Workers' Compensation

The employer objected to a case manager's decision allowing the worker loss of earnings benefits during a temporary work disruption caused by a plant re-tooling.

The worker had previously been performing suitable work at no wage loss following a compensable bilateral knee injury.

The Appeals Resolution Officer found that the worker met the criteria under WSIB Operational Policy 15-06-02, as their work history demonstrated they would normally seek new employment during a layoff, and their significant medical restrictions impacted their ability to earn income through new employment.

The employer's objection was denied and the benefits were maintained.

The worker appealed a Return-to-Work Specialist's decision that identified Computer Network Technician - Systems Administrator as a suitable occupation and approved an associated Work Transition plan.

The worker, who sustained physical and psychological injuries after falling through a floor hole, argued the occupation was not suited to their transferrable skills or functional abilities.

The Appeals Resolution Officer found that while the occupation was within the worker's physical functional abilities, it was not suited to their transferrable skills, aptitudes, or education, noting significant gaps in English literacy and math skills.

The Work Transition plan was also found inappropriate as it did not sufficiently address these proficiency gaps.

The worker's objection was allowed.

The worker, a police sergeant with an accepted claim for post-traumatic stress disorder, objected to a decision denying loss of earnings (LOE) benefits after October 31, 2020.

The worker argued that because they were permanently restricted from police work, they were entitled to LOE benefits despite retiring.

The Appeals Resolution Officer found that the worker made a fully informed, voluntary decision to retire and withdraw from all return-to-work services, including those aimed at the general labour market.

Consequently, the post-retirement wage loss was not caused by the workplace injury, and the objection was denied.

The worker objected to a Case Manager's decision that they had reached maximum medical recovery (MMR) by July 23, 2024, with no permanent impairment resulting from a work-related left ankle/foot injury.

The Appeals Resolution Officer reviewed the medical evidence, including reports from a WSIB Lower Extremity Specialty Clinic, which indicated the ankle fracture had fully healed with full range of motion and no residual impairment.

Applying the AMA Guides, the Appeals Resolution Officer confirmed the range of motion measurements did not result in a measurable impairment rating.

The worker's objection was denied, and the Case Manager's decision was upheld.

The employer appealed a decision granting the worker entitlement for a low back soft tissue injury.

The worker reported experiencing severe lower back pain after bending over to pick up an egg carton at work, which subsequently required hospitalization.

The employer argued there were discrepancies in the accident history and a delay in reporting.

The Appeals Resolution Officer found that the worker suffered a personal injury by accident that arose out of and in the course of employment, and that the diagnosis of a low back sprain/strain was compatible with the accident history.

The employer's appeal was denied and entitlement was confirmed.

The worker appealed the denial of entitlement to Traumatic Mental Stress (TMS) and Chronic Mental Stress (CMS) following a road rage incident where another driver approached the worker's truck with a knife.

The Appeals Resolution Officer denied the appeal, finding that the worker did not have a confirmed DSM diagnosis for a mental stress injury.

Furthermore, the medical evidence did not support that the workplace incident was the predominant cause of the worker's mental stress condition, as the treating physicians attributed the stress to personal and non-occupational issues.

The worker, a project superintendent at a mine, suffered an acute myocardial infarction at work following two highly stressful and confrontational meetings where he was blamed for production delays outside his control.

The WSIB initially denied entitlement, finding no unusual physical exertion or acute emotional stress.

On appeal, the Appeals Resolution Officer found the worker's testimony credible and accepted the independent medical opinion of a cardiologist that the acute emotional stress of the meetings played a causative role in the cardiac event.

The appeal was allowed, and initial entitlement for the heart condition was granted.

The worker, a 64-year-old former crane operator, suffered a compensable left ankle fracture and dislocation.

After reaching maximum medical recovery with permanent restrictions, the WSIB identified Customer Service Representative as a Suitable Occupation (SO) and later denied secondary entitlement for a right hip condition.

The worker objected to both decisions.

The Appeals Resolution Officer allowed the appeal, finding that the worker's age, limited transferable skills, and physical impairments rendered them competitively unemployable in the general labour market, entitling them to full loss of earnings benefits to age 65.

Furthermore, the Officer granted secondary entitlement for a right hip soft tissue injury, concluding it was caused by an altered gait resulting from the compensable left ankle impairment.

The worker appealed a decision denying initial entitlement for chronic idiopathic axonal sensory neuropathy, which he claimed resulted from occupational exposure to solvents and heavy metals during his employment as a gas station attendant and miner.

The Appeals Resolution Officer reviewed medical and occupational hygiene evidence, including conflicting medical opinions on causation.

The Officer preferred the opinions of the WSIB's medical consultants, finding that the worker's exposure levels and the latency period between exposure and symptom onset did not support a toxic neuropathy diagnosis.

The appeal was denied, as the evidence did not establish that workplace exposures significantly contributed to the condition.

The worker suffered a workplace injury after falling from scaffolding, sustaining bilateral wrist fractures and a concussion.

The Case Manager determined the worker reached Maximum Medical Recovery (MMR) for the concussion without a permanent impairment.

The worker objected to this decision.

The Appeals Resolution Officer reviewed the medical evidence, including assessments from the Neurology Specialty Program, and found that the worker's ongoing symptoms were predominantly psychological and related to an accepted psychological condition for which they were already receiving benefits.

The appeal was denied, confirming the worker reached MMR for the concussion without a permanent impairment.

The worker appealed a Case Manager's decision denying a Non-Economic Loss (NEL) redetermination for a mild traumatic brain injury and neck injury sustained at work.

The Appeals Resolution Officer reviewed the medical evidence, including reports from a physical medicine specialist and a family doctor, against the American Medical Association's Guides to the Evaluation of Permanent Impairment.

The Officer concluded that the evidence did not establish a permanent and significant deterioration in the worker's condition since the previous 23% combined NEL rating.

The appeal was dismissed.

The worker appealed two decisions regarding their workplace injury claim: the 100 percent offset of their Canada Pension Plan (CPP) disability benefits from their loss of earnings benefits, and the 30 percent quantum of their non-economic loss (NEL) award for a psychotraumatic disability.

The Appeals Resolution Officer allowed the appeal in part.

The officer found that the CPP disability benefits were granted in part for a non-compensable back condition, and therefore reduced the offset to 33.33 percent.

However, the officer upheld the 30 percent NEL quantum, finding that the medical evidence supported a mid-range Class 3 moderate impairment rating for the worker's psychological condition.

The worker, a police officer, appealed a decision denying initial entitlement for a right chest injury (breast cellulitis) attributed to wearing a police vest.

The worker had a pre-existing condition due to a prior lumpectomy.

The Appeals Resolution Officer applied the five-point check system and the thin skull doctrine, finding that the worker sustained a personal work-related injury and that the accident history was compatible with the diagnosis.

The worker's objection was allowed, granting entitlement for right breast cellulitis, with the issue of loss of earnings benefits deferred to the operating area.

The worker appealed the denial of their claim for mental stress and the determination that their position did not meet the definition of a correctional officer under the first responder PTSD presumption policy.

The Appeals Resolution Officer found that the worker's roles as a Behavioural Technologist and Correctional Programs Officer involved direct responsibility for the care, health, discipline, safety, and custody of inmates, thereby meeting the policy definition.

The worker was diagnosed with PTSD by a psychiatrist following workplace traumas, including witnessing a stabbing.

The Officer concluded the presumption applied and was not rebutted by pre-existing conditions or employment issues, granting entitlement to health care and loss of earnings benefits.

The worker appealed decisions denying loss of earnings (LOE) benefits after May 8, 2023, limiting his low back entitlement to a strain, and finding he reached maximum medical recovery (MMR) without a permanent impairment (PI).

The Appeals Resolution Officer found the worker was totally disabled and entitled to LOE benefits from May 8 to July 5, 2023, after which he was capable of performing the suitable modified work offered by the employer.

The Officer upheld the decision limiting the low back injury to a lumbar strain, preferring the diagnosis of the back and neck specialty program over a chronic pain specialist.

Finally, the Officer concluded the worker reached MMR for his knee and head injuries with no PI, but found he had a permanent impairment for his lumbar strain, entitling him to a non-economic loss (NEL) assessment.

The worker appealed a Case Manager's decision denying Loss of Earnings (LOE) benefits beyond October 2, 2022.

The worker had sustained a permanent low back impairment and was working reduced hours as a driving instructor.

The Appeals Resolution Officer found that the worker was underemployed and capable of working 25 hours per week in the Suitable Occupation of Accounting Technicians and Bookkeepers.

The objection was allowed in part, granting the worker partial LOE benefits based on deemed wages in the suitable occupation.

The worker's estate objected to a decision limiting the Loss of Retirement Income (LRI) pre-retirement death benefit to the mandatory contributions made by the WSIB and accumulated investment income.

The worker had elected to make voluntary 5% contributions from their loss of earnings benefits, but due to an administrative error, the WSIB never deducted these amounts.

The Appeals Resolution Officer denied the objection, finding that because the voluntary contributions were paid directly to the worker as part of their benefits and never invested into the LRI fund, they did not generate accumulated investment income.

Therefore, the estate was not entitled to any supplementary pre-retirement death benefit.

The worker suffered a complete T3 spinal cord injury in a workplace accident and was prescribed a power standing wheelchair.

When the standing actuator broke, the WSIB denied repairs and instead approved a replacement wheelchair, which took nine months to arrive.

The worker paid $4,375.85 out-of-pocket to repair the standing actuator in the interim to manage his pain and maintain independence.

The Appeals Resolution Officer allowed the worker's appeal, finding it was reasonable for the worker to pay for the repair to maintain access to the prescribed power standing feature while awaiting the replacement wheelchair.

The worker, an addictions Case Manager, appealed a decision denying her entitlement to benefits for a mental stress injury.

The worker claimed she developed posttraumatic stress disorder (PTSD) due to repeated exposure to violent and unpredictable clients at a drop-in centre, including incidents where she was physically struck and threatened with a knife.

The Appeals Resolution Officer allowed the appeal, finding that the worker experienced multiple objectively traumatic events in the course of her employment that caused her appropriately diagnosed PTSD.

The worker was granted initial entitlement under the Traumatic Mental Stress policy and full loss of earnings benefits effective January 23, 2023.

The worker, a police victim services coordinator, suffered a traumatic mental stress injury due to cumulative exposure to traumatic events.

After a period of accommodated work, the worker's psychological condition deteriorated in August 2022, leading them to stop working.

The Case Manager initially denied entitlement for a recurrence and loss of earnings (LOE) benefits, attributing the deterioration to an employment decision.

On appeal, the Appeals Resolution Officer found that the deterioration was a direct result of the cumulative occupational exposures and diagnosed PTSD, not an employment decision.

The worker's objection was allowed, granting entitlement to the August 2022 recurrence and full LOE benefits from August 8, 2022, with partial LOE benefits during a brief period of teaching.