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H.M. v. Wawanesa Mutual Insurance Company (18-011655)

  • August 4, 2020

The claimant sought entitlement to pre-104 and post-104 weeks IRBs. The claimant was self-employed as a steel worker at the time of the accident and he owned 75 percent of a small steel fabrication business. Adjudicator Hans determined that the claimant established that he was substantially unable to perform the essential tasks of his pre-accident employment. The claimant provided convincing evidence regarding how his impairments affected his functionality and ability to perform the essential tasks. Adjudicator Hans agreed with the Functional Capacity Evaluation that the claimant did not meet the heavy physical demand level of his pre-accident employment. Adjudicator Hans noted that the focus of the test was broader than whether the claimant could perform some tasks, but whether he was substantially unable to perform the essential tasks of his pre-accident employment as a steel worker. The insurer argued that causation was an issue with respect to the applicant’s headaches, low back pain and right leg radiculopathy. However, Adjudicator Hans held that the claimant met his burden in establishing causation. Adjudicator Hans concluded that there was no convincing evidence documenting the claimant’s inability to engage in any employment for which he was reasonably suited and the claimant’s medical professionals did not conduct an analysis of the post-104 week test or make convincing substantive submissions in this regard. The applicant was not entitled to post-104 IRBs but he was entitled to receive weekly IRBs for the pre-104 period and interest on the overdue payments.

Full decision here

TGP Analysis

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