M. Rodrigues

The worker appealed a case manager's decision that their work-related left ankle sprain had fully resolved without permanent impairment and denied loss of earnings (LOE) benefits from May 9, 2023.

The Appeals Resolution Officer found that maximum medical recovery was achieved by April 12, 2023, but that the clinical evidence supported a permanent impairment with permanent restrictions.

As there was no suitable work available within the worker's restrictions, entitlement to LOE benefits from May 9, 2023 was allowed, and the matter was remitted to the operating area to determine the nature and duration of benefits.

The worker, a special needs assistant, suffered a left ankle sprain and avulsion fracture at work.

The case manager determined the injury had fully resolved by April 12, 2023, with no permanent impairment, and denied loss of earnings (LOE) benefits from May 9, 2023.

The worker appealed.

The Appeals Resolution Officer allowed the appeal, finding that while maximum medical recovery was achieved by April 12, 2023, the clinical evidence supported a permanent impairment with permanent restrictions.

As there was no suitable work available within the worker's restrictions, entitlement to LOE benefits from May 9, 2023 was allowed, and the matter was remitted to the operating area to determine the duration and nature of ongoing benefits.

The worker, a personal support worker, appealed a case manager's decision denying entitlement for a right shoulder rotator cuff tear and finding that multiple injuries had fully resolved by January 14, 2022.

The Appeals Resolution Officer allowed the appeal in part, finding that the rotator cuff tear was compatible with the workplace accident where a 200-lb resident fell on the worker.

The Officer also found that while the worker's bruises had resolved by December 2, 2021, maximum medical recovery had not been reached for the right shoulder injury.

The worker appealed a decision denying their WSIB claim for failing to meet the legislated six-month time limit.

The worker suffered an injury on October 4, 2021, after falling from a yoga ball chair at work, and immediately reported it to their employer and sought medical attention.

However, the employer failed to file a Form 7, and the worker did not file a Form 6 until April 13, 2022, nine days after the six-month deadline.

The Appeals Resolution Officer found that exceptional circumstances existed, noting the worker's immediate reporting to the employer and hospital, and the employer's failure to follow up on the incident report.

The time limit was extended, allowing the claim to proceed for an initial entitlement determination.

The worker appealed a case manager's decision finding that the suitable occupation of Sales and Account Representative was suitable and denying loss of earnings benefits following a permanent work disruption.

The Appeals Resolution Officer found that the suitable occupation was appropriate given the worker's extensive employment history and transferable skills.

However, the Officer determined that the worker was only capable of earning entry-level wages, rather than median-level wages, in that occupation.

The appeal was allowed in part, granting the worker entitlement to partial loss of earnings benefits based on entry-level wages at full-time hours.

The worker, a classroom teacher, suffered a concussion at work in February 2015.

The WSIB case manager initially allowed entitlement but later concluded the concussion fully resolved by July 10, 2015, denying ongoing benefits.

The worker objected, arguing they suffered from post-concussion syndrome and seeking partial loss of earnings (LOE) benefits.

The Appeals Resolution Officer found that the work-related concussion did not fully resolve until November 24, 2016, based on clinical evidence including a physiotherapy discharge report.

The Officer allowed partial LOE benefits from September 2015 to June 2016 based on a 0.5-work day, as the employer accommodated the worker's cognitive restrictions during that period.

However, LOE benefits beyond June 2016 were denied because the worker voluntarily resigned and retired, and there was no evidence the employer could not continue to accommodate them.

The worker's objection was allowed in part.

The worker objected to a non-economic loss (NEL) clinical specialist's decision that determined a 15% NEL quantum for neck and thoracic soft tissue strains, whiplash, and exacerbation of a pre-existing previously silent syrinx following a motor vehicle accident.

The worker argued the calculation failed to account for two work-related spinal surgeries.

The Appeals Resolution Officer agreed, finding that the incorrect impairment percentage was assigned to the cervical and thoracic regions of the spine under the AMA Guides.

The NEL quantum was recalculated and increased to 19%.

A flight attendant suffered a right ankle sprain and left knee contusion after missing a step in an employer-paid hotel during a layover.

The employer objected to the initial allowance of health care and loss of earnings benefits, arguing the worker was engaged in a personal activity while going to meet crew members for dinner.

The Appeals Resolution Officer denied the objection, finding that the injury arose out of and in the course of employment because dining during a layover is reasonably incidental to the employment and the employer paid for the hotel.

The worker objected to decisions finding that their work-related right shoulder sprain/strain had fully resolved with no permanent impairment, and denying entitlement to a recurrence.

The Appeals Resolution Officer reviewed the medical evidence and found that the worker had reached maximum medical recovery by January 10, 2020, with no restrictions and a significant gap in subsequent medical treatment.

The Officer also found that the worker's ongoing shoulder pain lacked a formal diagnosis establishing clinical compatibility with the original injury, and that a subsequent deterioration was the result of a new workplace incident.

The worker's objections were denied.

The worker suffered a concussion after a slip and fall at work.

The case manager determined that the concussion had fully resolved by March 31, 2022, with no permanent impairment, and denied loss of earnings (LOE) benefits from April 13, 2022.

The worker objected, arguing that ongoing symptoms, particularly while driving, required further treatment.

The Appeals Resolution Officer reviewed the medical evidence, including reports from a neurology specialty clinic and a driver rehabilitation program, and concluded that the worker had fully recovered from the concussion with no permanent impairment.

The objection was denied, and the denial of LOE benefits was upheld.

The worker objected to a case manager's decision that their work-related lumbar strain had fully resolved with no permanent impairment.

The Appeals Resolution Officer reviewed the clinical evidence, including specialty clinic reports, and found that the worker had not fully recovered and had permanent restrictions.

The objection was allowed, and a permanent impairment for the lumbar strain was recognized.

The worker objected to decisions by the case manager and nurse consultant determining that their work-related soft tissue injuries had fully resolved with no permanent impairment, and denying reimbursement for health care equipment (ankle weights, a massager, and a cane).

The Appeals Resolution Officer reviewed the clinical evidence and found that the worker had reached maximum medical recovery by February 23, 2021, with no evidence of ongoing impairment.

Furthermore, the clinical evidence did not support that the requested health care equipment was necessary or appropriate to treat the work-related injuries.

The worker's objection was denied.

The worker appealed decisions regarding the non-economic loss (NEL) quantum for a psychological condition (adjustment disorder with mixed anxiety and depressed mood) and the determination that there were no formal psychological restrictions for returning to work.

The Appeals Resolution Officer reviewed the clinical evidence and WSIB policies, concluding that the worker's psychological impairment was appropriately rated at 10% under Class 2 (Mild impairment), resulting in a 6% NEL benefit when combined with prior ratings.

The Officer also found that the clinical evidence supported workplace accommodations rather than formal psychological restrictions.

The worker's objection was denied.