OWSIB 2021

The worker appealed decisions denying entitlement for Traumatic Mental Stress (TMS), Chronic Mental Stress (CMS), and reimbursement for psychiatric medical reports.

The worker developed posttraumatic stress disorder (PTSD) after a co-worker yelled, swore, and acted aggressively towards them in October 2014.

The Appeals Resolution Officer denied the TMS claim, finding the events did not involve physical violence or threats of physical violence and were not objectively traumatic.

However, the CMS claim was allowed, as the co-worker's egregious conduct constituted workplace harassment and was a substantial work-related stressor that predominantly caused the worker's PTSD.

The worker was also granted reimbursement for one of the two requested psychiatric reports.

The employer objected to a decision granting the worker initial entitlement for a work-related COVID-19 infection.

The worker had interacted indoors with a COVID-19 positive co-worker on three occasions.

The employer argued that transmission was more likely community-acquired due to stringent workplace safety measures.

The Appeals Resolution Officer found that the workplace exposure was more likely than not the source of the infection, noting the absence of non-occupational exposure.

The employer's objection was denied.

The worker appealed a Case Manager's decision determining that the suitable occupation of Retail Salesperson was appropriate following a workplace injury.

The worker argued that their complete restrictions were not appropriately considered and that no suitable occupation was appropriate, or alternatively, that they were only capable of working 12 hours per week.

The Appeals Resolution Officer found that the occupation of Retail Salesperson was physically suitable and aligned with the worker's transferable skills and labour market availability.

However, based on medical recommendations, the worker's capacity was limited to part-time hours.

The appeal was allowed in part, confirming the suitable occupation but limiting it to 12 hours per week.

The worker, a school bus driver, suffered injuries after hitting a pothole and from repetitive job duties.

She was awarded a 36% Non-Economic Loss (NEL) benefit, which was subsequently reduced by 50% due to a pre-existing condition.

The worker appealed the apportionment.

The Appeals Resolution Officer found that the medical evidence did not support a major pre-existing condition, such as fibromyalgia, prior to the workplace injury.

The degenerative findings were deemed minor and asymptomatic before the accident.

Therefore, in accordance with WSIB policy, the minor pre-existing condition did not warrant a reduction of the NEL benefit.

The worker's appeal was allowed, and the full 36% NEL quantum was reinstated.

The worker appealed decisions regarding the calculation of her loss of earnings (LOE) benefits, her non-economic loss (NEL) quantum, and entitlement to psychotraumatic disability benefits following a workplace slip and fall.

The Appeals Resolution Officer found that the short-term average earnings were calculated correctly based on concurrent employment.

However, the worker was granted entitlement to benefits for major depressive disorder, as the medical evidence supported that her psychological condition resulted from her severe physical impairment.

Furthermore, the pre-injury job with accommodation was deemed unsuitable, entitling the worker to full LOE benefits for the period she was unable to work.

The worker appealed a decision denying entitlement to WSIB benefits for an adverse reaction to a COVID-19 vaccination.

The worker argued that they believed the vaccination was mandatory because the appointment was scheduled through the employer.

The Appeals Resolution Officer found that the employer did not mandate the vaccine or use coercion to require it.

Applying Operational Policy 15-04-10, the Officer concluded that the vaccination was not a compulsory immunization procedure.

The worker's objection was denied and entitlement to benefits was refused.

The worker, a former flight attendant, appealed a decision denying initial entitlement for Noise Induced Hearing Loss (NIHL).

The worker claimed exposure to excessive noise for 38 years.

The Appeals Resolution Officer found that while the worker met the basic eligibility criteria for noise exposure (at least 88 dBA for 38 years), their hearing loss values did not meet the basic eligibility criteria for entitlement.

Operational policy requires a hearing loss of at least 22.5 dB in each ear, but the worker's left ear hearing loss was only 21.25 dB.

The appeal was dismissed.

The worker appealed a decision denying their claim for benefits for a lower back injury on the basis that it was not reported within the six-month time limit.

The Appeals Resolution Officer found that because the injury was a gradual onset disablement, the six-month deadline began from the date the worker reported the disablement as work-related.

The worker first reported the injury to the WSIB on October 29, 2018, which was within the requisite timeframe.

The worker's objection was allowed, and the time limit was met.

The worker suffered a compensable low back injury in 2011, which required multiple surgeries and the implantation of a spinal cord stimulator.

The worker subsequently sought entitlement for a psychotraumatic disability, which was denied by the Case Manager.

On appeal, the Appeals Resolution Officer found that the worker's pre-existing anxiety disorder was exacerbated by the physical impairment, chronic pain, and socioeconomic factors resulting from the workplace injury.

The appeal was allowed, granting the worker entitlement to a psychotraumatic disability and a non-economic loss (NEL) determination.

The worker appealed a Case Manager's decision denying entitlement to a permanent impairment for narcotic dependence and finding the suitable occupation of Library, Correspondence and Related Information Clerks remained suitable.

The Appeals Resolution Officer found that the worker had successfully weaned off narcotics and achieved maximum medical recovery without a residual permanent impairment for narcotic dependence.

As no permanent impairment was established, the ARO had no jurisdiction to reconsider the suitability of the occupation.

The appeal was denied.

The worker, who had a recognized permanent impairment for reactive airways dysfunction syndrome (RADS), removed himself from his modified hospital housekeeping duties in March 2020 due to fears of contracting COVID-19.

He sought full loss of earnings (LOE) benefits for the period he was off work.

The Appeals Resolution Officer denied the appeal, finding that the hospital remained a safe workplace under the Occupational Health and Safety Act and had implemented appropriate COVID-19 protocols.

Because a suitable occupation remained available to the worker at a wage loss, his full wage loss was not solely caused by his work-related impairment, precluding entitlement to full LOE benefits.

The worker appealed a decision denying entitlement for basal cell carcinoma (BCC) allegedly caused by occupational exposure to mineral oil between 1969 and 1973.

The Appeals Resolution Officer found that while the worker was exposed to mineral oil and BCC is a Schedule 3 occupational disease, the statutory presumption was rebutted.

Medical evidence, including a surgical pathology report and an occupational medical consultant's opinion, established that the worker's significant sun exposure from decades of outdoor construction work was the main cause of the skin cancer.

The appeal was denied.

The worker's estate appealed two Case Manager decisions denying entitlement for chronic pain disability and loss of earnings (LOE) benefits after a permanent work disruption.

The worker had sustained multiple fractures after falling from scaffolding in 2012 and later developed chronic pain.

The Appeals Resolution Officer denied the chronic pain disability claim, finding that the worker's degree of pain was consistent with his organic findings, failing to meet the policy criteria.

However, the Officer allowed the appeal regarding LOE benefits, finding that the worker was entitled to partial LOE benefits following his permanent layoff in December 2015, as his compensable injuries partially contributed to his wage loss.

The appeal was allowed in part.

The worker, a former police officer who developed PTSD after an accidental firearm discharge and an undercover operation, appealed a Case Manager's decision calculating his partial loss of earnings benefit based on a 40-hour work week.

The Case Manager had determined the worker was voluntarily underemployed as a Farm Manager.

The Appeals Resolution Officer allowed the appeal, finding that medical evidence confirmed the worker was permanently restricted from full-time employment due to his PTSD symptoms.

The Officer rejected the employer's argument that the worker was voluntarily underemployed due to operating a personal hobby farm, and ordered the benefit to be based on the worker's actual average of 25 hours per week.

The worker, a partner in a construction business, suffered fatal injuries while clearing trees on a property purchased by the partnership for a townhouse development.

The WSIB initially denied entitlement, concluding the worker was performing a personal task on his own property.

The estate objected.

The Appeals Resolution Officer allowed the appeal, finding that the property was purchased for a business endeavor and the tree clearing was performed in the course of employment.

The presumption under s. 13(2) of the WSIA applied, and initial entitlement was granted.

The worker, a police officer, appealed a decision denying initial entitlement for a heart condition (myocardial infarction) allegedly caused by acute emotional stress from an internal investigation.

The Appeals Resolution Officer found that the stress did not meet the policy criteria for 'acute emotional stress' because the investigation was ongoing and not a sudden, unexpected event.

Furthermore, medical evidence showed the worker had experienced similar cardiac symptoms weeks prior to the specific meeting in question.

The appeal was dismissed.

The employer appealed the Eligibility Adjudicator's decision allowing initial entitlement for COVID-19, arguing the worker likely contracted the virus while on vacation.

The worker appealed the Occupational Disease Adjudicator's decision denying ongoing loss of earnings (LOE) benefits as of July 20, 2020.

The Appeals Resolution Officer found that the worker's employment at a long-term care facility created an elevated risk of contracting COVID-19 and that the worker was exposed to a positive resident, establishing initial entitlement.

However, the Officer denied the worker's appeal for ongoing LOE benefits, finding that as of July 20, 2020, the worker was only partially impaired and fit to perform the suitable modified duties offered by the employer.

Both objections were denied.

The employer objected to an Eligibility Adjudicator's decision allowing a dietary aide's claim for initial entitlement to COVID-19.

The worker tested positive during workplace surveillance testing at a long-term care facility.

The employer argued the positive test was a false positive and that the worker was not exposed at work.

The Appeals Resolution Officer found that the worker's employment created an elevated risk of contracting COVID-19 and that he had been working in the kitchen during the incubation period with a co-worker who had tested positive.

The employer's objection was denied, and initial entitlement to COVID-19 was upheld.

The employer objected to the Eligibility Adjudicator's decision granting the worker initial entitlement for COVID-19.

The worker, a warehouse package handler and driver, tested positive for COVID-19.

The employer argued the worker's exposure was not higher than the general public's and noted a lack of medical documentation.

The Appeals Resolution Officer found that multiple COVID-19 cases at the worksite and the worker's limited community exposure made it more probable than not that the infection was work-related.

The lack of formal medical evidence was deemed acceptable given public health guidance at the time.

The employer's objection was denied.

The worker appealed a decision denying initial entitlement to health care benefits and loss of earnings (LOE) benefits for a foreign body in his left eye.

The Appeals Resolution Officer found that the worker suffered a gradual onset disablement injury caused by his workplace duties as a framer/labourer, granting initial entitlement for health care benefits.

However, the claim for LOE benefits was denied because the medical evidence did not support total disability and the employer had offered suitable modified duties within the worker's functional abilities.

The appeal was allowed in part.