OWSIB 2023

The worker appealed a Case Manager's decision denying loss of earnings (LOE) benefits from November 15, 2019, to February 8, 2022.

The worker had suffered a compensable left elbow injury and was unable to return to his pre-injury heavy manual labour duties.

The Appeals Resolution Officer found that the worker made reasonable efforts to mitigate his wage loss by seeking retraining, attending school for Business Finance, and securing suitable employment that accommodated his permanent restrictions.

The appeal was allowed in part, granting the worker full LOE benefits for the period in question, less actual earnings received from three new jobs during that time.

The worker objected to a Case Manager's decision denying entitlement to a recurrence of work-related forehead, neck, and trapezius injuries originally sustained in 2014 when struck by a jig.

The worker sought benefits for neck and shoulder symptoms reported in 2019 and 2020.

The Appeals Resolution Officer found that the original injuries had resolved and that the new diagnoses of rotator cuff pathology, tendinosis, and lateral epicondylitis were not clinically compatible with the original soft tissue injuries.

The appeal was dismissed, and entitlement to a recurrence was denied.

The worker objected to a decision denying initial entitlement to benefits for injuries sustained when they were pushed to the ground by a lead hand during a dispute over work quality.

The initial decision found the worker was the aggressor because they threw their gloves on the ground.

The Appeals Resolution Officer allowed the objection, finding that throwing gloves to the ground in frustration was not an act of physical aggression that a reasonable person would interpret as a threat.

Therefore, the worker was not the aggressor, did not remove themselves from the course of employment, and is entitled to health care benefits for their injuries.

The worker appealed a decision denying secondary entitlement to post-traumatic stress disorder (PTSD) and a recurrence of a work-related psychotraumatic disability following a severe allergic reaction to epoxy at work.

The Appeals Resolution Officer reviewed medical evidence, including a WSIB-sponsored comprehensive assessment from CAMH, which confirmed the PTSD diagnosis and its causal link to the workplace incident.

The appeal was allowed, granting secondary entitlement to PTSD, a recurrence of the mental health condition, and funding for recommended psychological treatment.

A non-economic loss redetermination was deemed premature as the worker had not yet reached maximum medical recovery.

The worker appealed several WSIB decisions regarding his compensable right shoulder injury.

The Appeals Resolution Officer found that the modified duties offered by the employer were not suitable, as they exceeded the worker's restrictions and required him to overcompensate with his left arm.

The worker was granted secondary entitlement for a left shoulder injury and entitlement to a chronic pain disability (CPD).

The officer also restored full loss of earnings (LOE) benefits, finding the worker totally impaired and incapable of participating in the proposed suitable occupation.

Entitlement to a psychotraumatic disability was denied as CPD was granted.

The worker, a personal support worker, appealed a case manager's decision denying entitlement for a right shoulder rotator cuff tear and finding that multiple injuries had fully resolved by January 14, 2022.

The Appeals Resolution Officer allowed the appeal in part, finding that the rotator cuff tear was compatible with the workplace accident where a 200-lb resident fell on the worker.

The Officer also found that while the worker's bruises had resolved by December 2, 2021, maximum medical recovery had not been reached for the right shoulder injury.

The employer objected to an Eligibility Adjudicator's decision granting the worker initial entitlement to benefits for injuries sustained in a slip and fall.

The worker, a crossing guard, fell on an icy municipal sidewalk while walking to a coffee shop during a paid lunch break.

The employer argued the accident did not occur in the course of employment as it happened off-premises.

The Appeals Resolution Officer denied the employer's objection, finding that taking a lunch break is reasonably incidental to work, the worker was still being paid, and the distance travelled was reasonable.

Initial entitlement to benefits was confirmed.

The worker, a scoop tram operator, objected to a decision denying initial entitlement to benefits for a gradual onset bilateral shoulder injury.

The worker argued the injury resulted from the poor ergonomic setup of the scoop tram, which required awkward postures and exposed him to jarring and jostling.

The Appeals Resolution Officer found that the worker's job duties significantly contributed to the bilateral shoulder tears, relying on supportive medical opinions from the worker's health care professionals.

The worker's objection was allowed, and entitlement to benefits was granted.

The employer appealed a decision granting the worker full loss of earnings benefits following a left foot sprain.

The employer argued that it had offered suitable sedentary modified work.

The Appeals Resolution Officer found that although the worker was not totally disabled, the modified work offered was not safe.

The worker required crutches, could not wear proper footwear due to swelling, and would have had to navigate stairs and outdoor winter conditions to access the washroom.

The employer's appeal was dismissed.

The worker appealed multiple Eligibility Adjudicator decisions denying initial entitlement for a left shoulder injury allegedly sustained in 2003 and finding the worker missed the six-month time limit to file a claim.

The Appeals Resolution Officer found exceptional circumstances warranted extending the time limit, as the worker did not understand the requirements.

However, the appeal was denied on the merits because there was insufficient contemporaneous medical evidence to establish that the 2003 workplace incident caused the left shoulder dislocation.

The worker appealed the Eligibility Adjudicator's decision denying initial entitlement for an umbilical hernia.

The worker alleged the hernia was caused by pushing and pulling heavy skids with a manual hand jack at work.

The employer argued the hernia may have been caused by recent weight gain and noted a delay in reporting.

The Appeals Resolution Officer found that the worker met the five-point check system for an allowable claim, noting the diagnosed hernia was compatible with the reported mechanism of injury and there were no non-work activities identified that could have caused it.

The worker's objection was allowed and initial entitlement to an umbilical hernia was granted.

The worker, a police officer, appealed a Case Manager's decision denying entitlement to benefits for Posttraumatic Stress Disorder (PTSD).

The Case Manager had concluded the PTSD was caused by a non-work-related motorcycle accident and personal stressors.

The Appeals Resolution Officer found that the worker's symptoms were linked to attending multiple fatal accidents at work, and that the non-work-related motorcycle accident and alleged hormone issues were not the cause of the mental stress.

The presumption of entitlement for first responders under Policy 15-03-13 was not rebutted.

The worker's objection was allowed, and initial entitlement to PTSD was granted.

The worker suffered a compensable psychological injury after speaking with a suicidal caller.

The case manager determined that the worker had achieved maximum medical recovery by September 2020 with no permanent impairment.

The worker objected, arguing they still required accommodations and suffered from ongoing impairment.

The Appeals Resolution Officer allowed the appeal, finding that the treating psychologist's reports indicated the worker remained at risk for relapses, had ongoing functional impairments, and required further support.

The matter was remitted to the operating area to determine if maximum medical recovery had yet been achieved.

The worker objected to a Case Manager's decision denying ongoing entitlement to chronic mental stress and loss of earnings (LOE) benefits following a workplace harassment incident.

The Appeals Resolution Officer found that the worker had not reached maximum medical recovery by September 2006, but did so by November 2007 with no ongoing compensable impairment.

The Officer also determined that the worker was entitled to full LOE benefits from November 2005 until their return to work in 2006, as they had reasonably co-operated in the return-to-work process.

The objection was allowed in part.

The worker appealed a Case Manager's decision denying a redetermination of their Non-economic Loss (NEL) benefit for a compensable low back injury.

The worker argued that their lumbar spine flexion had deteriorated since the last NEL redetermination in 2006.

The Appeals Resolution Officer found that the slight loss of lateral flexion and the degree of sensory deficit did not constitute a significant and permanent worsening of the work-related impairment under the AMA Guides.

The appeal was dismissed.

The worker suffered a compensable left knee injury and was receiving loss of earnings (LOE) benefits.

The Case Manager suspended the worker's LOE benefits after the worker sustained a fall resulting in a hip replacement, determining this was a non-work-related change in circumstances that prevented participation in health care measures.

The Appeals Resolution Officer allowed the worker's objection, finding that the subsequent fall and hip injury were a direct result of the compensable knee impairment, and therefore the worker was entitled to the reinstatement of LOE benefits.

The employer objected to a Case Manager's decision granting a police officer entitlement to benefits for post-traumatic stress disorder (PTSD) under the first responder presumption in Policy 15-03-13.

The employer argued the claim coincided with disciplinary action and lacked specific dates of traumatic events.

The Appeals Resolution Officer denied the employer's objection, finding the worker met the diagnostic and employment criteria for the presumption.

The evidence of cumulative exposure to traumatic events over a 16-year career was sufficient, and the employer failed to rebut the presumption by showing the PTSD was caused by non-work-related factors or employer decisions.

The worker appealed a Case Manager's decision denying loss of earnings (LOE) benefits from July 19, 2020 onward.

The worker had an accepted low back injury but stopped working in July 2020.

The Appeals Resolution Officer found that the medical evidence demonstrated the worker's absence from work was due to non-compensable psychological issues, not the compensable low back injury.

The employer had been willing and able to accommodate the low back restrictions.

The appeal was dismissed.

The worker, a nurse, appealed a Case Manager's decision denying entitlement to benefits for a mental stress injury.

The worker attributed their psychological condition to cumulative traumatic events experienced during their employment, including witnessing a patient stab themselves and dealing with fatal drug overdoses.

The Appeals Resolution Officer found that while the worker did not meet the criteria for the statutory PTSD presumption due to conflicting diagnoses, the worker was entitled to benefits under the Traumatic Mental Stress policy.

The reported incidents were clearly identifiable, objectively traumatic, arose out of the course of employment, and significantly contributed to the worker's diagnosed trauma and stressor-related disorder.

The appeal was allowed.

The worker appealed a Case Manager's decision denying entitlement to psychotraumatic disability following a workplace accident where a forklift struck a table, causing a bar to hit the worker's right knee.

The worker claimed the accident and resulting pain caused depression and anxiety.

The Appeals Resolution Officer denied the appeal, finding the worker did not meet the criteria under the psychotraumatic disability policy.

The accident was minor, the psychological symptoms arose only after loss of earnings benefits were terminated, and the worker's ongoing psychological issues were primarily related to a pre-existing trauma and a non-compensable back condition.