Ontario Workplace Safety and Insurance Board

The worker suffered a right shoulder fracture at work in 2015 and initially returned to work after conservative treatment.

Years later, the worker developed avascular necrosis and severe osteoarthritis requiring a reverse shoulder arthroplasty.

The case manager denied entitlement for the surgery, finding the worker had fully recovered in 2015.

On appeal, the Appeals Resolution Officer found the worker had not fully recovered and that the need for surgery was a significant deterioration clinically compatible with the original injury.

The worker's objection was allowed, granting entitlement to health care benefits for the recurrence.

The employer appealed a Case Manager's decision denying cost relief under the Second Injury and Enhancement Fund (SIEF) following a worker's right hip injury.

The worker bumped their hip on a glass table, which was deemed a minor accident, but subsequently developed avascular necrosis and secondary advanced osteoarthritis, requiring a total hip replacement.

The employer argued that the worker's history of smoking and the rapid onset of osteoarthritis indicated pre-existing conditions.

The Appeals Resolution Officer dismissed the appeal, finding that the diagnoses were clinically compatible with the work-related injury and that smoking did not meet the definition of a pre-accident disability or pre-existing condition under the SIEF policy.

The worker, a truck driver, suffered a workplace injury in November 2019 and was subsequently laid off due to a seasonal work shortage, which became a permanent work disruption in June 2020.

The Case Manager denied loss of earnings (LOE) benefits, determining the worker could restore their wage loss as a Light Delivery Driver.

The Appeals Resolution Officer allowed the worker's appeal, finding that the physical restrictions and psychological barriers prevented the worker from securing employment in the suggested suitable occupation without return to work assistance.

The worker was granted full LOE benefits from June 1, 2020, and a return to work assessment.

The worker suffered a work-related low back strain and appealed the Case Manager's decisions that they had fully recovered by November 21, 2016, and denying entitlement to chronic pain disability (CPD) and psychotraumatic disability.

The Appeals Resolution Officer found that the medical evidence supported ongoing impairment beyond the recovery date, as the worker had not reached maximum medical recovery.

Furthermore, the worker met all five criteria under WSIB Policy 15-04-03 for CPD, including that the pain persisted beyond the usual healing time, was inconsistent with organic findings, and impaired earning capacity.

The worker's objection was allowed, granting ongoing entitlement and a Non-Economic Loss assessment for CPD.

The worker appealed the Case Manager's decisions that they had achieved maximum medical recovery (MMR) from a compensable low back injury by May 14, 2018 with no permanent impairment, and denying loss of earnings (LOE) benefits following a pandemic-related work disruption starting March 20, 2020.

The Appeals Resolution Officer found that the medical evidence supported MMR by May 2018 with no ongoing impairment, as there was a significant gap in medical records regarding low back complaints after that date.

Regarding LOE benefits, the work disruption was deemed temporary despite its length, and there was no evidence the worker sought alternative employment.

The appeal was denied.

The employer objected to a Case Manager's decision granting 25 percent cost relief under the Second Injury and Enhancement Fund (SIEF) for a worker's compensable post-traumatic stress disorder.

The Appeals Resolution Officer found that the accident (cumulative traumatic exposure as a dispatcher) was minor in severity.

The officer also found that the worker's pre-existing psychological reaction to a hypertrophic cardiomyopathy diagnosis was a minor pre-existing condition that prolonged recovery.

Under the SIEF policy, a minor accident and minor pre-existing condition warrant 50 percent cost relief.

The employer's objection was allowed.

The employer objected to the Eligibility Adjudicator's decision granting the worker, a registered nurse, initial entitlement for COVID-19.

The employer argued that the worker's non-occupational exposure to their COVID-19 positive daughter was the more probable cause of infection.

The Appeals Resolution Officer found that the worker had significant occupational exposure to COVID-19 patients within the incubation period and that the nature of the employment created an elevated risk of contracting the disease.

The Officer concluded that it was more probable than not that the circumstances of the worker's employment significantly contributed to the development of COVID-19, and denied the employer's objection.

The employer objected to a decision granting the worker ongoing full loss of earnings (LOE) benefits from December 18, 2020 to February 5, 2021, following a work-related Covid-19 infection.

The employer argued that Public Health had cleared the worker to return to work and that modified duties were available.

The Appeals Resolution Officer found that despite the Public Health clearance, two physicians had assessed the worker and concluded they were medically unable to return to any work until February 1, 2021, due to ongoing symptoms.

As the medical evidence supported total disability during the period, the worker was entitled to full LOE benefits.

The employer's objection was denied.

The worker appealed a Case Manager's decision denying entitlement for a recurrence of bilateral carpal tunnel syndrome and C7 nerve root compression.

The worker originally suffered the injury in 2011 and claimed a recurrence in October 2019 after a period of continuous flare-ups.

The Appeals Resolution Officer found that the original symptoms had largely resolved by August 2014 and that subsequent medical treatments were for various other physical complaints not compatible with the original injury.

The appeal was dismissed, with a direction to establish a new claim for the 2019 symptoms.

The worker appealed an Eligibility Adjudicator's decision denying entitlement to loss of earnings (LOE) benefits following a left hand and shoulder strain/sprain.

The employer did not participate in the appeal.

The Appeals Resolution Officer found that the medical evidence supported the worker's inability to return to pre-injury job duties and that the employer did not offer suitable modified work until October 14, 2021.

The worker's objection was allowed, and LOE benefits were granted from August 13, 2021 to October 14, 2021.

The worker appealed a decision denying loss of earnings (LOE) benefits for a low back strain injury.

The Appeals Resolution Officer found that the worker did not have clinical authorization to be off work on July 27, 2021, as they did not seek medical attention until August 16, 2021.

Furthermore, the medical evidence indicated the worker was capable of performing their pre-injury sedentary job duties, meaning suitable work was available.

The appeal was dismissed and the denial of LOE benefits was confirmed.

The worker appealed a Case Manager's decision denying Loss of Earnings (LOE) benefits retroactive to December 2, 2017.

The worker had previously suffered significant injuries from a workplace fall.

However, surveillance and social media evidence showed the worker engaging in intense physical workouts at a gym, contradicting his reported level of impairment.

The worker had also pleaded guilty to making false statements under the Workplace Safety and Insurance Act.

The Appeals Resolution Officer found the video evidence demonstrated the worker had no limitations or restrictions related to his accepted injuries, and denied the appeal.

The worker appealed a Case Manager's decision denying initial entitlement for dental fractures allegedly sustained during a workplace fall.

The worker had fallen and fractured their elbow, but did not report any facial or dental injuries until several weeks later, and did not seek dental treatment for over 14 months.

The Appeals Resolution Officer found insufficient evidence to establish that the broken teeth were caused by the workplace accident, noting the lack of contemporaneous medical documentation of facial injuries and the significant delay in seeking treatment.

The appeal was denied.

The worker appealed a decision denying initial entitlement for a low back injury allegedly sustained while lifting a 60-pound table at work.

The employer disputed the claim, citing delayed reporting and a lack of visible injury at the time.

The Appeals Resolution Officer allowed the appeal, finding the worker's consistent reporting of the mechanism of injury and subsequent medical diagnosis of a soft tissue injury satisfied the criteria for a disablement unexpected result under WSIB policy.

The issue of the impact of pre-existing degenerative changes shown on MRI was remitted to the operating area.

The worker suffered a workplace injury resulting in the amputation of soft tissues distal to the left fifth distal phalanx.

The WSIB determined the worker had achieved maximum medical recovery (MMR) with a permanent impairment but no ongoing physical restrictions.

The worker objected, arguing they continued to require modified work restrictions.

The Appeals Resolution Officer denied the objection, finding no medical evidence to support ongoing permanent physical limitations beyond the MMR date, as the worker had returned to work at no wage loss and was progressing to full duties.

The worker suffered a severe traumatic brain injury, facial fractures, and lacerations after being struck by a falling object at work.

The WSIB initially granted a 14% Non-Economic Loss (NEL) benefit for the brain injury, facial disfigurement, and loss of smell and taste.

The worker objected, seeking a higher NEL quantum.

The Appeals Resolution Officer reviewed the medical evidence and the AMA Guides, determining that the worker's impairments warranted a 1% rating for facial disfigurement, 20% for the traumatic brain injury, and 3% for loss of smell and taste.

Applying the Combined Values Chart, the worker's total whole person impairment was calculated at 23%.

The appeal was allowed.

The worker, a sanitation worker, appealed a decision denying initial entitlement to WSIB benefits for a lower back injury allegedly sustained on their first day of work.

The worker claimed the injury resulted from repetitive bending and reaching.

The Appeals Resolution Officer found insufficient evidence of an injuring process, noting the worker only performed the duties for two to three hours, delayed reporting the injury, and delayed seeking healthcare.

The appeal was dismissed, and initial entitlement to benefits was denied.

The employer appealed a decision granting the worker full loss of earnings (LOE) benefits for five hours of lost time on July 17, 2021.

The worker, a caregiver, suffered a compensable lower back and chest sprain.

The employer could not accommodate the worker's restrictions on the scheduled shift but offered 30 minutes of modified administrative duties at an alternate worksite after regular shifts the following week.

The Appeals Resolution Officer found the alternate work unsuitable, as it required an unreasonable 45-minute one-way commute for only 30 minutes of work.

The worker was therefore entitled to full LOE benefits for the missed shift.

The employer's objection was denied.

The worker, a law enforcement officer, suffered a left shoulder dislocation while striking a heavy bag during tactics training.

The WSIB initially allowed the claim but later determined the worker had reached maximum medical recovery and denied entitlement for recommended stabilization surgery, attributing the need for surgery to a pre-existing condition.

The worker appealed.

The Appeals Resolution Officer found that while the surgery was primarily required to address chronic, non-occupational instability, the workplace accident significantly contributed to the timing of the surgical recommendation.

The appeal was allowed, granting entitlement to the surgery as a "once only repair" under WSIB policy, though with no entitlement to a permanent impairment award.

The worker, employed as a Case Manager, appealed a decision denying initial entitlement to benefits for Traumatic Mental Stress (TMS) and Chronic Mental Stress (CMS).

The worker alleged that dealing with complex, suicidal clients and receiving threats constituted traumatic events and substantial work-related stressors.

The Appeals Resolution Officer denied the appeal, finding that the events did not meet the objective threshold for TMS, as there were no threats of physical violence involving weapons or bomb threats.

Furthermore, the routine stress of the Case Manager position, while high, did not involve life-and-death responsibility as defined by the CMS policy, and the stressors were not excessive compared to normal pressures in similar circumstances.