OWSIB 2017

The worker appealed decisions denying entitlement for a left wrist injury, granting a 10 percent non-economic loss (NEL) award for chronic pain disability (CPD), and denying full loss of earnings (LOE) benefits.

The Appeals Resolution Officer denied the left wrist entitlement due to a lack of timely reporting and continuity.

The 10 percent NEL award for CPD was confirmed as accurately reflecting the worker's mild impairment.

The request for full LOE benefits was denied, as the worker was found capable of minimum-wage employment in a suitable occupation; however, the partial LOE benefit rate was adjusted to reflect the actual minimum wages in effect between August 2014 and October 2016.

The worker suffered a left hand amputation injury at work and received loss of earnings benefits.

The worker objected to four decisions by the WSIB Operating Area: (1) that he was not a student at the time of the accident; (2) that the suitable occupation (SO) of security guard was appropriate; (3) that his benefits were correctly reduced based on the SO wages; and (4) that he was not entitled to a permanent impairment for psychotraumatic disability.

The Appeals Resolution Officer denied the worker's objections, finding that the worker had not been enrolled in an educational program for over two years and was not pursuing formal education, making him a worker rather than a student.

The Officer also found the SO of security guard was suitable and available, the wage reduction was appropriate, and the medical evidence did not support a permanent psychological impairment at the time.

The worker appealed a decision denying initial entitlement for a right shoulder injury, specifically a rotator cuff tear and AC joint arthritis.

The worker argued the injury resulted from 30 years of operating an excavator and performing other manual duties.

The Appeals Resolution Officer applied the five-point check system and found the diagnosis was not compatible with the accident history.

Relying on an Occupational Medical Consultant's opinion, the ARO concluded the condition was consistent with natural degenerative processes and the worker's duties did not involve the constant overhead activity required to cause the injury.

The appeal was dismissed.

The worker appealed a decision denying her entitlement to benefits for Traumatic Mental Stress (TMS) following an alleged assault by the store manager during a return-to-work meeting.

The worker claimed she was yelled at, touched on the face, and chased around a table.

The employer and multiple witnesses provided a conflicting account, stating the worker was aggressive and was calmly asked to leave the premises.

The Appeals Resolution Officer found the witness statements credible and concluded there was insufficient evidence of a sudden and unexpected traumatic event.

The appeal was dismissed, and entitlement to TMS was denied.

The worker, a Child Care Worker, suffered a compensable psychological injury (PTSD) after witnessing an assault at work in 2012.

In October 2014, the worker stopped working after being called to a meeting regarding performance issues and sought loss of earnings benefits, claiming a recurrence of the 2012 injury.

The WSIB initially denied the claim, attributing the absence to workplace performance issues rather than the compensable injury.

On appeal, the Appeals Resolution Officer found that the worker's performance issues and subsequent inability to work were likely caused by an exacerbation of her unmanaged PTSD and major depressive disorder.

The appeal was allowed, and the worker was granted loss of earnings benefits from October 7, 2014, onward.

The worker, a 75-year-old former crane operator, claimed entitlement for occupational noise-induced hearing loss (NIHL) due to exposure to hazardous noise between 1964 and 1974.

The Appeals Resolution Officer found that while the worker's hearing loss met the clinical requirements, his noise exposure did not meet the WSIB's minimum threshold of 90 dB for 8 hours per day for 5 years or its equivalent.

The worker's objection was denied.

The worker suffered a right arm crush injury and complex lacerations when his sleeve became caught in a machine.

He sought entitlement to Chronic Pain Disability (CPD) and ongoing psychotraumatic disability.

The Appeals Resolution Officer denied the CPD claim, finding that the degree of pain was consistent with the organic findings and there was no clear disruption in all aspects of his life.

However, the Officer granted ongoing entitlement to a psychotraumatic disability up to October 16, 2016, as medical evidence supported ongoing psychiatric issues directly related to the compensable injury.

The worker appealed a decision denying entitlement to Chronic Pain Disability (CPD) following a workplace slip and fall injury.

The Appeals Resolution Officer found that while the worker experienced ongoing pain, the workplace injury was not a significant contributor.

Non-compensable conditions, including a subsequent motor vehicle accident and pre-existing degenerative disc disease, were the primary causes of the pain.

Furthermore, the worker's pain behaviors were inconsistent, and there was no consistent marked life disruption.

The appeal was dismissed and CPD entitlement was denied.

The worker appealed a decision denying initial entitlement to benefits for a syncope episode that occurred during a training session.

The worker fainted and struck her head, attributing the episode to excessive heat in the training room.

The Appeals Resolution Officer found that the accident occurred in the course of employment and applied the statutory presumption under s. 13(2) of the Workplace Safety and Insurance Act.

The evidence, including witness statements corroborating the hot temperature and medical evidence confirming no prior history of fainting, supported that the accident arose out of employment.

The appeal was allowed.

The employer objected to a Case Manager's decision allowing the worker loss of earning (LOE) benefits for a period following a workplace burn injury.

The employer argued that suitable modified duties were offered to the worker, which she declined.

The Appeals Resolution Officer found that medical evidence supported the worker's fitness for modified duties and that the employer's offer was within her physical restrictions.

The employer's objection was allowed, and the worker was found not entitled to LOE benefits for the disputed period.

The worker suffered a compensable head and neck injury in 2011 after being struck by a robotic arm.

She received loss of earnings benefits and a non-economic loss award for a permanent cervical spine impairment.

The worker subsequently sought extended entitlement for psychotraumatic disability and chronic pain disability.

The Appeals Resolution Officer denied the appeal, finding no objective medical evidence of a compensable psychological condition or chronic pain disability, noting the worker had successfully returned to full-time regular employment and her pain complaints were consistent with her accepted organic injury.

The worker appealed the denial of initial entitlement for left elbow and shoulder injuries sustained when she struck her elbow on a door lock at work.

The Eligibility Adjudicator initially denied the claim due to a lack of clear information on when medical attention was first sought.

The Appeals Resolution Officer found that the evidence, including the worker's testimony, the Employer's Report of Injury, and medical records, established proof of accident.

The worker's objection was allowed, and initial entitlement for the left elbow and left shoulder was granted.

The worker, who suffered traumatic amputations and is in receipt of a 100% permanent disability pension, appealed a decision denying payment for a home propane generator.

The worker argued the generator was necessary to maintain essential home systems, including an elevator and climate control, during power outages in his rural community.

The Appeals Resolution Officer allowed the appeal, finding that the generator qualifies as an independent living device and a home modification under WSIB policies, as it restores the worker's ability to communicate, be mobile, and prevent future health complications.

The worker appealed the quantum of her Non-Economic Loss (NEL) benefit for a low back injury, which was offset due to a pre-existing condition.

Following a WSIAT decision directing a NEL redetermination, the worker's total impairment rating for her low back increased to 35%.

However, the Appeals Resolution Officer found that the worker had a moderately significant pre-existing condition that warranted a 25% reduction in the impairment rating.

As a result, the worker was not entitled to an increase in her NEL benefit.

The appeal was denied.

The employer appealed a decision denying Second Injury and Enhancement Fund (SIEF) relief regarding a worker's lower back strain injury.

The worker had tripped over a box at work, which the Appeals Resolution Officer classified as a minor accident.

The employer argued that the worker's pre-existing lumbar spine condition prolonged her recovery.

The Appeals Resolution Officer found that the worker recovered within the standard six to eight weeks for a lower back strain and that the pre-existing condition did not enhance or prolong the recovery period.

The employer's appeal was dismissed and the denial of SIEF relief was confirmed.

The worker appealed the Case Manager's decisions denying entitlement to a psychotraumatic disability and a Non-Economic Loss (NEL) redetermination for a work-related lower back injury.

The Appeals Resolution Officer found that the worker's psychological condition did not manifest within the required five-year period and was not significantly contributed to by the work accident.

The Officer also found no significant deterioration in the worker's lower back condition to warrant a NEL redetermination.

The worker's objections were denied.

The worker appealed the denial of loss of earnings (LOE) benefits for various periods following a workplace slip and fall that resulted in a nasal fracture, left radial head fracture, and soft tissue injuries.

The WSIB had denied full LOE benefits on the basis that the employer offered modified work.

The Appeals Resolution Officer found that the medical evidence supported the worker's inability to perform even modified work during the acute recovery phase and following nasal surgery.

The worker's appeal was allowed, granting full and partial LOE benefits for the disputed periods.

The worker, a roofer, objected to the WSIB's denial of initial entitlement for a lower back injury allegedly sustained while cutting out a flange on a roof.

The employer did not participate in the appeal but had previously disputed the claim due to delayed reporting.

The Appeals Resolution Officer found the worker's testimony credible and consistent with medical evidence, establishing proof of accident and compatibility of the disc protrusion diagnosis.

The objection was allowed, granting initial entitlement and full loss of earnings benefits for a specified period, with a referral for a back and neck assessment.

The worker, a 59-year-old teacher, suffered a compensable left shoulder rotator cuff tear after slipping on ice in 2009.

He underwent surgery and was deemed fully recovered by September 2010.

In 2014, he sought ongoing entitlement for his left shoulder, claiming a newly discovered bone spur was caused by the surgery, and initial entitlement for his right shoulder, claiming it was also injured in the 2009 fall but masked by the left shoulder pain.

The Appeals Resolution Officer denied both appeals.

The left shoulder claim lacked continuity and clinical compatibility, and the bone spur was deemed degenerative based on the WSIB Medical Consultant's opinion.

The right shoulder claim was denied due to a five-year delay in reporting and lack of contemporaneous medical evidence establishing proof of accident.

The worker appealed decisions regarding his non-economic loss (NEL) quantum and the calculation of his earnings basis following a severe workplace fall.

The Appeals Resolution Officer found that the worker was not an apprentice at the time of injury, as he had not demonstrated a clear path to becoming a licensed electrician despite working as an assistant for 20 years.

However, the worker's appeal regarding his NEL quantum was partially allowed.

The NEL rating for psychotraumatic disability was increased to 15 percent to reflect impairment at the upper level of mild impairment, and the rating for trigeminal nerve damage was increased to 7 percent.

The NEL ratings for tinnitus and cervical strain were confirmed.