Workplace Safety and Insurance Law

The worker, a tractor trailer driver, suffered bilateral hand injuries in a motor vehicle accident.

The WSIB recalculated her long-term loss of earnings (LOE) rate, determined she was capable of sedentary work including driving, identified Customer Service Representative as a suitable occupation (SO), and subsequently reduced her LOE benefits for non-cooperation when she refused to participate in a Work Transition (WT) plan.

On appeal, the Appeals Resolution Officer upheld the long-term recalculation but found the SO was not suitable because the worker's compensable hand impairments prevented her from safely driving the long distance required to attend the WT program.

The finding of non-cooperation was rescinded, and full LOE benefits were restored.

The worker objected to a Case Manager's decision denying secondary entitlement for conditions allegedly resulting from medication use for a 1989 work-related low back injury, and denying a reassessment of a 25% permanent disability benefit.

The Appeals Resolution Officer allowed the appeal in part, granting secondary entitlement for an abdominal/gastrointestinal condition and associated weight loss due to chronic opioid use.

Claims for organ failure and anxiety/depression were denied.

The request for a permanent disability reassessment was also denied, as there was insufficient evidence of a significant deterioration in the work-related impairment.

The worker appealed a decision denying entitlement to benefits for chronic lymphocytic leukemia (CLL).

The worker, a carpenter and maintenance worker, claimed the disease was caused by workplace exposure to benzene and other solvents.

The Appeals Resolution Officer reviewed conflicting medical and occupational hygiene evidence regarding the link between benzene exposure and CLL.

Preferring the medical opinion that the worker was at an elevated risk due to workplace exposures, and noting the worker's lack of non-occupational risk factors, the Officer concluded that the employment exposures likely made a significant contribution to the development of CLL.

The appeal was allowed.

The worker objected to a case manager's decision that their work-related lumbar strain had fully resolved with no permanent impairment.

The Appeals Resolution Officer reviewed the clinical evidence, including specialty clinic reports, and found that the worker had not fully recovered and had permanent restrictions.

The objection was allowed, and a permanent impairment for the lumbar strain was recognized.

The employer objected to a WSIB audit decision that transferred insurable earnings for rock truck drivers supplied to mining clients from Rate Group 929 (Supply of Non-clerical Labour) to Rate Group 570 (Supply of Drivers and Helpers) for the years 2017 to 2019.

The employer argued the transfer was a retroactive classification change prohibited by policy and contrary to a prior WSIAT decision.

The Appeals Resolution Officer found the transfer was a correction of incorrectly reported earnings between existing classification units, not a classification change, and thus retroactive adjustment to 2017 was permitted under the Two-Year Rule.

The Officer also found no basis for issue estoppel or detrimental reliance, as the employer had been instructed in subsequent audits to report drivers under Rate Group 570.

The objection was denied.

The worker appealed a Case Manager's decision denying entitlement for a left wrist injury and various right shoulder, knee, and hip diagnoses, and concluding the worker had fully recovered from their soft tissue injuries.

The Appeals Resolution Officer found no proof of accident for the left wrist injury due to a six-month delay in reporting.

Entitlement was granted for right shoulder bursitis and right hip greater trochanteric bursitis, but denied for right shoulder AC joint osteoarthritis, impingement, right knee osteoarthritis, and a lateral meniscus tear.

The worker was found to have fully recovered from the right knee and shoulder injuries, while the right hip injury was remitted for further adjudication.

The employer appealed a decision allowing the worker initial entitlement for injuries sustained when a forklift fell off a tow truck.

The employer argued the worker was acting outside the course of employment and that a pre-existing condition contributed to the injuries.

The Appeals Resolution Officer found that the worker was performing regular job duties using the employer's equipment at the time of the accident.

The officer also noted that initial entitlement cannot be denied due to a pre-existing condition.

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

The worker appealed two Non-Economic Loss (NEL) decisions regarding permanent impairments from a 2015 workplace injury.

The worker objected to a 24% NEL benefit for bilateral hip replacements and right thigh impairment, and a 20% NEL benefit for post-traumatic stress disorder and major depressive episode.

The Appeals Resolution Officer reviewed the medical evidence and the application of the AMA Guides and WSIB policies.

The Officer found that the clinical specialist correctly calculated the physical impairment ratings and appropriately classified the psychological impairment as a Class 3 Moderate impairment.

The appeals were dismissed and the NEL quantums were confirmed.

The worker appealed a Case Manager's decisions denying a permanent impairment for a concussion injury and denying entitlement for right optic neuropathy.

The Appeals Resolution Officer found that the worker had reached maximum medical recovery for the concussion but suffered a permanent impairment for post-concussion syndrome and posttraumatic migraines, entitling them to a Non-Economic Loss award.

However, the worker was not entitled to a permanent impairment for their right eye conditions, as the right optic neuropathy was determined to be a non-occupational condition likely due to microvascular issues rather than the workplace injury.

The appeal was allowed in part.

The worker appealed a case manager's decision denying loss of earnings (LOE) benefits from November 29, 2021, following a right shoulder injury.

The worker argued that the modified duties offered by the employer were not within their functional abilities.

The Appeals Resolution Officer found that the employer had identified suitable work that could be completed with one arm, and that the worker had declined to participate in the return-to-work process.

The worker's objection was denied, and LOE benefits were not granted.

The worker objected to a decision denying coverage for a cervical pillow and noise-reducing ear plugs following a workplace injury.

The worker had sustained physical and psychological injuries after being assaulted by a student.

The Appeals Resolution Officer found that the requested items were not supported by the multidisciplinary treatment team at the Neurology Specialty Program.

The evidence did not establish that the items were necessary, appropriate, and sufficient health care treatment for the work injury.

The worker's objection was denied.

The worker, a police officer, appealed a decision denying initial entitlement to WSIB benefits for a lower back injury allegedly sustained while clearing an encampment.

The Appeals Resolution Officer reviewed the evidence, including witness statements and medical reports, and found significant inconsistencies in the reported mechanism of injury.

Due to the delay in seeking healthcare, the delay in reporting a work-related accident, and the evolving accident history, the Officer concluded that proof of accident was not established.

The worker's objection was denied.

The worker appealed a Case Manager's decision denying ongoing entitlement to loss of earnings (LOE) benefits and a permanent impairment assessment for a right knee injury subsequent to October 19, 2018.

The Appeals Resolution Officer found that the medical evidence supported a permanent work-related impairment of the right knee, entitling the worker to a Non-Economic Loss (NEL) assessment.

However, the worker was not entitled to LOE benefits after October 19, 2018, as there was insufficient evidence that their loss of earnings resulted from the work-related injury.

The worker objected to decisions by the case manager and nurse consultant determining that their work-related soft tissue injuries had fully resolved with no permanent impairment, and denying reimbursement for health care equipment (ankle weights, a massager, and a cane).

The Appeals Resolution Officer reviewed the clinical evidence and found that the worker had reached maximum medical recovery by February 23, 2021, with no evidence of ongoing impairment.

Furthermore, the clinical evidence did not support that the requested health care equipment was necessary or appropriate to treat the work-related injuries.

The worker's objection was denied.

The worker objected to three decisions by the WSIB: the determination of a suitable occupation, the recalculation of their long-term average earnings rate, and the final lock-in rate for their loss of earnings (LOE) benefits.

The Appeals Resolution Officer found that the worker had successfully maintained employment in the identified suitable occupation for over four years, demonstrating its suitability.

The recalculation of the long-term average earnings rate was deemed appropriate due to the worker's non-permanent employment pattern.

Finally, the locked-in LOE rate was correctly based on the worker's actual earnings at the expiration of the 72-month review period.

The worker's objections were denied.

The worker suffered a compensable left wrist and hand soft tissue injury in February 2018 and returned to modified duties in April 2018.

After working for one week, the worker went on leave and subsequently claimed a recurrence of the work-related injury.

The Appeals Resolution Officer denied the appeal, finding no objective medical evidence of a significant deterioration in the compensable condition that would warrant recurrence entitlement, noting that non-compensable medical issues appeared to be the primary factor preventing a return to work.

The employer objected to decisions granting the worker entitlement for bilateral thumbs, wrists, hands, and elbows as gradual onset injuries, as well as a 10% Non-Economic Loss (NEL) award.

The Appeals Resolution Officer found that the worker's job duties as an offset press operator involved risk factors for repetitive strain injuries.

The officer upheld entitlement for bilateral thumb strain/sprain, exacerbation of pre-existing thumb osteoarthritis, and bilateral lateral epicondylitis, but denied entitlement for a bilateral wrist repetitive strain injury.

Consequently, the 10% NEL award was reduced to 8% to reflect the permanent impairment of the elbows only.

The worker, a special needs assistant, objected to a Case Manager's decision denying entitlement for Traumatic Mental Stress (TMS) and Chronic Mental Stress (CMS).

The worker alleged they were bullied and assaulted by a vice-principal who pushed a package of gowns into their chest after the worker requested additional personal protective equipment during the pandemic.

The Appeals Resolution Officer denied the appeal, finding no DSM diagnosis related to the incident and concluding the events did not constitute a clearly and precisely identifiable traumatic event or a substantial work-related stressor under WSIB policies.

The worker appealed the denial of entitlement for chronic mental stress and a physical chest wall strain.

The Appeals Resolution Officer found that the workplace conflicts did not amount to harassment or a substantial work-related stressor, denying the chronic mental stress claim.

However, the Officer allowed the physical injury claim, finding that a minor workplace incident permanently aggravated the worker's pre-existing left-sided intercostal neuralgia.

The worker was granted entitlement for the permanent aggravation, with a non-economic loss determination to follow.

The worker appealed a Case Manager's decision denying entitlement to benefits for neck and shoulder injuries, and denying full loss of earnings (LOE) benefits for several periods.

The Appeals Resolution Officer found no medical evidence to establish a compensable injury to the neck or shoulders.

The Officer also found that the worker was not entitled to LOE benefits for the disputed periods because suitable modified work was available and the worker's inability to work was due to non-compensable conditions or a refusal to wear safety gloves, which was not supported by medical restrictions.

The appeal was denied.