OWSIB 2025

The worker, a bus driver who developed PTSD after a passenger pointed a handgun at them, appealed a case manager's decision denying loss of earnings benefits for a period when the worker was out of the country.

The Appeals Resolution Officer found that the worker's out-of-country leave did not interfere with their ability to co-operate in health care measures or the return-to-work process.

The worker sought appropriate psychiatric treatment while abroad and was medically authorized off work during the entire period.

The appeal was allowed, and the worker was granted full loss of earnings benefits for the disputed period.

The worker and employer both objected to a Case Manager's decision regarding loss of earnings (LOE) benefits following a workplace injury to the worker's right finger.

The worker appealed the denial of LOE benefits from April 10, 2024 to May 6, 2024, arguing they were following medical advice to remain off work post-surgery.

The employer appealed the allowance of LOE benefits for April 8 and 9, 2024, arguing suitable modified duties were available.

The Appeals Resolution Officer denied the worker's appeal, finding that safe and suitable modified duties were available that accommodated the worker's functional limitations.

The employer's appeal was allowed in part; LOE benefits were denied for April 8 as the surgery occurred on April 9, but entitlement was confirmed for the actual surgery date of April 9.

The worker, a school principal, appealed the denial of entitlement for traumatic and chronic mental stress injuries following repeated harassment and social media defamation by a student's parent.

The Appeals Resolution Officer found that while the events did not meet the threshold for a traumatic mental stress injury, the parent's egregious and abusive conduct constituted a substantial work-related stressor.

The worker's appeal was allowed, granting entitlement for a chronic mental stress injury (acute adjustment disorder).

The worker, a primary care paramedic, suffered a work-related mental stress injury (PTSD) and was completely unable to work as of May 6, 2024.

The Case Manager denied loss of earnings (LOE) benefits from May 8 to May 20, 2024, because the worker was on a pre-approved vacation and received vacation pay.

On appeal, the Appeals Resolution Officer found that under WSIB operational policy, a fully impaired worker may continue to receive full benefits during a vacation of up to three weeks if it does not interrupt treatment.

The worker had notified the WSIB of the vacation and actively participated in treatment without significant interruption.

The appeal was allowed, and full LOE benefits were granted for the disputed period.

The worker appealed a Case Manager's decision that determined they were partially impaired, capable of working as a telephone solicitor, and entitled only to partial loss of earnings (LOE) benefits.

The Appeals Resolution Officer found that the occupation of telephone solicitor was not suitable given the worker's age, lack of transferable skills, need for extensive training, and the limited employment outlook for the position.

The Officer concluded the worker was unemployable due to their compensable injuries and awarded full LOE benefits effective January 31, 2025, locked in to age 65.

The worker appealed a Return-to-Work Specialist's decision that identified Computer Network Technician - Systems Administrator as a suitable occupation and approved an associated Work Transition plan.

The worker, who sustained physical and psychological injuries after falling through a floor hole, argued the occupation was not suited to their transferrable skills or functional abilities.

The Appeals Resolution Officer found that while the occupation was within the worker's physical functional abilities, it was not suited to their transferrable skills, aptitudes, or education, noting significant gaps in English literacy and math skills.

The Work Transition plan was also found inappropriate as it did not sufficiently address these proficiency gaps.

The worker's objection was allowed.

The employer objected to a case manager's decision allowing the worker loss of earnings benefits during a temporary work disruption caused by a plant re-tooling.

The worker had previously been performing suitable work at no wage loss following a compensable bilateral knee injury.

The Appeals Resolution Officer found that the worker met the criteria under WSIB Operational Policy 15-06-02, as their work history demonstrated they would normally seek new employment during a layoff, and their significant medical restrictions impacted their ability to earn income through new employment.

The employer's objection was denied and the benefits were maintained.

The employer appealed a decision granting the worker entitlement for a low back soft tissue injury.

The worker reported experiencing severe lower back pain after bending over to pick up an egg carton at work, which subsequently required hospitalization.

The employer argued there were discrepancies in the accident history and a delay in reporting.

The Appeals Resolution Officer found that the worker suffered a personal injury by accident that arose out of and in the course of employment, and that the diagnosis of a low back sprain/strain was compatible with the accident history.

The employer's appeal was denied and entitlement was confirmed.

The worker, a truck driver, appealed the denial of initial entitlement for a left foot injury.

The worker alleged that they stepped in a puddle containing chemicals at a recycling facility, which caused a chemical burn to their left foot.

The worker's pre-existing diabetes complicated the healing process, leading to multiple infections and ultimately a below-the-knee amputation.

The Appeals Resolution Officer found that the evidence supported a diagnosis of a chemical burn and that the occupational exposure significantly contributed to the injury.

The Officer also found that the amputation was a significant deterioration clinically compatible with the original injury.

The appeal was allowed.

The worker appealed the denial of entitlement to Traumatic Mental Stress (TMS) and Chronic Mental Stress (CMS) following a road rage incident where another driver approached the worker's truck with a knife.

The Appeals Resolution Officer denied the appeal, finding that the worker did not have a confirmed DSM diagnosis for a mental stress injury.

Furthermore, the medical evidence did not support that the workplace incident was the predominant cause of the worker's mental stress condition, as the treating physicians attributed the stress to personal and non-occupational issues.

The worker appealed a Case Manager's decision denying full loss of earnings (LOE) benefits and finding that the employer's modified work duties were suitable for their work-related right knee injury.

The Appeals Resolution Officer expanded the appeal to include two recurrences of the injury.

The Officer found that the worker suffered significant deteriorations clinically compatible with the original injury, entitling them to health care benefits including reimbursement for crutches and a Zimmer splint.

The Officer further determined that the worker was totally disabled for a brief period and partially disabled thereafter, and that the employer failed to provide suitable and available modified work.

Consequently, the worker was granted full LOE benefits for the disputed period.

The worker objected to a Case Manager's decision that they had reached maximum medical recovery (MMR) by July 23, 2024, with no permanent impairment resulting from a work-related left ankle/foot injury.

The Appeals Resolution Officer reviewed the medical evidence, including reports from a WSIB Lower Extremity Specialty Clinic, which indicated the ankle fracture had fully healed with full range of motion and no residual impairment.

Applying the AMA Guides, the Appeals Resolution Officer confirmed the range of motion measurements did not result in a measurable impairment rating.

The worker's objection was denied, and the Case Manager's decision was upheld.

The worker, a firefighter, sustained a work-related laceration to his left little finger and subsequently developed herpetic whitlow at the site of the cut.

The Case Manager initially denied entitlement for the herpetic whitlow as a secondary condition.

On appeal, the Appeals Resolution Officer found that the break in the worker's skin from the workplace injury provided a means of entry for the herpes simplex virus.

Relying on medical opinions establishing a causal association, the Officer concluded that the herpetic whitlow was a secondary condition resulting from the work-related laceration.

The worker's appeal was allowed.

The worker appealed a Case Manager's decision denying initial entitlement for vertigo.

The worker alleged that operating an OP machine, which required looking up and down, caused her to develop dizziness and nausea, later diagnosed as benign paroxysmal positional vertigo (BPPV).

The Appeals Resolution Officer found that the condition was not a chance event and did not arise out of the worker's employment, noting that BPPV is typically caused by head trauma or prolonged positioning on the back, neither of which occurred at work.

The appeal was dismissed.

The worker, a police sergeant with an accepted claim for post-traumatic stress disorder, objected to a decision denying loss of earnings (LOE) benefits after October 31, 2020.

The worker argued that because they were permanently restricted from police work, they were entitled to LOE benefits despite retiring.

The Appeals Resolution Officer found that the worker made a fully informed, voluntary decision to retire and withdraw from all return-to-work services, including those aimed at the general labour market.

Consequently, the post-retirement wage loss was not caused by the workplace injury, and the objection was denied.

The worker appealed decisions regarding their loss of earnings benefits and the determination of a Suitable Occupation (SO) following a compensable workplace injury.

The worker argued they were unemployable and entitled to full loss of earnings benefits.

The Appeals Resolution Officer found that while the worker had significant physical and psychological impairments, they were capable of working 20 hours per week in the SO of Customer Service Representative – Information and Kiosk Clerk as of September 7, 2017.

The Officer upheld the use of entry-level wages to calculate the benefits and confirmed the worker's entitlement to ongoing partial loss of earnings benefits from their 72-month lock-in date until age 65, based on part-time hours.

The worker's objection was allowed in part.

The employer appealed a WSIB decision registering its account and assessing premiums retroactively to January 1, 2020.

The employer, a cannabis retailer, argued it was unaware of the mandatory registration requirement and requested the activation date be changed to January 1, 2024, citing financial hardship.

The Appeals Resolution Officer dismissed the appeal, finding that the WSIB correctly applied its policies regarding retroactive premium adjustments after identifying the employer's non-compliance through an information exchange with the Canada Revenue Agency.

The employer's obligation to register arose when it first hired workers in 2020, and financial hardship did not exempt it from retroactive premiums, though a phased payment plan was available.

The Worker appealed a decision limiting their Non-Economic Loss (NEL) rating for a work-related neck injury to 14%.

The Worker argued that their range of motion measurements fell between the intervals in the AMA Guides and should not be rounded up to a 0% impairment rating.

The Appeals Resolution Officer agreed, finding that rounding up did not fairly recognize the Worker's accepted range of motion deficit.

The Officer applied in-between values, resulting in a 1% increase to the NEL rating, bringing the total to 15%.

The worker appealed a Case Manager's decision which determined that their compensable concussion and post-concussion-related symptoms had reached maximum medical recovery with no permanent impairment.

The Appeals Resolution Officer reviewed the medical evidence, including reports from neurologists and a pain specialist, which confirmed ongoing symptoms such as headaches, photophobia, and cognitive concerns directly attributable to the workplace injury.

The Appeals Resolution Officer found that the worker's condition had not resolved and had reached a plateau in recovery as of February 16, 2021.

The worker's objection was allowed, and the worker was found entitled to a Non-Economic Loss (NEL) benefit assessment.

The worker, a non-resident long-haul truck driver, was injured in a compensable motor vehicle accident and subsequently returned to their home country for medical care.

The worker appealed a decision denying loss of earnings (LOE) benefits beyond March 30, 2022, and a decision calculating their long-term rate without including alleged cash payments.

The Appeals Resolution Officer allowed the appeal in part, finding the worker was totally impaired and entitled to full LOE benefits until May 2022, and partially impaired and entitled to partial LOE benefits thereafter based on part-time earnings in their home country.

The appeal regarding the long-term rate calculation was dismissed due to insufficient proof of the alleged cash earnings.