WSIB investigation into work disruption not complete
Problem: Worker was denied loss of earnings (LOE) benefits for a five-day suspension from work. The worker and employer disagreed about the modified work offer.
Resolution: The WSIB investigated further and gathered more information. Benefits were still denied, but the WSIB did a more comprehensive assessment of the facts and issued a new decision letter based on that.
The employer suspended the worker for five days over a dispute about the suitability of the modified work offered to the worker on his post-injury return to work. The worker told the Commission that his case manager had denied his loss of earnings (LOE) benefits without considering the information he provided.
The worker had contacted the case manager immediately to offer his view of the dispute, submit witness statements to support his position, and discuss the employer’s position. Although the case manager noted in the file that further inquiries were needed, none were made.
The Commission contacted a WSIB manager, who directed the case manager to make the necessary inquiries and provide a decision without delay. The Commission closed the complaint, but checked two weeks later to see if there was a more complete decision on file. There wasn’t, and none of the parties had been interviewed.
The file contained two new contradicting memos. The first documented the case manager’s notice to the worker representative and employer that she would allow LOE for the suspension period. The other went on the file the following day, denying the LOE, but with no new information.
The Commission went back to the manager who had issued the directive for further investigation. The manager re-assigned the claim to another case manager and directed that the file be referred to a claims investigator to conduct inquiries with the parties to the dispute. Again, the order went out for a timely written decision based on all the facts. The manager kept the Commission informed of progress and the final decision when issued.
The new case manager reached the same conclusion as the first case manager and denied the LOE, saying the worker’s suspension had nothing to do with the modified duties and accommodation issue. But, this time, the decision was based on evidence and substantiated. In a fair decision-making process, the parties are entitled to see that the facts of the case are gathered and are the basis for a clearly-explained decision.