OWSIB 2023

The worker objected to a Case Manager's decision denying entitlement to benefits for a psychotraumatic disability following a 2018 workplace accident where she sustained soft tissue injuries.

The Appeals Resolution Officer found that the worker did not meet any of the three circumstances outlined in WSIB Policy 15-04-02.

The evidence did not establish that the psychological condition was an indirect result of the physical injury or related to an extended disablement, as the worker reached maximum medical recovery with no ongoing impairment shortly after the accident.

The worker's objection was denied.

The worker appealed a Case Manager's decision offsetting 100% of their CPP disability benefits from their loss of earnings (LOE) benefits, and a NEL Clinical Specialist's decision rating their non-economic loss (NEL) benefit for psychotraumatic disability at 25%.

The Appeals Resolution Officer allowed the appeal in part.

The officer found that the CPP disability benefits were granted for both work-related and non-work-related injuries, and reduced the offset to 67% to account for the non-compensable injuries.

The officer confirmed the 25% NEL rating for psychotraumatic disability, finding that the worker's impairment fell within the lower range of a Class 3 impairment under the AMA Guides and WSIB policy.

The worker suffered a compensable right foot sprain (turf toe) and was prescribed custom-made orthotics by a chiropodist.

The WSIB initially denied entitlement on the basis that orthotics are only funded for specific deformities.

The Appeals Resolution Officer allowed the worker's appeal, finding that the orthotics were necessary, appropriate, and sufficient for the compensable injury, even if they also addressed non-compensable conditions like flat feet.

The worker was granted entitlement to a one-time purchase of the orthotics, provided they were purchased prior to reaching maximum medical recovery.

The worker objected to a WSIB decision denying partial loss of earnings (LOE) benefits from July 7, 2021, to September 29, 2021, and confirming they reached maximum medical recovery (MMR) for a COVID-19 infection on July 6, 2021, with no permanent impairment.

The Appeals Resolution Officer found that the worker had continued to work modified hours as directed by the Return-to-Work Specialist pending an entitlement decision regarding a shoulder injury.

The worker gradually increased their hours and resumed full regular duties on October 3, 2021.

The Officer concluded the worker was entitled to partial LOE benefits for the disputed period and determined that MMR was reached on October 3, 2021, with no evidence of a permanent impairment.

The worker's objection was allowed in part.

The worker appealed the denial of initial entitlement for sarcoidosis, arguing the condition arose from environmental workplace exposures to chemicals, dust, bacteria, viruses, spores, and mold during her 13 years as a Medical Instrument Technician.

The Appeals Resolution Officer reviewed the medical and scientific evidence, including an Occupational Policy Branch scientific review, which concluded that the etiology of sarcoidosis remains unknown and there is inadequate evidence linking it to the worker's specific occupational exposures.

Finding that the workplace exposures were not a significant contributing factor to the development of the disease, the appeal was dismissed.

The worker appealed an adjudicator's decision denying initial entitlement for lung cancer claimed to be related to occupational exposures in the manufacturing industry and as a volunteer firefighter.

The Appeals Resolution Officer found that while the worker did not meet the presumptive criteria for firefighters due to their smoking history, the claim succeeded on its individual merits.

The evidence established that the worker's routine exposure to various known carcinogens, including asbestos, silica, and heavy metals, over a 40-year period was a significant contributing factor to the development of their lung cancer, alongside their smoking history.

The appeal was allowed.

The worker objected to a 2007 decision by a claims adjudicator that determined the suitable employment or business categories for their labour market re-entry (LMR) plan were Customer Service in Retail Establishment and Administrative Support Clerk.

The worker argued that non-occupational injuries and conditions were not considered when they were referred for the LMR plan.

The Appeals Resolution Officer denied the objection, finding that the contemporaneous evidence from 2007 did not support that the worker required limitations for their non-occupational conditions or that these conditions rendered them incapable of participating in LMR services.

The LMR plan was deemed suitable and appropriate based on the worker's functional abilities known at the time.

The worker, a communications operator, suffered a work-related mental stress injury (PTSD) in August 2019 and received loss of earnings (LOE) benefits.

After participating in a graduated return to work plan, the worker stopped working in October 2022 due to a deterioration in psychological symptoms.

The Case Manager denied entitlement to a recurrence of the work-related PTSD and LOE benefits, finding the deterioration was caused by significant non-work-related life stressors.

The worker objected to this decision and a subsequent decision denying partial LOE benefits during a March 2023 return to work plan.

The Appeals Resolution Officer dismissed the appeal, concluding that the worker's significant deterioration was due to a confluence of non-work-related life stressors, which equated to a significant new incident, and therefore the worker was not entitled to LOE benefits for a recurrence or partial LOE benefits during the subsequent return to work plan.

The estate of a deceased worker appealed a decision denying entitlement for colon cancer allegedly caused by workplace exposures to methyl ethyl ketone (MEK), creosote (PCBs), and ammonia.

The Appeals Resolution Officer found that, based on the Occupational Medical Consultant's review and the International Agency for Research on Cancer (IARC) classifications, there was no epidemiological link between the claimed agents and the development of colon cancer.

The appeal was dismissed.

The worker suffered a compensable right foot sprain and was prescribed custom-made orthotics.

The Nurse Consultant denied entitlement on the basis that orthotics are only funded for specific deformities.

The Appeals Resolution Officer allowed the worker's objection, finding that the orthotics were necessary, appropriate, and sufficient for the compensable injury, even if they also addressed non-compensable conditions.

The worker was granted entitlement to a one-time purchase of custom-made orthotics, provided they were purchased prior to reaching maximum medical recovery.

The worker, a front-line police officer, appealed a decision denying entitlement for an adverse reaction (EGPA) stemming from an employer-arranged COVID-19 vaccination.

The Appeals Resolution Officer found that although the vaccine was not strictly mandatory at the time, the employer strongly encouraged it, arranged the clinic during work hours, and imposed negative consequences for non-compliance.

The tribunal concluded the vaccination was an activity incidental to employment and granted initial entitlement for the adverse reaction.

The worker appealed a case manager's decision denying entitlement to traumatic mental stress and chronic mental stress benefits because the claim was filed outside the time limit.

The worker experienced a traumatic workplace incident in March 2016 but did not file a claim until October 2021.

The Appeals Resolution Officer found that the transitional provisions for mental stress policies required claims to be filed on or before July 1, 2018, and unlike general time limit policies, these transitional provisions do not contain discretionary authority to extend the deadline.

The appeal was denied.

The worker appealed the denial of loss of earnings (LOE) benefits following an accepted recurrence of a compensable low back injury.

The worker argued they experienced a significant deterioration in June 2021 that prevented them from working.

The Appeals Resolution Officer found that the medical evidence did not support a significant deterioration in June 2021, but did support a significant deterioration as of May 19, 2022, when the worker's family doctor reported moderately decreased range of motion.

The worker was found to be totally disabled from that date.

The appeal was allowed in part, granting full LOE benefits from May 19, 2022, ongoing.

The employer objected to a Case Manager's decision that the worker reached maximum medical recovery (MMR) by December 16, 2022, with a permanent low back impairment.

The worker, a personal support worker, suffered a low back strain and exacerbation of pre-existing spondylolisthesis after assisting a patient.

The Appeals Resolution Officer reviewed the medical evidence, including reports from a specialty clinic, and found that the worker had reached a plateau in recovery with no further significant improvement likely.

The Officer concluded that the worker continued to have an ongoing work-related impairment at the time of MMR, confirming the permanent impairment.

The employer's objection was denied.

The worker, a courier driver, suffered a compensable right eye and facial injury when struck by a truck door handle.

The worker objected to WSIB decisions denying entitlement for secondary eye conditions, setting the maximum medical recovery (MMR) date at October 1, 2022, and denying loss of earnings (LOE) benefits after September 13, 2022.

The Appeals Resolution Officer denied entitlement for the secondary eye conditions, finding them incompatible with the mechanism of injury.

However, the Officer varied the MMR date to February 21, 2023, based on specialist reports, and granted full or partial LOE benefits up to that date, pending confirmation of the worker's return-to-work hours and wages.

The worker appealed a Case Manager's decision that concluded they had reached maximum medical recovery for a right elbow biceps tendon insertion strain with no evidence of a permanent impairment.

The Appeals Resolution Officer found that the worker did have a permanent impairment, relying on a discharge report that documented permanent functional restrictions despite normal ranges of motion.

The matter was remitted to determine the degree of impairment using the RSI Rating Schedule.

The worker objected to a Case Manager's decision denying loss of earnings (LOE) benefits from May 7, 2019.

The worker had suffered a compensable right knee injury and returned to suitable modified work.

In April 2019, the worker took an extended unapproved vacation and failed to return to work on the agreed date, resulting in termination for job abandonment.

The Appeals Resolution Officer found that the worker's wage loss after May 7, 2019, was not the result of the work-related injury, but rather the result of employment termination unrelated to the injury.

The worker's objection was denied.

The employer appealed a decision granting the worker secondary entitlement for an infected burn on the left upper thigh and loss of earnings benefits.

The worker sustained a work-related thermal burn which subsequently became infected, causing the worker to miss work.

The employer argued the infection developed outside of work hours and was not work-related.

The Appeals Resolution Officer denied the employer's appeal, finding that the infection was causally linked to the work-related burn injury, as the worker would not have been subject to the risk of infection but for the initial work-related wound.

The worker, a child welfare support services worker, appealed a Case Manager's decision denying entitlement for Traumatic Mental Stress and Chronic Mental Stress.

The worker experienced multiple traumatic events during their employment, including being threatened with a knife by a youth in May 2021 and encountering another severely unwell youth in May 2022.

The Appeals Resolution Officer found that the May 2021 incident was objectively traumatic and significantly contributed to the worker's diagnosed PTSD.

The appeal was allowed for Traumatic Mental Stress, with the date of injury established as June 3, 2022, when the worker first sought medical attention.

The worker, a personal support worker, appealed the denial of initial entitlement for a low back injury after slipping and falling on hand sanitizer at work.

The eligibility adjudicator had denied the claim, finding the injury was not compatible with the mechanism of injury due to a pre-existing condition.

The Appeals Resolution Officer allowed the appeal, finding that the fall was a significant contributing factor to the exacerbation of the worker's pre-existing severe L4-L5 focal stenosis and cauda equina.

Initial entitlement, entitlement to surgery, entitlement for a secondary CSF leak, and loss of earnings benefits were granted.