Ongoing Knee Benefits Restored and Psychological Assessment Ordered
A published workers’ compensation appeal successfully advanced by JM Disability Management Solutions for a worker whose knee benefits were ended and whose psychological claim was denied without a complete assessment.
The Situation
The worker’s left knee claim was closed even though symptoms continued and surgery later improved the condition. WCB also denied psychological entitlement without completing the assessment needed to determine diagnosis and causation.
Why WCB Denied or Limited the Claim
- WCB ended knee responsibility despite continuing symptoms and later surgical evidence.
- The psychological claim was decided without all necessary treatment records.
- A comprehensive psychological assessment had not been completed.
How JMDMS Won the Appeal
JMDMS demonstrated continuity of the knee symptoms beyond the date WCB ended responsibility. JMDMS also showed that the psychological issue could not be fairly decided without the missing treatment information and a proper assessment.
What the Appeal Decision Achieved
Ongoing knee entitlement was restored. WCB was directed to obtain outstanding records, arrange an expedited comprehensive psychological assessment and make a new decision on psychological entitlement.
Why This Decision Matters to Other Injured Workers
A claim should not be denied because the evidence is incomplete when WCB has not taken reasonable steps to obtain the evidence required for a fair decision.
Could This Help Your Claim?
If your claim involves similar medical, psychological, vocational or benefit issues, this decision may help demonstrate that WCB’s first decision is not always the final answer. Every appeal depends on its own evidence, but a denial should be carefully reviewed to determine whether WCB applied the correct policy, considered all relevant evidence and fairly assessed the worker’s actual circumstances.
Why Experienced WCB Appeal Representation Matters
JMDMS recognizes when a medical record is incomplete and knows how to ask for the investigation, assessment and re-adjudication needed to protect the worker’s entitlement.
Successful appeals often require a detailed understanding of WCB legislation, policy, medical causation, vocational evidence, earnings calculations, functional limitations and Appeals Commission reasoning. JMDMS reviews the entire claim record, identifies what WCB missed and prepares focused submissions designed around the exact issue that must be proven.
Has WCB Denied Your Claim or Ended Your Benefits?
Speak with JM Disability Management Solutions about the decision, the evidence already on your file and the next available level of review or appeal.
Request a Free WCB Discussion Call 587-956-7530This case summary is provided for general information only. Every claim is decided on its own facts and evidence. A previous appeal result does not guarantee the outcome of another claim.