Since the Workplace Safety and Insurance Act was changed to recognize traumatic and chronic mental stress as compensable claims, the number of claims has been rising, and many employers say they are finding it difficult to understand and manage the claims in their workplaces.
To provide more clarity on this topic, representatives of the Office of the Employer Adviser met with WSPS Advisory Committee members to discuss traumatic mental stress and chronic mental stress claims and how each one is assessed.
In this blog post, we examine Traumatic Mental Stress Claims.
The hidden costs of mental stress
As employers, our goal should be to prevent mental stress in the workplace and avoid claims. If we leave this issue unchecked, it can take a significant toll on employees and our businesses through lost productivity, turnover, retraining and morale issues.
However, when incidents and situations do occur, we need to be sure we understand how to support employees. This starts with understanding how mental health claims arise, the differences between the entitlement categories and how each one is assessed.
Understanding the categories of entitlement
A mental stress claim can arise from an accident or an incident. It can be difficult to discern the category if timelines overlap and symptoms are similar. For example, a worker might experience harassment over months, which would be a case of chronic mental stress, and then witness workplace violence at work, which would be categorized as traumatic mental stress.
The first step is to understand each category, contributing factors and the evaluation processes.
Traumatic Mental Stress
Traumatic mental stress results from a sudden, unexpected traumatic event. The employee must have been involved first-hand or have heard about the event from someone who was involved.
Some examples would be an employee witnessing a fatality or horrific accident or witnessing or being a victim of an armed robbery or hostage taking.
The event must be identifiable and objectively traumatic. Meaning, another reasonable individual would also have to deem it to be traumatic.
However, a traumatic mental stress claim can also arise from repeated exposure. For example, an individual may be the key object of harassment culminating in a final event or cumulative outcome, such as ongoing harassment leading to physical violence or threats of physical violence.
Perceived threats may also be recognized. For example, a toy gun held to someone’s head may or may not qualify depending on how realistic and frightening the event was.
Examples of Traumatic Mental Stress Claim Outcomes
In case WSIAT 1741/21, an education assistant experienced a traumatic incident when a child exhibited violent behaviour including punching, kicking and stabbing with a pencil. Prior to the event, the worker had been receiving counselling and was on anti-depressants.
WSIB initially denied this claim, asserting that the incident was not objectively very traumatic as per policy guidelines. However, the Tribunal overturned the WSIB decision considering the worker’s role in maintaining a safe learning environment and the psychological assessment.
The Tribunal found that the pre-existing condition did not preclude entitlement. The focus was on the severity and impact of the event itself. While it was not similar to traditional examples of traumatic events, it was still traumatic due to the circumstances and the workers responsibilities.
This decision underscores the importance of taking an inclusive approach and understanding the context and impact of the event.
In case WSIAT Decision 33941/18, a Registered nurse removed restraints from a patient who subsequently committed suicide. While the worker wasn’t present at the time of the suicide and learned of it after, her prior interactions with the patient were considered relevant in assessing impact and the Tribunal granted entitlement for Traumatic Mental Stress.
They deemed that a sudden and traumatic event had occurred and the nature of the interactions between the worker and the patient were relevant, as was the immediacy of the event to the worker. The Tribunal was satisfied based on the temporal nexus between the events and the relationship between the worker and the patient.
Considerations in Assessing Traumatic Mental Stress Claims
Coverage is rarely determined with a simple yes or no answer. WSIB conducts a contextual assessment looking at both proximity and nature of exposure, as well as psychological impact. That is why it is critical to document and explain incidents in detail, and, ideally, documentation is supported by a doctor’s note.
After confirmation that an event did occur and it was work related, WSIB will assess the medical diagnosis to confirm that the mental condition is linked to that event. Employees must be diagnosed by a qualified health professional, including psychologists, psychiatrists, physicians and nurse practitioners. And, in some cases, WSIB may request another assessment from a qualified professional to clarify diagnosis and link to work in situations that are complex or there is overlapping information.
For example, if a diagnosis included anxiety and depression and possible pre-existing conditions, a second opinion might be sought to assess severity of the condition and connection to the workplace incident.
It is also possible for a worker to be entitled to PTSD coverage under the Traumatic Mental Stress policy, which covers injuries caused by specific traumatic workplace events. However, the traumatic mental stress policy is different from the PTSD policy, which applies to first responders and designated workers with presumptive entitlement based on their job role. While both involve PTSD, in Ontario, the pathways to entitlement are distinct.
In the next post, we’ll look at chronic mental stress claims, how they are assessed and examples of claims.
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