Workplace Safety and Insurance Law

The worker, a firefighter, appealed a decision denying entitlement for left foot and ankle injuries.

The worker developed left foot pain after working four 11-hour shifts at a mass vaccination clinic, which required prolonged standing and walking on concrete floors in safety boots.

The Appeals Resolution Officer found that the work at the vaccination clinic represented a significant change in physical demands compared to regular firefighting duties.

The Officer concluded that the excessive prolonged walking caused a repetitive overload of the Achilles tendon, resulting in Achilles tendinosis.

The appeal was allowed in part, granting initial entitlement for the left Achilles tendon injury, and the matter was remitted to determine loss of earnings benefits.

The worker appealed a decision denying entitlement for bladder cancer and loss of earnings (LOE) benefits.

The worker argued the bladder cancer was caused by occupational exposures in the petrochemical industry or by radiation treatment for a previously accepted follicular lymphoma claim.

The Appeals Resolution Officer dismissed the appeal, finding insufficient evidence that occupational exposures or the limited radiation treatment significantly contributed to the bladder cancer, noting the worker's smoking history as a major risk factor.

The claim for LOE benefits was also denied as the worker retired without functional limitations from the accepted lymphoma, and the bladder cancer was deemed non-compensable.

The worker, an educational assistant, was head-butted by a special needs student, sustaining a concussion and psychological injuries.

The worker appealed the Case Manager's decisions denying entitlement for post-traumatic stress disorder (PTSD) and post-traumatic vision syndrome.

The Appeals Resolution Officer allowed the appeal in part, granting entitlement for PTSD based on the WSIB Mental Health Specialty Clinic's assessment, finding the accident was objectively traumatic.

However, the claim for post-traumatic vision syndrome was denied, as multiple neurological assessments found no organic basis for a visual system impairment.

The worker, a police officer, appealed a Case Manager's decision denying entitlement for posttraumatic stress disorder (PTSD), traumatic mental stress, and chronic mental stress.

The worker had responded to a fatal motor vehicle incident involving a child in 2011, but did not seek psychological treatment until 2021, shortly after their own child suffered a severe medical emergency.

The employer argued the personal stressor rebutted the presumption of work-relatedness for first responders.

The Appeals Resolution Officer found that the work-related incident remained a significant contributing factor to the PTSD diagnosis, despite the co-existing personal stressor and the delay in seeking treatment.

The appeal was allowed, granting entitlement for PTSD as a first responder.

The worker appealed the denial of initial entitlement for a left finger injury sustained while opening dirty boxes at work.

The Appeals Resolution Officer found that the worker suffered a disablement injury when a foreign object lodged under their fingernail, leading to an infection, osteomyelitis, and eventual amputation of the fingertip.

The delay in reporting was deemed reasonable given the initially minor nature of the injury.

The appeal was allowed, granting initial entitlement to the infection and secondary entitlement to the amputation and permanent impairment, with loss of earnings benefits referred back for further investigation.

The worker, a corrections officer, appealed the denial of presumptive entitlement to PTSD and Chronic Mental Stress (CMS).

The worker alleged that a lack of workplace support and a supervisor's aggressive behaviour during a meeting triggered their PTSD symptoms.

The Appeals Resolution Officer found that the worker's PTSD was a pre-existing condition and that employment was not a significant contributing factor.

Furthermore, the officer concluded that the workplace events did not constitute a substantial work-related stressor or egregious behaviour, but rather fell under typical interpersonal conflict and management's employment functions.

The appeal was dismissed.

The worker objected to the recalculation of their long-term loss of earnings (LOE) benefit rate following a workplace injury.

The worker argued that the recalculation was unfair because it did not adequately consider overtime earnings and caused financial hardship.

The Appeals Resolution Officer found that the recalculation correctly applied WSIB policy regarding long-term average earnings for workers in permanent employment, and that there are no exceptions permitting adjustments based on compassionate grounds or financial need.

The worker's objection was denied.

The worker, a frame assembler for a window and door manufacturer, appealed the denial of initial entitlement for bilateral carpal tunnel syndrome (CTS).

The worker claimed the condition developed gradually over five to six years due to repetitive and forceful use of clamps and vibratory tools.

The employer argued the job duties were routine and did not involve awkward postures.

The Appeals Resolution Officer found the worker's testimony credible and detailed, concluding that the repetitive and forceful hand movements required to assemble windows were a significant contributing factor to the development of CTS.

The worker's objection was allowed and initial entitlement to bilateral CTS was granted.

The worker appealed a Case Manager's decision to offset 100% of their Canada Pension Plan Disability (CPP-D) benefits from their loss of earnings (LOE) benefits starting February 26, 2021.

The worker had sustained work-related injuries including an L1 burst fracture, neurogenic bladder, and left shoulder injury.

The Appeals Resolution Officer found that the worker's application for CPP-D benefits and the accompanying medical report listed only the work-related injuries as the basis for the disability.

Therefore, under WSIB Policy 18-01-13, the CPP-D benefits were paid solely because of the work-related injuries, and a 100% offset from the LOE benefits was appropriate.

The worker's objection was denied.

The employer objected to the WSIB's decision classifying its operations under NAICS Code 237210 (Land subdivision), arguing it should be classified under engineering or architectural services due to its purely administrative and consulting nature.

The Appeals Resolution Officer found that the employer's primary business activity was real estate development, which includes acquiring and developing land for subsequent sale or construction.

Because the employer had an aggregated payroll and was considered a small employer, it was correctly classified according to the activity accounting for the largest share of its insurable earnings.

The objection was denied and the classification was upheld.

The worker suffered a severe left hand and wrist injury in a 2003 workplace motor vehicle accident, reaching maximum medical recovery in 2005 with a 25% Non-economic Loss award.

In 2021, the worker experienced worsening symptoms and sought entitlement for secondary conditions and a left wrist fusion surgery.

The case manager denied the requests, finding the new diagnoses were not causally related to the index injury.

On appeal, the Appeals Resolution Officer weighed competing medical opinions and preferred the treating orthopaedic surgeon's opinion over the WSIB medical consultant's, finding the worker suffered a compensable recurrence.

The appeal was allowed, granting entitlement to the secondary conditions and the wrist fusion surgery.

The worker objected to a decision denying initial entitlement for a slip and fall injury that occurred in a parking lot prior to the start of their shift.

The worker argued they were employed by the City, which owned the parking lot.

The Appeals Resolution Officer determined that the worker's employer was the Police Services Board (the employer of record), not the City, despite sharing a WSIB firm number.

Furthermore, the worker was not in the course of employment at the time of the injury because they had not yet entered the employer's premises, and the employer did not own or control the parking lot.

The worker's objection was denied.

The worker appealed a decision denying entitlement to WSIB benefits for a mental health injury allegedly caused by occupational chemical exposures.

The worker experienced a mental breakdown and was diagnosed with a 'chemical concussion' by a naturopathic doctor.

The Appeals Resolution Officer denied the appeal, finding that 'chemical concussion' is not a recognized medical diagnosis and that the worker's confirmed diagnoses of Adjustment Disorder and Generalized Anxiety Disorder were not compatible with chemical workplace exposures.

The decision relied heavily on the opinion of a WSIB Occupational Medical Consultant who found no toxicological link between the exposures and the worker's mental health conditions.

The worker objected to a Case Manager's decision denying loss of earnings (LOE) benefits after July 7, 2023.

The worker had sustained soft tissue injuries and was offered a graduated return to work plan with sedentary administrative duties.

After working for one hour, the worker left claiming pain and did not return.

The Appeals Resolution Officer found that the medical evidence did not support total disability and that the offered work was suitable and within the worker's functional abilities.

The objection was denied as the worker failed to fully participate in the return to work process.

The employer appealed a $250 fine levied by the Eligibility Adjudicator for late reporting of a workplace accident.

The worker suffered an eye injury and sought medical treatment on the day of the injury, triggering the employer's reporting obligation.

The employer submitted the Form 7 over seven business days later.

The Appeals Resolution Officer denied the employer's objection, finding that administrative delays do not excuse late reporting under WSIB policy, and upheld the $250 fine.

The worker appealed a Case Manager's decision terminating his loss of earnings (LOE) benefits on the basis that the employer had offered suitable modified work.

The worker suffered a compensable low back injury and attempted a graduated return-to-work plan, but stopped working shortly after, citing an inability to tolerate the duties due to pain.

The Appeals Resolution Officer weighed conflicting medical evidence, preferring the WSIB Specialty Clinic's opinion that the worker was partially disabled and capable of modified work over his family physician's opinion of total disability.

While the modified work offered was deemed suitable, the Officer found that the employment relationship had effectively ended and the work was no longer available as of February 9, 2022.

Consequently, the worker was granted partial LOE benefits based on a suitable occupation and entitlement to return-to-work services.

The worker objected to a decision granting a 10% non-economic loss (NEL) permanent impairment rating for sleep apnea resulting from a workplace injury.

The worker sought an increase to 20%, arguing that severe sleep apnea significantly impacted their daily functioning and cognitive abilities.

The Appeals Resolution Officer denied the objection, finding that the worker's limitations were already captured in their psychological impairment rating and there was no clinical evidence requiring supervision for activities of daily living, as required for a 20% rating under the AMA Guides.

The employer objected to a Case Manager's decision allowing the worker entitlement for a low back sprain/strain as a secondary condition to a compensable right shoulder injury.

The worker developed low back pain while performing modified duties that required increased twisting and turning to accommodate the shoulder injury.

The Appeals Resolution Officer found a causal link between the altered movements and the low back strain, concluding that secondary entitlement remained in order.

The employer's objection was denied.

The worker appealed a case manager's decision that their work-related left ankle sprain had fully resolved without permanent impairment and denied loss of earnings (LOE) benefits from May 9, 2023.

The Appeals Resolution Officer found that maximum medical recovery was achieved by April 12, 2023, but that the clinical evidence supported a permanent impairment with permanent restrictions.

As there was no suitable work available within the worker's restrictions, entitlement to LOE benefits from May 9, 2023 was allowed, and the matter was remitted to the operating area to determine the nature and duration of benefits.

The worker objected to a decision denying reimbursement for out-of-province health care expenses, specifically an MRI and lower back surgery obtained in another country.

The worker argued the treatment was an emergency because they could not obtain an MRI or treatment fast enough in Ontario.

The Appeals Resolution Officer found that the worker had planned the trip prior to the workplace injury and that the treatment was elective, not emergent.

Under WSIB Policy 17-01-04, elective out-of-province health care requires pre-approval, which the worker did not obtain.

The objection was denied.