Incomplete information leads to poor decision

At the time of his workplace injury, Mr. H was unrepresented and spoke little English. His claim was denied and he appealed. The appeals resolution officer denied the appeal. The decision said, “The worker reported sustaining a low back injury as a result of the regular job duties. There is no medical diagnosis on file other than what the worker has reported….” Despite that, the legal clinic now representing Mr. H later found that the file had an x-ray and medical notes that Mr. H lost four weeks of work due to a dislocated disc.

The clinic contacted the Commission, who reviewed the file and found:

  • no Form 8 (Health Professional’s Report)
  • no investigation into the employer’s statement about the type of work
  • no inquiries into the employer’s statement that the worker had not missed work, although the legal clinic found he was off work for four weeks
  • no contact with any of the worker’s witnesses
  • medical information consisting of an x-ray report and a prescription note from the worker’s family           doctor recommending that he stay off work for four weeks with physiotherapy.

The Commission spoke with the Appeals Services Division (ASD), who, after looking at the file, acknowledged the decision was “thin.” The ASD agreed to provide a reconsideration decision if Mr. H asked and said they were prepared to be more flexible in this case to allow him the opportunity to gather any additional evidence.

The representative proceeded and the ASD allowed the reconsideration request. The Appeals manager then wrote to the representative, saying a field investigator would obtain statements from the workplace parties and share the information before making a new decision