OWSIB 2017

The worker appealed a Case Manager's decision denying her claim for benefits under the Traumatic Mental Stress (TMS) policy.

The worker alleged she developed post-traumatic stress disorder and bilateral shoulder trauma after being grabbed from behind by her supervisor.

The Appeals Resolution Officer found the worker's evidence credible, corroborated by a co-worker and medical reports.

The incident was deemed an unexpected traumatic event arising out of employment.

The appeal was allowed, granting the worker loss of earnings benefits from May 19, 2014, to September 12, 2014, with further entitlement remitted to the operating area.

The worker appealed the denial of entitlement for spinal stenosis, disc protrusions, and ongoing loss of earnings benefits following a workplace back injury.

The Appeals Resolution Officer found that the spinal stenosis and disc issues were pre-existing conditions not significantly aggravated by the workplace injury.

The work-related sprains had resolved, and there was no ongoing entitlement to benefits.

The appeal was denied.

The worker appealed decisions regarding the quantum of his permanent disability (PD) award, his level of employability, and the denial of an independent living allowance (ILA).

The worker suffered a right arm amputation in 1987 and later developed left arm and thumb issues.

The Appeals Resolution Officer confirmed the 72% total PD award, finding the ratings for the left wrist and thumb were appropriate based on the Ontario Rating Schedule and medical evidence.

The Officer also determined the worker was not essentially unemployable, noting the provision of a new myoelectric prosthesis and custom thumb brace.

Finally, the request for an ILA was denied because the worker's PD rating did not meet the 100% threshold required by policy.

The worker, a personal support worker, appealed the denial of initial entitlement for a right shoulder sprain.

The injury occurred when she reached back to close a door while carrying soiled linen after performing heavy patient care.

The Appeals Resolution Officer found that while closing a door would not normally cause a sprain, the heavy nature of her duties, understaffing, and awkward posture left her susceptible to injury.

The appeal was allowed, granting initial entitlement for the right shoulder sprain.

The worker, a 16-year-old cherry processor, objected to a decision denying initial entitlement for a right eye injury sustained when a co-worker threw a piece of wood at him.

The initial decision found the worker had participated in a fight and thus removed himself from the course of employment.

The Appeals Resolution Officer allowed the appeal, finding that the worker's verbal response to the co-worker's derogatory taunts did not constitute a fight under WSIB policy.

The worker was actively performing his regular job duties when assaulted, and was therefore in the course of his employment when injured.

The worker appealed a decision denying loss of earnings (LOE) benefits beyond August 17, 2015, following a compensable right eye injury.

The employer had offered modified work, which the worker declined, claiming it was unsuitable and unsafe.

The Appeals Resolution Officer found that the worker was not totally disabled and had failed to actively participate in the work reintegration process.

However, because the WSIB did not provide the required written warning before levying a non-cooperation penalty, the worker was granted full LOE benefits until September 22, 2015, and partial LOE benefits at 50 percent until October 6, 2015.

The appeal was allowed in part.

The worker, a waste collector, suffered a workplace fall and was granted entitlement for a concussion, laceration, left elbow abrasion, and right shoulder strain.

He subsequently sought entitlement for a massive right rotator cuff tear.

The Appeals Resolution Officer denied the appeal, finding that medical evidence, including an MRI showing fatty atrophy and prior medical records indicating right shoulder weakness, supported that the rotator cuff tear was a pre-existing degenerative condition rather than a result of the workplace fall.

The worker appealed the denial of Chronic Pain Disability (CPD) entitlement following a 2005 right shoulder injury.

The Appeals Resolution Officer found that the worker met all five criteria under Operational Policy 15-04-03, noting that the worker's chronic pain, diagnosed as fibromyalgia, was caused by the initial work injury and was inconsistent with organic findings.

The appeal was allowed and CPD entitlement was granted.

The worker appealed the denial of initial entitlement for a left shoulder and neck injury allegedly sustained while lifting boxes at work in June 2010.

The Appeals Resolution Officer reviewed the medical evidence, including a WSIAT Discussion Paper on shoulder injuries, and found that the worker's left rotator cuff tear and impingement syndrome were not compatible with the reported mechanism of injury.

The officer concluded that the lifting incident did not constitute a severe acute trauma, nor did the worker's duties involve prolonged or repetitive overhead work sufficient to cause the condition.

The worker failed to rebut the presumption clause, and the appeal was denied.

The worker appealed the denial of initial entitlement for a right wrist injury allegedly sustained in a slip and fall at work.

The Appeals Resolution Officer confirmed the denial, finding that the worker failed to establish proof of accident.

The decision noted multiple inconsistencies in the worker's accident history, including discrepancies about the weather, the date of the injury, and the nature of the incident reported to the employer.

Additionally, the worker delayed seeking medical attention and reporting the specific wrist injury for approximately one year without a reasonable explanation.

The worker, a truck driver, appealed a decision limiting her workplace injury entitlement to a right knee strain and denying ongoing benefits beyond July 21, 2016.

The worker argued that her duties, which involved rapidly pushing heavy linen carts around a tight curve, caused a right knee medial meniscal tear.

The Appeals Resolution Officer found that the diagnosed meniscal tear was clinically compatible with the disablement history, despite the presence of pre-existing degenerative conditions.

The appeal was allowed in part, granting entitlement for the meniscal tear and ongoing benefits from July 21, 2016 to September 19, 2016, with further entitlement to be determined by Operations.

The worker, a community support worker, appealed a decision denying initial entitlement for a ventral hernia allegedly sustained while using a Hoyer lift with a patient.

The Appeals Resolution Officer found that the incident did not represent a chance event and that proof of accident was not established, as the evidence did not support the worker's claim that she bore most of the patient's weight.

Furthermore, the medical evidence indicated the hernia was a recurrence of a previous condition and was not clinically compatible with the reported incident.

The worker's objection was denied.

The worker appealed a decision denying ongoing entitlement for a right shoulder partial tear of the supraspinatus tendon and calcific tendinopathy.

The Appeals Resolution Officer found that the worker's general job duties, which involved repetitive cross-body motion and pushing/pulling with force, made a significant contribution to the development of the conditions.

The objection was allowed, and the matter was remitted to the Operating Area to determine benefits.

The worker suffered a right knee injury after slipping on ice at work in March 2014.

He returned to full duties in June 2014 but stopped working in April 2015 due to a flare-up of knee pain, later diagnosed as a medial meniscal tear.

The worker sought entitlement for a recurrence of the workplace injury.

The Appeals Resolution Officer denied the appeal, finding that the meniscal tear was not clinically compatible with the original sprain/strain injury and that there was insufficient evidence to show the workplace accident accelerated the worker's pre-existing degenerative osteoarthritis.

The worker appealed a decision granting a 4% non-economic loss (NEL) award for a left hand injury, arguing the quantum should be greater due to ongoing problems with her whole hand and arm.

The Appeals Resolution Officer found that the NEL clinical specialist appropriately used the American Medical Association Guides to evaluate the permanent impairment based on range of motion and sensory loss specific to the accepted area of injury (the left small finger).

The objection was denied and the 4% NEL quantum was upheld.

The employer objected to the 2014 and 2015 Period Reconciliation not Reported (PRNR) charges on its Workplace Safety and Insurance Board account.

The employer argued that as a small business, it was difficult to navigate the reporting requirements and requested cancellation of the penalties.

The Appeals Resolution Officer found no justification for complete cancellation but applied the WSIB's 2008 guidelines, which allow for revision if a penalty exceeds 10% of the annual actual assessment.

The 2014 PRNR charges exceeded this threshold and were reduced to 10% of the 2014 premium.

The 2015 charges did not exceed the threshold and were confirmed.

The objection was allowed in part.

The worker appealed a decision denying ongoing entitlement for a right shoulder rotator cuff strain and secondary entitlement for a SLAP tear and subsequent surgery.

The Appeals Resolution Officer found that the accepted strain had fully resolved and that ongoing symptoms were related to pre-existing osteoarthritis and tendinosis.

The Officer also concluded that the SLAP tear was not causally linked to the workplace injury, as the mechanism of injury was not compatible with the diagnosis.

The appeal was dismissed.

The worker appealed a case manager's decision denying ongoing entitlement and treatment for a right knee injury beyond April 21, 2015.

The worker had suffered a work-related medial meniscal tear and subsequently developed persistent symptoms, including an exacerbated Baker's cyst, on a background of pre-existing osteoarthritis.

The Appeals Resolution Officer found that the pre-existing condition had not overwhelmed the work-related injury, which continued to be a significant contributing factor to the ongoing impairment.

The worker's appeal was allowed, granting continuing entitlement and treatment, including a Synvisc injection.

The employer objected to a decision granting the worker loss of earnings (LOE) benefits beyond February 19, 2016, following arthroscopic knee surgery.

The Appeals Resolution Officer found that the worker was only partially disabled by that date and that the employer had offered suitable modified work, which the worker failed to accept or attempt.

The employer also demonstrated a willingness to provide transportation if needed.

Consequently, the worker was not participating in the work reintegration process and was not entitled to further LOE benefits.

The employer's objection was allowed.

The worker, a personal support worker, suffered an ankle injury and was offered modified clerical duties by the employer.

The worker's family doctor advised against returning to work, stating the modified duties would delay recovery.

The decision maker initially denied loss of earnings (LOE) benefits, finding the modified work suitable.

On appeal, the Appeals Resolution Officer found that the worker was cooperative in the work reintegration process and appropriately followed her doctor's advice to remain off work.

The worker's objection was allowed, and entitlement to LOE benefits was granted for the disputed period.