WSIB renders decision on worker’s entitlement for liver transplant after lengthy delay

An injured worker complained that the WSIB refused to reimburse him for travel expenses incurred in 2017 and 2018 to prepare for a potential liver transplant, even though the WSIB allowed his claim for liver disease as a secondary condition.

According to the claim file, the worker had been advised by letter in December 2018 that reimbursement for travel expenses to pre–liver transplant appointments was denied because he did not have entitlement for liver transplant surgery under his claim. The WSIB wrote to the worker’s doctor to request additional medical information and further advised the worker that a case manager would make an entitlement decision for liver transplant surgery once the additional information was received.

Although the WSIB received the additional medical information in February 2019, no decision had been made by the time the worker contacted the Commission in April 2019. As the worker had not yet raised his concerns with a WSIB manager, the Commission referred the worker to the responsible manager.

The worker contacted the manager and was told that the additional medical information would be reviewed on a priority basis. The worker contacted the Commission again a week later, as he was concerned that he had still not heard from the WSIB or received a decision.

The Commission made an inquiry with a manager, who took immediate action. The worker was promptly contacted by the WSIB and advised that entitlement had been allowed for liver transplant surgery. Accordingly, the worker received reimbursement for travel expenses to his pre–liver transplant appointments.