Reviewing surveillance evidence

Mr. M injured his right shoulder at work in July 2008. He had surgery on the shoulder in August 2010 and was granted entitlement
for full loss-of-earnings benefits and psychological treatment.

The case manager spoke with Mr. M about his overall level of impairment in February 2012. The case manager then referred
the file to Regulatory Services requesting surveillance because of concerns about inconsistencies between Mr. M’s report of his level
of impairment and the medical reporting on file. After reviewing the surveillance evidence, the case manager concluded Mr. M had
misrepresented his level of impairment and terminated his benefits.

Mr. M’s representative disagreed with this conclusion and sent in a detailed submission requesting reconsideration. The submission
included a review by Mr. M’s psychiatrist of the surveillance evidence. The psychiatrist said the surveillance did not change his opinion that
Mr. M suffered from chronic depression and chronic pain to the extent that he was not able to carry on full-time employment in his previous
job.

The case manager reviewed the submission and affirmed his original decision. The reconsideration decision stated that a
comparison of Mr. M’s representation of his level of impairment and the surveillance evidence “made a strong case against Mr. M’s
credibility.”

Mr. M’s representative called the Commission. He believed the level of Mr. M’s impairment was a medical issue, not a credibility issue, and
that a WSIB medical consultant should review the file.

The Commission spoke to the manager, asking for clarification about the process of assessing surveillance evidence, particularly in
cases where the worker has a psychological impairment. The manager agreed that making a decision based on a finding of the worker’s
credibility was questionable. She also agreed that the case manager had not addressed the question of whether the actions on the
surveillance video were consistent with medical reports. The manager arranged for the evidence, including the surveillance evidence, to go
for a medical review.