OWSIB 2015

The worker suffered a right knee injury at work in 2005 and subsequently underwent multiple surgeries, including a total knee replacement.

The Case Manager rescinded ongoing entitlement, concluding the surgeries were for a pre-existing degenerative condition.

The Appeals Resolution Officer granted the worker's objection, finding that the workplace injury was a significant contributing factor that caused the previously asymptomatic knee to become symptomatic.

Applying the thin skull principle, the WSIB concluded the worker was entitled to ongoing benefits and surgeries.

The employer appealed a case manager's decision denying Second Injury and Enhancement Fund (SIEF) cost relief following a worker's left knee injury.

The employer argued that the worker's popliteus tendonitis, thalassemia, and improper body mechanics constituted pre-existing conditions that delayed recovery.

The Appeals Resolution Officer dismissed the appeal, finding no medical evidence that a pre-existing condition prolonged or enhanced the worker's recovery, and noting that the popliteus tendonitis was accepted as part of the compensable injury.

The Director of Service Delivery requested a reconsideration of an Appeals Resolution Officer (ARO) decision that granted the worker partial Loss of Earnings (LOE) benefits from September 17, 2007.

The Director argued that the ARO failed to properly apply the Workplace Safety and Insurance Act and WSIB policy regarding the 72-month final LOE benefit review.

The Appeals Manager agreed with the Director, finding that under section 44 of the Act, LOE benefits could only be reviewed and paid from December 14, 2011, the date the worker was granted entitlement for a Non-Economic Loss (NEL) assessment.

The ARO's reliance on the Merits and Justice policy to bypass the statutory timeframes was incorrect.

The reconsideration request was allowed, and benefits were ordered payable from December 14, 2011.

The worker, an automotive production worker, appealed the denial of entitlement for left thumb osteoarthritis and the determination that her compensable left wrist tenosynovitis had resolved.

The Appeals Resolution Officer found that the osteoarthritis was a pre-existing condition that had been denied in previous claims, and there was no compelling evidence that it was caused or accelerated by repetitive work.

Furthermore, a specialist assessment made no mention of ongoing tenosynovitis, confirming it had resolved.

The appeal was denied.

The worker objected to a decision denying an extension of the time limit to appeal a January 10, 2006 decision regarding future economic loss benefits.

The Appeals Resolution Officer found that the worker had actual notice of the time limit, had no serious health problems preventing understanding of the time limit, and had not met the criteria for an extension.

The worker's objection was denied.

The worker appealed a decision denying initial entitlement for a left rotator cuff tear.

The worker experienced a gradual onset of left shoulder pain after emptying heavy boxes at work over a weekend.

Although there was a five-month delay in seeking medical attention, the Appeals Resolution Officer found the delay was not unreasonable as the worker self-modified duties and self-treated during that time.

The appeal was allowed, granting initial entitlement for the left rotator cuff tear and resulting surgery.

The worker appealed a decision denying her entitlement to benefits for traumatic mental stress (TMS).

The worker alleged that a superior sent her an inappropriate lewd picture, sent inappropriate text messages, and inappropriately touched her during a night shift.

The Appeals Resolution Officer found that while the picture was inappropriate, it did not qualify as an objectively traumatic event under the TMS policy.

The Officer noted significant inconsistencies in the worker's account of the events, a lack of corroborating evidence for the alleged touching, and evidence that the worker had engaged in joking behaviour with the superior that contradicted her claims of fear and intimidation.

The appeal was dismissed.

The worker appealed a decision granting a 5% non-economic loss (NEL) benefit for a permanent vestibular impairment resulting from a workplace motor vehicle accident, seeking an increase to 10% or 15%.

The Appeals Resolution Officer weighed the medical evidence, preferring a neurologist's report over vestibular physiotherapy reports, and applied the AMA Guides.

The Officer found that the worker's tinnitus, balance, and gait issues were appropriately rated at the low end of a class 2 impairment.

The appeal was dismissed and the 5% NEL benefit was confirmed.

The worker appealed a decision denying initial entitlement for a left thumb sprain allegedly sustained when he slipped on ice in a parking lot at work.

The worker delayed seeking medical attention for approximately six weeks and continued to perform his regular duties without complaint.

The Appeals Resolution Officer dismissed the appeal, finding that the significant delay in seeking medical attention and the lack of impact on the worker's job performance meant a temporal relationship between the workplace incident and the diagnosis could not be established.

The worker suffered a low back injury and was placed in a Labour Market Re-entry plan to complete a Bachelor of Social Work.

After failing to complete the program within the allotted time, she requested a one-year extension, which was denied.

She subsequently completed a psychology degree and found employment as a Life Skills Co-ordinator earning $11.00 per hour.

The WSIB determined she was underemployed and based her final loss of earnings (LOE) review on deemed earnings of $15.50 per hour.

The Appeals Resolution Officer denied the request for a one-year extension to the retraining program but allowed the appeal regarding the LOE review, finding the worker was not underemployed and her benefits should be based on her actual wages of $11.00 per hour.

The worker objected to the 15 percent non-economic loss (NEL) award granted for chronic pain disability (CPD) following a workplace accident.

The worker's representative argued that the impairment rating should be classified in the high end of the Moderate Impairment category rather than the Mild Impairment category.

The Appeals Resolution Officer reviewed the medical evidence, including a psychiatric report and the worker's testimony at a prior WSIAT hearing, and found that the worker's condition aligned with the Mild Impairment category.

The appeal was denied and the 15 percent NEL award was confirmed.

The worker, who previously received a 17% non-economic loss award for bilateral carpal tunnel syndrome resulting from her pre-injury employment, appealed the denial of Chronic Pain Disability (CPD) benefits.

The Appeals Resolution Officer reviewed the medical and vocational evidence, finding that the worker's chronic pain and fibromyalgia were directly related to her compensable injury and subsequent surgeries.

The officer concluded that the worker met the criteria for CPD benefits, as her pain was continuous, consistent, and resulted in marked life disruption inconsistent with organic findings.

The appeal was allowed, and the matter was remitted for a non-economic loss assessment for CPD.

The worker appealed a decision denying entitlement for a right knee impairment as a secondary condition to a compensable 2005 left knee injury.

The Appeals Resolution Officer found that the right knee pain started gradually in 2012, six years after the worker returned to work, and that a previous decision had found the worker fully recovered from the left knee injury with no residual impairment.

The appeal was denied due to the late onset of symptoms and lack of causal connection.

The worker, who had a permanent knee impairment from a 2008 workplace accident, was performing modified duties when a general layoff occurred in December 2013.

The worker objected to the denial of loss of earnings benefits from December 23, 2013 to March 23, 2014.

The Appeals Resolution Officer found that the initial layoff was a general seasonal layoff affecting all employees, not caused by the worker's impairment.

However, because the worker required permanent accommodations that were unlikely to be provided by another employer, and because other employees were recalled in January 2014 while the worker was not due to a lack of modified work, the worker was entitled to full loss of earnings benefits from the date the first worker was recalled in January 2014 until March 23, 2014.

The worker appealed a decision regarding his workplace injury claim, seeking an increase in his Non-Economic Loss (NEL) award for his low back, entitlement to narcotic addiction treatment, and loss of earnings (LOE) benefits following his termination in March 2004.

The Appeals Resolution Officer found that the 18 per cent NEL award was correctly calculated and denied the request for narcotic addiction treatment due to a lack of causal connection to the workplace injury.

However, the Officer granted the worker's appeal for LOE benefits, finding that the employer failed to rebut the presumption under section 41(10) of the Workplace Safety and Insurance Act that the termination was related to the injury, and awarded full and partial LOE benefits for various periods.

The worker requested an extension to the time limit to object to two decisions from 2011 regarding her loss of earnings benefits and work transition services.

The Appeals Resolution Officer found that the worker was sophisticated enough to understand the time limits, had not demonstrated an intention to appeal within the statutory period, and lacked diligence in pursuing the appeal for over three years.

The request for a time limit extension was denied.

The worker suffered a compensable left knee patella fracture after tripping at work.

Following surgery and subsequent hardware removal, the Case Manager determined the worker had reached maximum medical recovery without any ongoing impairment.

The worker objected, seeking recognition of a permanent impairment.

The Appeals Resolution Officer allowed the objection, finding that although the worker did not have a significant impairment or require formal work restrictions, the medical evidence demonstrated a permanent limitation of movement in the left knee with no further improvement anticipated.

The worker suffered a right knee injury in 1979, diagnosed as an anterior cruciate ligament tear, and later underwent a high tibial osteotomy in 1995.

In 2013, the worker required a total knee replacement.

The WSIB initially denied entitlement, concluding the surgery was for progressive degenerative changes not arising from the work injury.

On appeal, the Appeals Resolution Officer found clinical compatibility between the original injury and post-traumatic osteoarthritis, accepting the treating surgeon's opinion that the knee replacement was occasioned by the 1979 injury.

The worker's objection was allowed, granting entitlement to the surgery, associated health care benefits, and temporary total disability benefits.

The worker, a police officer who sustained a shoulder injury during taser training, requested an extension of the time limit to appeal a Case Manager's decision dated February 14, 2011.

The Appeals Resolution Officer granted the extension, finding that the worker had demonstrated an intent to object and that subsequent decisions regarding maximum medical recovery and permanent impairment were inextricably linked to the initial denial of the recurrence and labral tear.

The worker appealed a decision denying ongoing loss of earnings (LOE) benefits after November 21, 2014, following a workplace slip and fall that resulted in a right scapula fracture and upper back strain.

The Appeals Resolution Officer found that the worker had reached maximum medical recovery for the compensable injuries by that date, and that ongoing shoulder and mid-back issues were not related to the workplace accident.

The appeal was denied.