Workers' Compensation

The estate of a deceased worker appealed the denial of initial entitlement for prostate cancer, arguing it was an occupational disease caused by workplace exposure to multiple carcinogens over 29 years in a manufacturing facility.

The Appeals Resolution Officer reviewed medical and occupational hygiene evidence, including reports from OHCOW and the WSIB's Occupational Hygienist.

Relying on the International Agency for Research on Cancer (IARC) findings that there are no agents with sufficient evidence in humans for prostate cancer, the Officer concluded that the workplace exposures were not a significant contributing factor.

The appeal was denied.

The worker objected to a WSIB decision denying partial loss of earnings (LOE) benefits from July 7, 2021, to September 29, 2021, and confirming they reached maximum medical recovery (MMR) for a COVID-19 infection on July 6, 2021, with no permanent impairment.

The Appeals Resolution Officer found that the worker had continued to work modified hours as directed by the Return-to-Work Specialist pending an entitlement decision regarding a shoulder injury.

The worker gradually increased their hours and resumed full regular duties on October 3, 2021.

The Officer concluded the worker was entitled to partial LOE benefits for the disputed period and determined that MMR was reached on October 3, 2021, with no evidence of a permanent impairment.

The worker's objection was allowed in part.

The worker, a child welfare support services worker, appealed a Case Manager's decision denying entitlement for Traumatic Mental Stress and Chronic Mental Stress.

The worker experienced multiple traumatic events during their employment, including being threatened with a knife by a youth in May 2021 and encountering another severely unwell youth in May 2022.

The Appeals Resolution Officer found that the May 2021 incident was objectively traumatic and significantly contributed to the worker's diagnosed PTSD.

The appeal was allowed for Traumatic Mental Stress, with the date of injury established as June 3, 2022, when the worker first sought medical attention.

The worker appealed a Case Manager's decisions denying initial entitlement to various physical and psychological conditions, denying ongoing loss of earnings benefits, and denying entitlement for a mental stress injury following a slip and fall on a wet escalator at work.

The Appeals Resolution Officer found that the worker's additional claimed physical conditions were either pre-existing or not compatible with the mechanism of injury.

The Officer also determined that the worker had reached maximum medical recovery for their accepted contusions with no ongoing work-related impairment.

Finally, the Officer concluded that the worker was not entitled to benefits for a mental stress injury, as the incident was not objectively traumatic and the worker's psychological condition pre-dated the workplace accident.

The worker's objection was denied.

The worker, a food services cashier, appealed a Case Manager's decision denying entitlement to benefits for a psychological condition following a workplace altercation.

The worker was verbally threatened and physically assaulted by a customer who threw a cup of pop in their face, prompting the worker to strike back in self-defense.

The Appeals Resolution Officer found that the worker did not provoke the fight and was acting in the course of employment.

The appeal was allowed, granting the worker entitlement to benefits for Post-Traumatic Stress Disorder (PTSD) under the Traumatic Mental Stress policy.

The employer objected to decisions granting the worker entitlement for bilateral thumbs, wrists, hands, and elbows as gradual onset injuries, as well as a 10% Non-Economic Loss (NEL) award.

The Appeals Resolution Officer found that the worker's job duties as an offset press operator involved risk factors for repetitive strain injuries.

The officer upheld entitlement for bilateral thumb strain/sprain, exacerbation of pre-existing thumb osteoarthritis, and bilateral lateral epicondylitis, but denied entitlement for a bilateral wrist repetitive strain injury.

Consequently, the 10% NEL award was reduced to 8% to reflect the permanent impairment of the elbows only.

The worker suffered a right arm crush injury and complex lacerations when his sleeve became caught in a machine.

He sought entitlement to Chronic Pain Disability (CPD) and ongoing psychotraumatic disability.

The Appeals Resolution Officer denied the CPD claim, finding that the degree of pain was consistent with the organic findings and there was no clear disruption in all aspects of his life.

However, the Officer granted ongoing entitlement to a psychotraumatic disability up to October 16, 2016, as medical evidence supported ongoing psychiatric issues directly related to the compensable injury.

The worker appealed the quantum of her Non-Economic Loss (NEL) benefit for a low back injury, which was offset due to a pre-existing condition.

Following a WSIAT decision directing a NEL redetermination, the worker's total impairment rating for her low back increased to 35%.

However, the Appeals Resolution Officer found that the worker had a moderately significant pre-existing condition that warranted a 25% reduction in the impairment rating.

As a result, the worker was not entitled to an increase in her NEL benefit.

The appeal was denied.

The worker appealed a decision denying entitlement to a permanent impairment for a 2002 right shoulder strain and denying entitlement for right rotator cuff tears and surgery.

The Appeals Resolution Officer allowed the appeal, finding that the worker's shoulder symptoms had never abated since the 2002 injury, entitling the worker to a Non-Economic Loss assessment.

Furthermore, the Officer found that the overhead lifting required in the worker's modified duties significantly contributed to the development of the rotator cuff tears, granting entitlement to the tears and surgery as a secondary condition.

The employer objected to a field auditor's decision denying an extension of time to appeal earlier classification decisions from 2008 and 2012.

The employer argued that it was not properly notified of the time limits and that the WSIB made an egregious error in classifying its business activities, resulting in a significant overcharge of premiums.

The Appeals Resolution Officer found that the employer was properly notified of the time limits and that there were no exceptional circumstances to justify an extension.

The appeal was denied.

The worker suffered a right knee injury in 1979, diagnosed as an anterior cruciate ligament tear, and later underwent a high tibial osteotomy in 1995.

In 2013, the worker required a total knee replacement.

The WSIB initially denied entitlement, concluding the surgery was for progressive degenerative changes not arising from the work injury.

On appeal, the Appeals Resolution Officer found clinical compatibility between the original injury and post-traumatic osteoarthritis, accepting the treating surgeon's opinion that the knee replacement was occasioned by the 1979 injury.

The worker's objection was allowed, granting entitlement to the surgery, associated health care benefits, and temporary total disability benefits.

The worker appealed the denial of benefits for a psychotraumatic disability (Major Depressive Disorder), Chronic Pain Disability (CPD), and coverage for a non-professional escort for medical appointments.

The Appeals Resolution Officer found that the worker's depression was not caused by the workplace slip and fall, given her significant pre-existing psychological history and the minor nature of the accident.

The CPD claim was denied because the worker's pain levels were consistent with her organic impairment (right hip trochanteric bursitis).

However, the appeal was allowed in part regarding the non-professional escort, which was approved for WSIB-approved medical appointments located more than 60 kilometres from the worker's home.

The worker, a truck driver, suffered a workplace injury when a tire blew out, causing him to fall and sustain back injuries.

The WSIB initially allowed the claim on an aggravation basis and later terminated benefits, concluding the worker had recovered to his pre-accident state.

The worker appealed, seeking recognition of a permanent thoracolumbar impairment, loss of earnings (LOE) benefits during a seasonal layoff, and entitlement for Chronic Pain Disorder (CPD) and psychotraumatic disability.

The Appeals Resolution Officer found that the worker suffered a permanent thoracolumbar impairment and was entitled to LOE benefits during the layoff period.

The Officer denied entitlement for CPD but granted entitlement for psychotraumatic disability, finding the pre-existing psychological condition was exacerbated by the workplace injury.

The WSIB was directed to conduct a work transition assessment to determine ongoing LOE benefits.

The worker appealed the WSIB's decisions regarding his earnings basis and Labour Market Re-entry (LMR) plan following a workplace injury.

The worker argued his earnings basis should reflect an apprentice journeyman's wages and requested a change in his training venue from a 51-week program at Everest College to a three-year program at Cambrian College.

The Appeals Resolution Officer denied the appeal, finding no evidence the worker was hired as an apprentice, and upholding the current Suitable Employment or Business (SEB) and training venue as suitable, reasonable, and cost-effective.

The worker appealed a decision denying entitlement for left carpal tunnel syndrome (CTS).

The worker had an accepted claim for a right shoulder injury and argued that the bilateral CTS arose from note-taking during a Labour Market Re-Entry program or as a secondary condition to the original injury.

The Appeals Resolution Officer found insufficient evidence that the note-taking was repetitive and forceful enough to cause CTS, and noted a significant delay between the start of the program and the onset of symptoms.

The objection was denied.

The worker appealed decisions regarding his non-economic loss (NEL) permanent impairment rating, entitlement for high blood pressure, closure of his labour market re-entry (LMR) plan, reduction of loss of earnings (LOE) benefits, and continuation of psychiatric treatment.

The Appeals Resolution Officer denied the worker's appeal, finding that the 4% NEL rating for the left hand was correct, the high blood pressure was not accident-related, the worker failed to co-operate in his LMR plan, and further psychiatric treatment was not beneficial.

The reduction of LOE benefits was confirmed.

The worker appealed the quantum of a 25 per cent chronic pain disability non-economic loss (NEL) award and the denial of loss of earnings benefits from November 14, 2006 onwards.

The Appeals Resolution Officer found that the 25 per cent award accurately reflected the worker's residual impairment under the chronic pain disability policy, as physical findings were limited and symptoms did not meet the criteria for a higher award.

The Officer also determined that the employer had offered suitable modified work that accommodated the worker's restrictions, justifying the denial of further loss of earnings benefits.

The worker's objection was denied.

The worker suffered a low back strain at work and was placed on modified duties.

He subsequently experienced a flare-up of pain, including new sciatica symptoms, and was authorized off work by his family physician.

The WSIB adjudicator denied lost time benefits, finding the worker should have participated in the employer's early and safe return to work (ESRTW) program.

On appeal, the Appeals Resolution Officer found that the flare-up was a recurrence related to the original injury and that the medical evidence supported a finding of total disability during the disputed period.

The worker's objection was allowed.

The worker appealed the denial of lost time benefits for two days following a workplace exposure to air freshener fumes that triggered a migraine headache.

The initial denial was based on the worker's failure to seek immediate medical attention and obtain medical authorization for the time off.

The Appeals Resolution Officer allowed the appeal, finding that the delay in seeking medical attention was reasonable as the incident occurred over a weekend.

Given the worker's long-term employment, lack of prior claims, and the employer's confirmation of the exposure, the lost time entitlement was granted.

The employer objected to an adjudicator's decision granting initial entitlement and loss of earnings benefits for a worker's low back injury.

The worker claimed he injured his back while lifting boxes, but the employer argued the injury was not reported immediately and questioned the worker's credibility due to his subsequent termination for alleged fraudulent behaviour.

The Appeals Resolution Officer found that the worker's account of the injury was consistent and corroborated by initial statements from a co-worker and the store manager.

The brief delay in seeking medical attention was deemed reasonable.

The adjudicator's decision was upheld and the employer's objection was denied.