Entitlement decision overturned following further review

A worker representative complained to the Commission that the WSIB hadn’t provided him with a meaningful response to concerns he had raised about an entitlement decision for his client’s arm injury.

The WSIB had denied entitlement because it determined that the worker’s diagnosis was incompatible with the mechanism of injury. Following the initial denial, the representative made a detailed submission to a WSIB manager, outlining flaws in the adjudication process. However, he complained that the reconsideration decision dismissed his concerns without explanation.

The Commission raised the representative’s concerns with the manager. Following her review, the manager referred the claim to a medical consultant for an opinion on the compatibility of the diagnosis with the mechanism of injury.

Approximately one week later, following receipt of the medical opinion, the denial was overturned and the worker was allowed entitlement for his arm injury.