PTSD Claim Sent Back for Proper Investigation
A published workers’ compensation appeal successfully advanced by JM Disability Management Solutions for a worker whose PTSD claim was denied without a complete investigation.
The Situation
The worker developed serious psychological symptoms after a workplace injury, but WCB did not accept additional responsibility for PTSD. Important diagnostic and causation evidence had not been fully investigated.
Why WCB Denied or Limited the Claim
- WCB made a decision before obtaining all necessary psychological evidence.
- The relationship between the workplace event, accepted injury and psychological symptoms was not fully explored.
- The available evidence was treated as insufficient without first completing the investigation.
How JMDMS Won the Appeal
JMDMS showed that WCB had not obtained all of the evidence needed to fairly determine the claim. The appeal emphasized the need for proper psychological assessment and a full review of causation.
What the Appeal Decision Achieved
The PTSD issue was returned to WCB for further investigation and a new decision.
Why This Decision Matters to Other Injured Workers
A referral back can be an important win. It prevents WCB from relying on an incomplete record and creates an opportunity for the necessary evidence to be obtained and fairly considered.
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
Psychological claims are often denied because the evidence is incomplete or the wrong legal test is applied. JMDMS knows what evidence should be gathered and how to challenge a premature denial.
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.