Suitable occupation and lock-in decisions reconsidered
A Worker’s representative advised the Commission that work-related psychological conditions affected the worker much more than the WSIB recognized. Psychological reports showed the worker was completely disabled due to agoraphobia, major depression, and anxiety. The WSIB determined that she could work as a cashier.
The worker told the Commission that her condition worsened after her work transition program ended because the WSIB stopped paying for psychological treatment.
The Commission reviewed the worker’s file. She had suffered a compensable back injury in 2008. In 2013, the WSIB determined that the worker also had a psychological disability caused by her workplace injury. Her psychological condition was permanent, so she received a 30 per cent non-economic loss (NEL) award. In 2014, the worker’s loss of earnings (LOE) payments were locked in on the basis that she could work part-time as a cashier.
The worker’s representative appealed the WSIB’s decision, arguing that the WSIB had not considered the worker’s psychological condition when it determined she could work part-time. While the appeal was pending, the WSIB received new medical information resulting in an increase in the worker’s NEL award for psychotraumatic disability to 40 per cent. By accepting that the worker’s permanent injury had worsened, the WSIB was required to review the suitable occupation (SO) and lock-in decisions, but didn’t do so.
In 2015 and 2016, the WSIB’s appeals staff directed the case management staff to review the SO and LOE in light of the worker’s NEL increase. Still, the reviews didn’t happen.
The Commission made inquiries with the WSIB and questioned whether the worker’s psychological conditions had been fully considered when determining the worker’s ability to work part-time as a cashier. As a result, the WSIB conducted further reviews and decided that the worker was unable to work as a cashier. Full LOE payments were reinstated retroactively. Based on a new assessment, the WSIB also allowed further psychological treatment.