A worker representative complained that the WSIB was not consistently adjudicating claims for mental stress under both its Traumatic Mental Stress (TMS) and Chronic Mental Stress (CMS) policies.

The representative provided several examples of the WSIB adjudicating his clients’ claims under the TMS policy only. In each of the claims, he asked the WSIB to adjudicate the claim under the CMS policy as well. After further review and adjudication, the WSIB either allowed the claim or issued a decision denying the claim under the CMS policy, thus allowing the representative to appeal the decision. However, the representative complained that his systemic concern about the WSIB’s practice went unaddressed.

In his complaint to the Commission, he noted that, as an experienced representative, he was aware that he could ask for a decision under the CMS policy, if necessary. He was concerned, however, that self-represented workers may be unaware of the CMS policy.

In reviewing the complaint, Commission staff considered the relevant legislation, policies and internal guidance documents. There did not appear to be any guidance for staff on informing workers about the two different policies or explaining under what circumstances decision-makers should consider both the CMS and TMS policies when adjudicating claims.

Commission staff spoke with a director in the Mental Stress Injury Program. She explained that the representative had already raised his concerns with her, and after further consideration, she determined that, going forward, if the WSIB were to deny a claim under the TMS or CMS policy, it would then adjudicate it under the other policy. She noted that the CMS policy is generally only considered for ongoing cumulative mental stress claims, but she acknowledged that it could also be applicable in single-event claims.