Traumatic mental stress claims reconsidered and allowed

Complainants: Four police officers

Problem: Three claims were denied; one allowed, then denied on recurrence.

Resolution: The four claims were sent to different case managers, and reviewed, some new information was gathered, and all four claims were allowed.

Four police officers asked for the Commission’s help with traumatic mental stress claims. The WSIB denied three of their claims and allowed the fourth, but then denied it on recurrence. The WSIB’s letters acknowledged that the officers had been exposed to numerous incidents, but stated there was no evidence to support “any psychological reaction”. The letters did not refer to any medical evidence.

WSIB policy allows for benefits when a worker is found to have suffered traumatic mental stress because of a sudden and unexpected traumatic event or the cumulative effect of multiple traumatic events.

A WSIB manager agreed to review the claims after the Commission asked for clarification as to what information the decisions were based upon and in fact, whether sufficient information had even been gathered to make decisions. The claims were separated, sent to different case managers, and all four were allowed.
Here’s what happened, case by case.

For one claim, the new case manager gathered further information, including statements from former colleagues of the officer and employer information about traumatic events and time missed from work. This information supported the officer’s claim of traumatic mental stress.

Another officer had been off work from 2006 to 2010, diagnosed with post-traumatic stress disorder (PTSD). Following the Commission’s inquiries, the WSIB determined that the officer was entitled to health care and loss of earnings (LOE) benefits.

The third case was initially allowed. The officer returned to work, but suffered a relapse six months later. The dispute was over benefits after the relapse. Following the Commission’s inquiries, the case manager gathered more information. The WSIB reconsidered, allowed the claim, and referred the officer to the Psychological Trauma Program.

The fourth case was rooted in a 2001 incident. The officer began to show psychological symptoms in 2003. The case manager had wanted the officer to participate in an assessment to be diagnosed, determine the relationship between the 2001 incident and the officer’s condition, and to review whether he had reached maximum medical recovery (MMR). The assessment would also help establish his ability to work, any barriers, and factors contributing to his condition. The officer argued the assessment wasn’t necessary. He had recently attended a residential treatment program.

After discussion with Commission staff, the officer decided to participate in the assessment. He, his colleagues, and his employer provided additional information about his symptoms and changes in duties. The case manager allowed the claim.