Workers' Compensation

The worker, a city bus driver, appealed a Case Manager's decision denying initial entitlement for Traumatic Mental Stress (TMS) and Chronic Mental Stress (CMS).

The worker had been subjected to verbal abuse and perceived threats of physical violence by two teenage passengers and an adult over a fare dispute.

The Appeals Resolution Officer found the incident was clearly and precisely identifiable and objectively traumatic, satisfying the criteria for TMS under WSIB operational policy 15-03-02.

The worker's objection was allowed, granting initial entitlement for TMS and full loss of earnings benefits for the period of lost time.

The employer objected to the WSIB's decisions granting the worker initial entitlement to health care benefits for a lower back strain and full loss of earnings (LOE) benefits from October 12, 2023 to November 6, 2023.

The worker sustained a lower back injury while shoveling in a trench.

The employer argued that the worker had a pre-existing back condition and that suitable modified duties were available.

The Appeals Resolution Officer found that the injury arose out of the worker's employment and that the pre-existing condition did not limit entitlement.

Furthermore, the medical evidence demonstrated that the worker's condition deteriorated, rendering them unable to perform the remote modified duties or safely drive to pick up printed materials.

The employer's objection was denied, and the initial entitlement and LOE benefits were confirmed.

The worker and employer both appealed decisions regarding the worker's entitlement to benefits following a right shoulder injury.

The worker sought loss of earnings (LOE) benefits from March 2020 onward and an increased non-economic loss (NEL) quantum for chronic pain.

The employer appealed the granting of psychotraumatic and chronic pain disability entitlements.

The Appeals Resolution Officer found the worker was entitled to full LOE benefits for a closed period and partial LOE benefits thereafter, as the modified duties offered were initially unsuitable.

The 10% NEL rating was maintained as the clinical evidence did not support a higher impairment class.

Finally, the worker's psychological condition was determined to be somatic symptom disorder with predominant pain, qualifying for chronic pain disability rather than psychotraumatic disability.

The worker appealed a Case Manager's decision denying entitlement to a psychotraumatic disability, a recurrence of a right shoulder injury, and ongoing loss of earnings (LOE) benefits.

The Appeals Resolution Officer allowed the appeal in part, granting initial entitlement to a temporary psychotraumatic disability for Adjustment Disorder with Mixed Anxiety and Depressed Mood, finding it was a direct result of the extended disablement from the work-related right shoulder injury.

However, the Officer denied entitlement to a recurrence and ongoing LOE benefits, concluding that the worker remained partially disabled without significant deterioration, and that the modified work duties offered by the employer were suitable and within the worker's functional restrictions.

The worker, a paramedic, developed PTSD following a traumatic call and was granted entitlement.

After a period of accommodated work, the Case Manager determined the pre-injury job was unsuitable and denied further loss of earnings (LOE) benefits and entitlement for an adjustment disorder.

On appeal, the Appeals Resolution Officer found that the pre-injury job of paramedic was suitable with accommodations, as the worker had successfully returned to accommodated duties.

The final LOE benefit review date was adjusted to June 10, 2020, with partial LOE benefits payable based on the worker's actual accommodated earnings.

However, entitlement for an adjustment disorder and additional LOE benefits for claimed recurrences in 2022 were denied, as the worker's psychological deterioration was caused by a significant new incident—grief over the perceived loss of her career—rather than the original workplace injury.

The worker appealed a WSIB decision denying entitlement for a left shoulder injury and determining that their work-related upper back strain reached maximum medical recovery (MMR) on December 21, 2019.

The Appeals Resolution Officer upheld the denial of the left shoulder injury and cervical disc protrusion, finding no clinical compatibility with the workplace incident of pulling a wheeled tote.

However, the officer adjusted the MMR date for the thoracic strain to February 5, 2020, to align with the end of authorized chiropractic treatment.

The appeal was allowed in part.

The worker appealed a Case Manager's decision denying ongoing entitlement for bilateral upper extremity issues, including a diagnosis of inflammatory arthritis, and denying loss of earnings (LOE) benefits from March 1, 2023.

The Appeals Resolution Officer found that the worker's ongoing diagnosis of seronegative rheumatoid arthritis was not clinically compatible with the workplace mechanism of injury (lifting wet plywood).

The Officer concluded that the work-related soft tissue injury had fully resolved by January 13, 2023, reaching maximum medical recovery with no permanent impairment.

Consequently, the worker was not entitled to LOE benefits from March 2023, as the ongoing wage loss was not caused by the work-related injury.

The appeal was denied.

The worker, a police officer, filed a claim for posttraumatic stress disorder (PTSD) under the presumptive legislation.

The Case Manager allowed the claim for health care benefits only, denying loss of earnings (LOE) benefits.

Both the worker and the employer objected.

The Appeals Resolution Officer found that the worker met the criteria for PTSD by presumption and was entitled to health care benefits.

However, the worker was not entitled to LOE benefits because the evidence showed that the worker's wage loss was primarily due to non-work-related factors, including a refusal to comply with the employer's COVID-19 masking mandates and a pending disciplinary review, rather than the PTSD.

Both objections were denied.

The worker appealed decisions denying entitlement for an ACL/PCL injury, left patellar subluxation, and Chronic Pain Disability (CPD) following a workplace incident where they slipped on a wet floor.

The Appeals Resolution Officer found that the ACL/PCL injury was a pre-existing condition not aggravated by the workplace injury.

The left patellar subluxation was found incompatible with the mechanism of injury, which involved a minor slip rather than a fall or extreme activity.

Finally, the worker did not meet the criteria for CPD, as their ongoing pain was attributed to non-compensable conditions and their earning capacity was affected by their termination rather than the work injury.

The worker's objections were denied.

The worker, a Personal Support Worker, appealed a decision denying initial entitlement to WSIB benefits for tinnitus and hearing loss allegedly caused by COVID-19 vaccinations received in 2021.

The Appeals Resolution Officer found that while the employer used coercion making the vaccinations a compulsory part of employment, the medical evidence did not establish a causal link between the vaccines and the worker's hearing loss and tinnitus.

Relying on the opinions of Occupational Medicine Consultants, the Officer concluded that on a balance of probabilities, the conditions were not an adverse reaction to the vaccines.

The appeal was denied.

The worker appealed a Case Manager's decision denying entitlement for posttraumatic stress disorder (PTSD).

The worker had previously been granted entitlement for bilateral upper extremity injuries and Major Depressive Disorder resulting from extended disablement.

The worker argued that PTSD developed due to workplace harassment and the employer's failure to accommodate medical needs.

The Appeals Resolution Officer dismissed the appeal, finding that the worker's PTSD was not an indirect result of the physical injury or attributable to the extended disablement, and that general concerns regarding workplace harassment were outside the scope of the claim.

The worker, an owner/operator of the employer, appealed an adjudicator's decision denying initial entitlement for an inhalational injury allegedly caused by exposure to diesel fumes from workplace heaters.

The Appeals Resolution Officer dismissed the appeal, finding no objective medical evidence of a personal work-related injury.

Medical reporting indicated only subjective symptoms, such as a cough, with normal physical examinations and x-rays, failing to establish a diagnosis compatible with the workplace exposure.

The worker, a volunteer firefighter for over 30 years, appealed a decision denying entitlement for colorectal cancer as an occupational disease.

The worker sought presumptive entitlement under Policy 23-02-01, but was diagnosed at age 65, failing to meet the requirement that diagnosis occur prior to age 61.

The worker also sought entitlement under Policy 16-02-11 for asbestos exposure, but the Appeals Resolution Officer found the exposure was not continuous, repetitive, or a major component of the worker's occupational activity.

Finally, considering the merits and justice of the case, the Officer relied on IARC findings to conclude that compatibility between the worker's occupational exposures and colorectal cancer was not established.

The appeal was denied.

The worker objected to decisions determining that Customer Service Representative was a Suitable Occupation (SO) and that his Loss of Earnings (LOE) benefits would be based on the entry-level earnings of that SO ($15.50 per hour).

The Appeals Resolution Officer found that the SO was within the worker's functional abilities and transferable skills following a Return-to-Work plan.

The Officer also confirmed that because the worker acquired a new skill set, LOE benefits were correctly based on entry-level wages.

The worker's objections were denied.

The worker objected to a Case Manager's decision denying entitlement for a left shoulder injury following a workplace accident where the worker was burned by hot tar.

The worker argued the shoulder injury occurred when they grabbed a fence to prevent a fall during the incident.

The Appeals Resolution Officer found the accident history credible and clinically compatible with the orthopaedic surgeon's diagnosis of supraspinatus tendinopathy and subacromial bursitis.

The worker's objection was allowed, and entitlement to the left shoulder injury was granted.

The worker objected to WSIB decisions denying loss of earnings (LOE) benefits for a specific period and denying entitlement to psychotraumatic disability benefits following a workplace accident involving a tow motor and a forklift.

The Appeals Resolution Officer found that the worker was completely disabled from working due to the physical injury from May 31, 2021, to June 23, 2021, and granted full LOE benefits for that period.

However, the claim for psychotraumatic disability was denied because the worker's psychological symptoms were found to be an emotional reaction to a dispute with the employer over the accident details and return-to-work process, rather than an indirect result of the physical injury itself.

The worker appealed a case manager's decision to adjust their loss of earnings (LOE) benefits based on updated entry-level wages for the suitable occupation of Customer Service Representative.

The Appeals Resolution Officer found that the updated entry-level wage of $16.55 per hour represented a material change of more than 10% from the previous $14.00 per hour rate.

The worker's objection was denied, and the adjustment of LOE benefits was confirmed.

The worker, a police officer, appealed a Case Manager's decision denying entitlement for posttraumatic stress disorder (PTSD), traumatic mental stress, and chronic mental stress.

The worker had responded to a fatal motor vehicle incident involving a child in 2011, but did not seek psychological treatment until 2021, shortly after their own child suffered a severe medical emergency.

The employer argued the personal stressor rebutted the presumption of work-relatedness for first responders.

The Appeals Resolution Officer found that the work-related incident remained a significant contributing factor to the PTSD diagnosis, despite the co-existing personal stressor and the delay in seeking treatment.

The appeal was allowed, granting entitlement for PTSD as a first responder.

The worker, a firefighter with 28 years of service, was diagnosed with right vocal cord squamous cell carcinoma (laryngeal cancer) and sought benefits for an occupational disease.

The initial adjudicator denied the claim because laryngeal cancer is not a prescribed cancer for firefighters under the presumptive policy.

On appeal, the Appeals Resolution Officer weighed competing medical opinions.

The Officer preferred the opinions of the worker's treating oncologist and an occupational medicine physician, who both concluded that the cancer was likely caused by occupational exposures given the worker's lack of other risk factors, over the opinion of the Board's medical consultant.

The appeal was allowed and entitlement to benefits was granted.

The worker appealed several decisions made by a Case Manager regarding entitlement to benefits following a workplace slip and fall.

The Appeals Resolution Officer denied initial entitlement for injuries to the worker's back, neck, shoulders, and head due to a significant delay in reporting and lack of contemporaneous medical evidence linking them to the accident.

However, the Officer found that the worker's left knee strain had reached maximum medical recovery with a permanent impairment, reversing the Case Manager's decision on that issue.

The Officer also upheld the permanent restrictions for the left ankle and knee, and confirmed that a 2% Non-Economic Loss benefit was appropriate for the left ankle impairment based on the AMA Guides.

The appeal was allowed in part.