R. Calvert

The worker appealed the denial of entitlement for fibromyalgia under the WSIB's Chronic Pain Disability (CPD) policy following a 1995 workplace injury where she slipped and wrenched her back and knee.

The Appeals Resolution Officer applied the five criteria under Policy 15-04-03.

While the worker met the criteria for having a work-related injury, pain persisting beyond usual healing time, and pain inconsistent with organic findings, she failed to establish that the chronic pain was caused by the injury or that it produced a marked life disruption impairing her earning capacity.

Medical evidence suggested a pre-existing chronic pain disorder and no significant disruption to her personal, occupational, social, or home life was found.

The objection was denied.

The worker appealed a case manager's decision denying ongoing entitlement and treatment for a right knee injury beyond April 21, 2015.

The worker had suffered a work-related medial meniscal tear and subsequently developed persistent symptoms, including an exacerbated Baker's cyst, on a background of pre-existing osteoarthritis.

The Appeals Resolution Officer found that the pre-existing condition had not overwhelmed the work-related injury, which continued to be a significant contributing factor to the ongoing impairment.

The worker's appeal was allowed, granting continuing entitlement and treatment, including a Synvisc injection.

The worker appealed decisions regarding the calculation of his earnings basis, denial of reimbursement for a medical report, and denial of entitlement for psychotraumatic and chronic pain disabilities.

The Appeals Resolution Officer found that employment insurance benefits were correctly excluded from the earnings basis calculation under the applicable policy.

The request for reimbursement of a $900 medical report was granted because the report was instrumental in increasing the worker's non-economic loss award.

The requests for psychotraumatic and chronic pain disability entitlements were denied because the worker did not meet the policy criteria, specifically lacking a timely psychological diagnosis and having pain consistent with his organic impairment.

The objection was allowed in part.

The worker objected to a Case Manager's decision denying ongoing entitlement for a left shoulder injury sustained in October 2007.

Initially diagnosed as a sprain, an ultrasound and MRI a year later revealed a full-thickness supraspinatus tendon tear.

The employer argued there was a lack of medical continuity during the intervening year.

The Appeals Resolution Officer allowed the objection, finding clinical compatibility between the original injury and the tendon tear, and noting the worker's stoic effort to continue working despite progressive deterioration.

Ongoing entitlement was granted.

The worker objected to a decision granting a permanent disability (PD) award of 20% for residual impairment to his left knee and left ankle, arguing it did not accurately reflect his current level of permanent disability following a 1979 workplace injury.

The Appeals Resolution Officer reviewed the medical evidence, including assessments from 1991 and 2008/2009, and found no significant deterioration in the left knee condition or functional limitations to warrant an increase beyond the 15% already awarded for the knee.

The 5% award for the left ankle was also found to be accurate.

The worker's objection was denied, and the 20% PD award was confirmed.

The worker appealed a decision denying initial entitlement for a workplace accident where she sustained an electrical shock.

She sought recognition of the injury, reimbursement for travel expenses to medical appointments, and loss of earnings benefits for personal time used to attend those appointments.

The Appeals Resolution Officer granted initial entitlement and travel expenses, finding the medical investigations were a direct necessity of the accident.

However, the request for loss of earnings benefits was denied because the worker did not actually lose any time from her scheduled working hours.

The employer objected to the Eligibility Adjudicator's decision to establish a new claim for the worker's carpal tunnel syndrome, arguing it should be amalgamated with the original accident claim.

The Appeals Resolution Officer found that the worker's symptoms were consistent since the original accident, which likely acted as a catalyst for the pre-existing condition.

The employer's objection was allowed, and the claims were amalgamated.