1. SAMPLE of WORK for Susan M. DeVore
ADJUDICATION QUESTIONS
By
Susan Michelle Devore
In Preparation for
Interview: Friday, February 5
th
, 2010 at 9:00 am

2. SAMPLE of WORK for Susan M. DeVore
QUESTION ONE:
A worker walks across the street on his coffee break for a chocolate bar and falls on the ice in the
7-11 parking lot and breaks his femur. He submits a worker’s report and claims for
compensation benefits. (policy information attached).
Part A:
How would you adjudicate this claim file?
1. Review the Employer’s Report of the incident;
2. Review the Worker’s Report of the incident;
3. Review the Physician’s Report, if available, upon receipt of the claim;
4. However, upon noting the location and circumstances of this incident, it is this
writer’s opinion that the claim be DENIED on the following grounds:
• Location: the incident did not occur on the Employer’s premises (“the worksite”)
nor did it occur as a result of the Worker’s employment duties;
• The Worker removed himself from the scope and course of his employment at the
time of the incident for purely personal reasons;
• The Worker chose to leave the worksite, of his own accord, and not under the
direction of his Employer either directly or indirectly;
• The Worker was crossing onto other public property and not that of the
Employer’s.
Unfortunately, in this instance, the Worker was the author of his own demise. Although the
Worker sustained a very unfortunate and serious injury, there is no “liability” on the part of the
Employer or WCB to initiate a claim.

3. SAMPLE of WORK for Susan M. DeVore
Part B:
Write a paragraph (like you were writing a letter to the worker) and explain your decision?
Dear Mr. Jack Tripper:
Re: Injury Date: 05 February 2010
We are in receipt of your Injury Report which occurred on the above noted date and thank you
for same.
Unfortunately, we are unable to accept your claim for WCB benefits and must deny your claim
upon the following grounds:
1. The injury did not occur on your Employer’s premises or as a direct or indirect result
of your employment duties (Policy 02-01, Part II, Application 1);
2. You removed yourself from the scope and course of your employment for personal
reasons on your own initiative and not at the direction of your Employer (Policy 02-
01, Part II, Application 5);
3. The injury was sustained on other public property and not on that of your Employer
(Policy 02-01, Part II, and Application II.
*
Should you have any further questions or concerns in regard to the foregoing, please do not
hesitate to contact the writer.
Kindest regards,
Susan M. DeVore
Adjudicator
* A thought for an additional paragraph; however, I am uncertain of WCB Protocol in this
respect.
Should you disagree with our decision, there is an Appeal Process available to you.
You may wish to obtain a copy of the Worker’s Handbook, visit the WCB website or
call the Contact Centre at the telephone numbers listed on this correspondence for
further details of the Appeal Process.
I did note the instructions indicated a “paragraph” - sorry couldn’t do it.

4. SAMPLE of WORK for Susan M. DeVore
QUESTION TWO:
The same worker listed in Question One calls you. He advises that he is a single parent of three
children. He advises that because of your decision his family will now be living in their car.
You are taking the food out of his family’s mouth.
Write down how you might verbally respond to this worker
“Oh Hello Mr. Tripper … How are you feeling? I am so sorry to hear that. Unfortunately, as
indicated in our correspondence to you as a result of the location of the injury, as well as the fact
that you were not in the scope and course of your employment we no alternative but to deny your
claim.
… I can certainly empathize with your situation however as I indicated to you previously, our
hands are tied, and there is nothing that we can do. Do you have any Extended Health Care
Benefits through your Employer or Union that have Short or Long Term Disability Benefits
available to you? Have you thought about Employment Insurance, I believe that they do have
Income Replacement Benefits for injury and/or illness? What about Social Assistance? I
understand these suggestions may be a hard pill to swallow since you have always been a good
provider; however, they are viable options that may be able to be of some assistance to you at
this time.
Yes, I understand Mr. Tripper … oh, one further option – did you obtain a copy of the Worker’s
Handbook? You can look it up on-line. If you so vehemently disagree with our decision, there
is an Appeal Process. The steps required are outlined in the book and on our website.
I hope that some of my suggestions might be helpful to you. If you have any further questions,
please call me and I’ll try to help you out the best that I can.
Best of luck and take care. G’Bye!”
• Again, not being familiar with WCB Protocol, I am uncertain if the foregoing are
acceptable suggestions. I have learned from experience in dealing with the public
that building a trusting, helpful rapport is paramount. A little empathy goes a
long way as well as acute listening. Injured and angry people do not want to be
patronized - they want results. It has been my experience that a few minutes of
my time to let the individual “vent” and then offering some subsequent helpful
suggestions can tend to put the individual at ease. Obviously, this is not always
the case but it usually my first approach with a disgruntled individual.

5. SAMPLE of WORK for Susan M. DeVore
QUESTION THREE:
What factors would you use to assess if an injured worker was entitled to Worker’s
Compensation Benefits?
Factors used to assess a Worker’s entitlement to benefits would include:
• The injury occurred on the Employer’s premises;
• The Worker was in the process of performing a task to benefit the Employer;
• The injury occurred whilst the Worker was on “company time”, so to speak;
• The injury occurred as a result of the use of equipment and/or materials provided
by the Employer;
• Causation of the injury –
i. Traumatic In jury;
ii. Injuries caused by repetitive work;
iii. Occupational disease;
iv. Re-Injury of a previous work related injury.
v. Ensure that the injury is not an exacerbation of pre-
existing unrelated injury, health issue, as a result of
routine travel to the work site or “willful
misconduct” of the Worker.
Describe the types of benefits and services that a worker could be entitled to?
Benefits and services available to a Worker through WCB would be relative to the seriousness
and nature of the injury. Benefits available might be as follows:
1. Disability Benefits (ie: Wage Loss) – based upon 90% of net earning;
2. Medical Benefits / Expenses: including but not limited to hospital care, treatment costs
(physiotherapy, chiropractic, massage, work-hardening programs, vocational re-
training) prescription costs, replacement of eyeglasses, equipment relative to the
Worker’s rehabilitation (crutches, walkers, orthopaedic devices), dental appliances;
3. Some other expenses to be considered may be home/hospice care, lump sum payments
relative to PD (permanent disability);
4. Pension;
5. In the event of a Fatal injury, some funeral expenses may be paid for as well as benefits
to the decedent’s dependents.
Likely, there are more benefits available which would be awarded on a case-by-case basis just as
the benefits set out above.

6. SAMPLE of WORK for Susan M. DeVore
QUESTION FOUR:
Describe what factors you would use in assessing fitness for work?
In assessing a Worker’s fitness to return to work, medical evidence would be the most salient
factor to be relied upon. For example, has the Worker’s Physician, Therapist’s, Specialist’s et al
given the green light to the worker to return to his pre-injury working capacity? Has the Worker
plateau'd in his recovery (ie: he is not going to get any better nor is he going to get any worse)?
Perhaps there may be some residual sequelae from the injury and the Worker would be at risk of
re-injury. However, he is not completely and total incapacity from performing certain duties. It
might be prudent that a return to light or modified duties may be of benefit to the Worker and the
Employer. Cost effective for both parties and the Worker can, within a reasonable time period,
return to his pre-accident capacity.
What is the Worker’s Functional Capacity – does he need to be sent for assessment? Is the
Worker even capable of returning to his former employment, is re-training in order?
This is a difficult question to answer as a Worker’s return to work is dependent upon many
variables but mostly the injury itself – is it a fairly minor injury, a serious injury or a catastrophic
injury? Thus, the possible factors in assessing a Worker’s fitness to work are enumerable.
Bottom line, in my humble opinion is Medical Evidence.

7. SAMPLE of WORK for Susan M. DeVore
QUESTION FOUR:
Describe what factors you would use in assessing fitness for work?
In assessing a Worker’s fitness to return to work, medical evidence would be the most salient
factor to be relied upon. For example, has the Worker’s Physician, Therapist’s, Specialist’s et al
given the green light to the worker to return to his pre-injury working capacity? Has the Worker
plateau'd in his recovery (ie: he is not going to get any better nor is he going to get any worse)?
Perhaps there may be some residual sequelae from the injury and the Worker would be at risk of
re-injury. However, he is not completely and total incapacity from performing certain duties. It
might be prudent that a return to light or modified duties may be of benefit to the Worker and the
Employer. Cost effective for both parties and the Worker can, within a reasonable time period,
return to his pre-accident capacity.
What is the Worker’s Functional Capacity – does he need to be sent for assessment? Is the
Worker even capable of returning to his former employment, is re-training in order?
This is a difficult question to answer as a Worker’s return to work is dependent upon many
variables but mostly the injury itself – is it a fairly minor injury, a serious injury or a catastrophic
injury? Thus, the possible factors in assessing a Worker’s fitness to work are enumerable.
Bottom line, in my humble opinion is Medical Evidence.