Sujethra Nadarajah

The worker appealed two Case Manager decisions regarding their right shoulder injury: a denial of partial loss of earnings (LOE) benefits from May 28, 2024 onwards, and the determination of permanent restrictions allowing lifting up to 5 kgs above shoulder level.

The Appeals Resolution Officer allowed the appeal in part, granting partial LOE benefits from May 29, 2024 to August 4, 2024 based on a graduated return to work plan recommended by the WSIB Specialty Clinic.

However, the worker's request for a complete restriction on above-shoulder activity was denied, as objective medical evidence supported a capacity to lift up to 5 kgs above shoulder level.

The worker appealed decisions denying entitlement for an ACL/PCL injury, left patellar subluxation, and Chronic Pain Disability (CPD) following a workplace incident where they slipped on a wet floor.

The Appeals Resolution Officer found that the ACL/PCL injury was a pre-existing condition not aggravated by the workplace injury.

The left patellar subluxation was found incompatible with the mechanism of injury, which involved a minor slip rather than a fall or extreme activity.

Finally, the worker did not meet the criteria for CPD, as their ongoing pain was attributed to non-compensable conditions and their earning capacity was affected by their termination rather than the work injury.

The worker's objections were denied.

The worker, a police officer, objected to decisions denying loss of earnings (LOE) benefits and entitlement for Alcohol Use Disorder as a secondary condition to their compensable PTSD.

The worker was suspended following a non-compensable motor vehicle accident and was required to sign in daily at a police station to receive wages, which they could not do due to PTSD symptoms.

The Appeals Resolution Officer granted LOE benefits, finding that the worker's PTSD was a significant contributing factor to their inability to perform the sign-in requirement.

However, entitlement for Alcohol Use Disorder was denied because medical evidence indicated the alcohol issues predated the PTSD diagnosis by fifteen years.

The worker, a personal support worker, appealed two Case Manager decisions regarding their workplace injury claim: the denial of full loss of earnings (LOE) benefits beyond November 2, 2020, and the determination that they had reached maximum psychological recovery (MPR) without a permanent impairment.

The Appeals Resolution Officer found that the worker was capable of participating in a graduated return to work plan and was therefore entitled to partial LOE benefits for a limited period, but not full LOE benefits.

Regarding the psychological claim, the Officer found that the worker had not reached MPR, as their condition was still improving with treatment and a recommended psychiatric assessment had not occurred.

The worker's appeal was allowed in part.

The worker objected to the Case Manager's decision determining their Suitable Occupation (SO) as Other Services Support Occupations following a bilateral wrist injury.

The worker argued they were competitively unemployable due to lack of transferrable skills, experience, and a language barrier.

The Appeals Resolution Officer confirmed the SO, finding it was within the worker's physical restrictions, education level, and basic English language skills, and that prior decisions had already established the worker was capable of performing suitable work without training.

The worker appealed two Non-Economic Loss (NEL) decisions regarding permanent impairments from a 2015 workplace injury.

The worker objected to a 24% NEL benefit for bilateral hip replacements and right thigh impairment, and a 20% NEL benefit for post-traumatic stress disorder and major depressive episode.

The Appeals Resolution Officer reviewed the medical evidence and the application of the AMA Guides and WSIB policies.

The Officer found that the clinical specialist correctly calculated the physical impairment ratings and appropriately classified the psychological impairment as a Class 3 Moderate impairment.

The appeals were dismissed and the NEL quantums were confirmed.

The employer objected to a Case Manager's decision granting 25 percent cost relief under the Second Injury and Enhancement Fund (SIEF) for a worker's compensable post-traumatic stress disorder.

The Appeals Resolution Officer found that the accident (cumulative traumatic exposure as a dispatcher) was minor in severity.

The officer also found that the worker's pre-existing psychological reaction to a hypertrophic cardiomyopathy diagnosis was a minor pre-existing condition that prolonged recovery.

Under the SIEF policy, a minor accident and minor pre-existing condition warrant 50 percent cost relief.

The employer's objection was allowed.

The employer appealed a Case Manager's decision granting the worker initial entitlement for an umbilical hernia and ongoing Loss of Earnings (LOE) benefits related to surgical repair.

The worker felt a pop in their abdomen while bending and reaching into a van at work.

The employer argued the hernia was a pre-existing congenital condition and that the mechanism of injury was insufficient to cause it.

The Appeals Resolution Officer applied the five-point check system under WSIB Policy 11-01-01 and found the injury was compatible with the accident history.

The medical evidence did not support the employer's assertion that the hernia was pre-existing.

The appeal was dismissed, and entitlement to the hernia, surgery, and related LOE benefits was upheld.

The worker objected to a Case Manager's decision denying Loss of Earnings (LOE) benefits beyond August 1, 2018.

The worker suffered a left arm proximal humerus fracture and was offered modified duties by the employer.

The Appeals Resolution Officer found that the worker was capable of returning to light sedentary duties as of August 1, 2018, and that the employer's offer of modified work was safe, productive, and consistent with the worker's functional abilities.

As the suitable work was available at no wage loss, the worker was not entitled to further LOE benefits.

The objection was denied.