Workers' Compensation

The worker appealed decisions denying permanent impairment for right knee and low back injuries, denying entitlement for chronic pain disability (CPD), and denying further loss of earnings (LOE) benefits.

The Appeals Resolution Officer found no permanent organic impairment for the knee or back injuries, as the clinical evidence and imaging did not support significant pathology.

However, the worker was granted entitlement for CPD, having met all five policy criteria, including pain persisting beyond usual healing time and inconsistent with organic findings.

The worker was also awarded LOE benefits for a previously denied period, with further benefits to be determined.

The worker suffered a right shoulder fracture at work in 2015 and initially returned to work after conservative treatment.

Years later, the worker developed avascular necrosis and severe osteoarthritis requiring a reverse shoulder arthroplasty.

The case manager denied entitlement for the surgery, finding the worker had fully recovered in 2015.

On appeal, the Appeals Resolution Officer found the worker had not fully recovered and that the need for surgery was a significant deterioration clinically compatible with the original injury.

The worker's objection was allowed, granting entitlement to health care benefits for the recurrence.

The worker, a drywall installer who suffered a workplace injury resulting in severed fingers, objected to the Case Manager's decision to adjust their Loss of Earnings (LOE) benefits to partial LOE benefits based on the expected wages of a Suitable Occupation (SO) in retail sales.

The worker had completed a return to work plan but remained unemployed.

The Appeals Resolution Officer upheld the decision, finding that under the Operational Policy Manual, the adjustment to partial LOE benefits using the identified SO entry-level wage of $14.25 per hour was appropriate at the closure of the return to work plan.

The worker suffered a compensable right ankle sprain and returned to work with minor accommodations.

Several months later, the worker's employment was terminated.

The worker alleged the termination was a reprisal for filing a WSIB claim, breaching the employer's re-employment obligations.

The Appeals Resolution Officer found that the employer successfully rebutted the presumption of a breach, as evidence demonstrated the termination was due to a significant economic downturn and the worker's unauthorized absence, rather than the work-related injury.

The worker's objection was denied.

The worker objected to the 21% non-economic loss (NEL) benefit rating for her low back and the determination that Customer Service was a suitable occupation (SO) with partial loss of earnings (LOE) benefits payable from May 30, 2017.

The Appeals Resolution Officer upheld the 21% NEL rating, finding it consistent with the AMA Guides and medical evidence.

However, the Officer found the previous SO of Security Guard became unsuitable earlier, on December 1, 2012, due to the worker's psychotraumatic impairment.

The worker was found capable of working in Customer Service for 15 hours per week at minimum wage from December 1, 2012, and was awarded partial LOE benefits from that date.

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 calculating his partial loss of earnings (LOE) benefits based on projected Suitable Employment or Business (SEB) wages rather than his actual wages from August 2005 to May 2006.

The worker argued he was performing duties within his SEB of storekeeper/parts clerk.

The Appeals Resolution Officer found that the worker's primary job duty was as a courier driver, which fell outside his identified SEB.

Consequently, the worker was not employed in his SEB, and his LOE benefits were correctly based on projected SEB wages.

The appeal was denied.

The worker appealed a decision regarding his Non-Economic Loss (NEL) award for a psychotraumatic disability resulting from a workplace right shoulder injury.

The worker sought an increase from the 10% rating and objected to a 25% reduction applied for a pre-existing psychological impairment.

The Appeals Resolution Officer found that the worker's impairment level was compatible with a Class 3 Moderate Impairment, increasing the NEL award to 20%.

Furthermore, the Officer determined that the worker's pre-existing depression was well-controlled prior to the accident and of minor medical significance, meaning no reduction should be applied to the NEL award.

The worker's objection was allowed.

The worker suffered a left hand injury at work, resulting in a permanent impairment.

The Workplace Safety and Insurance Board awarded a 4% non-economic loss (NEL) rating based on the American Medical Association Guides.

The worker appealed, arguing the quantum should be greater due to ongoing problems with her whole hand and arm.

The Appeals Resolution Officer dismissed the appeal, finding the 4% rating was correctly calculated based on the accepted area of injury (the left small finger) and the objective medical evidence.

The worker objected to a decision denying ongoing entitlement for Durolane injections for a work-related right knee injury.

The Appeals Resolution Officer found that the injections provided significant symptomatic relief and helped the worker remain employed.

The officer rejected the external medical consultant's opinion that the treatment was for a pre-existing condition, noting a prior WSIAT decision had accepted the pre-existing condition was rendered symptomatic by the work injury.

The objection was granted, and ongoing entitlement for injections every six months was allowed.

The worker suffered a compensable lower back injury and subsequently underwent elective spinal surgery in New Jersey without notifying or obtaining approval from the WSIB.

The worker sought reimbursement for the $18,000 surgery cost and associated travel expenses.

The Appeals Resolution Officer denied the appeal, finding that under WSIB policies, elective out-of-province healthcare requires prior approval, which the worker failed to obtain, and the worker breached his obligation to cooperate by withholding information about the surgery.

The worker appealed a decision denying initial entitlement for a right wrist injury.

The worker, an assembly line worker, developed right wrist pain and swelling after being instructed to fold weather strips twice instead of once.

The employer argued the symptoms were related to pre-existing arthritis and that there was no change in job duties.

The Appeals Resolution Officer found the worker's testimony credible and concluded that the change in work method constituted an accident/disablement.

The worker's appeal was allowed, granting initial entitlement for a right wrist sprain/tendonitis.

The worker suffered a compensable right knee injury in 1989 and was granted a 5% permanent disability (PD) award in 1993.

In 2013, she requested a reassessment of her PD award, arguing her condition had worsened.

The Appeals Resolution Officer denied the request, finding that the worker's current knee symptoms, which arose after a 20-year gap in medical continuity, were the result of degenerative pathology rather than an exacerbation of her compensable work-related condition.

The worker, a Youth Services Officer, suffered a soft tissue injury during an altercation at work.

The employer offered modified administrative duties, but the worker remained off work for four shifts, relying on a doctor's note advising rest.

The worker appealed the denial of Loss of Earnings (LOE) benefits for this period.

The Appeals Resolution Officer denied the appeal, finding that the clinical evidence did not confirm a complete inability to work and that the employer had appropriately offered suitable modified duties that would have mitigated any loss of earnings.

The worker, a personal support worker, appealed the denial of initial entitlement for left lateral epicondylitis and right de Quervain's tenosynovitis.

The worker claimed the conditions resulted from repetitive heavy manipulation, pushing, and massaging required to care for a client with severe spastic paralysis.

The Appeals Resolution Officer found the worker's job duties were compatible with the diagnosed conditions, supported by medical opinions.

The worker's objection was allowed, and initial entitlement was granted.

The worker, a security guard, suffered a left shoulder sprain while restraining a patient.

The Case Manager determined that the worker had reached maximum medical recovery (MMR) by October 7, 2014, and denied further health care benefits.

The worker appealed, arguing she had not fully recovered and required ongoing modified duties.

The Appeals Resolution Officer reviewed the medical evidence, including reports from an orthopaedic surgeon and a medical consultant, which indicated the work-related sprain had resolved and ongoing symptoms were due to pre-existing degenerative changes.

The appeal was dismissed, affirming the worker had fully recovered from the compensable injury with no permanent impairment and was not entitled to further benefits.

The worker appealed a Case Manager's decision denying entitlement for a psychotraumatic disability.

The worker had suffered a low back strain in 2005 and subsequently developed an Adjustment Disorder with Mixed Anxiety and Depressed Mood.

Although the worker had pre-existing mental health issues, the Appeals Resolution Officer found that the workplace injury was a significant contributing factor to the development or progression of the psychological condition.

The appeal was allowed, granting initial entitlement for a psychotraumatic disability, with the determination of permanent impairment deferred pending further treatment.

The worker, a concierge, sought benefits for Traumatic Mental Stress after fainting at work following three incidents of verbal harassment and aggressive behaviour by the company owner.

The Appeals Resolution Officer denied the appeal, finding that while the owner's conduct was unpleasant and inappropriate, it did not involve actual or threatened physical violence and therefore did not meet the policy definition of a sudden and unexpected traumatic event.

Furthermore, there was no required Axis 1 diagnosis from a psychiatrist or psychologist.

The worker, a building maintenance mechanic, appealed a decision denying initial entitlement for bilateral knee injuries allegedly sustained at work.

The worker claimed the injuries resulted from increased kneeling and crouching while assembling warehouse racks.

The Appeals Resolution Officer found insufficient proof of an accident or a compatible diagnosis, noting the medical evidence indicated non-occupational arthritic degeneration rather than a work-related injury.

The appeal was denied.

The employer appealed a decision denying cost relief under the Second Injury and Enhancement Fund (SIEF).

The worker, a 57-year-old mold maker, tripped at work and sustained a right knee injury that required surgery.

The Appeals Resolution Officer found that the worker's pre-existing moderate degenerative changes and diabetes prolonged his recovery period.

Given the minor severity of the accident and the moderate significance of the pre-existing condition, the employer was granted 75% cost relief under the SIEF policy.