OWSIB 2010

The worker appealed the case manager's decisions concluding that he was entitled to partial loss of earnings benefits based on a labour market re-entry (LMR) plan and suitable employment or business (SEB) target.

The worker suffered a lower back injury and received a 15 per cent non-economic loss award.

He argued he was unable to complete the LMR plan due to his back pain and inability to sit for prolonged periods.

The Appeals Resolution Officer found that the worker's ability to pace his activities at home for woodworking demonstrated he could have engaged in similar pacing to complete his LMR upgrading.

The appeal was denied, and the reduction to partial loss of earnings benefits was confirmed.

The worker appealed a decision denying initial entitlement for a bilateral knee condition and loss of earnings benefits.

The worker claimed the condition was caused by repetitive duties as a drywall installer.

The Appeals Resolution Officer found insufficient proof of an accident, noting a lack of reporting, contradictory medical history regarding a twisting incident, and insufficient evidence of the repetitiveness of the job duties.

The objection was denied.

The worker appealed a Case Manager's decision denying loss of earnings benefits beyond February 1, 2003, following the completion of a labour market re-entry (LMR) program.

The worker, who suffered a compensable neck and bilateral shoulder injury, argued she was competitively unemployable due to her compensable and non-compensable conditions.

The Appeals Resolution Officer found that while the worker could not return to her pre-injury employment, she was capable of returning to work in the identified suitable employment business (SEB) as a customer service representative at minimum wage.

The appeal was granted in part, and the WSIB was directed to pay partial loss of earnings benefits based on the difference between her pre-injury earnings and her post-LMR earning potential.

The worker appealed a Case Manager's decision denying partial loss of earnings (LOE) benefits and concluding he was capable of returning to suitable employment as a dispatcher.

The worker, who suffered from carpal tunnel syndrome and ulnar neuropathy, argued that the dispatcher position was unsuitable because he was not bondable.

The Appeals Resolution Officer agreed, finding the dispatcher target unsuitable due to the bondability issue.

The SEB target was altered to an elemental service position at minimum wage, and partial LOE benefits were restored effective May 21, 2009.

The worker's request for an older worker's no-review option was also granted.

The worker appealed the denial of psychotraumatic disability entitlement following a 1998 workplace injury to his low back and shoulder.

The worker argued his psychological condition was related to chronic pain and socioeconomic factors stemming from the injury.

The Appeals Resolution Officer found that the worker's emotional difficulties and diagnosed post-traumatic stress disorder were primarily related to non-compensable factors, specifically a home invasion and criminal charges, rather than the workplace injury.

The appeal was dismissed.

The worker, a welder, appealed the denial of initial entitlement for right carpal tunnel syndrome.

The claim was initially denied due to a delay in reporting beyond the six-month time limit.

The Appeals Resolution Officer found that the worker only became aware of the work-relatedness of his condition when he required surgery for a separate issue and consulted a specialist.

Applying the discovery principle, the time limit was met.

The Officer further found that the worker's use of vibratory tools and heavy manual labour significantly contributed to the gradual onset of carpal tunnel syndrome.

The worker's objection was allowed, granting initial entitlement, loss of earnings benefits, and health care benefits.

The worker, a long-haul truck driver, appealed a decision denying initial entitlement for a low back and hip injury allegedly sustained after slipping on ice and falling on boulders outside a coffee shop in February 2008.

The worker did not seek medical treatment until June 2008, managing his pain with over-the-counter and borrowed prescription medication.

The Appeals Resolution Officer denied the appeal, finding that the significant delay in seeking medical treatment, the lack of supporting medical evidence linking his current condition to the fall, and the presence of other factors such as significant weight gain undermined the claim.

The worker failed to establish that he suffered a personal injury arising out of and in the course of his employment.

The worker objected to the closure of labour market re-entry (LMR) services and loss of earnings (LOE) benefits following a left shoulder injury.

The Case Manager terminated the services because the worker failed two courses and demonstrated non-cooperation through frequent absences and failure to complete assignments.

The Appeals Resolution Officer found that the worker was provided ample opportunity to succeed but failed to fulfill his obligations to fully participate in the LMR program.

The objection was denied, and no further LOE benefits were awarded.

The employer objected to the WSIB's decision to classify its insurable earnings under Rate Group 764 (Homebuilding) from January 1, 2004 to December 31, 2006, arguing it should be classified under Rate Group 723 (Apartment and Condominium Construction).

The employer was involuntarily registered following an audit of an associated firm.

The Appeals Resolution Officer found that the employer provided ancillary services to the associated firm, which was classified under Rate Group 764 during the disputed period.

Therefore, the employer was correctly classified under Rate Group 764.

The retroactive premium adjustment to 2004 was also upheld due to a lack of full disclosure.

The employer's objection was denied.

The worker objected to a decision denying him loss of earnings (LOE) benefits following a right shoulder injury.

The worker claimed he was unable to perform modified duties because the pain medication he was prescribed prevented him from driving to work.

The Appeals Resolution Officer found that the worker was unfit for work immediately following the accident and granted LOE benefits up to July 11, 2007.

However, the Officer concluded that beyond July 11, 2007, the worker was capable of performing modified duties, was aware they were available, and could have resolved the non-work-related barriers to his return to work.

The objection was allowed in part.

The worker injured his left leg at work and received loss of earnings benefits.

The Case Manager terminated benefits effective August 12, 2009, concluding the worker was capable of returning to work without restrictions based on a physiotherapist's report.

The worker objected, claiming he was unable to return to regular duties until November 16, 2009.

The Appeals Resolution Officer denied the objection, finding insufficient evidence to support the worker's claim of ongoing impairment, as the physiotherapist and a specialist both confirmed he was capable of returning to work without restrictions.

The worker, a meter reader, appealed a Claims Adjudicator's decision denying entitlement to benefits for low back, right hip, and right leg pain.

The worker alleged the injuries resulted from the repetitive walking and driving required by his job.

The Appeals Resolution Officer reviewed the medical evidence, which indicated a history of back pain predating the employment and various sports injuries.

Relying on a medical consultant's opinion that the work duties were not a major contributor to the pathology, the Officer concluded there was insufficient evidence of a workplace accident or that the work duties caused or accelerated the injuries.

The worker's objection was denied.

The worker objected to the denial of a non-economic loss (NEL) redetermination for a 1995 low back injury.

The worker had previously been awarded a 30% NEL for the impairment.

The worker argued that his condition had deteriorated over the past two years, citing increased pain, altered medication, and reduced functional abilities.

The Appeals Resolution Officer reviewed the medical evidence and found an absence of objective clinical findings to support a permanent significant deterioration in the work-related impairment.

The objection was denied.

The worker appealed a decision denying full loss of earnings (LOE) benefits from January 28, 2009, and denying sponsorship for an Automotive Business Management course.

The Appeals Resolution Officer found that the worker was capable of working within the identified suitable and available employment or business (SEB) based on his organic medical restrictions, and thus was only entitled to partial LOE benefits.

However, the Officer allowed the appeal regarding the course, finding that it would enhance the worker's employability and build on his transferable skills.

The appeal was allowed in part.

The employer appealed the allowance of initial entitlement for a worker who suffered an insect bite at work that led to a severe group A streptococcal infection and septic shock.

The employer argued that the incident was not reported immediately and questioned whether the bite occurred on the job site.

The Appeals Resolution Officer denied the objection, finding that the worker's description of the event was consistent and that it was reasonable for him not to report what he initially thought was a minor insect bite.

The allowance of initial entitlement was confirmed.

The worker objected to the WSIB's denial of full reimbursement for a specialist's medical report.

The worker's representative paid $300 for the report, which was used by an Appeals Resolution Officer to allow secondary entitlement for the worker's right knee.

The WSIB initially reimbursed only $23.54.

The Appeals Resolution Officer found that the specialist's fee was reasonable based on the time required to review records and prepare the complex report.

The worker's objection was allowed, and the WSIB was ordered to reimburse the remaining balance of $276.46 to the worker's representative.

The worker appealed a case manager's decision denying entitlement for psycho-traumatic disability following a 1996 workplace injury to his low back and right calf.

The worker sought recognition for chronic pain, adjustment disorder, anxiety, and depression.

The Appeals Resolution Officer found that while the worker suffered from anxiety and depression, the condition was significantly impacted by non-compensable factors, including personal stressors and the worker's reaction to the WSIB decision-making process.

The Officer concluded that the psychiatric condition did not arise primarily from the work injury and denied the appeal.

The worker appealed a case manager's decision denying entitlement to hydrotherapy, a commutation of $80,000 of his pension award, and a lump sum advance to purchase a new home.

The Appeals Resolution Officer denied the appeal.

The worker conceded that hydrotherapy was not suitable.

The request for a pension commutation was denied because it would not reduce the effects of the disability or lead to employment.

The request for a lump sum advance to purchase a new home was denied as there is no legislative or policy authority to provide cash advances for home purchases, though the WSIB may consider modifications to a new home if the worker purchases one at his own expense.

The employer objected to the granting of initial entitlement to a worker for a neck and left shoulder strain.

The worker, a nutritional aide, developed the condition gradually due to repetitive lifting and handling of dishwasher racks.

The Appeals Resolution Officer found that the condition was a disablement arising out of and in the course of employment, as there was a causal relationship between the impairment and the nature of the work performed.

The employer's objection was denied.

The worker objected to decisions limiting her entitlement to initial health care benefits and denying ongoing entitlement for migraines, idiopathic environmental intolerance (IEI), and multiple chemical sensitivity (MCS) following a workplace exposure to cleaning agent fumes in April 2000.

The Appeals Resolution Officer found that while the worker experienced initial symptoms from the exposure, there was insufficient objective medical evidence to establish a causal link between the brief workplace exposure and her ongoing IEI/MCS condition.

The objection was denied.