Workers' Compensation

The worker suffered a compensable low back injury in 2011, which required multiple surgeries and the implantation of a spinal cord stimulator.

The worker subsequently sought entitlement for a psychotraumatic disability, which was denied by the Case Manager.

On appeal, the Appeals Resolution Officer found that the worker's pre-existing anxiety disorder was exacerbated by the physical impairment, chronic pain, and socioeconomic factors resulting from the workplace injury.

The appeal was allowed, granting the worker entitlement to a psychotraumatic disability and a non-economic loss (NEL) determination.

The worker appealed a decision denying entitlement to WSIB benefits for an adverse reaction to a COVID-19 vaccination.

The worker argued that they believed the vaccination was mandatory because the appointment was scheduled through the employer.

The Appeals Resolution Officer found that the employer did not mandate the vaccine or use coercion to require it.

Applying Operational Policy 15-04-10, the Officer concluded that the vaccination was not a compulsory immunization procedure.

The worker's objection was denied and entitlement to benefits was refused.

The worker appealed a decision denying entitlement for basal cell carcinoma (BCC) allegedly caused by occupational exposure to mineral oil between 1969 and 1973.

The Appeals Resolution Officer found that while the worker was exposed to mineral oil and BCC is a Schedule 3 occupational disease, the statutory presumption was rebutted.

Medical evidence, including a surgical pathology report and an occupational medical consultant's opinion, established that the worker's significant sun exposure from decades of outdoor construction work was the main cause of the skin cancer.

The appeal was denied.

The worker appealed a Case Manager's decision denying entitlement to a permanent impairment for narcotic dependence and finding the suitable occupation of Library, Correspondence and Related Information Clerks remained suitable.

The Appeals Resolution Officer found that the worker had successfully weaned off narcotics and achieved maximum medical recovery without a residual permanent impairment for narcotic dependence.

As no permanent impairment was established, the ARO had no jurisdiction to reconsider the suitability of the occupation.

The appeal was denied.

The worker, a former flight attendant, appealed a decision denying initial entitlement for Noise Induced Hearing Loss (NIHL).

The worker claimed exposure to excessive noise for 38 years.

The Appeals Resolution Officer found that while the worker met the basic eligibility criteria for noise exposure (at least 88 dBA for 38 years), their hearing loss values did not meet the basic eligibility criteria for entitlement.

Operational policy requires a hearing loss of at least 22.5 dB in each ear, but the worker's left ear hearing loss was only 21.25 dB.

The appeal was dismissed.

The worker appealed decisions regarding the calculation of her loss of earnings (LOE) benefits, her non-economic loss (NEL) quantum, and entitlement to psychotraumatic disability benefits following a workplace slip and fall.

The Appeals Resolution Officer found that the short-term average earnings were calculated correctly based on concurrent employment.

However, the worker was granted entitlement to benefits for major depressive disorder, as the medical evidence supported that her psychological condition resulted from her severe physical impairment.

Furthermore, the pre-injury job with accommodation was deemed unsuitable, entitling the worker to full LOE benefits for the period she was unable to work.

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.

The worker, a police officer, appealed a decision denying initial entitlement for a heart condition (myocardial infarction) allegedly caused by acute emotional stress from an internal investigation.

The Appeals Resolution Officer found that the stress did not meet the policy criteria for 'acute emotional stress' because the investigation was ongoing and not a sudden, unexpected event.

Furthermore, medical evidence showed the worker had experienced similar cardiac symptoms weeks prior to the specific meeting in question.

The appeal was dismissed.

The employer appealed the Eligibility Adjudicator's decision allowing initial entitlement for COVID-19, arguing the worker likely contracted the virus while on vacation.

The worker appealed the Occupational Disease Adjudicator's decision denying ongoing loss of earnings (LOE) benefits as of July 20, 2020.

The Appeals Resolution Officer found that the worker's employment at a long-term care facility created an elevated risk of contracting COVID-19 and that the worker was exposed to a positive resident, establishing initial entitlement.

However, the Officer denied the worker's appeal for ongoing LOE benefits, finding that as of July 20, 2020, the worker was only partially impaired and fit to perform the suitable modified duties offered by the employer.

Both objections were denied.

The employer objected to the Eligibility Adjudicator's decision granting the worker initial entitlement for COVID-19.

The worker, a warehouse package handler and driver, tested positive for COVID-19.

The employer argued the worker's exposure was not higher than the general public's and noted a lack of medical documentation.

The Appeals Resolution Officer found that multiple COVID-19 cases at the worksite and the worker's limited community exposure made it more probable than not that the infection was work-related.

The lack of formal medical evidence was deemed acceptable given public health guidance at the time.

The employer's objection was denied.

The worker appealed a decision denying initial entitlement to health care benefits and loss of earnings (LOE) benefits for a foreign body in his left eye.

The Appeals Resolution Officer found that the worker suffered a gradual onset disablement injury caused by his workplace duties as a framer/labourer, granting initial entitlement for health care benefits.

However, the claim for LOE benefits was denied because the medical evidence did not support total disability and the employer had offered suitable modified duties within the worker's functional abilities.

The appeal was allowed in part.

The worker, a former police officer who developed PTSD after an accidental firearm discharge and an undercover operation, appealed a Case Manager's decision calculating his partial loss of earnings benefit based on a 40-hour work week.

The Case Manager had determined the worker was voluntarily underemployed as a Farm Manager.

The Appeals Resolution Officer allowed the appeal, finding that medical evidence confirmed the worker was permanently restricted from full-time employment due to his PTSD symptoms.

The Officer rejected the employer's argument that the worker was voluntarily underemployed due to operating a personal hobby farm, and ordered the benefit to be based on the worker's actual average of 25 hours per week.

The worker objected to three case manager decisions denying loss of earnings (LOE) benefits for a brief period in May 2019, finding no breach of the employer's re-employment obligation upon his termination in October 2019, and denying LOE benefits subsequent to the termination.

The Appeals Resolution Officer allowed the worker's objections in part.

The Officer found the worker was entitled to full LOE benefits for the initial period of absence in May 2019.

Furthermore, the Officer determined the employer breached its re-employment obligation by terminating the worker within six months of re-employment, as the employer failed to rebut the presumption that the termination was related to the workplace injury.

The worker was awarded full and partial LOE benefits for various periods following his termination and referred for work transition assistance.

The worker appealed a Case Manager's decisions confirming the Suitable Occupation (SO) of Cashier and denying secondary entitlement for liver disease (cirrhosis).

The Appeals Resolution Officer found that the SO of Cashier was not suitable given the worker's lack of computer skills, education, and physical restrictions, but determined that Light Duty Cleaner was a suitable occupation during the relevant period.

The Officer denied secondary entitlement for liver disease, finding no causal link between the work-related neck injury and the cirrhosis, which pre-dated the workplace incident.

The appeal was allowed in part.

The worker appealed the denial of initial entitlement for a right foot tendon tear sustained while carrying a heavy parcel during an understaffed shift.

The Appeals Resolution Officer found that the injury was a disablement resulting from an unexpected increase in physical demands.

Relying on a WSIB Medical Consultant's opinion that the injury was compatible with the accident history despite underlying degenerative changes, the Officer allowed the appeal and granted initial entitlement.

The worker appealed the denial of initial entitlement for squamous cell carcinoma of the tongue, arguing it was caused by occupational exposure to coal tar and other toxins during his 40-year employment.

The Appeals Resolution Officer found that the worker's diagnosis fell within the definition of 'epitheliomatous cancer' under Schedule 3 of the Workplace Safety and Insurance Act.

Because the worker was exposed to coal tar, a listed process, the statutory presumption applied.

The presumption was not rebutted by the worker's smoking history, as no treating practitioner attributed the cancer to smoking.

The appeal was allowed and initial entitlement granted.

The worker appealed decisions denying entitlement to a psychotraumatic disability and funding for Bandito masks related to two separate workplace accidents: a smoke inhalation injury (claim A) and a right wrist crush injury (claim B).

The Appeals Resolution Officer found that the worker's post-traumatic stress disorder and major depressive disorder manifested within five years of the wrist injury and were directly related to the extended disablement and socioeconomic impacts of the work-related injuries.

Consequently, entitlement to a psychotraumatic disability was granted under claim B and denied under claim A. The Officer also granted funding for two Bandito masks under claim A, finding them to be necessary and appropriate health care equipment that improved the worker's independent living.

The worker suffered a head injury at work when struck by a falling ceiling tile, resulting in a concussion and cervical strain.

The worker appealed decisions denying entitlement for sleep apnea, hearing loss, and ongoing post-concussion and psychotraumatic disability benefits following a subsequent non-compensable motor vehicle accident.

The Appeals Resolution Officer allowed the appeal in part.

The worker was granted entitlement for hearing loss and a hearing aid, as the evidence supported it was more probable than not caused by the workplace accident.

The Officer also found that the worker's post-concussion syndrome and psychotraumatic disability had not resolved prior to the non-compensable motor vehicle accident, granting ongoing entitlement.

However, entitlement for sleep apnea was denied as it could not be causally linked to the workplace injury.

The worker appealed the denial of her claim for chronic mental stress (CMS) and traumatic mental stress (TMS) arising from a five to seven-year history of sexual harassment by her Production Manager, culminating in a threat of rape.

The Appeals Resolution Officer found that the worker met the diagnostic criteria for PTSD and major depressive disorder, and that the harassment constituted a substantial work-related stressor under the CMS policy.

The employer's investigation was found to be flawed and the worker's delay in reporting was reasonably explained by fear and vulnerability.

The appeal was allowed for CMS, but denied for TMS as the events prior to the threat were not precisely identifiable and the worker did not subjectively perceive the threat as objectively traumatic.

The worker, a long-haul truck driver, suffered work-related bilateral shoulder injuries resulting in permanent restrictions.

After the employer terminated his employment, the worker secured new employment and received partial Loss of Earnings (LOE) benefits.

The employer subsequently offered the worker a Highway Driver position, which the worker declined.

The Appeals Resolution Officer found that the employer came into compliance with their co-operation obligations by making the job offer.

However, the job offer was deemed not suitable because the employment contract superseded any verbal or written assurances and included physical requirements exceeding the worker's restrictions.

The worker was granted partial LOE benefits based on his actual earnings with his new employer.