PTSD & Workers’ Compensation Across Canada

From 2013 report by WCB Nova Scotia

Newfoundland and Labrador In order to be compensable, any injury must be shown to arise out of, and in the course of, employment, but in the case of stress, it must also be shown that it is “stress that is an acute reaction to a sudden and unexpected traumatic event.” The Act does not include stress other than stress that is an acute reaction to a sudden and unexpected traumatic event.” Further, the event must be shown to “sudden”, “unexpected” and “traumatic”. If it is found that the event meets the definition of a “sudden and unexpected traumatic event ” the worker’s reaction to the event is next examined in order to determine if it is ‘acute’ in nature.

Nova Scotia Workers covered by the Workers’ Compensation Act can be compensated only for an acute reaction to a traumatic event, because the current definition of accident in the act excludes compensation for stress except as an acute reaction to a traumatic event. Currently, there is no policy outlining entitlement criteria for psychological injury claims other than for those caused by a compensable physical injury. Province has acknowledged that a new policy needs to be developed to adjudicate psychological injuries.

New Brunswick Currently, first responders have to prove that their condition is work-related to receive workers' compensation for PTSD. Private member’s bill would amend the Workers' Compensation Act so that it would be presumed that PTSD diagnosed in any first responder is work-related, and therefore covered under WorkSafeNB. 7.1(2) If a worker who is or has been a firefighter, paramedic, police officer or sheriff is diagnosed with post-traumatic stress disorder by a physician or psychologist, the post-traumatic stress disorder shall be presumed, unless the contrary is proven, to be an injury that arose out of and occurred during the course of the worker’s employment in response to a traumatic event or a series of traumatic events to which the worker was exposed in carrying out the worker’s duties as a firefighter, paramedic, police officer or sheriff.

Prince Edward Island The Workers’ Compensation Board will consider entitlement to compensation benefits for a psychological or psychiatric condition where the condition is diagnosed by the treating physician and confirmed by a psychologist or psychiatrist according to the latest edition of the Diagnostic and Statistical Manual of Mental Disorders published by the American Psychiatric Association and the condition results from: a delayed acute reaction resulting from an accumulation of a number of work-related traumatic events which the worker was able to tolerate before. Stress is not an accepted medical diagnostic term. When a person’s ability to cope with stressors is overwhelmed, a negative form of stress (distress) can develop and result in a diagnosable psychological or psychiatric condition which may be compensable. To be compensable, stress must be an acute reaction to a traumatic event.

Prince Edward Island Note: entitled if stress caused by usual work pressures, or an employer’s employment decisions, or reasonable actions, for example: interpersonal relationships and conflicts; health and safety concerns; union issues; decisions to change work being performed; decisions to change working conditions; decisions to discipline or terminate the worker’s employment; routine labour relations actions. Excluded is stress caused by ongoing personal circumstances, regular workplace duties, management labour relations or that develops gradually over time which is not related to a traumatic event arising out of and in the course of employment.

Quebec Act defines an employment injury as “an injury or disease arising out of or in the course of an industrial accident, or an occupational disease, including recurrence, relapse or aggravation.” An “industrial accident” is defined as a “sudden and unforeseen event, attributable to any cause, which happens to a person, arising out of or in the course of his work and resulting in an employment injury to him.” An “occupational disease” is defined as a “disease contracted out of or in the course of work and characteristic of that work or directly related to the risks peculiar to that work.” The Commission de la santé et de la sécurité du travail (CSST) does not have a particular policy to deal with psychological stress claims, and files are processed according to the facts reported and on the balance of the evidence.

Quebec To support a claim for psychological stress, there will need to be some objective facts, rather than just a worker’s subjective evidence, and typically medical evidence will need to be presented, particularly if the claim is being made on the basis that it is an “occupational disease.” Some claims for stress associated with tasks to be carried out and work organization may be admitted when situations such as work overload, work under pressure, a climate of tension or the reassignment of tasks exceed the normal scope of work, however, for such claims to be accepted, it must be demonstrated, with objective evidence, that the workload was altered in such an important way so as to constitute a sudden, unforeseen event when circumstances are considered as a whole.

Ontario Bill to expand coverage for first responders in Ontario has been stalled at the legislature. The bill would require Workplace Safety and Insurance Board (WSIB) to presume the job of the first responders caused their Post-traumatic Stress Disorder (PTSD). Currently, police, firefighters, paramedics and other first responders have to prove it before receiving coverage. The proposed changes would mean that an emergency response worker suffers from post-traumatic stress disorder, the disorder is presumed to be an occupational disease that occurs due to the nature of the worker's employment as an emergency response worker, unless the contrary is shown. "Emergency response worker" is defined as a "firefighter, police officer or paramedic." PTSD is defined as "an anxiety disorder that develops after exposure to a traumatic event or experience with symptoms that may include flashbacks, nightmares and intense feelings of fear or horror."

Manitoba In June, the Manitoba government introduced amendments to the Workers Compensation Act that would recognize PTSD as a work-related occupational disease. The new bill extends coverage and benefits to all workers eligible under WCB who are diagnosed with PTSD by a medical professional. Goal is to ensure timely access to compensation and support services, with the long-term goal of reducing the stigma attached to mental illness. Manitoba’s Five-Year Plan for Workplace Injury and Illness Prevention launched in 2013 includes mental health as one of its 10 action areas. The plan commits Manitoba to improving supports, resources and coverage for workers who routinely face traumatic events as part of their work in an effort to reduce work-related PTSD.

Saskatchewan The legislation defines the term “injury” in a very broad manner. It includes the results of the wilful and intentional acts of others, the results of a chance event occasioned by a physical or natural cause, or “any disablement” which arises out of and in the course of employment. The Saskatchewan WCB has developed a clearly defined policy in relation to psychological or stress-related disorders that arise out of employment. The policy bases the adjudication of all psychological injury claims on the cause of the injury being reported: “acute cause criteria” or “chronic cause criteria.” The policy details what events would trigger or cause psychological conditions while taking into account the merits of each claim.

Saskatchewan For acute cause, there must be an acute traumatic event. Acute cause claims are adjudicated in the same manner as claims with physical injury from specific events; that being, the WCB determines if an injury occurred and whether it arose out of and in the course of employment. Chronic cause, is determined if the work-related events were excessive or unusual in comparison to the normal pressures and tensions experienced by the average worker in the same or similar occupation or work environment. For chronic cause claims to be accepted, workers must be employed in jobs involving events, or a series of events, considered traumatic to the general population.

Saskatchewan Non-traumatic chronic cause psychological claims may also be accepted that have arisen due to work relations, workload, or interpersonal conflicts. All chronic psychological injury claims generally will require a confirmed Mental Health Assessment, including a DSM diagnosis by a doctoral psychologist or psychiatrist.

Alberta PTSD is covered under policy for all workers, with each claim considered on a case-by-case basis. Compensation benefits are provided when it is confirmed through medical diagnosis and WCB’s follow-up investigation that the PTSD is work-related. First responders who suffer from PTSD are eligible for presumptive coverage through WCB-Alberta. It is important to confirm the diagnosis of PTSD. First responders include: Police officers appointed under provincial regulation but excluding the RCMP. Firefighters (both full-and part-time) as defined by Workers’ Compensation Act. Emergency medical technicians as defined under the Health Disciplines Act. Sheriffs (as defined under section 7 of the Peace Officer Act).

Alberta If a first responder is diagnosed with PTSD by a physician or a psychologist, it will be assumed to have risen out of and occurred during the course of employment, unless the contrary is proven. All workers who do not have presumptive coverage will continue to be eligible for the current workers’ compensation coverage for PTSD.

British Columbia WorkSafeBC may accept psychological conditions, such as mental stress or PTSD that do not result from any underlying physical injury or disease. A mental disorder may be accepted where the condition develops as a reaction to one or more traumatic work- related events or where it is predominantly caused by a significant work-related stressor, or a cumulative series of significant work-related stressors. Must be an identifiable event or stressor and more than only the worker’s subjective belief that an event was traumatic or a work situation was stressful. The events have to be emotionally shocking and the stressors have to be excessive in intensity and/or duration compared to the normal pressures or tensions of employment.

British Columbia Bullying or harassment could qualify as significant work stressors if the behaviour is threatening or abusive. WorksafeBC will only accept a claim for a mental disorder if the traumatic event was significant for the development of the mental disorder. Will not accept a claim if work-related factors are no more significant than a number of non-compensable factors such as personal relationship problems or non-compensable physical health problems. The work-related event or stressor must also be found by WorkSafeBC to have arisen out of and in the course of employment. No entitlement to compensation if the mental disorder is caused by a decision of your employer relating to your employment — includes decisions to change work duties or conditions, to discipline or terminate employment.