Stephanie Waters

The worker appealed several decisions made by a Case Manager regarding entitlement to benefits following a workplace slip and fall.

The Appeals Resolution Officer denied initial entitlement for injuries to the worker's back, neck, shoulders, and head due to a significant delay in reporting and lack of contemporaneous medical evidence linking them to the accident.

However, the Officer found that the worker's left knee strain had reached maximum medical recovery with a permanent impairment, reversing the Case Manager's decision on that issue.

The Officer also upheld the permanent restrictions for the left ankle and knee, and confirmed that a 2% Non-Economic Loss benefit was appropriate for the left ankle impairment based on the AMA Guides.

The appeal was allowed in part.

The worker appealed multiple Eligibility Adjudicator decisions denying initial entitlement for a left shoulder injury allegedly sustained in 2003 and finding the worker missed the six-month time limit to file a claim.

The Appeals Resolution Officer found exceptional circumstances warranted extending the time limit, as the worker did not understand the requirements.

However, the appeal was denied on the merits because there was insufficient contemporaneous medical evidence to establish that the 2003 workplace incident caused the left shoulder dislocation.

The worker appealed a Case Manager's decision denying loss of earnings (LOE) benefits from November 15, 2019, to February 8, 2022.

The worker had suffered a compensable left elbow injury and was unable to return to his pre-injury heavy manual labour duties.

The Appeals Resolution Officer found that the worker made reasonable efforts to mitigate his wage loss by seeking retraining, attending school for Business Finance, and securing suitable employment that accommodated his permanent restrictions.

The appeal was allowed in part, granting the worker full LOE benefits for the period in question, less actual earnings received from three new jobs during that time.

The worker appealed a Case Manager's decision granting the employer a time limit extension to object to a July 2016 initial entitlement decision for posttraumatic stress disorder.

The Appeals Resolution Officer found that the employer had demonstrated an objection to the initial allowance of entitlement within the time limit through correspondence and telephone discussions, satisfying the sixth criterion of the WSIB's Appeals Services Division Practices and Procedures.

The worker's appeal was denied, and the time limit extension for the employer was upheld.

The worker appealed the Case Manager's decisions regarding his loss of earnings (LOE) benefits and denial of psychological treatment for his compensable chronic pain disability (CPD).

The Appeals Resolution Officer found that the worker was entitled to an interdisciplinary pain rehabilitation program based on multiple medical recommendations.

Furthermore, the Officer determined that the identified suitable occupation of dump truck driver was not suitable or sustainable given the worker's functional restrictions and CPD.

The appeal was allowed in part, and the file was returned to the operating area to identify a new suitable occupation and recalculate LOE benefits.

The employer appealed a Case Manager's decision denying cost relief under the Second Injury and Enhancement Fund (SIEF) following a worker's left foot and ankle injury sustained while transferring a patient.

The employer argued that the worker's pre-existing hypothyroidism caused or contributed to their neuropathic pain and prolonged recovery.

The Appeals Resolution Officer found the accident was of minor severity but concluded there was no medical evidence that the pre-existing condition enhanced the injury or prolonged recovery.

The appeal was denied and SIEF cost relief was not granted.

The worker appealed two Case Manager decisions denying a Non-Economic Loss (NEL) redetermination for a lower back impairment and confirming the suitability of the electronics assembler occupation for Future Economic Loss (FEL) benefits.

The Appeals Resolution Officer denied the appeal, finding no objective clinical evidence of a significant and permanent deterioration of the lower back condition to warrant a NEL redetermination.

Furthermore, the Officer concluded that the suitable occupation of electronics assembler was safe, consistent with the worker's functional abilities, and available in the labour market, justifying the FEL benefit calculation based on entry-level wages.

The worker appealed a Case Manager's decision denying entitlement to benefits for neck and shoulder injuries, and denying full loss of earnings (LOE) benefits for several periods.

The Appeals Resolution Officer found no medical evidence to establish a compensable injury to the neck or shoulders.

The Officer also found that the worker was not entitled to LOE benefits for the disputed periods because suitable modified work was available and the worker's inability to work was due to non-compensable conditions or a refusal to wear safety gloves, which was not supported by medical restrictions.

The appeal was denied.

The worker appealed a Case Manager's decision limiting their entitlement to partial loss of earnings (LOE) benefits.

The worker had sustained physical injuries and a psychotraumatic disability after an incident with an aggressive patient.

While physical restrictions allowed for modified work, the Appeals Resolution Officer found that the worker's psychological condition completely prevented a return to work until January 2021, and suitable work was unavailable until March 2021.

The appeal was allowed, granting the worker full LOE benefits for the disputed period.

The worker appealed a Case Manager's decision denying entitlement for a psychotraumatic disability following a 2018 workplace accident that resulted in a left hip fracture and chronic pain.

The Appeals Resolution Officer found that the worker's adjustment disorder with mixed anxiety and depressed mood was an indirect result of the physical injury and extended disablement.

The appeal was allowed, and the worker was granted entitlement to benefits for a psychotraumatic disability.

The worker appealed a Case Manager's decision that stopped her loss of earnings (LOE) benefits.

The worker had suffered a mild traumatic brain injury and claimed she was unable to drive or return to work due to ongoing symptoms.

However, surveillance video showed the worker driving long distances on highways.

The Appeals Resolution Officer found that the worker's ability to drive constituted a material change in circumstances that she failed to report.

Furthermore, the modified duties offered by the employer were deemed suitable.

The appeal was denied, and the worker was found not entitled to LOE benefits effective June 15, 2018.

The worker appealed decisions denying entitlement for chronic and traumatic mental stress related to workplace harassment that primarily occurred between 2007 and 2008.

The Appeals Resolution Officer denied the appeal, finding that the post-2018 mental stress policies did not apply because the mental stress occurred before the retroactive application date of April 29, 2014.

Furthermore, the worker was not entitled under the pre-2018 traumatic mental stress policy because the claim was not filed within six months of the accident, the events were not objectively traumatic, and there were no exceptional circumstances to warrant extending the time limit.

The employer appealed decisions granting the worker healthcare and loss of earnings (LOE) benefits for injuries sustained after falling from a scaffold, and denying the employer Second Injury and Enhancement Fund (SIEF) cost relief.

The employer argued the fall was caused by a diabetic medical episode rather than a workplace accident.

The Appeals Resolution Officer found no evidence that the worker's low blood sugar caused the fall, concluding the injuries arose out of and in the course of employment.

The worker was entitled to LOE benefits as the injuries prevented any work for a month.

SIEF cost relief was denied because the accident was of moderate severity and there was no evidence the pre-existing diabetes caused the accident or prolonged recovery.

The employer's appeal was denied.

The worker appealed decisions denying loss of earnings (LOE) benefits from December 29, 2020 onward, and finding that their compensable neck strain and concussion injuries had reached maximum medical recovery (MMR) without permanent impairment.

The Appeals Resolution Officer allowed the appeal in part.

The worker was granted full LOE benefits from December 29, 2020 to January 17, 2021, as the evidence regarding why they were sent home from modified duties was equally weighted, triggering the benefit of the doubt policy.

LOE benefits were denied from January 18, 2021 onward because suitable modified work was available and the worker was only partially impaired.

The officer upheld the finding that the neck strain reached MMR by May 28, 2021, but found the concussion injury had not reached MMR by June 11, 2021, remitting that issue for further determination.

The worker's estate appealed two Case Manager decisions denying entitlement for chronic pain disability and loss of earnings (LOE) benefits after a permanent work disruption.

The worker had sustained multiple fractures after falling from scaffolding in 2012 and later developed chronic pain.

The Appeals Resolution Officer denied the chronic pain disability claim, finding that the worker's degree of pain was consistent with his organic findings, failing to meet the policy criteria.

However, the Officer allowed the appeal regarding LOE benefits, finding that the worker was entitled to partial LOE benefits following his permanent layoff in December 2015, as his compensable injuries partially contributed to his wage loss.

The appeal was allowed in part.