Workplace Safety and Insurance Law

The employer appealed a Case Manager's decision denying entitlement to Second Injury and Enhancement Fund (SIEF) relief following a worker's left shoulder injury.

The worker, a registered nurse, sustained a rotator cuff tear while lifting a patient.

The employer argued that the worker's pre-existing degenerative tissue changes and obesity enhanced the disability and prolonged recovery.

The Appeals Resolution Officer found the accident was minor in severity but concluded there was no evidence that a pre-existing condition caused or contributed to the injury, nor that it prolonged or enhanced the recovery period.

The employer's objection was denied.

The worker suffered a right shoulder fracture at work in 2015 and initially returned to work after conservative treatment.

Years later, the worker developed avascular necrosis and severe osteoarthritis requiring a reverse shoulder arthroplasty.

The case manager denied entitlement for the surgery, finding the worker had fully recovered in 2015.

On appeal, the Appeals Resolution Officer found the worker had not fully recovered and that the need for surgery was a significant deterioration clinically compatible with the original injury.

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

The employer objected to the Eligibility Adjudicator's decision granting the worker, a registered nurse, initial entitlement for COVID-19.

The employer argued that the worker's non-occupational exposure to their COVID-19 positive daughter was the more probable cause of infection.

The Appeals Resolution Officer found that the worker had significant occupational exposure to COVID-19 patients within the incubation period and that the nature of the employment created an elevated risk of contracting the disease.

The Officer concluded that it was more probable than not that the circumstances of the worker's employment significantly contributed to the development of COVID-19, and denied the employer's objection.

The worker appealed a Case Manager's decision denying initial entitlement for dental fractures allegedly sustained during a workplace fall.

The worker had fallen and fractured their elbow, but did not report any facial or dental injuries until several weeks later, and did not seek dental treatment for over 14 months.

The Appeals Resolution Officer found insufficient evidence to establish that the broken teeth were caused by the workplace accident, noting the lack of contemporaneous medical documentation of facial injuries and the significant delay in seeking treatment.

The appeal was denied.

The employer appealed a decision granting the worker full loss of earnings (LOE) benefits for five hours of lost time on July 17, 2021.

The worker, a caregiver, suffered a compensable lower back and chest sprain.

The employer could not accommodate the worker's restrictions on the scheduled shift but offered 30 minutes of modified administrative duties at an alternate worksite after regular shifts the following week.

The Appeals Resolution Officer found the alternate work unsuitable, as it required an unreasonable 45-minute one-way commute for only 30 minutes of work.

The worker was therefore entitled to full LOE benefits for the missed shift.

The employer's objection was denied.

The worker objected to the Case Manager's final 72-month lock-in decision, which locked in their partial Loss of Earnings (LOE) benefits to age 65 based on the updated median-level wages of their suitable occupation (Legal Assistant).

The Appeals Resolution Officer found that the worker was voluntarily underemployed at the time of the final review, as they were working part-time in a job outside their identified suitable occupation.

The WSIB policy directed the use of updated wage information for an experienced worker in the suitable occupation.

The Appeals Resolution Officer concluded that the median-level wage was appropriate given the worker's lack of experience in the suitable occupation, and denied the worker's objection.

The worker, employed as a Case Manager, appealed a decision denying initial entitlement to benefits for Traumatic Mental Stress (TMS) and Chronic Mental Stress (CMS).

The worker alleged that dealing with complex, suicidal clients and receiving threats constituted traumatic events and substantial work-related stressors.

The Appeals Resolution Officer denied the appeal, finding that the events did not meet the objective threshold for TMS, as there were no threats of physical violence involving weapons or bomb threats.

Furthermore, the routine stress of the Case Manager position, while high, did not involve life-and-death responsibility as defined by the CMS policy, and the stressors were not excessive compared to normal pressures in similar circumstances.

The worker appealed a Case Manager's decision that calculated their long-term average earnings based on non-permanent employment.

The worker argued they were a permanent employee, having worked full-time hours with no set termination date.

The employer did not participate but had previously asserted the worker was a temporary hire.

The Appeals Resolution Officer reviewed the earnings information and Operational Policies, finding the worker was employed 52 weeks a year with no seasonal layoffs or set termination date.

The appeal was allowed, and the matter was remitted to the Operating Area to recalculate the long-term rate based on permanent employment.

The employer appealed a Case Manager's decision denying entitlement to Second Injury and Enhancement Fund (SIEF) relief following a worker's right wrist injury.

The worker sustained a minor accident when lifting a heavy detergent bottle, resulting in de Quervain's tenosynovitis and subluxation of the extensor carpi ulnaris tendon requiring surgery.

The employer argued that the worker's age and untreated Lupus prolonged recovery.

The Appeals Resolution Officer dismissed the appeal, finding no medical evidence that a pre-existing condition caused or contributed to the accident, or prolonged the worker's recovery.

The worker, a drywall installer who suffered a workplace injury resulting in severed fingers, objected to the Case Manager's decision to adjust their Loss of Earnings (LOE) benefits to partial LOE benefits based on the expected wages of a Suitable Occupation (SO) in retail sales.

The worker had completed a return to work plan but remained unemployed.

The Appeals Resolution Officer upheld the decision, finding that under the Operational Policy Manual, the adjustment to partial LOE benefits using the identified SO entry-level wage of $14.25 per hour was appropriate at the closure of the return to work plan.

The worker suffered a compensable right ankle sprain and returned to work with minor accommodations.

Several months later, the worker's employment was terminated.

The worker alleged the termination was a reprisal for filing a WSIB claim, breaching the employer's re-employment obligations.

The Appeals Resolution Officer found that the employer successfully rebutted the presumption of a breach, as evidence demonstrated the termination was due to a significant economic downturn and the worker's unauthorized absence, rather than the work-related injury.

The worker's objection was denied.

The worker's estate appealed a WSIB adjudicator's decision denying initial entitlement for a fatal accident.

The worker, who co-owned a construction company in a partnership with his wife, was fatally injured while felling a tree on a property they had purchased.

The WSIB initially ruled the worker was performing a personal task.

The Appeals Resolution Officer found that the property was purchased as a business endeavor to develop townhomes, and the tree clearing was part of that business purpose.

Applying the five-point check system and the statutory presumption under s. 13(2) of the WSIA, the Officer concluded the worker was in the course of his employment at the time of his death.

The appeal was allowed and initial entitlement granted.

The employer appealed a WSIB audit decision that granted an executive officer exemption from mandatory coverage effective July 21, 2016, the date the declaration was received.

The employer sought retroactive exemption to January 1, 2014, arguing estoppel by representation because the WSIB's forms allegedly misled the employer into continuing to deduct executive officer earnings.

The Appeals Resolution Officer dismissed the appeal, finding no evidence of misrepresentation by the WSIB and noting that the legislation and policy clearly state the exemption takes effect only on the day the declaration is received.

The worker objected to the 21% non-economic loss (NEL) benefit rating for her low back and the determination that Customer Service was a suitable occupation (SO) with partial loss of earnings (LOE) benefits payable from May 30, 2017.

The Appeals Resolution Officer upheld the 21% NEL rating, finding it consistent with the AMA Guides and medical evidence.

However, the Officer found the previous SO of Security Guard became unsuitable earlier, on December 1, 2012, due to the worker's psychotraumatic impairment.

The worker was found capable of working in Customer Service for 15 hours per week at minimum wage from December 1, 2012, and was awarded partial LOE benefits from that date.

The worker appealed a Case Manager's decision calculating his partial loss of earnings (LOE) benefits based on projected Suitable Employment or Business (SEB) wages rather than his actual wages from August 2005 to May 2006.

The worker argued he was performing duties within his SEB of storekeeper/parts clerk.

The Appeals Resolution Officer found that the worker's primary job duty was as a courier driver, which fell outside his identified SEB.

Consequently, the worker was not employed in his SEB, and his LOE benefits were correctly based on projected SEB wages.

The appeal was denied.

The worker, a letter carrier, appealed a decision denying initial entitlement for a right shoulder injury allegedly caused by carrying heavy mail bags on a new route.

The Appeals Resolution Officer reviewed the medical evidence, which showed degenerative conditions including tendinosis and osteoarthritis.

The Officer found that the worker's diagnosed conditions were not compatible with the reported accident history of a sudden onset from carrying heavier bags.

The worker's objection was denied and initial entitlement was not granted.

The worker appealed a decision denying entitlement to loss of earnings (LOE) benefits following a low back strain.

The worker argued that severe back pain prevented him from continuing modified duties.

The Appeals Resolution Officer found that the medical evidence supported the worker's capability to perform the suitable modified work offered by the employer immediately following the injury.

The appeal was dismissed, and LOE benefits were denied.

The worker appealed a decision denying initial entitlement for a right foot/ankle injury.

The worker claimed he fell from a trailer while chaining down a load, fracturing his calcaneus.

The employer argued the worker injured his foot at home and pointed to medical records where the worker reported falling off a ladder.

The worker testified the employer pressured him not to file a WSIB claim and promised to pay his wages, leading him to provide a false history to medical professionals.

The Appeals Resolution Officer accepted the worker's testimony, corroborated by a later letter from his family doctor confirming the worker had initially reported a work accident but asked to record it as a home injury.

The appeal was allowed and initial entitlement granted.

The employer objected to a field auditor's decision denying an extension of time to appeal earlier classification decisions from 2008 and 2012.

The employer argued that it did not receive actual notice of the time limits and that the WSIB made an egregious error in classifying its business activities, resulting in significant premium overcharges.

The Appeals Resolution Officer found that the employer was provided with clear notice of the six-month appeal time limits in the original decision letters.

The Officer concluded that the circumstances were not exceptional and denied the request for an extension of time.

The worker suffered a left hand injury at work, resulting in a permanent impairment.

The Workplace Safety and Insurance Board awarded a 4% non-economic loss (NEL) rating based on the American Medical Association Guides.

The worker appealed, arguing the quantum should be greater due to ongoing problems with her whole hand and arm.

The Appeals Resolution Officer dismissed the appeal, finding the 4% rating was correctly calculated based on the accepted area of injury (the left small finger) and the objective medical evidence.