Workplace Safety and Insurance Law

The worker appealed a decision denying entitlement to health care benefits for onychomycosis (fungal nail infection).

The worker alleged the condition developed after wearing employer-provided safety boots in and around water and staying in a hotel during a multi-day work trip.

The Appeals Resolution Officer found that the worker's employment and exposure history, including the hotel stay and wearing wet safety boots, significantly contributed to the development of the condition.

The worker's objection was allowed and entitlement to health care benefits was granted.

A flight attendant suffered a right ankle sprain and left knee contusion after missing a step in an employer-paid hotel during a layover.

The employer objected to the initial allowance of health care and loss of earnings benefits, arguing the worker was engaged in a personal activity while going to meet crew members for dinner.

The Appeals Resolution Officer denied the objection, finding that the injury arose out of and in the course of employment because dining during a layover is reasonably incidental to the employment and the employer paid for the hotel.

The employer objected to a decision granting the worker initial entitlement to WSIB benefits for bilateral hand burns.

The worker sustained the burns when a personal chemical gas bomb, which they had brought to work and placed in their tool pouch, was accidentally ignited by sparks while cutting rebar.

The employer argued that bringing an explosive to work constituted serious and wilful misconduct under section 17 of the Workplace Safety and Insurance Act, 1997.

The Appeals Resolution Officer found that the injury resulted from a chance event accident in the course of employment.

The Officer concluded there was no evidence the worker deliberately planned to ignite the bomb at work, and therefore the injury was not solely attributable to serious and wilful misconduct.

The employer's objection was denied and initial entitlement was upheld.

The worker appealed decisions denying permanent impairment for right knee and low back injuries, denying entitlement for chronic pain disability (CPD), and denying further loss of earnings (LOE) benefits.

The Appeals Resolution Officer found no permanent organic impairment for the knee or back injuries, as the clinical evidence and imaging did not support significant pathology.

However, the worker was granted entitlement for CPD, having met all five policy criteria, including pain persisting beyond usual healing time and inconsistent with organic findings.

The worker was also awarded LOE benefits for a previously denied period, with further benefits to be determined.

The worker, an electrician, suffered a lower back injury in November 2020 and returned to modified duties.

In March 2021, the worker experienced a recurrence of lower back pain and sought further benefits, which the Case Manager initially denied.

On appeal, the Appeals Resolution Officer found that the worker experienced a significant deterioration that was clinically compatible with the original injury and not caused by a new incident.

The worker's objection was allowed, granting entitlement to health care benefits for the recurrence.

The worker appealed several decisions regarding their Workplace Safety and Insurance Board (WSIB) claim following a left ankle fracture.

The Appeals Resolution Officer determined that the Non-Economic Loss (NEL) quantum for the left ankle impairment was 8%, but this did not increase the worker's overall 49% NEL award.

The Officer also found that the worker's psychotraumatic disability was temporary and did not warrant a permanent impairment award.

Finally, the Officer concluded that the worker was capable of part-time suitable work, adjusting the Loss of Earnings (LOE) benefits based on a part-time entry-level wage rather than a full-time wage.

The employer appealed a decision granting the worker initial entitlement to health care and loss of earnings benefits for a left knee strain.

The worker alleged they injured their knee while walking up stairs and later re-injured it stepping into a truck.

The Appeals Resolution Officer reviewed video surveillance which contradicted the worker's claims of slipping or tripping.

The Officer concluded the injury was a disablement rather than a chance event, and that there was no workplace injuring process that could reasonably explain the onset of symptoms.

The employer's appeal was allowed and initial entitlement was rescinded.

The employer objected to an Eligibility Adjudicator's decision granting the worker secondary entitlement for a lower back strain/sprain and full loss of earnings (LOE) benefits.

The worker had suffered a work-related right foot injury and claimed the lower back condition resulted from using crutches and an air cast.

The Appeals Resolution Officer found insufficient evidence to establish a causal link between the use of the medical devices and the lower back injury, noting the worker was performing sedentary modified duties.

Consequently, secondary entitlement was denied, and LOE benefits were not payable as the wage loss was not the result of the workplace injury.

The employer's objection was allowed.

The worker, a school bus driver, appealed a decision denying entitlement for a low back and bilateral knee injury.

The worker claimed the injury was a disablement caused by prolonged sitting and excessive driving after a route change.

The Appeals Resolution Officer found that the worker's job duties significantly contributed to the low back injury with radiating symptoms down the left leg, noting the lack of prior back issues and supportive medical opinions from a chiropractor and physiotherapist.

The appeal was allowed for the low back injury.

The worker, a sales development representative, suffered facial scarring and psychological impairments (PTSD and Major Depressive Disorder) after being bitten by a dog at work.

They returned to modified duties but were permanently laid off in February 2020.

The Case Manager denied ongoing loss of earnings (LOE) benefits, concluding the wage loss was due to the lay-off rather than the injury.

On appeal, the Appeals Resolution Officer found that the worker remained partially impaired from a psychological perspective at the time of the lay-off, which affected their ability to fully restore their pre-injury earnings.

The worker's objection was allowed in part, granting ongoing partial LOE benefits from the date of the lay-off until they secured new employment in November 2020.

The worker appealed a decision denying entitlement for colon cancer, alleging it resulted from occupational exposures to chemicals and asbestos while employed in the rubber industry from 1954 to 1989.

The Appeals Resolution Officer reviewed medical and occupational hygiene evidence, including opinions from Occupational Medical Consultants and OHCOW.

The ARO found that the epidemiological evidence did not establish a significant association between rubber industry work and colon cancer.

The appeal was dismissed, as it was not shown that the worker's occupational exposures significantly contributed to the development of the disease.

The worker, a prep cook for over 18 years, appealed the denial of initial entitlement for a left shoulder injury.

The worker claimed the injury, diagnosed as rotator cuff tendinitis, subacromial bursitis, and biceps tenosynovitis, was a gradual onset disablement caused by heavy and repetitive work duties.

The Appeals Resolution Officer reviewed the worker's extensive daily tasks, which involved significant over-shoulder reaching and lifting.

Finding the medical evidence and job duties compatible with the injury, the Officer allowed the appeal and granted entitlement to benefits, including surgery and associated loss of earnings.

The employer appealed a Case Manager's decision denying cost relief under the Second Injury and Enhancement Fund (SIEF) following a worker's left foot and ankle injury sustained while transferring a patient.

The employer argued that the worker's pre-existing hypothyroidism caused or contributed to their neuropathic pain and prolonged recovery.

The Appeals Resolution Officer found the accident was of minor severity but concluded there was no medical evidence that the pre-existing condition enhanced the injury or prolonged recovery.

The appeal was denied and SIEF cost relief was not granted.

The worker objected to a Case Manager's decision discontinuing his loss of earnings (LOE) benefits after he left the country, which was deemed a material change in circumstances.

The worker, who was receiving full LOE benefits for a psychotraumatic disability, argued he attempted to notify the WSIB before leaving to visit family.

The Appeals Resolution Officer found that while the worker failed to properly report the material change, there was no evidence of willful concealment.

Because the worker was totally disabled and not participating in active treatment or return-to-work activities at the time of departure, the Officer allowed the objection in part, granting the worker three weeks of LOE benefits under the WSIB's vacation policy.

The worker appealed the denial of benefits related to a 1999 fall at home, the denial of section 147(4) supplementary benefits, and the denial of a permanent disability reassessment.

The worker had an accepted 1989 claim for an aggravation of pre-existing fibromyalgia.

The Appeals Resolution Officer found that the 1999 fall was not caused by the compensable injury, as the worker's condition had been stable and they had been working full-time prior to the fall.

The request for supplementary benefits was denied because the worker's earning capacity had significantly increased after completing a return-to-work program.

The request for a permanent disability reassessment was also denied, as any worsening of the worker's condition was attributable to the non-work-related second accident.

The appeal was dismissed.

The employer appealed an Eligibility Adjudicator's decision granting the worker initial entitlement for Welder's Flash and one day of loss of earnings (LOE) benefits.

The employer argued the worker reported the incident late, preventing the employer from offering modified duties to mitigate lost time.

The Appeals Resolution Officer found the reporting was prompt, as the worker reported the incident and sought medical attention the day after the injury.

The diagnosis was compatible with the accident history, and the worker had clinical authorization to be off work for the missed shift.

The employer's appeal was denied.

The worker, an electrician, suffered a fatal cardiac arrest shortly after arriving at a job site during an extreme cold weather alert.

The worker's estate sought initial entitlement, arguing the cardiac event was caused by work duties and the extreme cold, and relied on the statutory presumption under s. 13(2) of the WSIA.

The Appeals Resolution Officer denied the appeal, finding no evidence of unusual physical exertion or acute emotional stress.

The medical evidence indicated the worker had significant pre-existing coronary artery disease and had been experiencing symptoms prior to the incident.

The Officer concluded the heart condition did not arise out of employment.

The worker, who suffered a compensable low back injury resulting in a 61% combined Non-Economic Loss benefit, appealed decisions denying entitlement to hydrotherapy, a stationary modular home, and a hydropool.

The Appeals Resolution Officer denied the appeal, finding no objective medical evidence that hydrotherapy would provide more than transient relief or achieve the goals of maintenance treatment.

Furthermore, the requested stationary modular home and hydropool did not meet the criteria for specialized hobby equipment under the Independent Living Devices policy.

The worker appealed an adjudicator's decision denying initial entitlement for a vertebral artery dissection leading to a stroke, which the worker alleged was caused by bumping their head and neck while repairing a radiator in a tight workspace.

The Appeals Resolution Officer found that while the worker likely experienced minor bumps, the medical evidence and the delay in symptom onset did not support that the workplace activities were a significant contributing factor to the dissection.

Given the worker's significant pre-existing risk factors for stroke, the appeal was dismissed.

The worker appealed a Case Manager's decision terminating re-employment payments effective June 13, 2022, the date the worker secured alternate employment after being terminated by the accident employer.

The Appeals Resolution Officer found that securing alternate employment to mitigate wage loss did not sever the employment relationship.

However, the worker explicitly stated on August 8, 2022, that they did not intend to return to the accident employer, which severed the relationship.

The appeal was allowed in part, granting re-employment payments less actual earnings from June 13 to August 8, 2022.