M. Haughton

The worker appealed the Eligibility Adjudicator's decision denying initial entitlement for an umbilical hernia.

The worker alleged the hernia was caused by pushing and pulling heavy skids with a manual hand jack at work.

The employer argued the hernia may have been caused by recent weight gain and noted a delay in reporting.

The Appeals Resolution Officer found that the worker met the five-point check system for an allowable claim, noting the diagnosed hernia was compatible with the reported mechanism of injury and there were no non-work activities identified that could have caused it.

The worker's objection was allowed and initial entitlement to an umbilical hernia was granted.

The employer objected to a Case Manager's decision granting a police officer entitlement to benefits for post-traumatic stress disorder (PTSD) under the first responder presumption in Policy 15-03-13.

The employer argued the claim coincided with disciplinary action and lacked specific dates of traumatic events.

The Appeals Resolution Officer denied the employer's objection, finding the worker met the diagnostic and employment criteria for the presumption.

The evidence of cumulative exposure to traumatic events over a 16-year career was sufficient, and the employer failed to rebut the presumption by showing the PTSD was caused by non-work-related factors or employer decisions.

The worker appealed decisions denying secondary entitlement for left ear, neck, and right shoulder conditions, denying an increase in the dose and THC concentration of medical cannabis, and denying an increase in the frequency of maintenance massage therapy.

The Appeals Resolution Officer found no causal relationship between the accepted workplace injuries and the left ear, neck, or right shoulder conditions.

The requested increase in medical cannabis exceeded the maximum allowable dose under WSIB policy, and the worker's condition was not palliative.

Finally, the approved twice-monthly massage therapy was deemed necessary, appropriate, and sufficient.

The worker's appeals were dismissed.

The worker appealed several decisions of the Case Manager and Nurse Consultant regarding their workplace injury claim.

The worker sought secondary entitlement for a left ear condition allegedly caused by acupuncture, and for neck and right shoulder conditions.

The worker also requested an increase in their medical cannabis dose and THC concentration, as well as an increase in the frequency of maintenance massage therapy to weekly sessions.

The Appeals Resolution Officer dismissed the appeals, finding no causal relationship between the accepted workplace injuries and the left ear, neck, or right shoulder conditions.

The requested increase in medical cannabis exceeded policy limits and the worker's condition was not palliative.

Finally, the approved twice-monthly massage therapy was deemed necessary, appropriate, and sufficient.

The employer appealed a decision granting the worker partial loss of earnings (LOE) benefits.

The worker sustained a lower back injury and returned to modified work.

Prior to the injury, the worker regularly worked voluntary overtime, which was included in their short-term average earnings.

The employer's policy did not allow overtime for employees on modified work, resulting in a wage loss for the worker.

The Appeals Resolution Officer found that under WSIB policy, the worker's pre-injury overtime was correctly included in their earnings profile, and the inability to work overtime while on modified work constituted a compensable wage loss.

The employer's appeal was denied.

The worker appealed a Case Manager's decision denying ongoing entitlement to loss of earnings (LOE) benefits and a permanent impairment assessment for a right knee injury subsequent to October 19, 2018.

The Appeals Resolution Officer found that the medical evidence supported a permanent work-related impairment of the right knee, entitling the worker to a Non-Economic Loss (NEL) assessment.

However, the worker was not entitled to LOE benefits after October 19, 2018, as there was insufficient evidence that their loss of earnings resulted from the work-related injury.

The worker, a journeyman plumber, suffered a compensable right knee injury and subsequently developed a non-compensable left hip condition requiring surgery.

The Case Manager denied loss of earnings (LOE) benefits from October 23, 2018, to January 28, 2020, finding the hip condition was the primary reason for the inability to work, and identified 'Other Service Support Occupations' as a suitable occupation (SO).

On appeal, the Appeals Resolution Officer found that the worker remained partially impaired due to the work-related knee injury during the disputed period.

However, as the worker was capable of performing the identified SO and made no efforts to secure alternate employment, the worker was entitled to partial, rather than full, LOE benefits based on entry-level earnings in the SO.

The appeal was allowed in part.

The worker, a journeyman plumber, suffered a work-related right knee injury and subsequently developed a non-compensable left hip impairment requiring surgery.

The worker appealed a Case Manager's decision denying loss of earnings (LOE) benefits from October 23, 2018, to January 28, 2020, and identifying 'Other Service Support Occupations' as a suitable occupation (SO).

The Appeals Resolution Officer found that the worker was partially impaired due to the work-related knee injury but was capable of performing suitable work.

The ARO concluded that the identified SO was appropriate and that the worker was entitled to partial LOE benefits based on full-time employment in the SO at an entry-level wage, rather than full LOE benefits.

The appeal was allowed in part.

The worker appealed a Case Manager's decision denying loss of earnings (LOE) benefits from August 15, 2015 to November 26, 2015.

The worker had sustained a workplace injury to their neck and right shoulder and later experienced an exacerbation.

The Appeals Resolution Officer found that the worker was unable to return to work for a portion of the period and, although capable of modified work later, was not provided with a graduated return to work plan by the employer.

The appeal was allowed, granting LOE benefits for the disputed periods.

The worker suffered a compensable crush injury to their right foot, resulting in toe amputations.

The worker subsequently developed lower back pain and sought secondary entitlement, which was initially denied by the Case Manager.

On appeal, the Appeals Resolution Officer found that medical evidence supported a causal relationship between the worker's altered gait following the foot injury and their diagnosed right sacroiliac dysfunction and facet irritation.

The worker's objection was allowed, granting secondary entitlement for the lower back.

The worker, a personal support worker, appealed two decisions: the denial of initial entitlement for a lower back strain (Claim B) and the denial of loss of earnings (LOE) benefits following the termination of their employment (Claim A).

The Appeals Resolution Officer allowed the appeal on both issues.

For Claim B, the Officer found that the worker established proof of accident after stumbling on a carpet mat, and the diagnosed lower back strain was compatible with the mechanism of injury.

For Claim A, the Officer determined that the worker's termination for alleged fraudulent injury claims did not amount to an intervening cause that broke the chain of causation between their prior compensable right shoulder injury and their ongoing wage loss.

The employer's termination of the worker ended the early and safe return to work process, making modified work unavailable.

The worker was granted initial entitlement for the lower back strain and LOE benefits following their termination.

The worker, a letter carrier, appealed a decision denying initial entitlement for a right shoulder injury allegedly caused by carrying heavy mail bags on a new route.

The Appeals Resolution Officer reviewed the medical evidence, which showed degenerative conditions including tendinosis and osteoarthritis.

The Officer found that the worker's diagnosed conditions were not compatible with the reported accident history of a sudden onset from carrying heavier bags.

The worker's objection was denied and initial entitlement was not granted.