NEL award based on surveillance evidence, and denial of a 100% FEL award.

The Appeals Resolution Officer found that the overpayment was fully recoverable as the worker knew or ought to have known he was receiving duplicate payments.

Claims for psychotraumatic disability, NEL redetermination, supplementary benefits, and a 100% FEL award were denied.

However, the Officer found the operating area erred in rescinding the worker's original 33% NEL award based solely on surveillance evidence, reinstating the organic NEL award.

The worker requested an extension to the time limit to object to two decisions from 2011 regarding her loss of earnings benefits and work transition services.

The Appeals Resolution Officer found that the worker was sophisticated enough to understand the time limits, had not demonstrated an intention to appeal within the statutory period, and lacked diligence in pursuing the appeal for over three years.

The request for a time limit extension was denied.

The worker, a head cook, appealed decisions denying entitlement for cervical spine degenerative disc disease and hand osteoarthritis, denying psychotraumatic disability, finding her not totally disabled, approving a Work Transition plan as a Food Service Supervisor, and setting her Non-Economic Loss (NEL) award at 21.25%.

The Appeals Resolution Officer allowed the appeal in part.

Entitlement for the cervical spine and hand osteoarthritis was denied as they were not work-related.

Entitlement for psychotraumatic disability was granted, with a referral for an independent psychiatric assessment.

The worker was found not totally disabled, but the Work Transition plan was deemed unsuitable, and full loss of earnings benefits were reinstated pending a new plan.

The NEL award was increased to 27.25%.

The worker suffered a low back injury and was placed in a Labour Market Re-entry plan to complete a Bachelor of Social Work.

After failing to complete the program within the allotted time, she requested a one-year extension, which was denied.

She subsequently completed a psychology degree and found employment as a Life Skills Co-ordinator earning $11.00 per hour.

The WSIB determined she was underemployed and based her final loss of earnings (LOE) review on deemed earnings of $15.50 per hour.

The Appeals Resolution Officer denied the request for a one-year extension to the retraining program but allowed the appeal regarding the LOE review, finding the worker was not underemployed and her benefits should be based on her actual wages of $11.00 per hour.

The worker appealed a decision regarding his workplace injury claim, seeking an increase in his Non-Economic Loss (NEL) award for his low back, entitlement to narcotic addiction treatment, and loss of earnings (LOE) benefits following his termination in March 2004.

The Appeals Resolution Officer found that the 18 per cent NEL award was correctly calculated and denied the request for narcotic addiction treatment due to a lack of causal connection to the workplace injury.

However, the Officer granted the worker's appeal for LOE benefits, finding that the employer failed to rebut the presumption under section 41(10) of the Workplace Safety and Insurance Act that the termination was related to the injury, and awarded full and partial LOE benefits for various periods.

The worker appealed a decision denying him loss of earnings (LOE) benefits beyond October 6, 2014, after he refused to return to modified work.

The Appeals Resolution Officer found that the modified duties offered by the employer were unsuitable, entitling the worker to full LOE benefits from the date of termination.

However, the worker suffered a non-work-related slip and fall on November 19, 2014, which re-injured his back.

Because the worker was near full recovery from his compensable injury at the time of the second accident, entitlement to benefits ceased as of November 19, 2014.

The worker, a correctional officer, appealed a decision denying initial entitlement for a left shoulder impairment.

She claimed her shoulder pain was caused by repetitively moving window coverings and depressing light switches during midnight shifts.

Medical evidence, including an ultrasound, diagnosed calcific tendonitis with no evidence of a rotator cuff tear.

The Appeals Resolution Officer found that calcific tendonitis is a non-compensable condition that is neither caused nor aggravated by work activities, relying on a WSIAT medical discussion paper.

The appeal was denied.

The employer objected to the WSIB's decisions granting the worker initial entitlement for pigmented villonodular synovitis (PVNS) and denying the employer Second Injury and Enhancement Fund (SIEF) cost relief.

The worker had suffered a twisting injury to her right ankle at work, and was later diagnosed with PVNS, a rare tumour, which required surgery.

The Appeals Resolution Officer found that, on a balance of probabilities, the workplace injury either caused or aggravated the PVNS, satisfying the significant contribution test.

The Officer also found no evidence that the PVNS was a pre-existing condition that enhanced or prolonged the claim, and therefore denied SIEF cost relief.

The employer's objections were denied.