Sufficiency of medical evidence

A worker representative complained about the number of medical assessments the WSIB was asking the worker to attend before making a Future Economic Loss (FEL) decision. He felt that the medical evidence already in the file was adequate to make the decision and the delays were unreasonable.

The Commission reviewed the worker’s claim file and contacted the manager, who the representative spoke to some months earlier about the delay in the FEL decision. The manager was asked to review the representative’s correspondence, paying particular attention to: 1) a letter from the worker’s representative referring to a medical report from the worker’s treating specialist since the Commission could not find the report in the file; and 2) a multi-disciplinary assessment the worker attended, which was not referred to in the letter advising the worker about a new assessment the WSIB was requesting.

The manager located the specialist’s report, which had been incorrectly filed in the wrong section of the file. He then arranged to have a medical advisor review the specialist’s report and multi-disciplinary assessment. As a result of that review, the WSIB decided not to proceed with the planned assessment and agreed to make a decision based on the information available in the claim file. The worker was awarded a 100% FEL.