Workplace Safety and Insurance Law

The worker objected to three case manager decisions denying loss of earnings (LOE) benefits for a brief period in May 2019, finding no breach of the employer's re-employment obligation upon his termination in October 2019, and denying LOE benefits subsequent to the termination.

The Appeals Resolution Officer allowed the worker's objections in part.

The Officer found the worker was entitled to full LOE benefits for the initial period of absence in May 2019.

Furthermore, the Officer determined the employer breached its re-employment obligation by terminating the worker within six months of re-employment, as the employer failed to rebut the presumption that the termination was related to the workplace injury.

The worker was awarded full and partial LOE benefits for various periods following his termination and referred for work transition assistance.

The worker appealed a Case Manager's decisions confirming the Suitable Occupation (SO) of Cashier and denying secondary entitlement for liver disease (cirrhosis).

The Appeals Resolution Officer found that the SO of Cashier was not suitable given the worker's lack of computer skills, education, and physical restrictions, but determined that Light Duty Cleaner was a suitable occupation during the relevant period.

The Officer denied secondary entitlement for liver disease, finding no causal link between the work-related neck injury and the cirrhosis, which pre-dated the workplace incident.

The appeal was allowed in part.

The worker appealed the denial of initial entitlement for a right foot tendon tear sustained while carrying a heavy parcel during an understaffed shift.

The Appeals Resolution Officer found that the injury was a disablement resulting from an unexpected increase in physical demands.

Relying on a WSIB Medical Consultant's opinion that the injury was compatible with the accident history despite underlying degenerative changes, the Officer allowed the appeal and granted initial entitlement.

The worker appealed the denial of initial entitlement for squamous cell carcinoma of the tongue, arguing it was caused by occupational exposure to coal tar and other toxins during his 40-year employment.

The Appeals Resolution Officer found that the worker's diagnosis fell within the definition of 'epitheliomatous cancer' under Schedule 3 of the Workplace Safety and Insurance Act.

Because the worker was exposed to coal tar, a listed process, the statutory presumption applied.

The presumption was not rebutted by the worker's smoking history, as no treating practitioner attributed the cancer to smoking.

The appeal was allowed and initial entitlement granted.

The worker, a police sergeant, suffered a compensable psychological injury after being exposed to fentanyl at work.

She attempted to return to work on December 16, 2019, but suffered a severe increase in her psychological symptoms after reading a negative performance review, forcing her to leave work after less than two hours.

The WSIB initially denied entitlement for a recurrence, finding the performance review was a new incident.

The Appeals Resolution Officer allowed the worker's appeal, finding that the worker had not fully recovered, was still receiving active treatment, and that the performance review was not a significant new incident but rather a trigger that worsened her existing compensable symptoms.

The worker was granted full loss of earnings benefits from December 17, 2019, to March 11, 2020.

The worker appealed decisions denying entitlement to a psychotraumatic disability and funding for Bandito masks related to two separate workplace accidents: a smoke inhalation injury (claim A) and a right wrist crush injury (claim B).

The Appeals Resolution Officer found that the worker's post-traumatic stress disorder and major depressive disorder manifested within five years of the wrist injury and were directly related to the extended disablement and socioeconomic impacts of the work-related injuries.

Consequently, entitlement to a psychotraumatic disability was granted under claim B and denied under claim A. The Officer also granted funding for two Bandito masks under claim A, finding them to be necessary and appropriate health care equipment that improved the worker's independent living.

The worker suffered a head injury at work when struck by a falling ceiling tile, resulting in a concussion and cervical strain.

The worker appealed decisions denying entitlement for sleep apnea, hearing loss, and ongoing post-concussion and psychotraumatic disability benefits following a subsequent non-compensable motor vehicle accident.

The Appeals Resolution Officer allowed the appeal in part.

The worker was granted entitlement for hearing loss and a hearing aid, as the evidence supported it was more probable than not caused by the workplace accident.

The Officer also found that the worker's post-concussion syndrome and psychotraumatic disability had not resolved prior to the non-compensable motor vehicle accident, granting ongoing entitlement.

However, entitlement for sleep apnea was denied as it could not be causally linked to the workplace injury.

The worker, a carpenter, appealed a Case Manager's decision denying entitlement for Traumatic Mental Stress (TMS) and Chronic Mental Stress (CMS) following a workplace altercation.

The worker alleged he was threatened and shoved by a co-worker and the project manager after raising safety concerns and supporting a unionization attempt.

The Appeals Resolution Officer found that the incident did not meet the threshold for an objectively traumatic event involving physical violence or a life-threatening situation, denying the TMS claim.

However, the Officer found that the co-worker's aggressive conduct, which included profanities and poking the worker in the chest, amounted to workplace harassment and was the predominant cause of the worker's diagnosed posttraumatic stress disorder.

The appeal was allowed in part, granting entitlement for CMS.

The worker appealed a decision denying entitlement to the reimbursement of costs for medical cannabis to treat his compensable Post-Traumatic Stress Disorder (PTSD).

The Appeals Resolution Officer found that the worker was not severely impaired as defined by policy, and that there was insufficient reliable medical or scientific evidence demonstrating the effectiveness of cannabis for treating PTSD.

The worker's objection was denied.

The employer objected to the Eligibility Adjudicator's decisions granting the worker initial entitlement for bilateral carpal tunnel syndrome, left forearm tendonitis, and bilateral deQuervain's tenosynovitis, along with 12 weeks of loss of earnings (LOE) benefits.

The worker, a food order selector, developed the conditions after performing repetitive and forceful hand movements during 12-hour shifts.

The Appeals Resolution Officer found that the worker's job duties significantly contributed to his injuries and confirmed the date of injury as June 19, 2015.

The employer's objection was denied, and the worker's entitlement to benefits was upheld.

The worker suffered a left leg crush injury at work in 2012, resulting in compartment syndrome and a 5% Non-Economic Loss (NEL) award.

The worker subsequently developed severe, intractable neuropathic and somatic pain, leading to a request for Chronic Pain Disability (CPD) entitlement.

The Case Manager initially denied CPD, finding the worker did not meet all policy criteria.

On appeal, the Appeals Resolution Officer found that the worker's continuous and genuine pain was inconsistent with the minor organic findings and significantly impaired his earning capacity.

The appeal was allowed, granting the worker entitlement to CPD and a permanent impairment assessment.

The worker, a long-haul truck driver, suffered work-related bilateral shoulder injuries resulting in permanent restrictions.

After the employer terminated his employment, the worker secured new employment and received partial Loss of Earnings (LOE) benefits.

The employer subsequently offered the worker a Highway Driver position, which the worker declined.

The Appeals Resolution Officer found that the employer came into compliance with their co-operation obligations by making the job offer.

However, the job offer was deemed not suitable because the employment contract superseded any verbal or written assurances and included physical requirements exceeding the worker's restrictions.

The worker was granted partial LOE benefits based on his actual earnings with his new employer.

The worker appealed decisions granting a 20% Non-Economic Loss (NEL) award for Chronic Pain Disability (CPD) and reducing his Loss of Earning (LOE) benefits based on a finding that he was uncooperative in a Work-Transition assessment.

The Appeals Resolution Officer found that the worker's presentation, which had been interpreted by some assessors as malingering, was culturally based and consistent with his CPD and lack of education.

The Officer increased the NEL award to 35% to reflect a mid-range Class 3 impairment and concluded that the worker was unemployable, restoring full LOE benefits to age 65.

The worker, a personal support worker, appealed the denial of entitlement for traumatic mental stress (TMS) and chronic mental stress (CMS) following an alleged incident where an administrator waved a knife at her.

The Appeals Resolution Officer found insufficient evidence to corroborate the worker's account of the knife incident or any workplace harassment.

The evidence indicated the worker was disciplined for excessive absences and insubordination, which are employment functions and not substantial work-related stressors.

The appeal was denied.

The worker appealed a decision denying initial entitlement for a right shoulder injury.

The worker claimed he sustained a new tear to his right shoulder while pulling chains at work, following a return to modified duties after a non-compensable shoulder surgery.

The Appeals Resolution Officer found that the worker's testimony regarding the specific incident was inconsistent and not supported by medical reporting.

The medical evidence indicated the worker's ongoing shoulder problems were likely a continuation of his pre-existing condition due to non-compliance with post-operative restrictions.

The appeal was denied as the worker failed to establish proof of accident and compatibility of diagnosis.

The worker appealed decisions regarding her loss of earnings (LOE) benefits, the suitability of a Labour Market Re-Entry (LMR) plan for a Retail Sales Clerk, and the denial of Chronic Pain Disability (CPD) entitlement following a 2003 bilateral elbow fracture injury.

The Appeals Resolution Officer denied the CPD entitlement, finding the pain was consistent with the organic injury (bilateral lateral epicondylitis).

The ARO also found the worker was partially disabled and that the Retail Sales Clerk role was suitable.

However, the ARO allowed the appeal in part regarding the LOE benefits, finding that the benefits should be based on entry-level wages ($9.50 per hour) rather than the wages of an experienced worker, given the worker's personal and vocational characteristics and the short time between the LMR plan closure and the final review.

The worker, a warehouse associate, claimed WSIB benefits for trachomatous conjunctivitis and dry eyes, alleging the condition was caused by his shift schedule, blinking LED lights, and the dry, humid environment of the warehouse.

The Eligibility Adjudicator denied initial entitlement.

The Appeals Resolution Officer dismissed the worker's appeal, finding no objective medical evidence or information to support a work-related cause for the diagnosed condition, and therefore no compatibility between the diagnosis and the disablement history.

The worker appealed a decision denying initial entitlement for a C7-T1 disc herniation and subsequent surgery, which he claimed resulted from a 2010 workplace fall from an ambulance roof.

The Appeals Resolution Officer found that the worker had a significant pre-existing cervical spine condition and had not reported neck symptoms or sought medical attention for his neck for over a year following the accident.

Given the lack of continuity of complaint and a significant intervening event at a new job, the tribunal concluded the disc herniation was not related to the 2010 workplace accident.

The appeal was dismissed.

The worker appealed a Case Manager's decision denying entitlement to psychotraumatic disability related to a 1993 compensable back injury.

The Appeals Resolution Officer found that the worker's depression manifested within five years of the injury and was related to the extended disablement, satisfying the criteria under Operational Policy 15-04-02.

The appeal was allowed, granting entitlement to psychotraumatic disability, but the Officer found the condition resolved in 1997 and referred the issue of subsequent recurrences back to the Operating Area.

The worker, a roofer who sustained a fractured left leg after falling from a ladder in 2006, appealed a Case Manager's decision denying entitlement for numerous additional injuries (including neck, shoulders, back, hands, and head/brain).

The Appeals Resolution Officer reviewed the medical evidence and found significant delays in the reporting of these additional symptoms, ranging from nearly two to ten years post-accident.

Applying the five-point check system under Policy 11-01-01, the Officer concluded there was no compatibility of diagnosis to the original accident for the newly claimed areas.

The worker's objection was denied.