Overview of Psychological Injuries and Workers Compensation Claims
Workers compensation is an employer-funded insurance program that provides benefits to injured workers in the event of a workplace or work-related injury. Injuries can be physical or psychological in nature and can be caused a specific event or can develop over time.
The Government of Manitoba determines the legislative framework, which enables the Workers Compensation Board (WCB) to administer the workers compensation program in Manitoba.
The Workers Compensation Act (the “Act”) sets out the rules under which the WCB operates and describe the rights and responsibilities for both workers and employers. It enables the WCB to provide benefits and services to injured workers but also sets limits on the nature of injuries that can be accepted and what benefits will be approved. Specifically, the Act defines what is the WCB can accept as an “accident.”
The WCB develops policies to provide consistency in how the Act is applied. Policy 44.05.30, Adjudication of Psychological Injuries, explains that the WCB can only accept responsibility for psychological injuries caused by a “chance event,” a “wilful and intentional act” or those that are considered an “occupational disease.”
- Examples of a “chance event” include collisions, building collapses and natural disasters.
- Examples of a “wilful and intention act” include assault, robbery, riots, threats and harassment.
- In cases of psychological injury, an “occupational disease” is typically considered an “acute reaction” to a traumatic event and series of traumatic events.
- Post-traumatic Stress Disorder (PTSD) is a medical diagnosis, which describes a number of psychological symptoms that some people have following a traumatic experience. These symptoms may come on soon after an event, but their onset can be delayed by weeks, months or even years. PTSD can be considered an occupational disease under certain conditions.
Psychological injuries are often complex. Sometimes there are both work and non-work factors that are responsible for their development. In order for the WCB to accept responsibility for a psychological condition as an “occupational disease,” its development must be “predominantly attributable” to occupational factors.
The Act includes a legislative presumption for workers who are diagnosed with PTSD, which requires the WCB to presume their condition is a consequence of their job when certain conditions are met. In simple terms, they need to have been diagnosed with PTSD by a physician or psychologist and they have to have had exposure to occupational trauma. While one would think this legislation would speed up the claim process, WCB policy requires that the presumption be considered only as a last resort when adjudicating claims for psychological injuries.
It is important to know that the Act does not allow the WCB to accept responsibility for all psychological conditions that might be considered “work related.” Claims for psychological conditions caused by what the WCB considers as ordinary work stress or labour-relation matters will not be accepted. Examples include:
- performing a difficult or demanding job,
- having a heavy workload,
- performing a boring or repetitive job for a lengthy period of time,
- a difficult, demanding or unpleasant supervisor.
- difficult or unpleasant co-workers and/or clients
- job insecurity, lack of promotion,
- personal relationships problems.
It can be difficult to know what the WCB will accept responsibility for (what is considered “compensable”) and what it will not. For example, stress from having a loud and demanding supervisor would not be compensable, while psychological symptoms caused harassment by a supervisor would be.
The WCB is, however, responsible for investigating claims made by workers and deciding whether their individual circumstances meet the necessary criteria for accepting responsibility for their psychological condition.
If you believe you have been physically or psychologically injured as a result of your work, you should:
- Make a report to your employer
- Ensure your report is documented. Each employer/workplace has its own reporting expectations; some use a “Green Card” for workers to report accidents and injuries to their employer, while others have internal forms or online tools to make a formal report. The WCB does not require that any specific form be completed as long as the report can be verified, so regardless of how the report is made to the employer, it is important to keep a copy.
- Report as soon as possible. The Act says workers have 30 days to report injuries to their employer, but a claim can be denied if a worker failed to report their injury despite opportunity to do so.
- In cases of psychological injury, you might not know what caused you to feel unwell, but if you believe your difficulties were caused by something work related, you should make a report to your employer.
- It is never really too late to report an injury to your employer. Sometimes you don’t feel the impact of an experience until much later. Sometimes, you don’t miss work initially due to a psychological injury, but begin to do so later when symptoms become worse. While delays in reporting will make it more difficult for the WCB to confirm that an accident occurred, the late recognition of symptoms can be a valid explanation.
- Get medical help
- It is important to see a health care provider for a number of reasons:
- To get professional support to assist in managing your symptoms and to facilitate recovery and overcome your injury,
- To initiate the process of referral to a psychologist or psychiatrist,
- To have your psychological condition assessed and documented for the WCB.
- In cases of psychological injury, you might not immediately recognize that you are unwell. It could be co-workers or family who notice and comment that your behaviour has changed. If people who care about you are expressing concern, it would be a good idea to check in with your health care provider.
- It is important to see a health care provider for a number of reasons:
- Make a WCB claim
An adjudicator at the WCB will be responsible for investigating your situation and deciding whether or not your claim is acceptable. The adjudicator will gather information from you, your employer, co-workers, or other sources of information, to verify your report. The WCB will also request a report, and potentially a detailed medical history from your health care providers. The adjudicator may ask a WCB psychological or psychiatric consultant to review the information gathered as part of their investigation in order to get clarification about your injury. If you did not already see a health care provider on your own, the adjudicator might refer you to a psychologist for an initial assessment.
Questions commonly asked by a WCB adjudicator include:
- What is your job title?
- Can you describe your employment history?
- When did your symptoms begin?
- Can you describe your current symptoms?
- Have your symptoms changed over time since they began?
- What do you believe caused your symptoms?
- Were there any specific incidents that you experienced that are relevant to your injury?
- When did they occur?
- What was your involvement?
- Who else was present?
- Was the incident documented in some way?
- Did you seek out medical attention after these specific incidents?
- Did you tell your employer that you were experiencing psychological difficulties?
- If so, what did you report?
- Who did you report to?
- If you missed time from work, did you explain the reason for your absences to your employer?
- If you continued to work after your symptoms began, how did you cope?
- Did you struggle to do your job effectively?
- Did you tell anyone at work about your difficulties/symptoms?
- Did you see a doctor, counsellor or other health care provider?
- If so, when?
- If there was a delay in seeing a doctor or counsellor, why did that occur?
- If you did not get treatment, why not?
- Were you having any performance issues at work?
- Were you having issues with your work attendance?
- Is there any history of pre-existing psychological difficulties?
- If so, provide a summary of those difficulties and indicate whether medical attention was sought and if any medications were prescribed.
- Is there any personal, family or financials stressors?
- Are you experiencing any other medical issues?
- What activities are you involved with outside of work?
Once the adjudicator completes their investigation, they will contact you with their decision. If the claim is accepted, they will need to do further review to determine your entitlement to benefits, such as wage loss benefits, treatment coverage, etc. If the adjudicator denies your claim, they will typically contact you by telephone and follow-up with a formal letter, which should provide a rationale for the decision.
If the WCB denies responsibility for your injury, the MGEU can help. You can contact your MGEU Staff Representative directly, or through the Resource Centre (204-982-6438 / 1866-982-6438), to discuss your situation and to complete forms necessary to facilitate a referral to the MGEU Workers Compensation Specialist.
With your consent, the MGEU Workers Compensation Specialist will get a copy of your claim file from the WCB. The file will contain everything obtained by the WCB as part of their investigation, including your reports to the WCB and your employer, information submitted by your employer as well as all documentation provided by your health care providers.
The MGEU Workers Compensation Specialist will review the file evidence in conjunction with the Act and relevant WCB policies to determine if there is a basis to appeal the WCB’s decision. In some cases, the MGEU does not pursue an appeal because there was no clear error in the WCB’s decision or if there is no reasonable chance of success. At times, the MGEU will try to clarify evidence or gather additional information relevant to the claim. If the Workers Compensation Specialist finds sufficient support, the MGEU will pursue an appeal on your behalf.