Final LOE review

An inquiry from the Commission about the decision-making process may trigger a review of the decision itself

A 47-year-old worker suffered a lower-back injury in 2004 that aggravated a compensable pre-existing condition. She underwent three surgeries, including a spinal fusion. She also developed a psychotraumatic disability that was related to her work injury. She was granted full LOE benefits as well as psychological treatment. In 2007, the WSIB determined that the worker was “totally impaired with regards to a return to work.”

In June 2010 the worker’s case manager conducted a review pending the 72-month lock-in date and determined that the worker would not receive ongoing benefits—her benefits would be locked in at zero. The decision was based on the accident employer’s statement that it could now provide modified work. The case manager concluded that, as a result, there was no wage loss. The Commission inquired into the short notice the worker received about the decision and a lack of information from the employer.

Meanwhile, the worker appealed the decision. The Appeals Branch sent the case back to Operations for a final decision on the worker’s compensable psychotraumatic disability. The case manager requested a review from the WSIB’s external psychology consultant, who reported that the worker had a major depressive disorder and her prognosis for returning to work was poor. The worker’s treating specialists and family doctor reported that it was unlikely she would be able to work in any capacity because of her extreme functional limitations related to her back injuries and spinal fusion surgery.

Based on this information and new information from the employer, the manager reconsidered the 72-month lock-in decision and found that the worker was competitively unemployable, given the combination of her organic and psychotraumatic disabilities.

The worker’s appeal was discontinued, and the manager said she will receive ongoing benefits.