Worker upset by unjustified review of benefits

A worker representative complained to the Commission that the WSIB had reviewed his client’s benefits after the worker’s final benefit review, without sufficient basis.

Section 44 of the WSIA states that the WSIB cannot review a worker’s benefit payments more than 72 months after the date of injury, except in limited circumstances (e.g., if the worker suffers a significant deterioration in his or her condition that results in a redetermination of the degree of the worker’s permanent impairment).

In this case, the worker did not suffer a significant deterioration in his condition; instead, an ARO allowed an increase to the worker’s degree of impairment after the worker appealed the WSIB’s initial decision. The representative told the WSIB that the worker was terribly upset by the uncertainty caused by the review of his benefits.

The worker’s representative escalated the matter by writing to a WSIB director. Nevertheless, he received no response. Upon further inquiry, the director told the Commission that the letter hadn’t been brought to his attention.

As a result of the Commission’s inquiry, the director consulted with the WSIB’s Legal and Policy teams. It was subsequently determined that the worker’s benefits should not have been reviewed. The director committed to training the staff responsible for the claim on legislative requirements for post-72-month reviews of benefits. He also reminded his team that letters addressed to his attention should be flagged for him.

The WSIB apologized to the worker’s representative and removed the letter regarding the review of the worker’s benefits from the claim file.