K. MacMillan

The worker and employer both objected to a Case Manager's decision regarding loss of earnings (LOE) benefits following a workplace injury to the worker's right finger.

The worker appealed the denial of LOE benefits from April 10, 2024 to May 6, 2024, arguing they were following medical advice to remain off work post-surgery.

The employer appealed the allowance of LOE benefits for April 8 and 9, 2024, arguing suitable modified duties were available.

The Appeals Resolution Officer denied the worker's appeal, finding that safe and suitable modified duties were available that accommodated the worker's functional limitations.

The employer's appeal was allowed in part; LOE benefits were denied for April 8 as the surgery occurred on April 9, but entitlement was confirmed for the actual surgery date of April 9.

The employer appealed a Case Manager's decision finding it in breach of its re-employment obligation under the Workplace Safety and Insurance Act.

The worker, an ironworker, suffered a workplace injury and was terminated within six months of returning to work, triggering a presumption of a breach.

The employer argued the termination was due to poor performance and insubordination, unrelated to the injury.

The Appeals Resolution Officer found irregularities in the employer's disciplinary records, noting that the worker was not provided with written warnings or corrective plans prior to termination, unlike other employees involved in the same incidents.

The employer failed to rebut the presumption that the termination was related to the injury or claim.

The breach and the associated penalty were confirmed.

The worker, a police sergeant with an accepted claim for post-traumatic stress disorder, objected to a decision denying loss of earnings (LOE) benefits after October 31, 2020.

The worker argued that because they were permanently restricted from police work, they were entitled to LOE benefits despite retiring.

The Appeals Resolution Officer found that the worker made a fully informed, voluntary decision to retire and withdraw from all return-to-work services, including those aimed at the general labour market.

Consequently, the post-retirement wage loss was not caused by the workplace injury, and the objection was denied.

The worker objected to a Return-to-Work Specialist's decision authorizing a 12-month Self-Directed Transition Plan for the suitable occupation of Production Logistics Coordinator at an entry-level wage of $21.07 per hour.

The worker argued they lacked the necessary skills and that the wage was too high.

The Appeals Resolution Officer denied the objection, finding that the occupation was within the worker's functional abilities and transferrable skills, and that the updated labour market information supported the determined wage.

The employer objected to the WSIB's decisions granting the worker initial entitlement to health care benefits for a lower back strain and full loss of earnings (LOE) benefits from October 12, 2023 to November 6, 2023.

The worker sustained a lower back injury while shoveling in a trench.

The employer argued that the worker had a pre-existing back condition and that suitable modified duties were available.

The Appeals Resolution Officer found that the injury arose out of the worker's employment and that the pre-existing condition did not limit entitlement.

Furthermore, the medical evidence demonstrated that the worker's condition deteriorated, rendering them unable to perform the remote modified duties or safely drive to pick up printed materials.

The employer's objection was denied, and the initial entitlement and LOE benefits were confirmed.

The worker appealed a WSIB decision denying entitlement for a left shoulder injury and determining that their work-related upper back strain reached maximum medical recovery (MMR) on December 21, 2019.

The Appeals Resolution Officer upheld the denial of the left shoulder injury and cervical disc protrusion, finding no clinical compatibility with the workplace incident of pulling a wheeled tote.

However, the officer adjusted the MMR date for the thoracic strain to February 5, 2020, to align with the end of authorized chiropractic treatment.

The appeal was allowed in part.

The worker appealed a Case Manager's decision denying ongoing entitlement for bilateral upper extremity issues, including a diagnosis of inflammatory arthritis, and denying loss of earnings (LOE) benefits from March 1, 2023.

The Appeals Resolution Officer found that the worker's ongoing diagnosis of seronegative rheumatoid arthritis was not clinically compatible with the workplace mechanism of injury (lifting wet plywood).

The Officer concluded that the work-related soft tissue injury had fully resolved by January 13, 2023, reaching maximum medical recovery with no permanent impairment.

Consequently, the worker was not entitled to LOE benefits from March 2023, as the ongoing wage loss was not caused by the work-related injury.

The appeal was denied.

The worker objected to a Case Manager's decision denying entitlement for a left shoulder injury following a workplace accident where the worker was burned by hot tar.

The worker argued the shoulder injury occurred when they grabbed a fence to prevent a fall during the incident.

The Appeals Resolution Officer found the accident history credible and clinically compatible with the orthopaedic surgeon's diagnosis of supraspinatus tendinopathy and subacromial bursitis.

The worker's objection was allowed, and entitlement to the left shoulder injury was granted.

The worker objected to WSIB decisions denying loss of earnings (LOE) benefits for a specific period and denying entitlement to psychotraumatic disability benefits following a workplace accident involving a tow motor and a forklift.

The Appeals Resolution Officer found that the worker was completely disabled from working due to the physical injury from May 31, 2021, to June 23, 2021, and granted full LOE benefits for that period.

However, the claim for psychotraumatic disability was denied because the worker's psychological symptoms were found to be an emotional reaction to a dispute with the employer over the accident details and return-to-work process, rather than an indirect result of the physical injury itself.

The worker, a police officer, appealed a Case Manager's decision denying entitlement for posttraumatic stress disorder (PTSD), traumatic mental stress, and chronic mental stress.

The worker had responded to a fatal motor vehicle incident involving a child in 2011, but did not seek psychological treatment until 2021, shortly after their own child suffered a severe medical emergency.

The employer argued the personal stressor rebutted the presumption of work-relatedness for first responders.

The Appeals Resolution Officer found that the work-related incident remained a significant contributing factor to the PTSD diagnosis, despite the co-existing personal stressor and the delay in seeking treatment.

The appeal was allowed, granting entitlement for PTSD as a first responder.

The worker objected to a decision denying initial entitlement for a slip and fall injury that occurred in a parking lot prior to the start of their shift.

The worker argued they were employed by the City, which owned the parking lot.

The Appeals Resolution Officer determined that the worker's employer was the Police Services Board (the employer of record), not the City, despite sharing a WSIB firm number.

Furthermore, the worker was not in the course of employment at the time of the injury because they had not yet entered the employer's premises, and the employer did not own or control the parking lot.

The worker's objection was denied.

The worker objected to two Case Manager decisions denying entitlement to a recurrence of a work-related right knee injury, partial loss of earnings (LOE) benefits, and a redetermination of the non-economic loss (NEL) benefit.

The Appeals Resolution Officer found insufficient objective clinical evidence of a significant deterioration in the work-related impairment to justify a recurrence or a NEL redetermination.

The officer also concluded that the worker's inability to perform pre-injury hours was not a result of the work-related injury.

The worker's objections were denied.

The worker objected to the Case Manager's decisions to reduce loss of earnings benefits due to a post-accident change in circumstances.

The worker had suffered a compensable left knee injury and was participating in a return-to-work plan involving computer skills training.

The worker left the province for a family vacation without pre-authorization, interrupting the training.

The Appeals Resolution Officer found that the unapproved vacation constituted a material change in circumstances, justifying the reduction of benefits based on a suitable occupation without training.

Furthermore, the ongoing reduction of benefits was upheld because the worker subsequently withdrew from return-to-work services and failed to re-engage.

The worker's objection was denied.

The worker appealed decisions denying ongoing loss of earnings (LOE) benefits, finding no breach of the employer's re-employment obligation, and determining maximum medical recovery (MMR) was reached with no ongoing impairment.

The Appeals Resolution Officer allowed the appeal in part, granting LOE benefits from April 8, 2022, to July 12, 2022, as the worker was not fit for regular duties and no suitable modified work was available.

However, the Officer found no breach of the re-employment obligation, as the employer rebutted the presumption by showing no suitable work was available at a comparable workplace.

Finally, the Officer upheld the determination that MMR was reached on July 12, 2022, with no ongoing work-related impairment, concluding that the worker's disc herniations were unrelated to the workplace accident.

The employer objected to a Case Manager's decision finding that it breached its re-employment obligation by terminating the worker.

The worker had suffered a workplace injury and was subsequently terminated from a new accommodated position due to alleged workplace harassment and mismanagement.

The Appeals Resolution Officer found that the employer failed to follow its own internal policies regarding formal investigations and progressive discipline prior to termination.

Consequently, the employer failed to prove the termination was unrelated to the workplace injury, and the objection was denied, upholding the re-employment penalty.

The employer objected to an Eligibility Adjudicator's decision granting the worker secondary entitlement for a lower back strain/sprain and full loss of earnings (LOE) benefits.

The worker had suffered a work-related right foot injury and claimed the lower back condition resulted from using crutches and an air cast.

The Appeals Resolution Officer found insufficient evidence to establish a causal link between the use of the medical devices and the lower back injury, noting the worker was performing sedentary modified duties.

Consequently, secondary entitlement was denied, and LOE benefits were not payable as the wage loss was not the result of the workplace injury.

The employer's objection was allowed.

The employer objected to a Case Manager's decision denying entitlement to cost relief under the Second Injury and Enhancement Fund (SIEF) following a worker's trip and fall injury.

The employer argued that the worker's pre-existing conditions, including diabetes and lumbar degeneration, prolonged recovery.

The Appeals Resolution Officer found the accident severity was moderate and that the pre-existing conditions did not cause the accident or prolong the recovery period within the meaning of the policy.

The employer's objection was denied.

The employer objected to a Case Manager's decision to apply a re-employment penalty for breaching its re-employment obligation.

The worker had suffered a right arm injury and returned to modified duties before being laid off due to the pandemic, and subsequently terminated without cause.

The employer argued the termination was due to performance issues and lack of skills, not the workplace injury.

The Appeals Resolution Officer found insufficient contemporaneous evidence to support the employer's claim of pre-existing performance issues.

The termination was deemed a breach of the re-employment obligation, and the penalty was upheld.

The worker objected to a Return-to-Work Specialist's decision authorizing the suitable occupation of Customer Service and an associated Work Transition plan.

The worker argued they lacked the transferrable skills and education for the role and requested full loss of earnings benefits to age 65.

The Appeals Resolution Officer found that the worker's extensive experience as a business owner provided relevant customer service skills, and that the physical demands of the role were within the worker's permanent restrictions.

The suitable occupation and Work Transition plan were confirmed, and the worker's objection was denied.

The worker objected to a Case Manager's decision denying secondary entitlement for conditions allegedly resulting from medication use for a 1989 work-related low back injury, and denying a reassessment of a 25% permanent disability benefit.

The Appeals Resolution Officer allowed the appeal in part, granting secondary entitlement for an abdominal/gastrointestinal condition and associated weight loss due to chronic opioid use.

Claims for organ failure and anxiety/depression were denied.

The request for a permanent disability reassessment was also denied, as there was insufficient evidence of a significant deterioration in the work-related impairment.