K. MacMillan

The worker appealed the denial of entitlement for chronic mental stress and a physical chest wall strain.

The Appeals Resolution Officer found that the workplace conflicts did not amount to harassment or a substantial work-related stressor, denying the chronic mental stress claim.

However, the Officer allowed the physical injury claim, finding that a minor workplace incident permanently aggravated the worker's pre-existing left-sided intercostal neuralgia.

The worker was granted entitlement for the permanent aggravation, with a non-economic loss determination to follow.

The employer and worker both appealed decisions of the Case Manager regarding the worker's shoulder conditions.

The worker claimed a left shoulder injury developed gradually from their duties as an in-house technician, leading to calcific tendonitis, adhesive capsulitis, and a secondary right shoulder condition.

The Appeals Resolution Officer found insufficient evidence of a disablement situation arising out of and in the course of employment, noting the worker's symptoms worsened during a one-month vacation and while performing modified duties without overhead activities.

Consequently, initial entitlement for the left shoulder, loss of earnings benefits, permanent impairment, secondary right shoulder entitlement, and SIEF cost relief were all denied.

The employer's objection was allowed and the worker's objection was denied.

The worker and employer both objected to WSIB decisions regarding the worker's level of impairment, ability to participate in return-to-work services, and entitlement to secondary conditions following a compensable psychological injury (PTSD and depression).

The Appeals Resolution Officer found that the worker was capable of participating in work transition services and that there was no permanent restriction preventing a return to the injury employer in an accommodated capacity, provided the worker was not exposed to a police station or traumatic content.

The Officer denied the worker's claim of a significant deterioration in their psychological condition but granted secondary entitlement to ptosis as a physical manifestation of the work-related psychological impairment.

The worker, employed as a Case Manager, appealed a decision denying initial entitlement to benefits for Traumatic Mental Stress (TMS) and Chronic Mental Stress (CMS).

The worker alleged that dealing with complex, suicidal clients and receiving threats constituted traumatic events and substantial work-related stressors.

The Appeals Resolution Officer denied the appeal, finding that the events did not meet the objective threshold for TMS, as there were no threats of physical violence involving weapons or bomb threats.

Furthermore, the routine stress of the Case Manager position, while high, did not involve life-and-death responsibility as defined by the CMS policy, and the stressors were not excessive compared to normal pressures in similar circumstances.

The worker appealed a Case Manager's decisions denying entitlement for generalized anxiety disorder and PTSD, confirming psychological maximum medical recovery (MMR) with no restrictions, and rating the permanent psychological impairment at 15% for Non-economic loss (NEL).

The Appeals Resolution Officer allowed the appeal in part.

Entitlement was granted for panic disorder as a reaction to the treatment process, but denied for PTSD due to insufficient validity testing.

The MMR date was confirmed, but permanent psychological restrictions were recognized.

Consequently, the NEL rating was increased from 15% to 30% to reflect a moderate impairment.

The worker appealed a Case Manager's decision denying entitlement to a recurrence for a low back injury sustained on August 22, 2020, and refusing to amalgamate the new claim into the original 2017 claim.

The Appeals Resolution Officer found that the August 2020 incident, which involved lifting a patient from the floor to a chair, constituted a significant new incident rather than a recurrence.

Furthermore, the new injury was not clinically compatible with the original injury, as the symptoms and MRI findings shifted from the left side to a new right-sided disc herniation.

The appeal was dismissed.

The worker appealed a decision denying initial entitlement to health care benefits and loss of earnings (LOE) benefits for a foreign body in his left eye.

The Appeals Resolution Officer found that the worker suffered a gradual onset disablement injury caused by his workplace duties as a framer/labourer, granting initial entitlement for health care benefits.

However, the claim for LOE benefits was denied because the medical evidence did not support total disability and the employer had offered suitable modified duties within the worker's functional abilities.

The appeal was allowed in part.

The worker, a carpenter and business owner, appealed the denial of initial entitlement for a low back and left hip injury allegedly sustained while lifting heavy beams at work.

The Appeals Resolution Officer found that the incidents constituted an unexpected result disablement rather than a chance event.

However, the appeal was dismissed because there was a pronounced delay of approximately three months in seeking medical attention, failing to establish proof of accident.

Furthermore, clinical compatibility was not established, as there were insufficient clinical findings to causally link the L5-S1 herniation to the workplace incidents.

The worker objected to a 30% non-economic loss (NEL) rating for a permanent chronic pain disability, arguing for a higher rating in the marked impairment range (Class 4).

The Appeals Resolution Officer reviewed the medical evidence, including psychiatric reports, and applied the AMA Guides and WSIB Operational Policy 18-05-11.

The Officer concluded that the worker's impairment in activities of daily living, social functioning, concentration, and adaptation to stress aligned with a moderate impairment (Class 3).

The 30% rating was confirmed and the worker's objection was denied.

The worker appealed a decision denying entitlement to a right shoulder arthroscopic surgery and related benefits.

The worker had previously been granted entitlement for right shoulder tendonitis/repetitive strain injury.

The Appeals Resolution Officer found that the worker's job duties as a general helper did not involve prolonged or repetitive activities at or above shoulder level.

Relying on physician case file reviews, the Officer concluded that the surgical findings, which included significant biceps pathology and rotator cuff tears, were indicative of a degenerative etiology rather than the accepted workplace injury.

The appeal was dismissed as the surgery was not clinically compatible with the work-related injury.

The worker objected to the Case Manager's decision that maximum medical recovery (MMR) for a work-related head injury was achieved with no permanent impairment.

The Appeals Resolution Officer found that there was insufficient evidence to confirm if MMR had been achieved, given conflicting medical reports regarding ongoing symptoms.

The worker was directed to attend a WSIB-arranged multidisciplinary traumatic brain injury assessment at a Specialty Clinic, which the worker had previously refused to attend.

The objection was allowed in part, with further determination of MMR and permanent impairment deferred until the worker cooperates with the required medical examination.

The employer appealed a Case Manager's decision denying entitlement to Second Injury and Enhancement Fund (SIEF) relief following a worker's low back injury sustained while lifting boxes.

The employer argued that the worker's pre-existing conditions, including a prior back injury, obesity, and degenerative changes, prolonged her recovery.

The Appeals Resolution Officer found that the accident severity was moderate and that there was insufficient evidence that a prior disability caused or contributed to the accident, or that a pre-existing condition enhanced or prolonged the work-related disability.

The employer's objection was denied.

The worker, a truck driver, appealed a decision limiting her workplace injury entitlement to a right knee strain and denying ongoing benefits beyond July 21, 2016.

The worker argued that her duties, which involved rapidly pushing heavy linen carts around a tight curve, caused a right knee medial meniscal tear.

The Appeals Resolution Officer found that the diagnosed meniscal tear was clinically compatible with the disablement history, despite the presence of pre-existing degenerative conditions.

The appeal was allowed in part, granting entitlement for the meniscal tear and ongoing benefits from July 21, 2016 to September 19, 2016, with further entitlement to be determined by Operations.

The worker, a community support worker, appealed a decision denying initial entitlement for a ventral hernia allegedly sustained while using a Hoyer lift with a patient.

The Appeals Resolution Officer found that the incident did not represent a chance event and that proof of accident was not established, as the evidence did not support the worker's claim that she bore most of the patient's weight.

Furthermore, the medical evidence indicated the hernia was a recurrence of a previous condition and was not clinically compatible with the reported incident.

The worker's objection was denied.

The worker appealed a decision granting a 5% non-economic loss (NEL) benefit for a permanent vestibular impairment resulting from a workplace motor vehicle accident, seeking an increase to 10% or 15%.

The Appeals Resolution Officer weighed the medical evidence, preferring a neurologist's report over vestibular physiotherapy reports, and applied the AMA Guides.

The Officer found that the worker's tinnitus, balance, and gait issues were appropriately rated at the low end of a class 2 impairment.

The appeal was dismissed and the 5% NEL benefit was confirmed.

The worker appealed a decision denying initial entitlement for a left rotator cuff tear.

The worker experienced a gradual onset of left shoulder pain after emptying heavy boxes at work over a weekend.

Although there was a five-month delay in seeking medical attention, the Appeals Resolution Officer found the delay was not unreasonable as the worker self-modified duties and self-treated during that time.

The appeal was allowed, granting initial entitlement for the left rotator cuff tear and resulting surgery.