Ontario Workplace Safety and Insurance Board

The worker appealed decisions denying a course of physiotherapy and confirming a 3% non-economic loss (NEL) quantum for a left knee meniscal tear and patellofemoral syndrome.

The Appeals Resolution Officer found that while the worker's ITB syndrome was not compensable, her patellar tendinopathy was medically compatible with the compensable injury, entitling her to physiotherapy.

The 3% NEL quantum was confirmed as it correctly applied the AMA Guides to the 7% lower extremity impairment.

The appeal was allowed in part.

The worker objected to the denial of entitlement to Chronic Pain Disability (CPD) following a 2007 workplace injury involving an acute lumbar strain.

The Appeals Resolution Officer found that the compensable low back strain had resolved without permanent impairment and that the worker's ongoing symptoms were related to non-compensable degenerative conditions.

The appeal was dismissed and entitlement to CPD was denied.

The worker appealed a Case Manager's decision denying entitlement for a psychotraumatic disability.

The worker had suffered a low back strain in 2005 and subsequently developed an Adjustment Disorder with Mixed Anxiety and Depressed Mood.

Although the worker had pre-existing mental health issues, the Appeals Resolution Officer found that the workplace injury was a significant contributing factor to the development or progression of the psychological condition.

The appeal was allowed, granting initial entitlement for a psychotraumatic disability, with the determination of permanent impairment deferred pending further treatment.

The worker appealed a decision denying initial entitlement for a left rotator cuff tear.

The worker experienced a gradual onset of left shoulder pain after emptying heavy boxes at work over a weekend.

Although there was a five-month delay in seeking medical attention, the Appeals Resolution Officer found the delay was not unreasonable as the worker self-modified duties and self-treated during that time.

The appeal was allowed, granting initial entitlement for the left rotator cuff tear and resulting surgery.

The worker, an administrator at a provincial youth correctional facility, appealed the denial of her claim for Traumatic Mental Stress (TMS).

She claimed TMS resulted from the cumulative effect of four traumatic workplace incidents between 1998 and 2011, including a riot, a staff strike, threats from a dismissed employee, and perceived threats from youth inmates.

The Appeals Resolution Officer allowed the appeal, finding that the incidents met the threshold for TMS entitlement related to exposure to multiple sudden and traumatic events, and that the worker's PTSD and major depressive disorder diagnoses were causally related to these workplace exposures.

The worker appealed several decisions regarding entitlement to benefits following workplace accidents in April and May 2008.

The Appeals Resolution Officer denied permanent worsening of the neck injury, ongoing entitlement to the left rib, and entitlement to the lower back and right shoulder.

However, the Officer accepted a permanent impairment for the left shoulder tear, entitlement for the upper back, and full loss of earnings benefits from January 29, 2014, continuing into the final review, finding the worker competitively unemployable due to the compensable injuries.

The worker appealed a decision denying her entitlement to benefits for traumatic mental stress (TMS).

The worker alleged that a superior sent her an inappropriate lewd picture, sent inappropriate text messages, and inappropriately touched her during a night shift.

The Appeals Resolution Officer found that while the picture was inappropriate, it did not qualify as an objectively traumatic event under the TMS policy.

The Officer noted significant inconsistencies in the worker's account of the events, a lack of corroborating evidence for the alleged touching, and evidence that the worker had engaged in joking behaviour with the superior that contradicted her claims of fear and intimidation.

The appeal was dismissed.

The worker objected to decisions determining she was partially impaired and capable of earning $10.25/hour over a 20-hour work week in the suitable occupation of customer service representative.

The worker sought a finding of total impairment and full Loss of Earnings benefits.

The Appeals Resolution Officer reviewed the expanded areas of entitlement, which included a 3% non-economic loss award for the left upper extremity, in addition to previous awards for the right upper extremity and psychotraumatic impairment.

The Officer found that the worker remained partially impaired and that the part-time suitable occupation was safe, consistent with her functional abilities, and available in the labour market.

The worker's objection was denied.

The worker, a concierge, sought benefits for Traumatic Mental Stress after fainting at work following three incidents of verbal harassment and aggressive behaviour by the company owner.

The Appeals Resolution Officer denied the appeal, finding that while the owner's conduct was unpleasant and inappropriate, it did not involve actual or threatened physical violence and therefore did not meet the policy definition of a sudden and unexpected traumatic event.

Furthermore, there was no required Axis 1 diagnosis from a psychiatrist or psychologist.

The worker, a personal support worker, appealed a decision denying initial entitlement for a left shoulder injury allegedly sustained while transferring a resident.

The Appeals Resolution Officer found insufficient evidence to establish proof of an accident, noting that the worker did not report the incident, continued regular duties without complaint, and delayed seeking medical attention for almost three months.

The worker's objection was denied.

The worker appealed decisions regarding the calculation of his earnings basis, denial of reimbursement for a medical report, and denial of entitlement for psychotraumatic and chronic pain disabilities.

The Appeals Resolution Officer found that employment insurance benefits were correctly excluded from the earnings basis calculation under the applicable policy.

The request for reimbursement of a $900 medical report was granted because the report was instrumental in increasing the worker's non-economic loss award.

The requests for psychotraumatic and chronic pain disability entitlements were denied because the worker did not meet the policy criteria, specifically lacking a timely psychological diagnosis and having pain consistent with his organic impairment.

The objection was allowed in part.

The worker, a building maintenance mechanic, appealed a decision denying initial entitlement for bilateral knee injuries allegedly sustained at work.

The worker claimed the injuries resulted from increased kneeling and crouching while assembling warehouse racks.

The Appeals Resolution Officer found insufficient proof of an accident or a compatible diagnosis, noting the medical evidence indicated non-occupational arthritic degeneration rather than a work-related injury.

The appeal was denied.

The worker appealed a decision denying a Non-Economic Loss (NEL) redetermination for a lower back strain injury.

The worker argued that their condition had significantly deteriorated.

The Appeals Resolution Officer found that while the worker had decreased range of motion and increased pain, medical evidence attributed these changes to pre-existing degenerative disc disease rather than the compensable lower back strain.

As the deterioration was caused by a pre-existing condition unrelated to the claim, the appeal was dismissed and the NEL redetermination was denied.

The worker objected to the 15 percent non-economic loss (NEL) award granted for chronic pain disability (CPD) following a workplace accident.

The worker's representative argued that the impairment rating should be classified in the high end of the Moderate Impairment category rather than the Mild Impairment category.

The Appeals Resolution Officer reviewed the medical evidence, including a psychiatric report and the worker's testimony at a prior WSIAT hearing, and found that the worker's condition aligned with the Mild Impairment category.

The appeal was denied and the 15 percent NEL award was confirmed.

The worker suffered a work-related fingertip amputation in 2008 and later underwent revision surgery on November 28, 2013.

The Case Manager initially paid loss of earnings (LOE) benefits until March 1, 2014, but a manager later rescinded all LOE benefits because the worker was unemployed at the time of surgery.

The worker appealed, seeking LOE benefits until he secured employment on June 9, 2014.

The Appeals Resolution Officer allowed the appeal, finding that the sole reason for the worker's loss of earnings was the surgery and recovery period, and that but for the surgery, he would have been available to accept work from his union hall.

The employer objected to the WSIB's decisions granting the worker initial entitlement for pigmented villonodular synovitis (PVNS) and denying the employer Second Injury and Enhancement Fund (SIEF) cost relief.

The worker had suffered a twisting injury to her right ankle at work, and was later diagnosed with PVNS, a rare tumour, which required surgery.

The Appeals Resolution Officer found that, on a balance of probabilities, the workplace injury either caused or aggravated the PVNS, satisfying the significant contribution test.

The Officer also found no evidence that the PVNS was a pre-existing condition that enhanced or prolonged the claim, and therefore denied SIEF cost relief.

The employer's objections were denied.

The worker objected to the WSIB's decision to offset his loss of earnings (LOE) benefits by the amount of his Canada Pension Plan (CPP) disability benefits.

The worker argued that because his CPP benefits were granted after his LOE benefits were locked in, the offset should not apply.

The Appeals Resolution Officer found that because the worker had suffered a significant deterioration resulting in an initial determination of a permanent psychological impairment, the WSIB was permitted to review the LOE benefits after the lock-in date.

The objection was denied and the offset was upheld.

The employer appealed a decision denying cost relief under the Second Injury and Enhancement Fund (SIEF).

The worker, a 57-year-old mold maker, tripped at work and sustained a right knee injury that required surgery.

The Appeals Resolution Officer found that the worker's pre-existing moderate degenerative changes and diabetes prolonged his recovery period.

Given the minor severity of the accident and the moderate significance of the pre-existing condition, the employer was granted 75% cost relief under the SIEF policy.

The worker appealed the denial of benefits for a psychotraumatic disability (Major Depressive Disorder), Chronic Pain Disability (CPD), and coverage for a non-professional escort for medical appointments.

The Appeals Resolution Officer found that the worker's depression was not caused by the workplace slip and fall, given her significant pre-existing psychological history and the minor nature of the accident.

The CPD claim was denied because the worker's pain levels were consistent with her organic impairment (right hip trochanteric bursitis).

However, the appeal was allowed in part regarding the non-professional escort, which was approved for WSIB-approved medical appointments located more than 60 kilometres from the worker's home.

The worker requested reconsideration of an Appeals Resolution Officer's decision regarding the nature of her pre-existing right knee condition and the employer's entitlement to Second Injury and Enhancement Fund (SIEF) cost relief.

The Appeals Manager found that the worker had only mild pre-existing osteoarthritis at the time of her slip and fall accident, and that her subsequent severe post-traumatic osteoarthritis was directly related to the accident and a subsequent misdiagnosis.

The Appeals Manager concluded that the pre-existing condition did not contribute to the accident or prolong the disability, thereby denying the employer's request for SIEF cost relief.