Case Summary : Decision-Making Process
Practice guidelines for 72-month review
An injured worker’s husband called the Commission with concerns about the WSIB’s 72-month lock-in decision-making process. The injured worker had been on full loss-of-earnings benefits since September 2007 when the WSIB determined the worker was not capable of continuing in her labour market re-entry (LMR) program due to a back injury she suffered while participating in the program. The worker did not hear again from the WSIB until April 2011 when the case manager called to discuss her participation in further work transition services. The worker told the case manager she was physically unable to consider resuming her LMR program.
The case manager decided the worker’s inability to participate in LMR was the result of injuries she suffered in a car accident in March 2008. Thus, the worker no longer had an earnings loss related to her compensable accident. As a result, the worker’s benefits would be locked in at zero to age 65. The worker disputed this finding, and the case manager told her she would reconsider the decision if the worker submitted medical reports related to the car accident.
The Commission spoke to the manager about the decision making and reconsideration processes,noting that the December 1, 2010, Practice Guidelines and Special Circumstances for lock-in reviews requires advance written notice of a proposed change where a worker is on full benefits before the lock-in date as well as an opportunity to provide any new evidence before a decision is made. The manager agreed that the worker was not given the opportunity to submit the medical reports related to the car accident. He told the case manager to extend benefits until the medical reports were received and reviewed.