Workers' Compensation

The employer appealed a decision granting the worker secondary entitlement for an infected burn on the left upper thigh and loss of earnings benefits.

The worker sustained a work-related thermal burn which subsequently became infected, causing the worker to miss work.

The employer argued the infection developed outside of work hours and was not work-related.

The Appeals Resolution Officer denied the employer's appeal, finding that the infection was causally linked to the work-related burn injury, as the worker would not have been subject to the risk of infection but for the initial work-related wound.

The worker appealed the denial of loss of earnings (LOE) benefits following an accepted recurrence of a compensable low back injury.

The worker argued they experienced a significant deterioration in June 2021 that prevented them from working.

The Appeals Resolution Officer found that the medical evidence did not support a significant deterioration in June 2021, but did support a significant deterioration as of May 19, 2022, when the worker's family doctor reported moderately decreased range of motion.

The worker was found to be totally disabled from that date.

The appeal was allowed in part, granting full LOE benefits from May 19, 2022, ongoing.

The worker appealed a Case Manager's decision that concluded they had reached maximum medical recovery for a right elbow biceps tendon insertion strain with no evidence of a permanent impairment.

The Appeals Resolution Officer found that the worker did have a permanent impairment, relying on a discharge report that documented permanent functional restrictions despite normal ranges of motion.

The matter was remitted to determine the degree of impairment using the RSI Rating Schedule.

The employer objected to a Case Manager's decision that the worker reached maximum medical recovery (MMR) by December 16, 2022, with a permanent low back impairment.

The worker, a personal support worker, suffered a low back strain and exacerbation of pre-existing spondylolisthesis after assisting a patient.

The Appeals Resolution Officer reviewed the medical evidence, including reports from a specialty clinic, and found that the worker had reached a plateau in recovery with no further significant improvement likely.

The Officer concluded that the worker continued to have an ongoing work-related impairment at the time of MMR, confirming the permanent impairment.

The employer's objection was denied.

The worker, a courier driver, suffered a compensable right eye and facial injury when struck by a truck door handle.

The worker objected to WSIB decisions denying entitlement for secondary eye conditions, setting the maximum medical recovery (MMR) date at October 1, 2022, and denying loss of earnings (LOE) benefits after September 13, 2022.

The Appeals Resolution Officer denied entitlement for the secondary eye conditions, finding them incompatible with the mechanism of injury.

However, the Officer varied the MMR date to February 21, 2023, based on specialist reports, and granted full or partial LOE benefits up to that date, pending confirmation of the worker's return-to-work hours and wages.

The worker appealed the Eligibility Adjudicator's decision denying initial entitlement for an umbilical hernia.

The worker alleged the hernia was caused by pushing and pulling heavy skids with a manual hand jack at work.

The employer argued the hernia may have been caused by recent weight gain and noted a delay in reporting.

The Appeals Resolution Officer found that the worker met the five-point check system for an allowable claim, noting the diagnosed hernia was compatible with the reported mechanism of injury and there were no non-work activities identified that could have caused it.

The worker's objection was allowed and initial entitlement to an umbilical hernia was granted.

The worker appealed a decision denying their WSIB claim for failing to meet the legislated six-month time limit.

The worker suffered an injury on October 4, 2021, after falling from a yoga ball chair at work, and immediately reported it to their employer and sought medical attention.

However, the employer failed to file a Form 7, and the worker did not file a Form 6 until April 13, 2022, nine days after the six-month deadline.

The Appeals Resolution Officer found that exceptional circumstances existed, noting the worker's immediate reporting to the employer and hospital, and the employer's failure to follow up on the incident report.

The time limit was extended, allowing the claim to proceed for an initial entitlement determination.

The worker appealed a Case Manager's decision denying entitlement to benefits for chronic mental stress (CMS) following the implementation of the employer's COVID-19 vaccination policy.

The worker alleged harassment and discrimination by the employer after declining to be vaccinated.

The Appeals Resolution Officer denied the appeal, finding no medical evidence of a DSM diagnosis and concluding that the employer's actions were part of the normal employment function rather than a substantial work-related stressor or workplace harassment.

The worker suffered a compensable lower back injury and was prescribed muscle relaxants that caused dizziness.

The employer refused to allow the worker to return to modified duties while experiencing these side effects.

The Case Manager denied loss of earnings (LOE) benefits from October 27, 2021, arguing the medication was not in accordance with a specialty program's recommendations.

The Appeals Resolution Officer allowed the worker's objection, finding the dizziness was a compensable side effect of treatment for the work-related injury and that no modified work was available.

LOE benefits were granted from October 27, 2021, to November 17, 2021, when the side effects resolved.

The worker appealed a case manager's decision finding that the suitable occupation of Sales and Account Representative was suitable and denying loss of earnings benefits following a permanent work disruption.

The Appeals Resolution Officer found that the suitable occupation was appropriate given the worker's extensive employment history and transferable skills.

However, the Officer determined that the worker was only capable of earning entry-level wages, rather than median-level wages, in that occupation.

The appeal was allowed in part, granting the worker entitlement to partial loss of earnings benefits based on entry-level wages at full-time hours.

The worker appealed decisions denying secondary entitlement for left ear, neck, and right shoulder conditions, denying an increase in the dose and THC concentration of medical cannabis, and denying an increase in the frequency of maintenance massage therapy.

The Appeals Resolution Officer found no causal relationship between the accepted workplace injuries and the left ear, neck, or right shoulder conditions.

The requested increase in medical cannabis exceeded the maximum allowable dose under WSIB policy, and the worker's condition was not palliative.

Finally, the approved twice-monthly massage therapy was deemed necessary, appropriate, and sufficient.

The worker's appeals were dismissed.

The worker appealed a Case Manager's decision reducing their loss of earnings (LOE) benefits from full to partial as of April 1, 2022.

The worker had sustained a right knee injury requiring surgery and subsequently developed a psychotraumatic disability.

The Appeals Resolution Officer found that although the worker was not totally disabled, they had made reasonable efforts to secure suitable employment and engaged in health care measures aimed at improving their employability.

As suitable work was not available from the employer, the worker met the criteria for full LOE benefits.

The appeal was allowed, granting full LOE benefits from April 1, 2022 to March 10, 2023.

The employer objected to several WSIB decisions granting the worker entitlement for an exacerbation of pre-existing osteoarthritis, a permanent impairment, an 8% non-economic loss (NEL) award, and a return-to-work plan for the suitable occupation of General Office Worker at an entry-level wage.

The Appeals Resolution Officer confirmed the entitlement to the exacerbation, the permanent impairment, and the 8% NEL award, finding that the workplace accident significantly contributed to the deterioration of the worker's pre-existing condition.

The Officer also confirmed the suitable occupation but found that the worker's extensive prior managerial experience meant she was capable of earning a median wage rather than an entry-level wage.

The employer's objection was allowed in part.

The worker, a correctional officer with a recognized permanent impairment for work-related posttraumatic stress disorder (PTSD), sought loss of earnings benefits for a recurrence of PTSD symptoms from July 21, 2022, to October 18, 2022.

The Case Manager initially denied the claim, finding that the worsening symptoms were caused by other factors, such as a toxic work environment.

On appeal, the Appeals Resolution Officer found that the worker experienced a significant deterioration in PTSD symptoms that was clinically compatible with the original injury, leaving them less capable of coping with usual occupational stressors.

The worker's objection was allowed, and full loss of earnings benefits were granted for the period in question.

The worker objected to a Case Manager's decision that they had reached maximum medical recovery for a lower back strain and disc herniation with no evidence of functional impairment.

The Appeals Resolution Officer reviewed the medical evidence, including reports from a neurosurgeon and the WSIB Back and Neck Specialty Program, which indicated ongoing functional restrictions and chronic radiculopathy.

The Appeals Resolution Officer concluded that the worker reached maximum medical recovery with evidence of a work-related permanent impairment and directed a referral for a Non-Economic Loss assessment.

The estate of the worker appealed the denial of initial entitlement for lung cancer.

The worker had been employed in the rubber manufacturing industry for nearly 30 years and had a significant smoking history.

While the Appeals Resolution Officer found that the worker did not meet the criteria for lung cancer due to asbestos exposure under Policy 16-02-13, the appeal was allowed based on the merits and justice of the case.

Relying on findings from the International Agency for Research on Cancer (IARC) and the worker's prior compensable claim for Chronic Lymphocytic Leukemia, the Officer concluded that the worker's occupational exposures significantly contributed to the development of lung cancer, notwithstanding the non-occupational risk factors.

Initial entitlement to lung cancer was granted.

The worker suffered a work-related neck and shoulder injury and was accommodated with modified duties.

The employer subsequently terminated the worker's employment after the worker declined an early retirement package.

The worker appealed decisions finding no breach of re-employment obligations and terminating entitlement to the neck injury.

The Appeals Resolution Officer found no breach of re-employment obligations, as the termination was motivated by interpersonal conflict and attitude issues, not the workplace injury.

However, the Officer allowed the appeal regarding the neck injury, applying the thin skull doctrine to find that the workplace accident significantly aggravated an asymptomatic pre-existing degenerative disc disease.

The worker was granted ongoing entitlement and approval for the proposed neck surgery.

The worker, a first responder, appealed a Case Manager's decision denying entitlement to benefits for Posttraumatic Stress Disorder (PTSD).

The employer argued the worker's mental stress was caused by the employer's decision to close their work location and relocate them, thereby rebutting the statutory presumption.

The Appeals Resolution Officer found that while the relocation news prompted the worker to seek medical attention, the medical evidence established that cumulative traumatic workplace events materially contributed to the PTSD diagnosis.

The appeal was allowed and entitlement to benefits for PTSD was granted.

The worker, a sales development representative, suffered facial scarring and psychological impairments (PTSD and Major Depressive Disorder) after being bitten by a dog at work.

They returned to modified duties but were permanently laid off in February 2020.

The Case Manager denied ongoing loss of earnings (LOE) benefits, concluding the wage loss was due to the lay-off rather than the injury.

On appeal, the Appeals Resolution Officer found that the worker remained partially impaired from a psychological perspective at the time of the lay-off, which affected their ability to fully restore their pre-injury earnings.

The worker's objection was allowed in part, granting ongoing partial LOE benefits from the date of the lay-off until they secured new employment in November 2020.

The worker objected to a Case Manager's decision discontinuing his loss of earnings (LOE) benefits after he left the country, which was deemed a material change in circumstances.

The worker, who was receiving full LOE benefits for a psychotraumatic disability, argued he attempted to notify the WSIB before leaving to visit family.

The Appeals Resolution Officer found that while the worker failed to properly report the material change, there was no evidence of willful concealment.

Because the worker was totally disabled and not participating in active treatment or return-to-work activities at the time of departure, the Officer allowed the objection in part, granting the worker three weeks of LOE benefits under the WSIB's vacation policy.