APPEALS RESOLUTION OFFICER DECISION
DECISION NUMBER:
20250017
OBJECTING PARTY:
WORKER
REPRESENTED by:
WORKER REPRESENTATIVE
RESPONDENT PARTY:
EMPLOYER (NOT PARTICIPATING)
HEARING:
VIDEOCONFERENCE – sEPTEMBER 10, 2024
HEARD by:
Kelly Gordon, appealS resolution officer
September 19, 2024
ISSUE
The worker, through their representative is objecting to the Case Manager’s (CM) decision dated January 18, 2023. Specifically, the denial of the August 2022, mental stress recurrence, and the denial of loss of earnings (LOE) benefits for the worker’s lost time from work starting August 8, 2022.
BACKGROUND
On December 16, 2021, this police victim service coordinator reported a mental stress injury to their employer. The worker related their mental stress condition to their cumulative exposure of traumatic events together with vicarious trauma while supporting victims of crime. The worker sought medical attention with a psychologist, and they were diagnosed with an Adjustment Disorder. On January 28, 2022, the CM accepted entitlement to health care benefits for Traumatic Mental Stress (TMS). Initially, the worker did not lose time from work as the employer provided the worker with alternate work as a fleet coordinator.
In July 2022, the worker was advised that the employer hired someone else to perform the fleet coordinator job on a permanent basis. The worker trained a co-worker in this position for two weeks before starting their two-week vacation. On August 2, 2022, while on vacation, the worker contacted the CM, and advised that their mental health condition deteriorated, and they would be taking additional time off work to focus on treatment. The employer submitted an Employer’s Continuity Report (Form REO7) dated August 8, 2022, confirming the worker stopped working on August 8, 2022.
After obtaining further information from the worker, the employer and Dr. Burger, the worker’s psychologist, the CM issued a decision dated January 18, 2023. In this decision, the CM determined the deterioration in the worker’s mental health condition was due to an employment situation. As such, they denied entitlement to the August 2022, recurrence, and also denied entitlement to LOE benefits for the worker’s lost time from work starting August 8, 2022.
The worker representative submitted the Intent to Object (ITO) Form dated April 18, 2023. The representative included new medical evidence, and they requested a reconsideration of the January 18, 2023, decision. Although the CM considered the new information submitted, they upheld their decision to deny entitlement to the August 2022 recurrence in their reconsideration decision dated May 12, 2023.
The worker representative submitted the Appeal Readiness Form (ARF) dated May 27, 2024, confirming the worker’s objection to the denial of the August 2022, recurrence, and the denial of LOE benefits for the worker’s lost time from work as of August 8, 2022.
The worker’s objection to the denial of the August 2022 recurrence, and the denial of LOE benefits starting August 8, 2022, forms the basis of this appeal.
AUTHORITY
Operational Policy Manual
Published
15-03-02 Traumatic Mental Stress 15-02-05 Recurrences 18-03-02 Payment and Reviewing LOE Benefits (Prior to the Final Review)
February 29, 2024 April 9, 2021 September 1, 2021
ANALYSIS
For the reasons that follow, I find the worker does have entitlement to the August 2022 recurrence. I also find the worker has entitlement to LOE benefits for their lost time from work from August 8, 2022, to the date of this appeal decision. In reaching this decision, I have carefully considered all the available information on file, the worker’s testimony, and the relevant operational policies.
Prior to the start of the appeal hearing, the worker representative confirmed they are requesting entitlement to the August 2022 recurrence as well as entitlement to full LOE benefits from August 8, 2022, and ongoing.
The employer is not participating in this appeal, and no submissions have been provided for my review.
During the hearing, the worker testified that they have worked as a police victim services co-ordinator for the police department for 11 years. The worker confirmed they work as a civilian, as they are not a police officer. Part of their job involves being called to the scene of the incident to provide assistance to the victim. While at the scene, the worker is witness to the aftermath of the traumatic incident. The worker is called to the scene of incident at least two times per month, and sometimes they would provide victim support to the same person for five to six years.
The worker testified that the employer has implemented a peer support program with yearly psychological wellness assessments as their job is high risk for mental health issues. The wellness assessment results either allow the workers to continue with their job duties, or they are flagged. In the worker’s case, they did not pass the 2021 psychological wellness assessment. At the time of the assessment, the worker noticed they were developing psychological problems. The worker was starting to avoid co-workers at work, they were making mistakes, and started disassociating themselves. Sometimes as they were driving somewhere for work, they saw dead people driving cars beside them.
The worker testified that since they did not pass their 2021 wellness assessment, the employer advised the worker that they would be moved to a different position. It was at this time that the worker was given the temporary accommodated job as a fleet coordinator. The job involved a lot of work off site, and the hours were different than their pre-injury hours. While performing the alternate job, the worker continued to undergo psychological treatment with Dr. Burger weekly.
In terms of their reaction to the permanent fleet coordinator position being given to someone else, the worker testified that they were not upset about this. The worker stated that they knew they were not qualified for the position, and such, when it was posted as a permanent position, they did not apply for it. The worker testified that they never told the CM that they were upset about not getting the permanent position. The worker did express feelings of abandonment at the time as they were not sure where or what work they would be returning to after their vacation. The worker testified that they hoped their psychological condition would improve, and that they would be able to return to their pre-injury job. As such, when they started the accommodated job in February 2022, the worker advised their doctor that they did not want to start the anti-depressant medication that was recommended. However, while performing the alternate job, their symptoms continued, and in the spring, their symptoms worsened. The worker recalled an incident in May 2022, when they broke down in a work meeting with the Human Resources (HR) person and a co-worker. The co-worker told the worker that they should go home. In the spring (around May/June 2022) they started taking the recommended medication to assist them with their anxiety and sleep difficulties.
The worker testified that they were off on vacation for two weeks starting in July 2022. During their vacation, the worker’s condition deteriorated. The worker barely left their house, rarely had a shower, and they were depressed. The worker cancelled plans, and they did not enjoy their hobbies of gardening, or woodworking. The worker continued to receive treatment with Dr. Burger during their vacation, and noting the deterioration in their condition, neither the worker, nor Dr. Burger felt the worker was able to perform any type of work. At the end of the worker’s vacation, Dr. Burger recommended the worker take additional time off work.
The worker testified that from September 2022 to December 2022 (one semester) they worked at a college teaching a self-care course. The worker and Dr. Burger thought this might assist the worker with their mental health condition as the purpose of the course was to learn and apply self-care measures to improve mental health. The worker advised that they were able to teach in person, but sometimes due to their mental health condition, they conducted the course by zoom.
The worker testified that although their claim has not been approved for LOE benefits, WSIB has continued to pay for their psychological treatments with Dr. Burger, and they referred the worker for an assessment at a mental health treatment centre. Although the assessors recommended the worker attend additional treatment, due to scheduling issues with the treatment center, the worker has not started the additional recommended treatment.
The worker confirmed that except for teaching from September 2022 to December 2022, they have not worked since August 8, 2022. The worker first received benefits from their employer’s short term disability plan, then through their long-term disability plan. The worker continues to see Dr. Burger biweekly, and they see an occupational therapist (OT) weekly.
As entitlement in this claim has been accepted for TMS, I refer to Policy 15-03-02 that states a worker is entitled to benefits for TMS arising out of and in the course of the worker’s employment.
A worker is not entitled to benefits for TMS caused by decisions or actions of the worker’s employer relating to the worker’s employment, including a decision to change the work to be performed or the working conditions, to discipline the worker or to terminate the employment.
In this case, initial entitlement was accepted for TMS as the CM determined the evidence supports the worker’s mental stress diagnosis is a result of cumulate exposure to traumatic events while the worker was working as a victim’s service coordinator. The employer confirmed the worker’s job required the worker to be exposed to the aftermath of violent crimes, and suicides when called on scene for support, and that the worker was exposed to graphic content at these scenes.
Entitlement to the August 2022 recurrence
Policy 15-02-05 states that a worker may be entitled to benefits for a recurrence of a work-related injury/disease if the worker experiences a significant deterioration that:
does not result from a significant new incident/exposure, and
is clinically compatible with the original injury/disease.
A significant deterioration refers to a marked degree of deterioration in the work-related impairment that is demonstrated by a measurable change in the clinical findings.
Indicators of a significant deterioration may include:
the need for active (non-maintenance) clinical treatment
a change in functional abilities, or
a change in the ability to perform a job or suitable occupation.
If the significant deterioration results from a significant new incident/exposure (work-related or not) a recurrence is not considered. Instead, if the significant new incident/exposure is work-related, a new claim is considered.
If the significant deterioration occurs when there is no new incident/exposure or results from an insignificant new incident/exposure (work-related or not), a recurrence is considered.
A significant new incident/exposure is one of some consequence or importance (e.g., falling from a ladder). An insignificant new incident/exposure is one of negligible consequence or importance (e.g., reaching for an object on a shelf).
In this case, I refer to the CM’s memorandum dated November 16, 2022. The worker advised that they have continued to see Dr. Burger weekly or biweekly depending on the month. By March 2022, the worker advised that their mental health condition deteriorated and they could no longer handle their anxiety/depression. The worker noticed they were making mistakes in their job. For example, the worker would do things like miss a turn while driving. The worker also noticed they were becoming more emotional, and to give them time to compose themself, they would take additional time to get to their destination. After work, the worker reported they would sleep for two to three hours, get up, eat, and go back to bed. The worker reported that in May 2022, they attended a meeting with a colleague and the HR person. During the meeting, they discussed planning a peer support program event, and when the HR person made a comment to the effect that the event would not be appreciated, the worker broke down. The worker advised the HR person that they would help put the program together, but they cannot be in front of people or around people. Although there was no further discussion about the worker’s breakdown, a colleague did pull the worker aside after the meeting and suggested that maybe the worker should not be at work right now. The worker thinks that the colleague spoke to a senior member of the team, and this is the reason they were not considered for the permanent job in fleet coordination.
In addition to their psychological treatment with Dr. Burger, the worker sought medical attention with their family doctor who recommended medication to assist with their anxiety and depression. The worker confirmed there were no new incidents or traumatic exposures in the workplace or at home to cause the deterioration in their mental health condition.
In the same memorandum noted above, the worker reported that for two weeks, they trained the person hired for the permanent fleet coordinator position. The worker then went on vacation for two weeks. During their vacation, the worker reported that they felt abandoned with no place to call home at work. They realized they needed more time off work, and they used their flex time to take a third week off work. The worker advised that over those three weeks, they were unable to leave their house, and they noticed a shift in themselves. While off, the worker slept for 16 to 18 hours a day, and they did not enjoy their regular activities, such as gardening, paddle boarding, and woodworking. The worker believed that if they “fake it ‘til you make it”, they would get better, but they did not. The worker advised that following their vacation, the employer confirmed they would be provided with an alternate job in the records department doing criminal record checks. The employer advised the worker that the fingerprinting job is also an option and noted that they discussed this with Dr. Burger. Although both the worker and Dr. Burger felt this would be a good position for the worker, they both felt the worker was not ready to return to work. Specifically, the worker stated they do not have the concentration and organization skills that are needed to work. The worker stated it is hard to be in the spot they are currently in, they never thought they would be here, and hoped this experience leads them to be able to help others better in the future. The worker described guilt, and shame about not being at work, and although they have good days, they also have bad and very emotional days.
The CM contacted Dr. Burger on November 16, 2022. Dr. Burger confirmed they have been treating the worker for a long time through annual wellness assessments in the workplace. Dr. Burger advised they were seeing the worker every three to four weeks for maintenance treatment up until May/June 2022. The worker then found out they would not be interviewed for the permanent position they were performing. The worker felt hurt about being passed over, as the worker was a star employee in Victim’s Services. The worker deteriorated rapidly over the span of three to four weeks after this issue in the workplace. Dr. Burger stated the worker is still dealing with exposure to several workplace traumas. The CM noted the last case the worker had involvement with occurred after the worker was removed from Victim’s Services, but that the worker remained involved as a friend and as a support for the victim.
Dr. Burger diagnosed the worker with post traumatic stress disorder (PTSD) and advised that the PTSD and the worker’s depression render the worker unable to perform any type of work including the part-time job as offered at the college.
In my review of the medical evidence, I note that Dr. Burger completed a Health Professional’s Report of Injury, Form 8 dated September 13, 2022. Dr. Burger provides a diagnosis of adjustment disorder and PTSD. Dr. Burger states that it is their understanding the worker will meet with their HR department to discuss a new appropriate job assignment when the worker is able to attempt work re-entry. Dr. Burger states the worker is not psychologically ready to attend such a meeting.
Dr. Burger submitted a consultation report dated October 24, 2022. Dr. Burger refers to the worker’s pre-injury job as a victim services coordinator, and notes that starting in 2015, the worker became part of an annual wellness assessment. The early assessment suggested that the worker was coping well with their job exposures, but their last two assessments were consistent with their reported increased difficulties coping with their workplace stress. The final assessment supported the worker’s request for a job transfer to a position that did not demand the intense personal emotional commitment that was required in victim services. In July 2022, the worker was completing a six-month interim work placement managing the police fleet service. This position was intended to be a transitional placement after the worker left their pre-injury job in victims services after 11 years.
Dr. Burger provides a diagnosis of cumulative PTSD, and adjustment disorder with mixed Anxiety and Depressed Mood. They outline three traumatic cases in which the worker was involved. Dr. Burger goes on to state they recommend ongoing individual psychotherapy on a weekly or biweekly basis for the next six months. Dr. Burger states it is too soon to offer a time or work restrictions for a planned return to work. Instead, the worker is to focus their attention on re-establishing their psychological equilibrium and stop their deterioration of self-worth.
Dr. Boyes, the worker’s family doctor, submitted their clinical notes for the worker’s visits from March 24, 2022, to October 24, 2022. As per the notes for the worker’s visits in March and April 2022, Dr. Boyes confirms the worker reported issues with sleeping, depression, and anxiety. Although the worker was prescribed Trazodone and Zoloft, the worker reported no improvement with these medications. Therefore, the medications were discontinued. When seen on June 20, 2022, the worker reported their mood had worsened over the past two weeks, they were not enjoying things, and they were not sleeping well. The worker advised they would like to trial a new antidepressant. The worker was then prescribed Cipralex. When seen on August 19, 2022, the worker reported not much improvement with Cipralex. In the clinical notes dated August 30, 2022, and November 2022, Dr. Boyes states the worker continues to have symptoms of anxiety and depression. The worker reported that while taking Fluoxetine they had issues with concentration, and they were confused.
Dr. Burger submitted consultation reports dated April 16, 2023, and March 8, 2024. In these reports, Dr. Burger states they continue to treat the worker for their diagnosed PTSD and given the worker’s history of cumulative and complex PTSD, it is not surprising that their therapeutic process is not infrequently disrupted by flare ups of their debilitating, and on occasion immobilizing symptoms.
Dr. Burger notes the worker has flashbacks, traumatic recollections, disturbing dreams, nightmares, and episodes of social withdrawal. Recurring nightmares have been an ongoing and persistent problem for the worker. In addition to treatment, the worker has been prescribed Effexor. Dr. Burger notes that following the decision from WSIB that denied entitlement to LOE benefits, the worker’s condition deteriorated significantly, and the worker developed suicidal ideation as well as fear that they were unjustified in being off work. Dr. Burger confirms that the worker is on a legitimate leave as a direct result of the cumulative effects of multiple trauma responses.
In the same consultation reports noted above, Dr. Burger refers to their conversation with the CM on November 17, 2022, and states they want to clarify what they said during the conversation. During the call, the CM referred to the workplace incident in December 2015, in which the worker was involved in a murder of a doctor by their 19-year-old son. Dr. Burger states that during the conversation, the CM implied that since the worker no longer worked in victim services, they should not have been involved when the crown attorney conveyed the implications of a Supreme Court decision to the victim. At that time, Dr. Burger suggested that the relations between the worker and the victim were far more complex than a friendship given their shared experience of one of the most traumatizing events in the community’s history. Although Dr. Burger had to end the call due to a client’s appointment, the CM did not call Dr. Burger back as they advised they would do so. Dr. Burger refers to the CM’s decision in which the CM implies that the worker was managing well until May or June 2022, when they found out they would not be considered for the position that they were doing temporarily. However, Dr. Burger states that they explained to the CM that the worker accepted the accommodate role as fleet coordinator and had managed to do an adequate job. Under extreme emotional distress, the worker effectively isolated themselves, and managed to deal with the basic requirements of the job. The worker is by nature an engaging and socially outgoing individual. Given the significant stress of the job, they utilized a strategy of completely isolating themselves from others to carry out their tasks. Dr. Burger states that in hindsight, these were red flags about their psychological deterioration, and at no point did they imply that the worker’s emotional deterioration was a result of the temporary fleet coordinator position being completed.
The worker’s decision to perform the job of fleet coordinator was an avoidance strategy to try to not confront their deteriorating medical health. The worker suffered a complete emotional collapse when they left work, and at that point, they began the process of a rapid deterioration in their mental health culminating in active overwhelming PTSD symptomology and profound anxiety and depression.
Dr. Burger states that in their clinical judgment, the worker has been unable to contemplate any attempt at gainful employment since they left the fleet coordinator position. Dr. Burger notes that the worker’s PTSD resulted in their inability to return to work, and this was a direct result of multiple cumulative traumatic experiences over the course of their career in victim services. The worker continues to struggle with many experiences of their very carious trauma over the course of their career in victim services.
Dr. Burger believes the worker is moving in the direction of finding a healthy balance between the painful recollections that are part of their work encounters, and the meaningful experience of having made significant positive life altering contributions to help others navigate their way through their profane traumatic life encounters.
As per the memorandum dated November 29, 2023, the CM referred the worker for an assessment at a mental health treatment centre in order to provide recommendations to assist with recovery and treatment. Dr. Zrenner, psychiatrist and Dr. Fitzgerald, psychologist assessed the worker at the treatment centre on April 9, 2024. As per the assessment report submitted, the assessors considered all evidence pertaining to the worker’s workplace exposures, and the medical evidence as provided by Dr. Burger and Dr. Boyes. The assessors confirm that during the course of the worker’s career as a victim support coordinator, the worker was on site for multiple events including motor vehicle accidents (MVAs), suicides, and homicides. Therefore, the criteria as described by DSM 5 exposure to actual or threatened death, serious injury, or sexual violence has been met. At the time of the assessment, the worker’s current intrusive re-experiencing symptoms include recurrent, involuntary, and intrusive distressing memories, distressing dreams, flashbacks, and psychological distress. The worker’s symptoms include avoidance of external reminders of the incidents to which they were exposed. The worker’s altered cognitions or mood include negative beliefs about self or others, change in cognitions, persistent negative moods, diminished interest in activities, feelings of being distant or cut off from others, and persistent inability to experience positive emotions like love, or happiness. Symptoms of hyperarousal or reactivity include anger and irritability, constant hypervigilance, concentration difficulties, and sleep disturbances. The assessors state that the above noted symptoms were reported to have onset progressively in the context of cumulative trauma. The symptoms have interfered with the ability to function at work and at home. The symptoms were at their worst in the fall 2023, and since then, the worker has noticed a 20% improvement. Based on the worker’s presentation and report of symptoms, the assessors determined the criteria has been met for PTSD. Under Occupational diagnosis, the following is reported:
Reported symptoms of PTSD started progressively in the context of recurrent work-related trauma exposure, the symptoms are directly attributable in onset to cumulative work-related trauma exposure.
Reported symptoms of major depressive disorder started progressively in the context of recurrent work-related trauma exposure, the symptoms are directly attributable in onset to cumulative work-related trauma exposure.
No non-occupational diagnosis is provided.
In terms of prognosis, the mental health treatment centre’s assessors determined the worker has partial functional recovery, and that the worker has not reached maximum psychological recovery. Recommendation is made for the worker to attend more intensive services offered through the mental health specialty program for a period of 6 to 12 months. However, even with the recommended treatment, a full functional recovery will not be reached as it is likely the worker will continue to experience vulnerability to exacerbations of trauma symptoms in response to further traumatic exposure.
In addition, the mental health treatment centre’s assessors state it is anticipated the worker may experience chronic persistent fluctuating difficulties in the following symptoms that will require initial and most likely permanent accommodations:
- sleep
- concentration
- hypervigilance
Under Return-to-Work recommendations, the assessors recommend no RTW due to the frequency and intensity of nightmares that negatively impact the worker’s sleep, and their ability to maintain daily routines, and hypervigilance. Considering the worker’s current abilities and limitations, recommendation is made for no engagement in RTW services and/or a gradual RTW. Instead, recommendation is made for the worker to continue weekly treatment sessions with Dr. Burger and OT treatment. The worker is also to be referred to a first responder focused program for treatment.
Based on my assessment of the evidence, I find the worker does have entitlement to the August 2022, recurrence. In making this determination, I have placed significant weight on the psychological reports provided by Dr. Burger, and the clinical notes provided by Dr. Boyle. I have also placed weight on the findings as provided in the mental health treatment centre’s assessment, and the worker’s testimony. I find it important to note the CM denied entitlement to the August 2022 recurrence as they determined the deterioration in the worker’s symptoms was due to the employer’s decision to hire someone else for the permanent fleet coordinator position. However, as confirmed during the appeal hearing, the worker testified that they did not apply for the permanent fleet coordinator position as they knew they were not qualified for the job. The worker also testified that while performing this job, their psychological symptoms did not improve. Instead, their symptoms worsened, and in the spring (May/June 2022) they agreed to take the anti-depressant medication as recommended by Dr. Boyle. I find this significant as this occurred prior to the end of the temporary fleet coordinator job. Dr. Boyle’s clinical notes support the worker was seen in May/June 2022, and due to an increase in their symptoms, the worker was prescribed anti-depressants.
In addition to the worker’s testimony, Dr. Burger has submitted psychological consultation reports confirming that not only have they provided the worker with extensive psychological treatment, but they have also extended the worker’s occupational diagnosis to include PTSD. Dr. Burger provides the opinion that the worker’s August 2022 recurrence is a direct result of their cumulative occupational exposures to traumatic events. In their report dated April 16, 2023, Dr. Burger also tries to explain the CM’s misinterpretation of their November 2022 phone call regarding the cause of the worker’s recurrence. As the CM based their decision on their call with Dr. Burger, I accept Dr. Burger’s clarification of their findings during the call. Specifically, that the worker’s recurrence was not a result of not being considered for the permanent fleet coordinator position, but instead that the completion of this job increased the worker’s feelings of abandonment and self-confidence. Finally, I have also taken into consideration the mental health treatment centre’s assessment. The assessors had the benefit of reviewing all medical evidence submitted by Dr. Boyle and Dr. Burger, and after psychologically assessing the worker, they also provide the opinion that the worker’s ongoing psychological impairment is a direct result of the workplace exposures. The assessors confirm that the worker is not fit to return to any type of work, and that any RTW planning should be considered after the worker attends the recommended first responder’s treatment.
Having considered all the evidence, I accept the worker suffered a significant deterioration in their psychological condition in August 2022. I find the significant deterioration did not result from a significant new incident/exposure, and that the significant deterioration is clinically compatible with the TMS accepted in this claim. I find the evidence also supports the worker’s diagnosed PTSD is clinically compatibility with the original injury accepted in this claim. Therefore, I find the worker does have entitlement to the diagnosed PTSD as well as the August 2022 recurrence.
Entitlement to LOE benefits for the worker’s lost time from work starting August 8, 2022
Policy 15-02-05 states that generally, a worker who experiences an actual loss of earnings due to a recurrence is entitled to LOE benefits. A worker who does not experience an actual loss of earnings due to a recurrence may be entitled to LOE benefits if, at the time of the recurrence, he/she was expected to have actual earnings in the near future.
To determine whether a worker was expected to have actual earnings in the near future, the WSIB may consider whether the worker:
- was expected to return to an existing job
- was scheduled to start a new job
- was actively engaged in formal job search activities, or
- recently completed a return-to-work plan.
A worker who had permanently exited the workforce or was not actively engaged in the workforce at the time of the recurrence would not be expected to have actual earnings in the near future.
I also refer to Policy 18-03-02, that states if the nature or seriousness of the injury/disease completely prevents a worker from returning to any type of work, or if the worker 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 provided the worker co-operates in health care measures and all aspects of the return-to-work (RTW) process
As previously noted, Dr. Burger has provided psychological consultation reports in which they provide the opinion that due to the extent of the worker’s symptoms, the worker is not fit to perform any type of work. Dr. Burger continued to treat the worker weekly from August 2022 to present, and their opinion regarding return to work has been unchanged. I find the mental health treatment centre’s assessment report dated April 2024, supports Dr. Burger’s opinion, as the assessors also relate the worker’s ongoing psychological condition to their occupational exposures, and they provide the opinion that the worker is unfit to return to any type of work. I find the mental health treatment centre’s assessment confirms the worker’s level of impairment has been unchanged since August 2022, and that the worker remained unfit to return to work from August 2022 to April 2024 (the date of the mental health treatment centre’s report). As outlined in the assessment, recommendation is made for the worker to attend first responder treatment prior to determining whether the worker can return to work. While I note the worker did teach a mental health course at a college from September 2022 to December 2022, Dr. Burger recommended the worker teach this course as they felt the course would provide the worker with information to assist the worker in improving their mental stress condition. The worker taught this one course, and sometimes they taught the course through a zoom call.
For the reasons stated above, I find the worker has entitlement to full LOE benefits from August 8, 2022, to the date they started teaching a course at the college in September 2022. I find the worker has entitlement to partial LOE benefits from September 2022 to December 2022, based on their earnings from the college. I find the worker is entitled to full LOE benefits from the date they stopped teaching in December 2022 to the date of this appeal decision. Finally, I find the worker is to be referred to the first responder focused program for treatment, and that RTW discussions occur based on the recommendations as provided by the treatment team in this program.
CONCLUSION
I find the worker has entitlement to full LOE benefits from August 8, 2022, to the date they started teaching a course at a college in September 2022.
I find the worker has entitlement to partial LOE benefits from September 2022 to December 2022.
I find the partial LOE benefits paid for this period should be based on the difference between their pre-injury earnings and the earnings they received while teaching a course at a college for this semester.
I find the worker is entitled to full LOE benefits from the date they stopped teaching in December 2022 to the date of this appeal decision.
I find the worker is to be referred to the first responder focused program for treatment, and that return-to-work discussions occur based on the recommendations as provided by the treatment team in this program.
The worker’s objection is allowed.
DATED September 19, 2024
Kelly Gordon Appeals Resolution Officer Appeals Services Division