Workplace Safety and Insurance Law

The worker appealed a Case Manager's decision that determined they were partially impaired, capable of working as a telephone solicitor, and entitled only to partial loss of earnings (LOE) benefits.

The Appeals Resolution Officer found that the occupation of telephone solicitor was not suitable given the worker's age, lack of transferable skills, need for extensive training, and the limited employment outlook for the position.

The Officer concluded the worker was unemployable due to their compensable injuries and awarded full LOE benefits effective January 31, 2025, locked in to age 65.

The worker appealed an Adjudicator's decision denying initial entitlement to WSIB benefits for an allergic reaction allegedly caused by exposure to nitrile gloves at work.

The Appeals Resolution Officer reviewed the medical evidence, placing significant weight on the opinion of an occupational allergist who concluded the worker's symptoms were not compatible with a typical allergic reaction to gloves.

The Appeals Resolution Officer found no evidence that workplace exposure significantly contributed to the worker's symptoms and denied the appeal.

The employer objected to a case manager's decision allowing the worker loss of earnings benefits during a temporary work disruption caused by a plant re-tooling.

The worker had previously been performing suitable work at no wage loss following a compensable bilateral knee injury.

The Appeals Resolution Officer found that the worker met the criteria under WSIB Operational Policy 15-06-02, as their work history demonstrated they would normally seek new employment during a layoff, and their significant medical restrictions impacted their ability to earn income through new employment.

The employer's objection was denied and the benefits were maintained.

The worker and employer both objected to a Case Manager's decision regarding loss of earnings (LOE) benefits following a workplace injury to the worker's right finger.

The worker appealed the denial of LOE benefits from April 10, 2024 to May 6, 2024, arguing they were following medical advice to remain off work post-surgery.

The employer appealed the allowance of LOE benefits for April 8 and 9, 2024, arguing suitable modified duties were available.

The Appeals Resolution Officer denied the worker's appeal, finding that safe and suitable modified duties were available that accommodated the worker's functional limitations.

The employer's appeal was allowed in part; LOE benefits were denied for April 8 as the surgery occurred on April 9, but entitlement was confirmed for the actual surgery date of April 9.

The worker appealed a Return-to-Work Specialist's decision that identified Computer Network Technician - Systems Administrator as a suitable occupation and approved an associated Work Transition plan.

The worker, who sustained physical and psychological injuries after falling through a floor hole, argued the occupation was not suited to their transferrable skills or functional abilities.

The Appeals Resolution Officer found that while the occupation was within the worker's physical functional abilities, it was not suited to their transferrable skills, aptitudes, or education, noting significant gaps in English literacy and math skills.

The Work Transition plan was also found inappropriate as it did not sufficiently address these proficiency gaps.

The worker's objection was allowed.

The worker appealed multiple decisions regarding their entitlement to benefits following a work-related COVID-19 infection.

The Appeals Resolution Officer found that the worker had not fully recovered from Long COVID and was entitled to Chronic Pain Disability (CPD) and ongoing Loss of Earnings (LOE) benefits as of July 15, 2024, as the severity of the conditions prevented a return to work.

However, the Officer determined that the worker had fully recovered from an accepted exacerbation of pre-existing rheumatoid arthritis and denied entitlement to psychotraumatic disability, noting that CPD was the predominant contributing factor to the ongoing impairment.

The appeal was allowed in part.

The employer appealed a decision denying initial WSIB entitlement for a volunteer firefighter who suffered a fatal cardiac arrest while responding to a water rescue.

The worker collapsed after running down a steep embankment and across a sandy beach in full gear.

The Appeals Resolution Officer found that while the worker had pre-existing risk factors for heart disease, the physical exertion required during the rescue was unusual for the worker.

Applying WSIB Operational Policy 15-03-10, the officer concluded the unusual physical exertion caused the acute cardiac condition without significant delay.

The employer's objection was allowed and initial entitlement was granted.

The worker, a primary care paramedic, suffered a work-related mental stress injury (PTSD) and was completely unable to work as of May 6, 2024.

The Case Manager denied loss of earnings (LOE) benefits from May 8 to May 20, 2024, because the worker was on a pre-approved vacation and received vacation pay.

On appeal, the Appeals Resolution Officer found that under WSIB operational policy, a fully impaired worker may continue to receive full benefits during a vacation of up to three weeks if it does not interrupt treatment.

The worker had notified the WSIB of the vacation and actively participated in treatment without significant interruption.

The appeal was allowed, and full LOE benefits were granted for the disputed period.

The worker, a bus driver who developed PTSD after a passenger pointed a handgun at them, appealed a case manager's decision denying loss of earnings benefits for a period when the worker was out of the country.

The Appeals Resolution Officer found that the worker's out-of-country leave did not interfere with their ability to co-operate in health care measures or the return-to-work process.

The worker sought appropriate psychiatric treatment while abroad and was medically authorized off work during the entire period.

The appeal was allowed, and the worker was granted full loss of earnings benefits for the disputed period.

The worker, who previously suffered a compensable neck injury and concussion from a fall at work, sought entitlement for new cervical spine diagnoses and a Non-Economic Loss (NEL) redetermination following a subsequent trip and fall at home.

The Appeals Resolution Officer denied the appeal, finding no causal link between the fall at home and the work-related injury.

The medical evidence did not establish a confirmed diagnosis of cervical spine instability or anterolisthesis, nor did it demonstrate a significant and permanent deterioration of the work-related cervical spine impairment to warrant a NEL redetermination.

The worker, a truck driver, appealed the denial of initial entitlement for a left foot injury.

The worker alleged that they stepped in a puddle containing chemicals at a recycling facility, which caused a chemical burn to their left foot.

The worker's pre-existing diabetes complicated the healing process, leading to multiple infections and ultimately a below-the-knee amputation.

The Appeals Resolution Officer found that the evidence supported a diagnosis of a chemical burn and that the occupational exposure significantly contributed to the injury.

The Officer also found that the amputation was a significant deterioration clinically compatible with the original injury.

The appeal was allowed.

The worker, an Educational Assistant, appealed a Case Manager's decision denying entitlement to benefits for mental stress.

The worker developed PTSD, anxiety, and depression after being physically assaulted by a student on two consecutive days in March 2022.

The Appeals Resolution Officer found that the incidents were clearly and precisely identifiable and objectively traumatic, acting as the catalyst for the worker's psychological decompensation due to the cumulative effect of multiple traumatic workplace events throughout her career.

The worker's pre-existing mental health condition did not negate entitlement.

The appeal was allowed, and initial entitlement was granted under the Traumatic Mental Stress policy.

The worker, a police sergeant with an accepted claim for post-traumatic stress disorder, objected to a decision denying loss of earnings (LOE) benefits after October 31, 2020.

The worker argued that because they were permanently restricted from police work, they were entitled to LOE benefits despite retiring.

The Appeals Resolution Officer found that the worker made a fully informed, voluntary decision to retire and withdraw from all return-to-work services, including those aimed at the general labour market.

Consequently, the post-retirement wage loss was not caused by the workplace injury, and the objection was denied.

The worker, a school principal, appealed the denial of entitlement for traumatic and chronic mental stress injuries following repeated harassment and social media defamation by a student's parent.

The Appeals Resolution Officer found that while the events did not meet the threshold for a traumatic mental stress injury, the parent's egregious and abusive conduct constituted a substantial work-related stressor.

The worker's appeal was allowed, granting entitlement for a chronic mental stress injury (acute adjustment disorder).

The worker objected to a Case Manager's decision that they had reached maximum medical recovery (MMR) by July 23, 2024, with no permanent impairment resulting from a work-related left ankle/foot injury.

The Appeals Resolution Officer reviewed the medical evidence, including reports from a WSIB Lower Extremity Specialty Clinic, which indicated the ankle fracture had fully healed with full range of motion and no residual impairment.

Applying the AMA Guides, the Appeals Resolution Officer confirmed the range of motion measurements did not result in a measurable impairment rating.

The worker's objection was denied, and the Case Manager's decision was upheld.

The worker, a firefighter, sustained a work-related laceration to his left little finger and subsequently developed herpetic whitlow at the site of the cut.

The Case Manager initially denied entitlement for the herpetic whitlow as a secondary condition.

On appeal, the Appeals Resolution Officer found that the break in the worker's skin from the workplace injury provided a means of entry for the herpes simplex virus.

Relying on medical opinions establishing a causal association, the Officer concluded that the herpetic whitlow was a secondary condition resulting from the work-related laceration.

The worker's appeal was allowed.

The employer appealed a decision granting the worker entitlement for a low back soft tissue injury.

The worker reported experiencing severe lower back pain after bending over to pick up an egg carton at work, which subsequently required hospitalization.

The employer argued there were discrepancies in the accident history and a delay in reporting.

The Appeals Resolution Officer found that the worker suffered a personal injury by accident that arose out of and in the course of employment, and that the diagnosis of a low back sprain/strain was compatible with the accident history.

The employer's appeal was denied and entitlement was confirmed.

The worker appealed a Case Manager's decision denying initial entitlement for vertigo.

The worker alleged that operating an OP machine, which required looking up and down, caused her to develop dizziness and nausea, later diagnosed as benign paroxysmal positional vertigo (BPPV).

The Appeals Resolution Officer found that the condition was not a chance event and did not arise out of the worker's employment, noting that BPPV is typically caused by head trauma or prolonged positioning on the back, neither of which occurred at work.

The appeal was dismissed.

The worker appealed the denial of entitlement to Traumatic Mental Stress (TMS) and Chronic Mental Stress (CMS) following a road rage incident where another driver approached the worker's truck with a knife.

The Appeals Resolution Officer denied the appeal, finding that the worker did not have a confirmed DSM diagnosis for a mental stress injury.

Furthermore, the medical evidence did not support that the workplace incident was the predominant cause of the worker's mental stress condition, as the treating physicians attributed the stress to personal and non-occupational issues.

The worker appealed a decision denying a review of their Loss of Earnings (LOE) benefits from June 6, 2016 onwards, which fell after the 72-month final review date.

The worker argued that a permanent impairment recognized by WSIAT in 2023 constituted a significant deterioration, and that they were cooperating in return-to-work activities at the 72-month mark.

The Appeals Resolution Officer found that the worker reached maximum medical recovery prior to the 72-month date, meaning there was no significant deterioration post-72 months.

Furthermore, the worker had been performing accommodated duties for years, so there were no active return-to-work activities at the time of the final review.

The appeal was denied.