Decision Number: 20100073, 2010 CanLII 35604 (ON W.S.I.B.)

Appeals Resolution Officer Decision, No. 2010073

OBJECTION BY: Worker
EMPLOYER: Not Participating
REPRESENTATIVES: Worker

Issue:
The worker objects to the denial of entitlement to Loss of Earnings (LOE) benefits between March and June, 2009 for medical treatment/physiotherapy.

How the Issue Arises:
On January 23, 2001, the worker, who was employed as a Mechanical Maintainer, injured his low back when he bent over and moved a soot blower. He was dianosed with a lumbar strain. Entitlement was granted and benefits were paid in accordance with the medical evidence received. Initially there was no loss of time however the worker laid off on June 28, 2001 as a result of ongoing problems and this recurrence was accepted. Recurrences were further accepted from June 20 to July 2, 2006 and July 11 to 17, 2006, as well as lost time in November and December of 2006. On October 11, 2007 a WSIB Chiropractic Consultant reviewed his file but it was unclear whether or not this was a care for further entitlement. An Independent Medical Examination was done in November 2007 and the worker was referred for a Non-Economic Loss (NEL) assessment. The worker subsequently had further recurrences from Feb, 2007 to May, 2008. He claimed further lost time to attend medical treatment/physiotherapy for various days between March 26, 2009 and June 12, 2009. The workers request for reimbursement for lost time to attend medical appointments between March and June, 2009 was denied. In the meantime, the worker was granted a 14% NEL award in June, 2009.

Assessment of the Evidence:
What is important to note is that this case was at the 72 month final review stage as of Janurary 23, 2007. LOE benefits may be extended beyond the 72 month lock-in date if the worker is either co-operating in a Labour Market Re-entry (LMR) plan or there is a significant deterioration in the worker's condition subsequent to the 72 month mark. The worker was not involved in an LMR program as he remained employed by the employer. Thus benefits cannot be considered on the first basis.

When reviewing the policy for payment of LOE benefits when there is a significant deterioration, in the case of the worker, he was considered to have reached a point of Maximum Medical Rehabilitation in November, 2007. Medical documentation on file both before and after March, 2009 does not confirm that his condition was significantly worse in either March, April, May or June.

Conclusion:

The worker's objection is denied.