WORKPLACE SAFETY AND INSURANCE BOARD
APPEALS RESOLUTION OFFICER DECISION
DECISION NUMBER: 20190102
OBJECTING PARTY: Worker
REPRESENTED by: Worker Representative
RESPONDENT: Employer
HEARING: Hearing in Writing
HEARD by: H. Shaw, Appeals Resolution Officer
DATED: May 22, 2019
ISSUE
The worker is objecting to the denial of loss of earnings (LOE) benefits for May 19 & 20, 2018, in the Case Manager decision of June 7, 2018.
BACKGROUND
The worker worked at a dryer stacker for a forest products manufacturer. On May 18, 2018, she was picking up debris from under the hoist of the dryer and sustained an abrasion/contusion of her middle back when she bumped her back on a frame. She was 24 years old at the date of the injury. She sought medical attention on May 19, 2018 at a hospital emergency.
She missed scheduled shifts on May 19 & 20, 2018. She was not scheduled to work on May 21 & 22, 2018. She returned to work on regular duties on May 23, 2018.
In the decision of June 7, 2018, LOE benefits were denied because the clinical evidence did not support she was unable to work.
AUTHORITY
Operational Policy
18-03-02 Payment and Reviewing LOE Benefits (Prior to Final Review)
ANALYSIS
I have considered all of the available information, legislation and relevant operational policies in reaching this decision and find LOE benefits are not in order. My reasons are explained below.
According to Operational Policy 18-03-02, if the nature or seriousness of the injury completely prevents a worker from returning to any type of work, or if she is able to return to some form of work but the WSIB determines no suitable work is available, the worker is generally entitled to full LOE benefits providing she co-operates in health care measures and all aspects of the work reintegration process.
The worker representative provided an Appeal Readiness Form dated January 10, 2019, relying on a letter from the worker’s doctor to support LOE benefits for the requested lost time.
The employer provided a Respondent Form dated April 11, 2019. No new evidence or submissions were provided.
Based on the medical evidence, I find the injury did not prevent the worker from returning to work on May 19, 2018. The Health Professional’s Report (Form 8) completed by the hospital on May 19, 2018 diagnosed an abrasion/contusion of the middle back. The recommended treatment was Tylenol and Advil. Although the report recommended a return to regular duties on May 23, 2018, it failed to explain why time off work was required, noting it also indicated the worker had full functional abilities. The hand written emergency record from the hospital is illegible and does not provide any additional information.
The worker’s family doctor provided a letter dated August 15, 2018, supporting the lost time from work. The letter indicated it was being written at the request of the patient. The letter documented the history of the injury and suggested the Form 8 was mistaken in indicating the worker had full functional abilities, as the worker was clearly unable to climb, lift or operate heavy equipment.
I have considered the contents of the letter from the family doctor, but I am unable to give it significant weight. It was written almost three months after the injury occurred, at the request of the worker, to support her claim for LOE benefits. There is no information in the report to indicate the doctor had seen her at or near the day of the injury. Noting this evidence, the family doctor’s opinion was not based on a clinical examination of the worker at or near the time of the injury and was instead based on the worker’s self-reporting of her symptoms almost three months later. For that reason, I accept the findings contained in the Form 8, completed the day after the injury, which indicated the worker had full functional abilities.
Noting the absence of objective clinical evidence to explain why the worker was unable to work her regular job duties following the injury, I find LOE benefits are not in order.
CONCLUSION
I conclude there is no entitlement to LOE benefits for time lost from work in May 2018.
The worker’s objection is denied.
DATED: May 22, 2019
H. Shaw
Appeals Resolution Officer
Appeals Services Division