Workers' Compensation

The employer appealed a Case Manager's decision granting the worker initial entitlement for inhalation exposure to barbeque fumes and denying the employer's request for Second Injury and Enhancement Fund (SIEF) cost relief.

The Appeals Resolution Officer found no objective medical evidence supporting the worker's claim of allergies or sensitivities to fumes or cooking exposure, noting inconsistencies between the worker's reported symptoms and the medical records.

Consequently, the worker's entitlement for inhalation exposure was revoked, rendering the SIEF cost relief issue moot.

The employer's objection was allowed.

The worker appealed the denial of entitlement for a left shoulder injury allegedly sustained on April 24, 2013, while performing regular duties.

The worker claimed the injury resulted from over-exertion due to understaffing, but did not report the injury until nearly two weeks later.

The Appeals Resolution Officer found insufficient evidence of a workplace accident or disablement, noting the employer's evidence that overtime was available but not requested, and that the worker's symptoms were likely attributable to pre-existing degenerative disc disease.

The worker's objection was denied.

The worker appealed a Case Manager's decision that based his long-term Loss of Earnings rate on his short-term earnings.

The worker, who had previously worked as a mechanic but had been unemployed and receiving Employment Insurance, was injured on the second day of a one-week contract as a labourer.

The Appeals Resolution Officer denied the appeal, finding that the worker did not have an established pattern of irregular employment and that using his previous mechanic earnings would misrepresent his long-term earning profile.

The use of short-term earnings for the long-term earnings basis was deemed justified.

The employer appealed a case manager's decision denying Second Injury and Enhancement Fund (SIEF) cost relief following a worker's left knee injury.

The employer argued that the worker's popliteus tendonitis, thalassemia, and improper body mechanics constituted pre-existing conditions that delayed recovery.

The Appeals Resolution Officer dismissed the appeal, finding no medical evidence that a pre-existing condition prolonged or enhanced the worker's recovery, and noting that the popliteus tendonitis was accepted as part of the compensable injury.

The worker, who previously received a 17% non-economic loss award for bilateral carpal tunnel syndrome resulting from her pre-injury employment, appealed the denial of Chronic Pain Disability (CPD) benefits.

The Appeals Resolution Officer reviewed the medical and vocational evidence, finding that the worker's chronic pain and fibromyalgia were directly related to her compensable injury and subsequent surgeries.

The officer concluded that the worker met the criteria for CPD benefits, as her pain was continuous, consistent, and resulted in marked life disruption inconsistent with organic findings.

The appeal was allowed, and the matter was remitted for a non-economic loss assessment for CPD.

The Director of Service Delivery requested a reconsideration of an Appeals Resolution Officer (ARO) decision that granted the worker partial Loss of Earnings (LOE) benefits from September 17, 2007.

The Director argued that the ARO failed to properly apply the Workplace Safety and Insurance Act and WSIB policy regarding the 72-month final LOE benefit review.

The Appeals Manager agreed with the Director, finding that under section 44 of the Act, LOE benefits could only be reviewed and paid from December 14, 2011, the date the worker was granted entitlement for a Non-Economic Loss (NEL) assessment.

The ARO's reliance on the Merits and Justice policy to bypass the statutory timeframes was incorrect.

The reconsideration request was allowed, and benefits were ordered payable from December 14, 2011.

The worker suffered a compensable low back injury in 1974 and was subsequently awarded a 35% permanent disability (PD) rating.

Following two spinal surgeries, the worker requested a PD reassessment, arguing his condition had deteriorated.

The Appeals Resolution Officer compared the physical findings from the last PD reassessment in 2009 to the most recent medical report in 2014.

Finding that the worker's flexion and reflexes had improved post-surgery, the Officer concluded there was no objective medical evidence of deterioration and denied the request for a PD reassessment.

The worker suffered a right knee strain at work in 2008, superimposed on advanced pre-existing osteoarthritis.

He received a non-economic loss award and other benefits.

In 2013, total knee replacement surgery was recommended.

The worker sought entitlement for the surgery under his claim.

The Appeals Resolution Officer denied the appeal, finding that the need for surgery arose from the natural progression of the pre-existing, non-compensable osteoarthritis, which was likely caused by a remote injury 30 years prior, rather than the 2008 workplace strain.

The worker objected to a decision denying entitlement to a permanent impairment determination for a low back injury sustained in 2006.

The Appeals Resolution Officer reviewed the medical evidence, which showed that the worker had recovered following conservative treatment and had no ongoing medical attention after June 2007.

The officer concluded that there was no assessable permanent impairment resulting from the work injury and denied the objection.

The worker appealed several decisions by the WSIB operating area, including the creation of a $76,647.48 recoverable overpayment, denial of psychotraumatic disability, denial of a NEL redetermination, termination of supplementary benefits, rescission of an organic NEL award based on surveillance evidence, and denial of a 100% FEL award.

The Appeals Resolution Officer found that the overpayment was fully recoverable as the worker knew or ought to have known he was receiving duplicate payments.

Claims for psychotraumatic disability, NEL redetermination, supplementary benefits, and a 100% FEL award were denied.

However, the Officer found the operating area erred in rescinding the worker's original 33% NEL award based solely on surveillance evidence, reinstating the organic NEL award.

The worker, who had a permanent knee impairment from a 2008 workplace accident, was performing modified duties when a general layoff occurred in December 2013.

The worker objected to the denial of loss of earnings benefits from December 23, 2013 to March 23, 2014.

The Appeals Resolution Officer found that the initial layoff was a general seasonal layoff affecting all employees, not caused by the worker's impairment.

However, because the worker required permanent accommodations that were unlikely to be provided by another employer, and because other employees were recalled in January 2014 while the worker was not due to a lack of modified work, the worker was entitled to full loss of earnings benefits from the date the first worker was recalled in January 2014 until March 23, 2014.

The worker, a car haul truck driver, objected to a decision denying initial entitlement for a left shoulder injury allegedly sustained while repairing a truck on the side of the road.

The worker continued to work and delayed seeking medical attention for three weeks, believing he had only pulled a muscle.

The Appeals Resolution Officer found the worker credible, noting he reported the incident to the employer immediately and sought medical attention when symptoms persisted.

The objection was allowed, and initial entitlement for a left shoulder strain and possible rotator cuff tear was confirmed.

The worker appealed a decision denying entitlement for a right knee impairment as a secondary condition to a compensable 2005 left knee injury.

The Appeals Resolution Officer found that the right knee pain started gradually in 2012, six years after the worker returned to work, and that a previous decision had found the worker fully recovered from the left knee injury with no residual impairment.

The appeal was denied due to the late onset of symptoms and lack of causal connection.

The worker, a call centre agent, appealed a decision denying initial entitlement for a repetitive strain injury to her right wrist.

The worker testified that her workstation was not ergonomically set up, she worked in cramped conditions, and she performed significant overtime following the introduction of a new call system.

The Appeals Resolution Officer found the worker's testimony credible and concluded that her diagnosis of right wrist tendonitis was compatible with the accident history.

The appeal was allowed, granting entitlement for right wrist tendonitis and two weeks of loss of earnings benefits.

The worker objected to a decision denying an extension of the time limit to appeal a January 10, 2006 decision regarding future economic loss benefits.

The Appeals Resolution Officer found that the worker had actual notice of the time limit, had no serious health problems preventing understanding of the time limit, and had not met the criteria for an extension.

The worker's objection was denied.

The worker appealed a decision granting a 5% non-economic loss (NEL) benefit for a permanent vestibular impairment resulting from a workplace motor vehicle accident, seeking an increase to 10% or 15%.

The Appeals Resolution Officer weighed the medical evidence, preferring a neurologist's report over vestibular physiotherapy reports, and applied the AMA Guides.

The Officer found that the worker's tinnitus, balance, and gait issues were appropriately rated at the low end of a class 2 impairment.

The appeal was dismissed and the 5% NEL benefit was confirmed.

The worker appealed a decision regarding his workplace injury claim, seeking an increase in his Non-Economic Loss (NEL) award for his low back, entitlement to narcotic addiction treatment, and loss of earnings (LOE) benefits following his termination in March 2004.

The Appeals Resolution Officer found that the 18 per cent NEL award was correctly calculated and denied the request for narcotic addiction treatment due to a lack of causal connection to the workplace injury.

However, the Officer granted the worker's appeal for LOE benefits, finding that the employer failed to rebut the presumption under section 41(10) of the Workplace Safety and Insurance Act that the termination was related to the injury, and awarded full and partial LOE benefits for various periods.

The worker, an automotive production worker, appealed the denial of entitlement for left thumb osteoarthritis and the determination that her compensable left wrist tenosynovitis had resolved.

The Appeals Resolution Officer found that the osteoarthritis was a pre-existing condition that had been denied in previous claims, and there was no compelling evidence that it was caused or accelerated by repetitive work.

Furthermore, a specialist assessment made no mention of ongoing tenosynovitis, confirming it had resolved.

The appeal was denied.

The worker appealed decisions denying a course of physiotherapy and confirming a 3% non-economic loss (NEL) quantum for a left knee meniscal tear and patellofemoral syndrome.

The Appeals Resolution Officer found that while the worker's ITB syndrome was not compensable, her patellar tendinopathy was medically compatible with the compensable injury, entitling her to physiotherapy.

The 3% NEL quantum was confirmed as it correctly applied the AMA Guides to the 7% lower extremity impairment.

The appeal was allowed in part.

The worker objected to the 15 percent non-economic loss (NEL) award granted for chronic pain disability (CPD) following a workplace accident.

The worker's representative argued that the impairment rating should be classified in the high end of the Moderate Impairment category rather than the Mild Impairment category.

The Appeals Resolution Officer reviewed the medical evidence, including a psychiatric report and the worker's testimony at a prior WSIAT hearing, and found that the worker's condition aligned with the Mild Impairment category.

The appeal was denied and the 15 percent NEL award was confirmed.