Workers' Compensation

The worker appealed a Case Manager's decision denying entitlement to psychotraumatic disability following a workplace accident where a forklift struck a table, causing a bar to hit the worker's right knee.

The worker claimed the accident and resulting pain caused depression and anxiety.

The Appeals Resolution Officer denied the appeal, finding the worker did not meet the criteria under the psychotraumatic disability policy.

The accident was minor, the psychological symptoms arose only after loss of earnings benefits were terminated, and the worker's ongoing psychological issues were primarily related to a pre-existing trauma and a non-compensable back condition.

The worker appealed the WSIB Case Manager's decisions denying entitlement for secondary organic conditions and a psychotraumatic disability, and reducing their benefits to partial loss of earnings (LOE).

The worker suffered a compensable right ankle fracture and claimed that compensating for the injury caused widespread secondary pain and psychological distress.

The Appeals Resolution Officer denied the appeal, finding no clear organic diagnoses to support the secondary conditions and insufficient evidence of a psychotraumatic diagnosis.

The reduction to partial LOE benefits was upheld, as the identified suitable occupation of Administrative Clerk was consistent with the worker's permanent restrictions and transferable skills.

The worker, a personal support worker, appealed two Case Manager decisions regarding their workplace injury claim: the denial of full loss of earnings (LOE) benefits beyond November 2, 2020, and the determination that they had reached maximum psychological recovery (MPR) without a permanent impairment.

The Appeals Resolution Officer found that the worker was capable of participating in a graduated return to work plan and was therefore entitled to partial LOE benefits for a limited period, but not full LOE benefits.

Regarding the psychological claim, the Officer found that the worker had not reached MPR, as their condition was still improving with treatment and a recommended psychiatric assessment had not occurred.

The worker's appeal was allowed in part.

The worker appealed decisions of the case manager regarding re-employment obligations and loss of earnings (LOE) benefits following surgery.

The worker suffered a right hand injury and continued to work until their employment was terminated due to corporate restructuring.

The Appeals Resolution Officer found that the re-employment threshold was not met because the worker was not 'unable to work' prior to termination.

However, the worker was entitled to LOE benefits for a limited period following a subsequent surgery, as they were actively engaged in job search activities at the time of the recurrence.

The appeal was allowed in part.

The employer objected to the initial entitlement to benefits for a personal support worker who sustained multiple injuries in a motor vehicle accident.

The accident occurred after the worker's last client visit while she was driving to her daughter's residence, where she was staying.

The employer argued that traveling to a location other than her personal residence constituted a distinct departure on a personal errand, removing her from the course of employment.

The Appeals Resolution Officer denied the objection, finding that the worker was required to drive as a condition of her employment and was on a direct route to the residence where she was staying.

The trip did not constitute a personal errand, and the worker remained in the course of employment.

The worker objected to a decision denying initial entitlement for a left wrist fracture sustained after slipping on ice while walking to work.

The worker argued they were using a safe, commonly used pathway near the employer's facility.

The Appeals Resolution Officer found that the pathway was privately owned and not controlled by the employer.

Applying WSIB policies on premises and course of employment, the Officer concluded the worker had not yet arrived at the employer's premises and was therefore not in the course of employment.

The worker's objection was denied.

The estate of a deceased worker appealed a decision denying WSIB entitlement for the worker's colon cancer, alleging it was caused by occupational exposure to various chemicals during their 42-year employment in the rubber manufacturing industry.

The Appeals Resolution Officer reviewed the medical and scientific evidence, including IARC monographs and internal medical consultant opinions.

The Officer found no compelling evidence that the worker was exposed to the claimed chemicals or that such exposures are causally linked to colon cancer.

The appeal was denied.

The worker objected to a decision denying initial entitlement for mental stress as both Chronic Mental Stress (CMS) and Traumatic Mental Stress (TMS).

The worker alleged she suffered mental stress after a visiting officer whispered an inappropriate sexual comment to her, and the employer subsequently extended the officer's contract.

The Appeals Resolution Officer found that while the comment was inappropriate and unwelcome, it was not objectively traumatic and did not meet the policy definition of workplace harassment.

Furthermore, the employer's actions in managing the situation were part of the employment function and were not egregious or abusive.

The objection was denied.

The worker appealed a decision denying her entitlement to escort fees for her husband to drive her to physiotherapy appointments following a compensable right foot injury.

The worker argued that she could not drive due to her injury and preferred her husband to drive her rather than taking a taxi.

The Appeals Resolution Officer found that under WSIB policy, escort fees are only payable when there is a clinical necessity or for legal/basic clinical reasons.

Since the worker did not require an escort for clinical reasons and the WSIB had offered to arrange taxi transportation, the request for escort fees was denied.

The worker's husband was appropriately compensated for mileage.

The worker appealed a decision denying her loss of earnings (LOE) benefits from October 3 to October 25, 2018, following a right ankle sprain sustained at work.

The Appeals Resolution Officer found that the worker was only partially disabled and that the employer had offered suitable modified duties which the worker declined without adequate medical justification.

As the worker failed to cooperate in the work-reintegration process by declining suitable work, she was not entitled to LOE benefits for the claimed period.

The appeal was denied.

The worker, a library employee, appealed the denial of entitlement for chronic mental stress.

She claimed her stress resulted from a tense relationship with her manager, lack of support, and incidents involving unruly clients.

The Appeals Resolution Officer found that the interpersonal conflicts and managerial decisions were part of the normal employment function.

Furthermore, the incidents with clients were not considered substantial work-related stressors given the nature of the public work environment.

The appeal was dismissed.

The worker appealed the eligibility adjudicator's decision denying initial entitlement for bilateral foot and knee injuries, health care, and loss of earnings (LOE) benefits following a trip and fall at work.

The Appeals Resolution Officer allowed the appeal in part, finding that the worker's delay in reporting the accident was reasonable and that proof of accident was established.

Initial entitlement was granted for a minor right foot soft tissue injury, with maximum medical recovery reached on October 4, 2016.

However, entitlement for left foot, bilateral knee, right shoulder, and wrist injuries was denied as they were not compatible with the mechanics of the accident or were reported too late.

LOE benefits were also denied because the worker was not totally disabled and had refused suitable modified work.

The applicant was injured in a motor vehicle accident while working as a truck driver.

He commenced a tort action and applied for statutory accident benefits.

The insurer argued that the applicant was statute-barred from proceeding to arbitration under s. 61 of the Schedule because he was entitled to WSIB benefits and his tort action was not bona fide.

The arbitrator found that the tort action was instituted bona fide and not primarily for the purpose of claiming statutory accident benefits.

The applicant was therefore not statute-barred from proceeding to arbitration.

The applicant, a long-haul truck driver, was injured in a motor vehicle accident in North Carolina.

He elected to opt out of the WSIB scheme to pursue a tort action and subsequently applied for statutory accident benefits.

The insurer argued that the applicant's tort claim was barred under North Carolina law due to contributory negligence, and that his election out of WSIB was made primarily to claim accident benefits, which would bar his claim under section 61 of the Schedule.

The arbitrator found the applicant credible and concluded that, at the time of the election, his primary purpose was to pursue a tort action to recover his losses.

Therefore, the election was valid and the claim for accident benefits was not barred.

The applicant alleged that the Workplace Safety and Insurance Board discriminated against him on the basis of age and disability when it terminated his benefits.

Following a summary hearing, the Tribunal found that the dispute was essentially an attack on the correctness of the WSIB's decision to deny benefits.

The Tribunal held that it lacks jurisdiction to review the substantive or procedural correctness of decisions made under other statutory schemes absent a Code violation.

The application was dismissed.

The applicant was injured in a motor vehicle accident and applied for statutory accident benefits.

The insurer brought a motion to dismiss the arbitration on the basis that the applicant was entitled to workers' compensation benefits under the Workplace Safety and Insurance Act.

The Workplace Safety Insurance Appeals Tribunal had previously ruled that the applicant was entitled to workers' compensation benefits.

The arbitrator found that section 59(1) of the Statutory Accident Benefits Schedule precluded the applicant from receiving accident benefits and dismissed the arbitration.

The insurer was awarded expenses of $3,443.71.

The applicant, an injured worker, alleged that the WSIB discriminated against him on the basis of disability by misinforming him about the impact of a non-compensable neck surgery on his benefits and Work Transition program.

The applicant claimed this misinformation caused him to delay necessary surgery.

The Tribunal dismissed the application, finding that even if the Claims Manager provided incorrect information, there was no evidence that the misinformation was based on the applicant's disability.

The Tribunal reiterated that it does not have jurisdiction to review the correctness of WSIB benefit decisions or to remedy poor customer service absent a connection to a Code-protected ground.

The applicant was injured in a motor vehicle accident and initially denied income replacement benefits by his insurer due to a suspended driver's licence.

He subsequently applied for and received workplace benefits from the WSIB, but later withdrew his WSIB claim and commenced a tort action, seeking to re-elect accident benefits.

The Director's Delegate affirmed the arbitrator's decision that the applicant was precluded from claiming accident benefits under section 59 of the SABS, as his tort action was commenced primarily for the purpose of claiming accident benefits.

The insurer's appeal regarding the licence suspension issue was deemed moot, though the Delegate noted errors in the arbitrator's finding that the applicant had exercised due diligence regarding his mail.

The applicant was injured in a motor vehicle accident and applied for statutory accident benefits.

The insurer denied the claim, arguing the applicant was precluded under s. 59(1) of the Statutory Accident Benefits Schedule because he was entitled to workers' compensation benefits.

The applicant argued the insurer was estopped from relying on s. 59 because it initially denied benefits on the basis of a suspended licence, prompting him to apply for WSIB benefits.

The arbitrator found the insurer was not estopped, as it had not misrepresented its position and the applicant did not rely on it to his detriment.

The arbitrator also found the applicant did not fall under the s. 59(2) exception, as he failed to prove his tort action was not commenced primarily for the purpose of claiming accident benefits.

The applicant was therefore precluded from receiving accident benefits.

The applicant was injured in a motor vehicle accident involving three tractor-trailers while in the course of his employment.

He elected to pursue a tort action and claim statutory accident benefits rather than WSIB benefits.

The insurer argued the election was invalid under s. 61(2) of the Schedule, claiming it was made primarily to obtain accident benefits, especially after the applicant later applied for WSIB benefits following a WSIAT decision barring most of his tort claim.

The Arbitrator found the initial election was valid, as the applicant's primary intention was to pursue a tort action for pain and suffering, and the subsequent WSIB application was made out of confusion and desperation, not reflecting his original intent.