OWSIB 2019

The worker appealed a decision denying loss of earnings (LOE) benefits for two days following a workplace back injury.

The Appeals Resolution Officer found that the initial medical report indicated the worker had full functional abilities and recommended over-the-counter pain medication.

A subsequent letter from the worker's family doctor, written three months later, was given little weight as it was based on self-reporting rather than a contemporaneous clinical examination.

The appeal was dismissed.

The worker appealed a case manager's decision denying entitlement for chronic mental stress (CMS).

The worker claimed CMS resulting from a company restructuring that changed her position to a bargaining unit role, requiring her to reapply for her job and causing significant uncertainty.

The Appeals Resolution Officer denied the appeal, finding that under WSIB Policy 15-03-14, workers are not entitled to CMS benefits for stress caused by an employer's decisions or actions relating to employment, including changes to work or working conditions.

There was no evidence of workplace harassment or a substantial work-related stressor beyond the normal pressures of a company restructuring.

The employer appealed several decisions of the Case Manager allowing the worker's claims for initial entitlement, a recurrence of a left shoulder injury, loss of earnings benefits, surgery, and a graduated return to work following a motor vehicle accident.

The worker, a Registered Practical Nurse, sustained neck and left shoulder injuries when she rear-ended another vehicle while driving between clients.

The Appeals Resolution Officer found that the clinical evidence supported the continuity of the worker's symptoms and the development of post-traumatic adhesive capsulitis from the initial injury.

The employer's objections were denied, and all decisions granting entitlement and benefits to the worker were confirmed.

The worker appealed a Case Manager's decision denying entitlement for Traumatic Mental Stress (TMS) and Chronic Mental Stress (CMS).

The worker alleged she developed mental stress injuries due to an incident with a hockey user-group in January 2002, as well as ongoing sexual and physical harassment by co-workers and management.

The Appeals Resolution Officer found that the 2002 incident did not meet the criteria for TMS, as it did not involve physical violence or life-threatening circumstances, and was not the predominant cause of a diagnosed mental stress injury.

Regarding CMS, the Officer found insufficient corroborating evidence of the alleged harassment, noting instead that the worker had a pattern of instigating interpersonal conflicts.

The employer's actions in response to the worker's complaints were deemed reasonable employment decisions.

The appeal was dismissed.

The worker, a carpenter and business owner, appealed the denial of initial entitlement for a low back and left hip injury allegedly sustained while lifting heavy beams at work.

The Appeals Resolution Officer found that the incidents constituted an unexpected result disablement rather than a chance event.

However, the appeal was dismissed because there was a pronounced delay of approximately three months in seeking medical attention, failing to establish proof of accident.

Furthermore, clinical compatibility was not established, as there were insufficient clinical findings to causally link the L5-S1 herniation to the workplace incidents.

The worker, a special needs assistant, suffered a compensable left ankle injury shortly before the annual summer school break.

She was fit for modified work, but the employer could not accommodate her, so she received full loss of earnings (LOE) benefits until the summer break began.

The Case Manager denied LOE benefits during the summer break, finding the wage loss was due to the seasonal layoff rather than the injury.

The worker appealed, arguing that under WSIB Operational Policy 15-06-02, her LOE benefits should have continued during the temporary work disruption.

The Appeals Resolution Officer dismissed the appeal, concluding that the worker did not intend to work during the summer break and historically collected employment insurance.

Paying LOE benefits during the seasonal layoff would place her in a better position than if she had not been injured.

The worker objected to a decision denying initial entitlement for mental stress as both Chronic Mental Stress (CMS) and Traumatic Mental Stress (TMS).

The worker alleged she suffered mental stress after a visiting officer whispered an inappropriate sexual comment to her, and the employer subsequently extended the officer's contract.

The Appeals Resolution Officer found that while the comment was inappropriate and unwelcome, it was not objectively traumatic and did not meet the policy definition of workplace harassment.

Furthermore, the employer's actions in managing the situation were part of the employment function and were not egregious or abusive.

The objection was denied.

The worker, a roofer who sustained a fractured left leg after falling from a ladder in 2006, appealed a Case Manager's decision denying entitlement for numerous additional injuries (including neck, shoulders, back, hands, and head/brain).

The Appeals Resolution Officer reviewed the medical evidence and found significant delays in the reporting of these additional symptoms, ranging from nearly two to ten years post-accident.

Applying the five-point check system under Policy 11-01-01, the Officer concluded there was no compatibility of diagnosis to the original accident for the newly claimed areas.

The worker's objection was denied.

The employer objected to the Eligibility Adjudicator's decisions granting the worker initial entitlement for bilateral carpal tunnel syndrome, left forearm tendonitis, and bilateral deQuervain's tenosynovitis, along with 12 weeks of loss of earnings (LOE) benefits.

The worker, a food order selector, developed the conditions after performing repetitive and forceful hand movements during 12-hour shifts.

The Appeals Resolution Officer found that the worker's job duties significantly contributed to his injuries and confirmed the date of injury as June 19, 2015.

The employer's objection was denied, and the worker's entitlement to benefits was upheld.

The worker, a warehouse associate, claimed WSIB benefits for trachomatous conjunctivitis and dry eyes, alleging the condition was caused by his shift schedule, blinking LED lights, and the dry, humid environment of the warehouse.

The Eligibility Adjudicator denied initial entitlement.

The Appeals Resolution Officer dismissed the worker's appeal, finding no objective medical evidence or information to support a work-related cause for the diagnosed condition, and therefore no compatibility between the diagnosis and the disablement history.

The worker, a personal support worker, appealed the denial of entitlement for traumatic mental stress (TMS) and chronic mental stress (CMS) following an alleged incident where an administrator waved a knife at her.

The Appeals Resolution Officer found insufficient evidence to corroborate the worker's account of the knife incident or any workplace harassment.

The evidence indicated the worker was disciplined for excessive absences and insubordination, which are employment functions and not substantial work-related stressors.

The appeal was denied.

The worker appealed a decision denying entitlement to the reimbursement of costs for medical cannabis to treat his compensable Post-Traumatic Stress Disorder (PTSD).

The Appeals Resolution Officer found that the worker was not severely impaired as defined by policy, and that there was insufficient reliable medical or scientific evidence demonstrating the effectiveness of cannabis for treating PTSD.

The worker's objection was denied.

The worker appealed a Case Manager's decision denying entitlement to psychotraumatic disability related to a 1993 compensable back injury.

The Appeals Resolution Officer found that the worker's depression manifested within five years of the injury and was related to the extended disablement, satisfying the criteria under Operational Policy 15-04-02.

The appeal was allowed, granting entitlement to psychotraumatic disability, but the Officer found the condition resolved in 1997 and referred the issue of subsequent recurrences back to the Operating Area.

The worker appealed decisions regarding her loss of earnings (LOE) benefits, the suitability of a Labour Market Re-Entry (LMR) plan for a Retail Sales Clerk, and the denial of Chronic Pain Disability (CPD) entitlement following a 2003 bilateral elbow fracture injury.

The Appeals Resolution Officer denied the CPD entitlement, finding the pain was consistent with the organic injury (bilateral lateral epicondylitis).

The ARO also found the worker was partially disabled and that the Retail Sales Clerk role was suitable.

However, the ARO allowed the appeal in part regarding the LOE benefits, finding that the benefits should be based on entry-level wages ($9.50 per hour) rather than the wages of an experienced worker, given the worker's personal and vocational characteristics and the short time between the LMR plan closure and the final review.

The worker appealed a decision denying initial entitlement for a right shoulder injury.

The worker claimed he sustained a new tear to his right shoulder while pulling chains at work, following a return to modified duties after a non-compensable shoulder surgery.

The Appeals Resolution Officer found that the worker's testimony regarding the specific incident was inconsistent and not supported by medical reporting.

The medical evidence indicated the worker's ongoing shoulder problems were likely a continuation of his pre-existing condition due to non-compliance with post-operative restrictions.

The appeal was denied as the worker failed to establish proof of accident and compatibility of diagnosis.

The worker appealed decisions granting a 20% Non-Economic Loss (NEL) award for Chronic Pain Disability (CPD) and reducing his Loss of Earning (LOE) benefits based on a finding that he was uncooperative in a Work-Transition assessment.

The Appeals Resolution Officer found that the worker's presentation, which had been interpreted by some assessors as malingering, was culturally based and consistent with his CPD and lack of education.

The Officer increased the NEL award to 35% to reflect a mid-range Class 3 impairment and concluded that the worker was unemployable, restoring full LOE benefits to age 65.

The worker appealed a decision denying initial entitlement for a C7-T1 disc herniation and subsequent surgery, which he claimed resulted from a 2010 workplace fall from an ambulance roof.

The Appeals Resolution Officer found that the worker had a significant pre-existing cervical spine condition and had not reported neck symptoms or sought medical attention for his neck for over a year following the accident.

Given the lack of continuity of complaint and a significant intervening event at a new job, the tribunal concluded the disc herniation was not related to the 2010 workplace accident.

The appeal was dismissed.

The worker appealed a Case Manager's decision denying loss of earnings (LOE) benefits from October 16, 2018 onwards for a lower back injury.

The worker argued that the modified work offered by the employer was not suitable and aggravated his injury.

The Appeals Resolution Officer reviewed the medical evidence, including a Functional Abilities Evaluation, and determined that the modified quality control work offered by the employer was safe, productive, and within the worker's functional abilities.

Consequently, the worker was not totally disabled and was not entitled to LOE benefits.

The appeal was denied.

The worker, a correctional officer, appealed the denial of initial entitlement for a mental stress injury, claiming Chronic Mental Stress (CMS) and Posttraumatic Stress Disorder (PTSD) resulting from workplace harassment and bullying.

The Appeals Resolution Officer denied the appeal.

Entitlement for CMS was denied because the worker's symptoms pre-dated the transitional provision period and the alleged interpersonal conflicts did not meet the threshold of a substantial work-related stressor or workplace harassment.

Presumptive entitlement for PTSD was rebutted because the worker attributed her condition to workplace harassment and employment functions rather than traumatic employment exposures, and significant non-work-related stressors were present.

The worker, a housekeeper, suffered seizures and was diagnosed with a conversion disorder following a verbal and physical confrontation with her supervisor regarding room assignments.

The worker sought entitlement for Traumatic Mental Stress (TMS) and Chronic Mental Stress (CMS).

The Appeals Resolution Officer found that while the incident was not an 'objectively traumatic' event required for TMS, the supervisor's aggressive behaviour—including pulling a duvet from the worker and cornering her in a washroom—constituted workplace harassment and a substantial work-related stressor.

As the medical evidence confirmed the incident was the predominant cause of the worker's conversion disorder, initial entitlement for CMS was granted.