OWSIB 2015

The worker objected to the calculation of her Non-Economic Loss (NEL) award for a psychotraumatic disability, arguing that the 13% rating did not reflect the severity of her condition.

The Appeals Resolution Officer reviewed the medical evidence and WSIB Operational Policy 18-05-11, concluding that the worker's condition met the criteria for the lower range of a Class 3 moderate impairment.

The officer confirmed that the 20% psychotraumatic impairment rating was correctly combined with the worker's existing 33% organic impairment rating using the AMA Guides, resulting in a 46% overall NEL award.

The worker's objection was denied.

The worker appealed a decision denying full retroactive loss of earnings (LOE) benefits from November 13, 2006.

The worker claimed total impairment due to a combination of compensable organic (neck) and non-organic (psychotraumatic) injuries.

The Appeals Resolution Officer found that the worker's layoff in 2006 was primarily due to a non-compensable eye condition, and that the employer had provided physically and psychologically suitable accommodated duties at no wage loss.

The worker's appeal was denied, as his ongoing loss of earnings was not directly attributable to his compensable injuries.

The worker suffered a workplace injury in 2008 and was granted a permanent impairment award and partial Loss of Earnings benefits.

The worker sought to appeal an October 18, 2010 decision regarding his benefits, but failed to do so within the legislative time limit.

The worker requested an extension of time to appeal, citing depression, confusion, and a lack of medical resources.

The Appeals Resolution Officer denied the request, finding no compelling personal reasons or exceptional circumstances that would justify an extension of the time limit.

The worker appealed decisions denying entitlement for complex regional pain syndrome (CRPS), finding her non-cooperative in her Work Transition (WT) plan, and adjusting her loss of earnings (LOE) benefits following the closure of WT services.

The Appeals Resolution Officer found that the CRPS was not causally linked to the original workplace injury due to the significant delay in symptom onset.

However, the Officer determined that the worker was not non-cooperative in her WT plan, as her inability to participate was due to non-compensable health factors rather than a willful refusal.

Finally, the Officer upheld the LOE benefit adjustment based on the suitable occupation earnings, as the worker's work-related impairment was partial.

The objection was allowed in part.

The worker, a heavy equipment mechanic, twisted his left knee at work but delayed seeking medical attention for nearly a year.

The WSIB initially denied entitlement for a left knee medial meniscal tear.

On appeal, the Appeals Resolution Officer granted entitlement, finding that the worker reported the incident immediately, experienced immediate pain, and had a reasonable explanation for the delay in seeking medical attention due to his strong work ethic and belief the injury would heal on its own.

The worker objected to the denial of Loss of Earnings (LOE) benefit payments from May 24, 2001, following a prior workplace injury.

The Appeals Resolution Officer found that the worker had returned to modified work and essentially restored his pre-injury earnings prior to a subsequent injury on May 24, 2001.

Because the worker was not experiencing a loss of earnings from the prior injury at the time the second injury occurred, the objection was denied and the denial of LOE benefits was confirmed.

The worker's spouse objected to a recoverable overpayment created when her eldest child retroactively received Survivors' benefits for attending post-secondary education.

The WSIB Appeals Resolution Officer found that the total benefits payable to all survivors cannot exceed 85% of the worker's net average earnings.

Because the spouse had already received the maximum 85% during the retroactive period, diverting 10% to the child correctly resulted in a corresponding overpayment debt for the spouse.

The objection was denied.

The worker appealed decisions regarding his Non Economic Loss (NEL) benefit quantum, the suitability of his Suitable Occupation (SO) as an accounting clerk, and a Future Economic Loss (FEL) benefit redetermination.

The worker suffered a compensable lower back strain in 1996 and later developed non-compensable conditions including plantar fasciitis and small fiber neuropathy.

The Appeals Resolution Officer found that the 7% reduction to the NEL rating for pre-existing conditions was correctly applied, resulting in a 20% total NEL.

The SO of accounting clerk remained suitable as the worker's inability to work was primarily due to non-compensable conditions.

Finally, the minor deterioration in the compensable condition did not warrant a FEL redetermination.

The appeal was denied.

The worker objected to decisions determining she was partially impaired and capable of earning $10.25/hour over a 20-hour work week in the suitable occupation of customer service representative.

The worker sought a finding of total impairment and full Loss of Earnings benefits.

The Appeals Resolution Officer reviewed the expanded areas of entitlement, which included a 3% non-economic loss award for the left upper extremity, in addition to previous awards for the right upper extremity and psychotraumatic impairment.

The Officer found that the worker remained partially impaired and that the part-time suitable occupation was safe, consistent with her functional abilities, and available in the labour market.

The worker's objection was denied.

The worker appealed decisions denying entitlement to benefits for a psychotraumatic disability and Chronic Pain Disability, as well as the quantum of her 10% Non-economic Loss (NEL) award and the suitability of her work transition plan.

The Appeals Resolution Officer found that the worker's severe depression and pain symptoms were not directly caused by her compensable bilateral shoulder and elbow repetitive strain injuries, noting the presence of concurrent non-compensable medical issues.

The 10% NEL award was confirmed as accurately reflecting the worker's organic impairment based on clinical findings.

The work transition plan and suitable occupation of customer service and information clerks were also confirmed as reasonable and suitable for the worker's physical restrictions.

The appeal was denied.

The worker objected to a decision adjusting his Loss of Earnings (LOE) benefits, arguing he was unemployable due to chronic pain and entitled to full benefits until age 65.

The WSIB had reviewed his final LOE benefit entitlement after a Non-Economic Loss assessment for chronic pain disability and obtained video surveillance.

The Appeals Resolution Officer found significant discrepancies between the worker's reported severe limitations and his observed activities on surveillance, which included walking his dog without apparent difficulty, socializing, and running errands.

The appeal was dismissed, with the ARO concluding the worker was capable of earning minimum wage in suitable occupations.

The employer objected to the establishment of initial entitlement for a worker who sustained multiple injuries when the company truck he was driving rolled over.

The employer argued the accident resulted from speeding and constituted serious and willful misconduct, noting the worker's past driving offences.

The Appeals Resolution Officer denied the objection, finding that under s. 17 of the Workplace Safety and Insurance Act, even if an injury is attributable solely to serious and willful misconduct, benefits are payable if the injury results in serious impairment.

As the worker suffered serious organic and non-organic impairments, initial entitlement was upheld.

The worker, a caseworker, appealed a decision denying her initial entitlement for Traumatic Mental Stress (TMS) after a former client yelled profanities at her from a passing taxicab while she was walking to work.

The worker claimed the client uttered a death threat, which caused her to develop post-traumatic stress disorder.

The Appeals Resolution Officer found that while the worker was in the course of employment during the incident, the event was not a sudden and unexpected traumatic event under the TMS policy.

The evidence did not support that a death threat was made, and verbal abuse was an inherent risk in the worker's job.

The appeal was dismissed.

The worker, an administrator at a provincial youth correctional facility, appealed the denial of her claim for Traumatic Mental Stress (TMS).

She claimed TMS resulted from the cumulative effect of four traumatic workplace incidents between 1998 and 2011, including a riot, a staff strike, threats from a dismissed employee, and perceived threats from youth inmates.

The Appeals Resolution Officer allowed the appeal, finding that the incidents met the threshold for TMS entitlement related to exposure to multiple sudden and traumatic events, and that the worker's PTSD and major depressive disorder diagnoses were causally related to these workplace exposures.

The worker suffered a compensable left shoulder injury in 1986, underwent surgery, and received a 10% permanent disability award.

In April 2013, the worker claimed a recurrence of the injury.

The Appeals Resolution Officer denied the recurrence claim, finding that the worker's ongoing shoulder problems, including a rotator cuff tear and tendinitis, were attributable to age-related degenerative changes rather than the initial 1986 workplace injury.

The worker appealed a decision determining that the Suitable Occupation (SO) of shipper/receiver was suitable, which resulted in partial loss of earnings (LOE) benefits based on deemed earnings.

The worker argued that her permanent left foot impairment prevented prolonged standing and walking required for the role.

The Appeals Resolution Officer found that the shipper/receiver SO was not consistent with the worker's functional abilities.

The officer determined that a customer service representative role was suitable and ordered LOE benefits to be paid based on the earnings of a customer service representative, granting the worker's objection.

The employer appealed the reconciliation debt interest (RDI), premium not reported (PNR), and period reconciliation not reported (PRNR) charges levied by the Workplace Safety and Insurance Board for the years 2012, 2013, and 2014.

The employer argued it was unaware of its registration obligations prior to being contacted by the Board.

The Appeals Resolution Officer allowed the appeal in part, rescinding the PRNR penalty based on a prior assurance from the Board, and reducing the PNR penalty to 10% of the annual actual premium assessment as the original amount was deemed unreasonable.

The RDI charges were upheld as the employer was compulsorily covered and premiums were due but unpaid, with no valid policy grounds for revocation.

The employer, TUV, sought to transfer 100% of the costs of a workplace accident claim to the respondent, Company XYZ.

The worker was injured when pressurized oil shot out of a flange he was loosening on a machine assembled by TUV but designed and overseen by XYZ.

The Appeals Resolution Officer found that the worker's actions and TUV's failure to secure detailed written instructions or properly identify hazards were the proximal causes of the accident.

The respondent was found not to have breached its duty of care, and the request for a transfer of costs was denied.

The worker appealed a decision denying a Non-Economic Loss (NEL) redetermination for a lower back strain injury.

The worker argued that their condition had significantly deteriorated.

The Appeals Resolution Officer found that while the worker had decreased range of motion and increased pain, medical evidence attributed these changes to pre-existing degenerative disc disease rather than the compensable lower back strain.

As the deterioration was caused by a pre-existing condition unrelated to the claim, the appeal was dismissed and the NEL redetermination was denied.

The worker appealed decisions regarding the quantum of Non-Economic Loss (NEL) benefits for a coccyx fracture and psychological impairment, as well as a reduction to partial Loss of Earnings (LOE) benefits.

The Appeals Resolution Officer found that the modified work offered by the employer as a traffic controller was not suitable given the worker's physical and psychological restrictions, including the use of assistive devices for ambulation.

Consequently, full LOE benefits were restored from November 9, 2012.

However, the appeals regarding the NEL quantums were dismissed, as the 5 percent rating for the coccyx fracture was the maximum allowable under the AMA Guides, and the 25 percent rating for psychological impairment appropriately reflected a moderate level of impairment.