Workers' Compensation

The worker appealed the denial of initial entitlement for non-ischemic dilated cardiomyopathy (NIDC), which he alleged was caused by myocarditis arising from an occupationally compulsory COVID-19 vaccination.

The Appeals Resolution Officer reviewed conflicting medical opinions, including those from treating cardiologists, a general practitioner, and an occupational medicine consultant.

The Officer found that while there was a temporal relationship between the vaccination and the onset of symptoms, the objective medical evidence did not confirm a diagnosis of myocarditis according to CDC criteria.

As the diagnosis of myocarditis was not objectively confirmed, the appeal was dismissed and initial entitlement was denied.

The worker appealed a Case Manager's decision that determined they were partially impaired, capable of working as a telephone solicitor, and entitled only to partial loss of earnings (LOE) benefits.

The Appeals Resolution Officer found that the occupation of telephone solicitor was not suitable given the worker's age, lack of transferable skills, need for extensive training, and the limited employment outlook for the position.

The Officer concluded the worker was unemployable due to their compensable injuries and awarded full LOE benefits effective January 31, 2025, locked in to age 65.

The worker appealed an Adjudicator's decision denying initial entitlement to WSIB benefits for an allergic reaction allegedly caused by exposure to nitrile gloves at work.

The Appeals Resolution Officer reviewed the medical evidence, placing significant weight on the opinion of an occupational allergist who concluded the worker's symptoms were not compatible with a typical allergic reaction to gloves.

The Appeals Resolution Officer found no evidence that workplace exposure significantly contributed to the worker's symptoms and denied the appeal.

The worker appealed a decision denying an extension of time to file a claim for a mental stress injury allegedly arising from a work incident in March 2001.

The worker filed the claim 23 years later, in January 2024, alleging paranoia caused by workplace video monitoring.

The Appeals Resolution Officer denied the appeal, finding that the 23-year delay prejudiced the employer and rendered the evidence too stale to adjudicate the claim on its merits.

Furthermore, the contemporaneous medical evidence did not support a work-related cause for the worker's hospitalization, and no exceptional circumstances justified the delay.

The worker appealed a Case Manager decision regarding loss of earnings (LOE) benefits following a 2015 motor vehicle accident that resulted in permanent physical and psychotraumatic impairments.

The Appeals Resolution Officer found that the worker was completely unable to work due to the combined effects of his physical and psychological impairments, and that the identified suitable occupation of Cashier was not suitable.

The Officer upheld the decision to treat taxable dividends received in 2016 and 2017 as post-injury earnings, resulting in no LOE benefits for late 2016 and partial LOE benefits for 2017.

However, the worker was granted full LOE benefits from January 1, 2018 to the 72-month review date, and continuing to age 65.

The worker appealed a Nurse Consultant's decision denying entitlement for Botox injections.

The worker sustained a workplace injury in 2016, for which they received entitlement for a neck strain, cervicogenic headaches, and chronic pain disability.

The worker's representative argued Botox was prescribed to treat chronic migraines and persistent headaches related to the compensable condition.

The Appeals Resolution Officer denied the appeal, finding that the worker's ongoing headaches were not caused by the accepted physical conditions, and that chronic migraines were not an accepted compensable condition.

Furthermore, WSIB policy and Drug Advisory Committee recommendations did not support Botox for neck pain, myofascial pain, or headache disorders.

The worker, a housekeeping aide, appealed a decision denying initial entitlement for bilateral hand conditions (palmar psoriasis, contact dermatitis, and allergic contact dermatitis) claimed to result from workplace exposure to cleaning chemicals and gloves.

The Appeals Resolution Officer reviewed medical evidence, including a dermatologist's opinion and patch testing results, which ruled out palmar psoriasis and allergic contact dermatitis but confirmed a diagnosis of irritant contact dermatitis.

Finding a temporal relationship and significant contribution from occupational exposure to cleaning chemicals, the Officer granted initial entitlement for irritant contact dermatitis.

The worker was also granted loss of earning (LOE) benefits for lost time from work, as the employer could not accommodate the worker's restrictions.

The worker and employer both objected to a Case Manager's decision regarding loss of earnings (LOE) benefits following a workplace injury to the worker's right finger.

The worker appealed the denial of LOE benefits from April 10, 2024 to May 6, 2024, arguing they were following medical advice to remain off work post-surgery.

The employer appealed the allowance of LOE benefits for April 8 and 9, 2024, arguing suitable modified duties were available.

The Appeals Resolution Officer denied the worker's appeal, finding that safe and suitable modified duties were available that accommodated the worker's functional limitations.

The employer's appeal was allowed in part; LOE benefits were denied for April 8 as the surgery occurred on April 9, but entitlement was confirmed for the actual surgery date of April 9.

The worker appealed a decision denying WSIB entitlement for pulmonary fibrosis and emphysema allegedly caused by occupational asbestos exposure while working as an HVAC technician.

The Appeals Resolution Officer reviewed the medical evidence, including opinions from a respirologist and an occupational medical consultant, both of whom concluded the lung disease was secondary to an underlying connective tissue disease rather than asbestos exposure.

The appeal was denied, as the worker's employment exposure was found not to be a significant contributing factor to the development of the conditions.

The worker appealed the denial of loss of earnings benefits for the periods of July 11 to October 2, 2019, and November 8, 2019, following a workplace injury.

The Appeals Resolution Officer found that the medical evidence supported the worker's inability to return to work until September 30, 2019, and granted full loss of earnings benefits for that period.

However, the claim for November 8, 2019, was denied as there was no medical evidence confirming the absence was for a medically justified health care appointment.

The worker appealed multiple decisions regarding their entitlement to benefits following a work-related COVID-19 infection.

The Appeals Resolution Officer found that the worker had not fully recovered from Long COVID and was entitled to Chronic Pain Disability (CPD) and ongoing Loss of Earnings (LOE) benefits as of July 15, 2024, as the severity of the conditions prevented a return to work.

However, the Officer determined that the worker had fully recovered from an accepted exacerbation of pre-existing rheumatoid arthritis and denied entitlement to psychotraumatic disability, noting that CPD was the predominant contributing factor to the ongoing impairment.

The appeal was allowed in part.

The employer appealed a Case Manager's decision finding it in breach of its re-employment obligation under the Workplace Safety and Insurance Act.

The worker, an ironworker, suffered a workplace injury and was terminated within six months of returning to work, triggering a presumption of a breach.

The employer argued the termination was due to poor performance and insubordination, unrelated to the injury.

The Appeals Resolution Officer found irregularities in the employer's disciplinary records, noting that the worker was not provided with written warnings or corrective plans prior to termination, unlike other employees involved in the same incidents.

The employer failed to rebut the presumption that the termination was related to the injury or claim.

The breach and the associated penalty were confirmed.

The employer appealed a decision denying initial WSIB entitlement for a volunteer firefighter who suffered a fatal cardiac arrest while responding to a water rescue.

The worker collapsed after running down a steep embankment and across a sandy beach in full gear.

The Appeals Resolution Officer found that while the worker had pre-existing risk factors for heart disease, the physical exertion required during the rescue was unusual for the worker.

Applying WSIB Operational Policy 15-03-10, the officer concluded the unusual physical exertion caused the acute cardiac condition without significant delay.

The employer's objection was allowed and initial entitlement was granted.

The worker, a primary care paramedic, suffered a work-related mental stress injury (PTSD) and was completely unable to work as of May 6, 2024.

The Case Manager denied loss of earnings (LOE) benefits from May 8 to May 20, 2024, because the worker was on a pre-approved vacation and received vacation pay.

On appeal, the Appeals Resolution Officer found that under WSIB operational policy, a fully impaired worker may continue to receive full benefits during a vacation of up to three weeks if it does not interrupt treatment.

The worker had notified the WSIB of the vacation and actively participated in treatment without significant interruption.

The appeal was allowed, and full LOE benefits were granted for the disputed period.

The worker appealed a decision denying entitlement to medical cannabis for neuropathic pain stemming from a 2012 workplace injury.

The Appeals Resolution Officer applied WSIB Policy 17-01-10 and found that while the worker had a designated condition, they had not exhausted conventional treatments, lacked an appropriate clinical assessment, and had contraindications that outweighed the benefits.

Furthermore, the prescribed dosage exceeded policy guidelines.

The appeal was dismissed.

The worker, a bus driver who developed PTSD after a passenger pointed a handgun at them, appealed a case manager's decision denying loss of earnings benefits for a period when the worker was out of the country.

The Appeals Resolution Officer found that the worker's out-of-country leave did not interfere with their ability to co-operate in health care measures or the return-to-work process.

The worker sought appropriate psychiatric treatment while abroad and was medically authorized off work during the entire period.

The appeal was allowed, and the worker was granted full loss of earnings benefits for the disputed period.

The worker, a detector dog handler, appealed the denial of initial entitlement for a cerebrospinal fluid (CSF) leak and intracranial hypotension.

The worker alleged the condition developed due to the high level of physical activity required in their duties, including running, bending, lifting, and twisting while handling a 70-pound dog.

The Appeals Resolution Officer found that the worker's duties were a significant contributing factor to the onset of the condition, satisfying the compatibility criteria under Operational Policy 11-01-01.

The appeal was allowed, and the issue of loss of earnings benefits was remitted to the Operating Area for further adjudication.

The worker, who previously suffered a compensable neck injury and concussion from a fall at work, sought entitlement for new cervical spine diagnoses and a Non-Economic Loss (NEL) redetermination following a subsequent trip and fall at home.

The Appeals Resolution Officer denied the appeal, finding no causal link between the fall at home and the work-related injury.

The medical evidence did not establish a confirmed diagnosis of cervical spine instability or anterolisthesis, nor did it demonstrate a significant and permanent deterioration of the work-related cervical spine impairment to warrant a NEL redetermination.

The worker, a school principal, appealed the denial of entitlement for traumatic and chronic mental stress injuries following repeated harassment and social media defamation by a student's parent.

The Appeals Resolution Officer found that while the events did not meet the threshold for a traumatic mental stress injury, the parent's egregious and abusive conduct constituted a substantial work-related stressor.

The worker's appeal was allowed, granting entitlement for a chronic mental stress injury (acute adjustment disorder).

The worker appealed a decision denying a review of their Loss of Earnings (LOE) benefits from June 6, 2016 onwards, which fell after the 72-month final review date.

The worker argued that a permanent impairment recognized by WSIAT in 2023 constituted a significant deterioration, and that they were cooperating in return-to-work activities at the 72-month mark.

The Appeals Resolution Officer found that the worker reached maximum medical recovery prior to the 72-month date, meaning there was no significant deterioration post-72 months.

Furthermore, the worker had been performing accommodated duties for years, so there were no active return-to-work activities at the time of the final review.

The appeal was denied.