Commission’s inquiries prompt fresh review of worker’s psychological impairment

The WSIB determined the worker able to work fulltime despite several psychological assessments that said he couldn’t work at all.

The 56-year-old worker was injured in 2009 and received temporary entitlement for a major depressive disorder in 2010. An appeals resolution officer determined in 2014 that, from a psychological perspective, a return to work with the accident employer, in any capacity, was not suitable.

In 2014, the WSIB placed the worker in a work transition program. Two psychological assessments determined that the worker was unable to work or retrain. Yet, the WSIB locked his loss of earnings (LOE) benefits in as though he could work 40 hours a week at minimum wage.

In 2015, the worker’s representative asked the WSIB to reconsider the LOE decision. He argued that the worker was unemployable because of his compensable psychological condition. The WSIB reviewed the worker’s claim and determined that the worker remained partially psychologically impaired, but not in ways that would prevent him from working. The WSIB advised that it would consider psychological limitations in any return to work or work transition program.

In July 2017, the worker’s new representative sent an updated psychological assessment to the WSIB. The document noted that all mental health care professionals who assessed or treated the worker agreed that he is unable to work or retrain because of his prolonged and severe work-related mental illness. The assessment stated categorically that no mental health professional will set out psychological restrictions for work or retraining when the patient is deemed permanently psychologically disabled. Still, the WSIB upheld its previous decision.

The Commission made initial inquiries with a manager and then an assistant director regarding the WSIB’s assessment of the medical evidence and its process for determining the worker’s psychological limitations. The WSIB told the Commission that staff had thoroughly reviewed the medical evidence and that it supported the psychological limitations set out by the WSIB.

The Commission escalated its concerns about the decision-making process to an executive director who asked a new case manager to review the worker’s impairment. The finding in 2018: the worker had been unemployable since 2014 based on psychological reports filed with the WSIB that same year.

As such, the WSIB paid the worker full LOE benefits retroactive to 2014 and will continue to pay full LOE benefits until the age of 65.