- Alcoholism
- Drug addiction
- Loss of earnings {LOE} (cooperation)
- Permanent impairment {NEL} (degree of impairment) (psychotraumatic disability)
- Loss of earnings {LOE} (review) (final)
- Consequences of injury (secondary condition)
On October 27, 2014, the worker was repairing balconies on a multi-story residential building when he fell. He likely came into contact with a lower balcony before his safety harness arrested his fall approximately two stories below where he was working. The worker was granted entitlement for lumbar and cervical strain injuries and Post-Traumatic Stress Disorder (PTSD). The worker sought the following: a) entitlement for a Substance Abuse Disorder (SUD) as a secondary condition; b) an increase in his Non-Economic Loss (NEL) award for his accident-related psychological condition set at 30%; and c) entitlement to full Loss of Earnings (LOE) benefits at the time of the final review on May 20, 2023.
The Vice-Chair allowed the appeal.The Vice-Chair allowed entitlement to a SUD and health care that is necessary as a result of the disorder. The Medical Discussion Paper on Addiction indicates that "There is strong evidence that SUDs are highly co-morbid with PTSD [50-70%]". The Vice-Chair determined that the worker's psychological condition was best described at the top end of Class 3, which is associated with a 45% NEL rating.In the absence of a formal finding of non-cooperation in required rehabilitation measures in adherence with applicable WSIB policy (see OPM Document No. 22-01-03), and in the circumstances of this claim, the Vice-Chair did not accept that it had been demonstrated that the worker's non-cooperation in medical rehabilitation measures caused his own inability to participate in vocational rehabilitation or return to work. At the time of final review of LOE entitlement, the worker was incapable of returning to work. He was therefore entitled to full LOE entitlement from the time of final review until he reaches 65 years of age. The Vice-Chair noted that despite the worker's young age and other factors related to treatment, the WSIA does not contemplate an open-ended vocational rehabilitation and compensation process. The Act contemplates that the process is to be complete and LOE benefits finalized within 6 years of an accident. The ability to extend that 6 year time frame is limited to the circumstances and for the timeframes provided for in section 44 of the WSIA. In the present appeal it was more than 10 years following the worker's accident, the worker had not returned to work since the time of the accident, and the medical reporting indicated that he was still not able to return to work at the latest possible time for conducting a final review of LOE benefits.