OWSIB 2018

The employer appealed a case manager's decision granting the worker loss of earnings (LOE) benefits from August 31, 2017 to September 5, 2017, following a workplace shoulder injury.

The Appeals Resolution Officer found that the employer had offered suitable modified work on the day of the injury, which the worker declined.

Medical evidence indicated the worker had functional abilities that would have allowed him to perform the modified work.

Consequently, the worker was not totally disabled and was not entitled to LOE benefits for the period in question.

The employer's objection was allowed.

The worker, a postal carrier, appealed a decision denying initial entitlement for a pelvis and left knee injury allegedly resulting from a slip and fall on ice at work in January 2016.

The worker did not seek medical attention until February 2017, at which time she was diagnosed with a pelvic stress fracture and underwent surgery.

The Appeals Resolution Officer dismissed the appeal, finding that the worker's ability to perform regular duties for over a year without medical attention or documented continuity of complaints meant proof of accident was not established.

The worker, a 60-year-old cashier, suffered a compensable bilateral shoulder injury and was offered modified duties at her pre-injury hours.

The worker chose to work reduced hours, claiming she was following her doctor's advice and could not cope with the demands.

The Appeals Resolution Officer found that the modified duties were suitable, within the worker's functional abilities, and that there was no clinical evidence supporting her inability to work pre-injury hours.

The worker's objection was denied, and she was found not entitled to partial loss of earnings benefits.

The employer objected to the approval of loss of earnings (LOE) benefits up to March 20, 2017, and the denial of its request to reverse healthcare costs associated with the worker's assessments and treatment at a specialty program.

The worker had sustained a concussion and neck strain after being struck by a student.

The Appeals Resolution Officer found that the worker's ongoing impairment was significantly contributed to by the work-related injury, despite a pre-existing condition.

The LOE benefits and healthcare costs were deemed appropriate and the employer's objection was denied.

The employer appealed a Case Manager's decision denying entitlement to Second Injury and Enhancement Fund (SIEF) relief following a worker's low back injury sustained while lifting boxes.

The employer argued that the worker's pre-existing conditions, including a prior back injury, obesity, and degenerative changes, prolonged her recovery.

The Appeals Resolution Officer found that the accident severity was moderate and that there was insufficient evidence that a prior disability caused or contributed to the accident, or that a pre-existing condition enhanced or prolonged the work-related disability.

The employer's objection was denied.

The worker suffered a minor head injury at work when struck by a falling wire holder.

A few hours later, he collapsed from a ventricular fibrillation (VF) cardiac arrest.

The worker sought initial entitlement for the cardiac impairment, arguing the head injury was a significant contributing factor.

The Appeals Resolution Officer denied the appeal, finding the head injury was minor and did not cause direct chest trauma or irregular cardiac rhythm as required by WSIB Operational Policy 15-03-10.

The evidence indicated the VF arrest was more likely related to the worker's pre-existing congenital heart defect rather than the workplace accident.

The employer objected to a WSIB account specialist's decision classifying its business under the mandatory construction rate group for Construction Project Management, rather than the by-application rate group for Miscellaneous Business Services (interior design).

The employer argued it provided only interior design services and did not manage construction projects.

The Appeals Resolution Officer reviewed the employer's website and statements, finding that its services extended beyond design to include tendering, site coordination, and construction administration.

The appeal was denied, and the classification as Construction Project Management was upheld.

The employer appealed a WSIB audit decision that granted an executive officer exemption from mandatory coverage effective July 21, 2016, the date the declaration was received.

The employer sought retroactive exemption to January 1, 2014, arguing estoppel by representation because the WSIB's forms allegedly misled the employer into continuing to deduct executive officer earnings.

The Appeals Resolution Officer dismissed the appeal, finding no evidence of misrepresentation by the WSIB and noting that the legislation and policy clearly state the exemption takes effect only on the day the declaration is received.

The worker objected to the 21% non-economic loss (NEL) benefit rating for her low back and the determination that Customer Service was a suitable occupation (SO) with partial loss of earnings (LOE) benefits payable from May 30, 2017.

The Appeals Resolution Officer upheld the 21% NEL rating, finding it consistent with the AMA Guides and medical evidence.

However, the Officer found the previous SO of Security Guard became unsuitable earlier, on December 1, 2012, due to the worker's psychotraumatic impairment.

The worker was found capable of working in Customer Service for 15 hours per week at minimum wage from December 1, 2012, and was awarded partial LOE benefits from that date.

The worker appealed a decision denying entitlement to loss of earnings (LOE) benefits following a low back strain.

The worker argued that severe back pain prevented him from continuing modified duties.

The Appeals Resolution Officer found that the medical evidence supported the worker's capability to perform the suitable modified work offered by the employer immediately following the injury.

The appeal was dismissed, and LOE benefits were denied.

The worker, a letter carrier, appealed a decision denying initial entitlement for a right shoulder injury allegedly caused by carrying heavy mail bags on a new route.

The Appeals Resolution Officer reviewed the medical evidence, which showed degenerative conditions including tendinosis and osteoarthritis.

The Officer found that the worker's diagnosed conditions were not compatible with the reported accident history of a sudden onset from carrying heavier bags.

The worker's objection was denied and initial entitlement was not granted.

The worker appealed a Case Manager's decision calculating his partial loss of earnings (LOE) benefits based on projected Suitable Employment or Business (SEB) wages rather than his actual wages from August 2005 to May 2006.

The worker argued he was performing duties within his SEB of storekeeper/parts clerk.

The Appeals Resolution Officer found that the worker's primary job duty was as a courier driver, which fell outside his identified SEB.

Consequently, the worker was not employed in his SEB, and his LOE benefits were correctly based on projected SEB wages.

The appeal was denied.

The worker appealed a decision denying initial entitlement for a right foot/ankle injury.

The worker claimed he fell from a trailer while chaining down a load, fracturing his calcaneus.

The employer argued the worker injured his foot at home and pointed to medical records where the worker reported falling off a ladder.

The worker testified the employer pressured him not to file a WSIB claim and promised to pay his wages, leading him to provide a false history to medical professionals.

The Appeals Resolution Officer accepted the worker's testimony, corroborated by a later letter from his family doctor confirming the worker had initially reported a work accident but asked to record it as a home injury.

The appeal was allowed and initial entitlement granted.

The worker appealed the denial of entitlement for fibromyalgia under the WSIB's Chronic Pain Disability (CPD) policy following a 1995 workplace injury where she slipped and wrenched her back and knee.

The Appeals Resolution Officer applied the five criteria under Policy 15-04-03.

While the worker met the criteria for having a work-related injury, pain persisting beyond usual healing time, and pain inconsistent with organic findings, she failed to establish that the chronic pain was caused by the injury or that it produced a marked life disruption impairing her earning capacity.

Medical evidence suggested a pre-existing chronic pain disorder and no significant disruption to her personal, occupational, social, or home life was found.

The objection was denied.

The worker appealed a decision regarding his Non-Economic Loss (NEL) award for a psychotraumatic disability resulting from a workplace right shoulder injury.

The worker sought an increase from the 10% rating and objected to a 25% reduction applied for a pre-existing psychological impairment.

The Appeals Resolution Officer found that the worker's impairment level was compatible with a Class 3 Moderate Impairment, increasing the NEL award to 20%.

Furthermore, the Officer determined that the worker's pre-existing depression was well-controlled prior to the accident and of minor medical significance, meaning no reduction should be applied to the NEL award.

The worker's objection was allowed.

The worker objected to a Case Manager's decision granting retroactive partial loss of earnings (LOE) benefits based on a determined suitable occupation.

The worker sought full LOE benefits from the date of injury until he returned to work with a different employer.

The Appeals Resolution Officer found that the worker was initially totally disabled and later partially disabled, but the employer did not offer suitable modified work.

Because the worker made reasonable efforts to mitigate his wage loss by seeking employment and engaging in health care treatment, he was entitled to full LOE benefits.

However, benefits were limited to January 14, 2014, as there was no medical evidence of ongoing impairment beyond that date.

The objection was allowed in part.