Workplace Safety and Insurance Law

The employer, a municipality, objected to a decision finding it associated with three affiliated municipal service corporations for the purposes of classification and premium rate setting under the rate framework.

The Appeals Resolution Officer found that while the employers did not meet the test of cooperation through primarily ancillary operations, they did meet the test through integrated operations, as they shared a substantial amount of staff, equipment, and processes to carry out their business activities.

The objection was denied, and the effective date of the association was confirmed as January 1, 2020.

The employer objected to a Case Manager's decision to apply a re-employment penalty for breaching its re-employment obligation.

The worker had suffered a right arm injury and returned to modified duties before being laid off due to the pandemic, and subsequently terminated without cause.

The employer argued the termination was due to performance issues and lack of skills, not the workplace injury.

The Appeals Resolution Officer found insufficient contemporaneous evidence to support the employer's claim of pre-existing performance issues.

The termination was deemed a breach of the re-employment obligation, and the penalty was upheld.

The worker objected to a Return-to-Work Specialist's decision authorizing the suitable occupation of Customer Service and an associated Work Transition plan.

The worker argued they lacked the transferrable skills and education for the role and requested full loss of earnings benefits to age 65.

The Appeals Resolution Officer found that the worker's extensive experience as a business owner provided relevant customer service skills, and that the physical demands of the role were within the worker's permanent restrictions.

The suitable occupation and Work Transition plan were confirmed, and the worker's objection was denied.

The worker, a personal support worker, experienced a severe muscular inflammatory response after receiving a mandatory work-related Covid-19 booster vaccination.

The initial adjudicator denied entitlement based on a medical consultant's opinion that the reaction was normal.

On appeal, the Appeals Resolution Officer allowed the objection, finding that under operational policy 15-04-10, the determination of an 'adverse reaction' is an adjudicative question.

Given the worker's need for emergency medical attention and temporary inability to work, the reaction was deemed adverse, and initial entitlement was granted.

The worker appealed a Case Manager's decision denying loss of earnings (LOE) benefits following his termination from the accident employer.

The worker had sustained a compensable right wrist injury and was performing modified duties at the time of his termination.

The employer terminated the worker citing multiple motor vehicle accidents and safety violations.

The Appeals Resolution Officer found that the termination was for cause and unrelated to the workplace injury, constituting an intervening event that broke the chain of causation.

The appeal was denied.

The worker suffered a concussion after a slip and fall at work.

The case manager determined that the concussion had fully resolved by March 31, 2022, with no permanent impairment, and denied loss of earnings (LOE) benefits from April 13, 2022.

The worker objected, arguing that ongoing symptoms, particularly while driving, required further treatment.

The Appeals Resolution Officer reviewed the medical evidence, including reports from a neurology specialty clinic and a driver rehabilitation program, and concluded that the worker had fully recovered from the concussion with no permanent impairment.

The objection was denied, and the denial of LOE benefits was upheld.

The employer appealed a decision denying cost relief under the Second Injury and Enhancement Fund (SIEF) for a worker who developed irritant contact dermatitis from frequent hand washing and sanitizing at work.

The Appeals Resolution Officer found that the worker had a pre-existing atopic predisposition that contributed to the development of the condition.

Assessing the accident severity as minor and the medical significance of the pre-existing condition as minor, the Officer granted the employer 50 per cent SIEF cost relief.

The employer objected to a decision granting the worker initial entitlement for a bilateral wrist repetitive strain injury.

The worker developed the injury after a machine malfunctioned, requiring them to manually handle boxes at a significantly increased frequency.

The Appeals Resolution Officer applied the five-point check system under OPM Document No. 11-01-01 and found that the change in job mechanics constituted a personal work-related injury.

The medical evidence supported that the work duties were the significant contributing factor to the injury, rather than pre-existing conditions.

The employer's objection was denied.

The worker, a police sergeant, objected to an 8% non-economic loss (NEL) award for a work-related bilateral shoulder impairment.

The worker argued the rating should be higher due to the significant impact the injuries had on their life, including their inability to remain on the Emergency Response Team and limitations in daily activities.

The Appeals Resolution Officer found that the NEL rating was correctly calculated using the prescribed American Medical Association's Guides to the Evaluation of Permanent Impairment, which do not account for lifestyle impacts.

The 8% NEL award was confirmed.

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 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 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.

The worker objected to a Case Manager's decisions finding that the employer did not breach its cooperation obligation and denying entitlement to loss of earnings (LOE) benefits from April 21, 2014.

The Appeals Resolution Officer found that the worker was terminated for reasons unrelated to the compensable injury or claim for benefits, specifically due to breaches of employer policies including theft and attempting side jobs.

Therefore, the employer's cooperation obligation ended on the date of termination.

Furthermore, because the worker was performing suitable work at no wage loss at the time of his unrelated termination, he did not have a loss of earnings resulting from his work-related injury.

The worker's objection was denied.

The worker objected to a decision denying ongoing entitlement to benefits for a left hand injury sustained at work.

The worker originally suffered a left 4th digit injury but later developed left wrist symptoms, including a TFCC tear, after returning to full duties following a period of off-work recovery for an unrelated toe fracture.

The Appeals Resolution Officer found that the worker experienced a significant deterioration that was clinically compatible with the original injury and did not result from a new incident.

The objection was allowed, granting entitlement for a recurrence including the left TFCC tear and joint effusion.

The worker appealed a Case Manager's decisions granting a 5% Non-Economic Loss (NEL) benefit for a concussion and denying ongoing entitlement for neck and upper back strains.

The Appeals Resolution Officer confirmed the 5% NEL rating based on the AMA Guides, finding the worker's cognitive and emotional symptoms warranted this rating.

The Officer denied ongoing entitlement for the upper back strain due to a lack of medical evidence but allowed ongoing entitlement for the neck strain, directing the operating area to obtain updated medical information to determine if the neck condition resulted in a permanent impairment.

The employer appealed a Case Manager's decision granting the worker initial entitlement for an umbilical hernia and ongoing Loss of Earnings (LOE) benefits related to surgical repair.

The worker felt a pop in their abdomen while bending and reaching into a van at work.

The employer argued the hernia was a pre-existing congenital condition and that the mechanism of injury was insufficient to cause it.

The Appeals Resolution Officer applied the five-point check system under WSIB Policy 11-01-01 and found the injury was compatible with the accident history.

The medical evidence did not support the employer's assertion that the hernia was pre-existing.

The appeal was dismissed, and entitlement to the hernia, surgery, and related LOE benefits was upheld.

The worker appealed a decision denying initial entitlement for a low back injury allegedly sustained while operating a jackhammer.

The worker felt a minor pinch but continued working and did not report the injury or seek medical attention for several weeks, eventually being diagnosed with a disc herniation.

The Appeals Resolution Officer dismissed the appeal, finding that the significant delay in reporting the injury and seeking medical attention broke the chain of causation, and therefore proof of accident was not established.