APPEALS RESOLUTION OFFICER DECISION

DECISION NUMBER:

20260009

OBJECTING PARTY:

WORKER

REPRESENTED by:

WORKER REPRESENTATIVE

RESPONDENT PARTY:

EMPLOYER

HEARING:

HEARING IN WRITING

HEARD by: K. ERKILA, APPEALS RESOLUTION OFFICER

DATED: SEPTEMBER 22, 2025

ISSUE

The worker objects to the case manager’s decision dated October 4, 2024, that determined that loss of earnings (LOE) benefits would cease, effective September 30, 2024.

BACKGROUND

On June 10, 2024, while riding on the back of a garbage truck collecting garbage, the worker reported injuring their right wrist when the truck they were holding on to turned a corner and stopped abruptly. Entitlement was accepted for a right wrist scaphoid fracture and LOE benefits as the employer was unable to accommodate their restrictions.

On September 26, 2024, the worker advised their physician they wanted to return to work. Consequently, their physician provided a medical note that indicated the worker was able to return to full duties as of September 30, 2024. In the decision dated October 4, 2024, the case manager determined the worker had fully recovered from their right wrist fracture and as they were able to return to regular duties, they were not entitled to any further LOE benefits beyond September 30, 2024.

On October 17, 2024, the worker sought additional medical attention as they were experiencing ongoing right wrist symptoms. They were diagnosed with a right wrist triangular fibrocartilage complex (TFCC) tear and surgery was recommended. The worker objected to the determination they had fully recovered and requested ongoing entitlement to LOE benefits. The case manager reconsidered their decision and allowed entitlement to the TFCC tear, however, upheld the denial of LOE benefits as they determined the worker was fit for regular duties.

The worker objects to this decision and the issue has been referred to the Appeals Services Division for further consideration.

AUTHORITY

Operational Policy Manual

Published

18-03-02 Payment and Reviewing LOE Benefits (Prior to Final Review)

September 1, 2021

ANALYSIS

I have carefully considered all the available information, legislation, and relevant operational policies in reaching this decision. Based on my review of the evidence and reasons explained below, I find the worker is entitled to LOE benefits from September 30, 2024.

The Worker’s Position and Remedy Sought

The worker submits in an Intent to Object form dated February 18, 2025, that they are unable to return to work due to their ongoing right wrist injury.

The worker is seeking entitlement to LOE benefits from September 30, 2024, to January 7, 2025, when they underwent surgery for their TFCC tear.

The employer is not participating in the appeal and has not provided any submissions.

Is the worker entitled to LOE benefits from September 30, 2024?

Based on my review of the evidence and reasons explained below, I find the worker is entitled to LOE benefits from September 30, 2024.

The worker is a temporary worker, employed with a placement agency. On the date of injury, the worker was performing duties of a sanitation engineer at their placement with Company A. Their main duties consisted of riding on the back of a garbage truck, and collecting and emptying bins into the truck, which required heavy lifting and repetitive bending and twisting with both hands.

Initial entitlement in this claim was accepted for a right wrist scaphoid fracture and full LOE benefits as the accident employer was unable to accommodate the worker’s right wrist limitations. In the return-to- work meeting memo dated August 15, 2024, the employer advised they did not have any other jobs where they could place the worker, and the worker would need to be fully recovered prior to being able to return to work.

On September 6, 2024, the worker underwent an MRI of the right wrist that identified a large TFCC disc tear. The functional abilities form dated September 16, 2024, supported ongoing limitations for the right wrist, including limited repetitive movements of the right wrist, and limited lifting and pushing/pulling restricted to 10-20kg.

On September 26, 2024, the worker advised their orthopaedic physician, Dr. Song, that there had been some improvement in their symptoms and as such, they wanted to return to work. Consequently, their physician provided a medical note that indicated the worker was able to return to full duties as of September 30, 2024.

The case manager spoke to the worker on October 4, 2024, and the worker reported they continued to have instability in their right wrist when picking things up and felt pain in their wrist with bending. The worker reported they had wanted to return to work because they needed the money and had bills to pay. In the decision dated October 4, 2024, the case manager determined that based on the new medical information on file that cleared the worker to return to their regular duties, the worker had fully recovered from their right wrist facture, and they were no longer entitled to LOE benefits.

On October 9, 2024, the worker contacted the case manager to report ongoing issues, as they were still unable to lift anything heavy with their right hand and they were having problems with performing their activities of daily living. The worker disagreed with the decision that they had fully recovered, and they were planning on getting a second opinion for their right wrist condition.

In the clinical report dated October 17, 2024, Dr. Song noted the worker reported increasing symptoms due to their right wrist injury when attempting to resume more physical activities. Dr. Song noted the significant TFCC tear would require further intervention and a referral to orthopaedic surgeon Dr.

Ostrowski was made. Dr. Song recommended ongoing modified work duties.

The worker was seen by Dr. Ostrowski on October 24, 2024. As per the clinical report of the same date, Dr. Ostrowski opined that due to the symptomatic TFCC tear of the right wrist, and given the severity and duration of their symptoms, surgical treatment was recommended.

In the reconsideration decision dated December 6, 2024, the case manager allowed entitlement to the diagnosis of TFCC tear as it was compatible with the workplace injury of June 10, 2024, and allowed entitlement to future LOE benefits for the planned surgical repair. However, the case manager upheld the denial of LOE benefits from September 30, 2024, ongoing, as they determined the worker remained capable of performing their regular duties. I note the worker underwent the recommended surgery, and entitlement to full LOE benefits was allowed from January 7, 2025.

Policy 18-03-02, Payment and Reviewing LOE Benefits (Prior to Final Review), states, in part, 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 providing the worker co-operates in health care measures and all aspects of the return-to-work (RTW) process.

Although Dr. Song gave the worker permission to return to full duties on September 30, 2024, the medical evidence supports the worker had not fully recovered from their injury. Dr. Song’s clinical report dated October 17, 2024, supports the worker’s symptoms returned when they attempted to resume more physical activities. As the case manager has accepted entitlement for the TFCC tear as it is compatible with the workplace injury, and the medical evidence supports a requirement for ongoing modified duties for the TFCC tear, I find the worker was partially impaired as of September 30, 2024, and required modified duties in order to be able to return to work.

It is unclear when (or if) the worker returned to work, or what work they returned to, however, the medical evidence supports the worker was unable to continue to perform their regular duties and required ongoing modified work duties. As the employer had previously confirmed they were unable to offer suitable modified duties and the worker continued to co-operate in health care measures, as per policy 18-03-02, I find the worker is entitled to full LOE from September 30, 2024, as the nature or seriousness of the injury completely prevented them from returning to regular duties and no suitable modified duties were available.

I remit back to the operating area to gather the necessary information to determine the exact date the worker began to lose time from work after September 30, 2024, and pay LOE benefits accordingly.

CONCLUSION

I find the worker is entitled to full LOE benefits from September 30, 2024. The objection is allowed.

DATED SEPTEMBER 22, 2025

K. Erkila

K. Erkila

Appeals Resolution Officer Appeals Services Division