Workers' Compensation

The employer appealed decisions allowing the worker's initial entitlement to a low back strain, denying entitlement on an aggravation basis, and denying the employer Second Injury and Enhancement Fund (SIEF) cost relief.

The worker sustained a low back injury while pushing a faulty stretcher.

The Appeals Resolution Officer found that the worker suffered a disablement accident arising out of and in the course of employment.

The Officer also found that the worker's pre-existing conditions did not meet the criteria for entitlement on an aggravation basis, nor did they cause, contribute to, or prolong the recovery from the compensable injury.

The employer's appeal was dismissed.

The employer appealed a Case Manager's decision denying Second Injury and Enhancement Fund (SIEF) relief following a worker's left ankle fracture sustained while operating an all-terrain vehicle.

The employer argued that the worker's pre-existing bilateral knee and plantar fasciitis conditions prolonged recovery and warranted relief.

The Appeals Resolution Officer found the accident was major in severity but concluded there was no medical evidence that a pre-existing condition caused the accident or enhanced the resulting disability.

The employer's objection was denied.

The worker appealed an Eligibility Adjudicator's decision denying entitlement to loss of earnings (LOE) benefits following a left hand and shoulder strain/sprain.

The employer did not participate in the appeal.

The Appeals Resolution Officer found that the medical evidence supported the worker's inability to return to pre-injury job duties and that the employer did not offer suitable modified work until October 14, 2021.

The worker's objection was allowed, and LOE benefits were granted from August 13, 2021 to October 14, 2021.

The worker's estate appealed the denial of loss of earnings (LOE) benefits following a temporary and subsequent permanent work disruption caused by the COVID-19 pandemic.

The worker had previously been accommodated with modified office duties after a compensable hand injury.

The Appeals Resolution Officer denied LOE benefits for the temporary disruption, finding the worker's inability to earn was due to the pandemic, not the injury.

However, for the permanent disruption, the Officer found the accommodated work was highly specific and did not exist in the general labour market.

Partial LOE benefits were granted based on the difference between pre-injury earnings and minimum wage.

The worker appealed the denial of his claim for occupational noise induced hearing loss.

The Appeals Resolution Officer found that while the worker had a sensorineural hearing loss consistent with occupational noise exposure, his calculated noise exposure of 83 dB over 8 hours per day for 40 years did not meet the WSIB's minimum threshold of 84 dB for 40 years.

The appeal was denied.

The applicant was injured in a motor vehicle accident.

The insurer denied statutory accident benefits on the basis that the applicant was in the course of his employment and covered by the Workplace Safety and Insurance Act (WSIA).

The insurer successfully applied to the Workplace Safety and Insurance Appeals Tribunal (WSIAT) under s. 31 of the WSIA, which determined the applicant had no right of action.

The insurer then moved to dismiss the FSCO arbitration as frivolous and vexatious under Rule 68 of the Dispute Resolution Practice Code.

The arbitrator granted the motion, finding that since the applicant had no right to sue, he could not claim accident benefits, and his failure to participate rendered the proceeding vexatious.

The applicant, a parking attendant, was injured when a car struck his booth.

He applied for both statutory accident benefits and WSIB benefits.

The WSIB denied his claim due to a lack of medical documentation, stating it was unable to allow the claim but would review additional information if submitted.

The insurer brought a motion arguing this was not a final decision and the applicant was precluded from receiving accident benefits under section 59(1) of the Statutory Accident Benefits Schedule.

The Arbitrator held that the WSIB letter was a final appealable order denying entitlement, and therefore the applicant was not precluded from pursuing his claim for statutory accident benefits.

The applicant, a school bus driver, was injured when her bus rolled forward and struck other vehicles.

She applied for statutory accident benefits but did not pursue a WSIB claim.

Two years later, after the insurer raised a defence under s. 59(1) of the SABS, she commenced a tort action against the bus manufacturer.

The arbitrator found that the applicant's delay in bringing the tort action and her failure to prosecute it demonstrated that her election to sue was made primarily for the purpose of claiming accident benefits.

Therefore, under s. 59(2) of the SABS, she was precluded from receiving statutory accident benefits.

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

The insurer denied the claim under section 59(1) of the Schedule, arguing the applicant was a Schedule 1 employee entitled to workers' compensation.

At the preliminary issue hearing, the insurer requested an adjournment to apply to WSIAT for a determination on the applicant's employment status.

The arbitrator denied the adjournment, finding no valid reason to stay the proceeding sine die when the insurer had ample notice to make the WSIAT application earlier.

Following the refusal, the parties consented to withdraw the preliminary issue.

The appellant was injured in a motor vehicle accident while in the course of his employment.

He elected to opt out of workers' compensation benefits under the Workplace Safety and Insurance Act to pursue a tort action, which would allow him to claim statutory accident benefits.

The arbitrator found that the election was not made bona fides, as the appellant's primary intention was to claim accident benefits rather than pursue a tort action.

On appeal, the Director's Delegate upheld the arbitrator's decision, finding no error of law in the arbitrator's preference for the appellant's subjective testimony over objective factors, such as the eventual settlement of the tort claim.

The appeal was dismissed.

The applicants were injured in a motor vehicle accident and applied for statutory accident benefits.

The insurer took the position that the applicants were in the course of their employment and therefore only entitled to workers' compensation benefits.

The applicants eventually withdrew their applications for arbitration.

The insurer sought its expenses under section 282(11) of the Insurance Act, arguing the proceedings were frivolous and vexatious.

The arbitrator dismissed the insurer's claim for expenses, finding that the insurer failed to provide the applicants with complete and correct information about the interaction between the Statutory Accident Benefits Schedule and the Workplace Safety and Insurance Act, 1997, and the proper dispute resolution procedures.

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

The insurer claimed the applicant was precluded from receiving benefits under section 59 of the Schedule because he was entitled to receive WSIB benefits.

On a preliminary issue, the arbitrator held that the Financial Services Commission of Ontario lacks jurisdiction to determine whether an individual is entitled to WSIB benefits, as the Workplace Safety and Insurance Board has exclusive jurisdiction over that question.

Since there was no evidence the Board had made such a determination, section 59(1) did not apply, and the applicant was not precluded from receiving accident benefits.

The applicant was injured in a motor vehicle accident in Texas while working as a co-driver of a tractor trailer.

He applied for and received loss of earning benefits from the Workplace Safety and Insurance Board (WSIB).

He subsequently applied for statutory accident benefits from his auto insurer, arguing he was entitled to benefits not covered by WSIB.

The arbitrator held that under section 59 of the Statutory Accident Benefits Schedule, the applicant was precluded from claiming statutory accident benefits because he was entitled to and received WSIB benefits, and he had not made a valid election to opt out of the WSIB scheme primarily to pursue a tort action.

The appellant was injured in a motor vehicle accident in the course of his employment.

He claimed and received statutory accident benefits but did not claim workers' compensation benefits.

After his accident benefits were terminated, he commenced a tort action just days before an arbitration pre-hearing.

The arbitrator found that the appellant's election to bring a tort action was made primarily for the purpose of claiming accident benefits, precluding him from relying on the exception in subsection 59(2) of the SABS-1996.

The Director's Delegate dismissed the appeal, finding no error in the arbitrator's consideration of the appellant's failure to pursue the tort claim as evidence of his primary purpose.

The applicant was injured in a motor vehicle accident while in the course of his employment.

He applied for statutory accident benefits, which the insurer denied on the basis that he was entitled to workers' compensation benefits.

The applicant argued he had validly elected to opt out of workers' compensation to pursue a third-party tort claim under section 59(2) of the Schedule.

The arbitrator found that the applicant's primary intention in making the election was to claim statutory accident benefits, not to pursue a tort action.

Consequently, the election was invalid, and the applicant was precluded from receiving accident benefits.

All claims were dismissed.

The applicant was injured in a motor vehicle accident while in the course of his employment.

He applied for statutory accident benefits from the insurer, claiming he had elected to opt out of the Workplace Safety and Insurance Act (WSIA) scheme to pursue a tort action.

The insurer argued the election was invalid because it was made primarily to claim statutory accident benefits, contrary to section 59(2) of the Schedule.

The arbitrator found that the applicant and his paralegal took no meaningful steps to pursue a tort action for over two years, ignored correspondence from the insurer regarding the tort claim, and only issued a Statement of Claim after the insurer sought repayment of benefits.

The arbitrator concluded the election was not made primarily to pursue a tort action and was therefore invalid, entitling the insurer to repayment of benefits paid.

The applicant was injured in a motor vehicle accident while being transported to work.

She applied for statutory accident benefits (SABs) from the insurer of the vehicle.

The insurer argued she was entitled to workers' compensation benefits and therefore precluded from receiving SABs under s. 59(1) of the Schedule.

The Workplace Safety and Insurance Appeals Tribunal (WSIAT) previously determined that the applicant was in the course of her employment at the time of the accident and was entitled to workers' compensation benefits.

At a preliminary issue hearing before FSCO, the arbitrator held that FSCO has no jurisdiction to go behind WSIAT's decision.

Because WSIAT determined the applicant is entitled to workers' compensation benefits, the insurer is not required to pay SABs.

The complainant alleged that the Workers' Compensation Board improperly collected and disclosed personal information regarding her sexual life to her employer and former representative.

The Information and Privacy Commissioner investigated and found that the information was 'personal information' under the Freedom of Information and Protection of Privacy Act.

The Board had the authority to collect the information as it was necessary for a Non-Economic Loss assessment.

The disclosure to the employer was authorized by the Workers' Compensation Act, but the disclosure to the former representative was not authorized and breached the Act.

The Commissioner recommended procedural changes for updating representative information and mailing medical information.

An employee of a municipal ambulance service filed a privacy complaint alleging that their supervisor and a staff psychologist improperly collected and disclosed their personal medical information to the Workers' Compensation Board (WCB) and to each other.

The Assistant Commissioner found that while the collection of information and the psychologist's disclosure to the WCB were authorized, the supervisor's direct disclosure to the WCB and the psychologist's disclosure to the supervisor violated the Municipal Freedom of Information and Protection of Privacy Act.

The municipality was ordered to implement policies ensuring staff awareness of disclosure limits and proper documentation of security measures for supervisor logs.

The appellant requested a correction to his attendance records to change 'sick' days to 'WCB' days, reflecting decisions by the Workers' Compensation Board.

The Ministry of Correctional Services refused, arguing the WCB decisions were under appeal.

The Commissioner found the information was personal information and ordered the Ministry to attach a memorandum to the records reflecting the WCB's findings, as the WCB decisions had not been set aside.