Document name

Psychological Injuries – General Injury Presumption (Section 27)

Document number

POL 12/2025

Accredited health care provider means a provider who has applied for accreditation with WCB and, following review of their credentials, WCB accepts their request for accreditation. Once accreditation is in place, the accredited health care provider can bill the WCB directly for services provided to workers.

Authorized Practice Endorsement (APE) is a professional designation for psychologists or social workers in Saskatchewan that allows those who hold the designation to make and communicate a psychological diagnosis.

DSM means the Diagnostic and Statistical Manual of Mental Disorders (DSM) published by the American Psychiatric Association to help mental health providers diagnose mental health disorders. The fifth edition (DSM-5) is to be used as prescribed by The Workers’ Compensation Miscellaneous Regulations. The DSM does not include guidelines for the treatment of a disorder.

DSM diagnosis, for the purpose of this policy, means a diagnosis that meets all diagnostic criteria for a disorder in accordance with the DSM, completed by a psychologist, psychiatrist, or a social worker who holds the APE.

Mental Health Assessment (MHA) is a psychological evaluation completed by a WCB accredited psychologist or psychiatrist and includes:

• An assessment and diagnosis of a disorder, or confirmation of a diagnosis, in accordance with the DSM,
• Recommended treatment, and
• Recommended return-to-work (RTW) planning.

Psychological injury means a psychological disorder or condition that meets the DSM diagnostic criteria (e.g., acute stress disorder or post-traumatic stress disorder) and has arisen, or is presumed to have arisen, out of and in the course of employment.

Standard of proof means the level of certainty required to prove an issue that is in question. For WCB, the standard of proof is whether a specific conclusion is more likely than not.

Substantial work-related stressor means an event, or series of events, that has arisen out of and in the course of employment that may give rise to a psychological injury. A work-related stressor will generally be considered substantial if it is excessive in intensity and/or duration in comparison to the normal pressures and tensions experienced by workers in similar work situations. The following circumstances would generally be considered substantial work-related stressors:

• Discrimination or harassment based on prohibited grounds as defined by The Saskatchewan Human Rights Code, 2018 (e.g., religion, creed, marital status, family status, sex, sexual orientation, disability, age, colour, ancestry, nationality, place of origin, race or perceived race, and receipt of public assistance) or physical weight or size.
• Bullying or personal harassment, which is a repeated or single serious or severe incident of aggressive or threatening conduct, comment, display, action, or gesture by a person towards a worker, with an intent to harm, exclude, threaten, humiliate or intimidate.
• Sexual harassment, which means conduct, comment, display, action, or gesture of a sexual nature.
• Excessive and long-standing workload issues that would be objectively considered beyond the normal pressures and tensions experienced within employment and constitute a threat or a lasting harmful effect to a worker’s health or safety.

Traumatic work-related event means exposure through direct personal experience or being a direct personal witness to an event, or series of events, arising out of and in the course of employment that may give rise to a psychological injury, including:

• Actual or threatened death or serious injury to a worker or others,
• Event(s) that are sudden and typically unexpected, occurring at a specific time and place, or
• Event(s) that would be objectively considered emotionally shocking or horrific (i.e., physical or sexual violence).

1. An injury means all or any of the following arising out of and in the course of employment:
   1. The results of a wilful and intentional act, not being the act of the worker,
   2. The results of a chance event occasioned by a physical or natural cause,
   3. A disabling or potentially disabling condition caused by an occupational disease, or
   4. Any disablement (Section 2(1)(r) of The Workers’ Compensation Act, 2013 (the Act)).
2. In accordance with Section 2(1)(r) of the Act, a psychological injury can be the result of a wilful and intentional act, not of the worker, the results of a chance event occasioned by a physical or natural cause or any disablement. Section 2(1)(r) also speaks to a disabling or potentially disabling condition caused by an occupational disease (i.e., asbestos related cancer or respiratory diseases) which would not apply in the case of a primary psychological injury.
3. The board has the exclusive jurisdiction to determine:
   1. Whether any condition or death with respect to which compensation is claimed was caused by an injury,
   2. Whether any injury has arisen out of or in the course of employment, and
   3. The existence, degree and permanence of any functional impairment resulting from an injury (Sections 20(2)(a)(b)(c)(d)).
4. The WCB may make inquiries (Section 25) and request any evidence (Sections 21 and 22)  it considers necessary pursuant to its exclusive jurisdiction to examine, hear, and determine all matters arising under the Act.
5. Unless the contrary is proven, if a worker or former worker is diagnosed with a psychological injury by a psychiatrist or psychologist, that injury is presumed to be an injury that arose out of and in the course of the worker’s employment when they have been exposed to a traumatic work-related event(s). POL 11/2025, Psychological Injuries – Psychological Injury Presumption (Section 28.1), provides guidelines for the adjudication of psychological injury claims that meet the legislated psychological injury presumptive criteria under Section 28.1 of the Act.
6. The general presumption in the Act states that if an injury arises out of a worker’s employment, it is presumed that it occurred in the course of employment and if an injury occurs in the course of a worker’s employment, it is presumed that it arose out of employment (Section 27). This presumption applies to all WCB claims.
7. POL 07/2021, Arising Out of and In the Course of Employment, outlines how the WCB determines if an injury arose out of and in the course of employment. This policy and corresponding procedure provide guidelines for the adjudication of psychological injury claims that do not meet the psychological injury presumption under Section 28.1 of the Act.
8. The WCB will not reject the claim of a worker or a worker’s dependant for compensation or reduce the amount of compensation payable by reason of a pre-existing condition of the worker if the injury materially aggravates or accelerates the pre-existing condition to produce a loss of earnings or death (Section 49).
9. The various circumstances where coverage applies cannot be addressed under one policy. This policy and procedure are intended as general guidelines only. The WCB will make its decisions on the real merits and justice of each case and is not bound to follow any legal precedent. In making its decisions, the Board may have regard to its policy directives (Section 23).

1. A psychological injury is presumed to be an injury arising out of and in the course of a worker’s employment when:
   1. The worker or former worker suffers from a psychological disorder, including post-traumatic stress disorder, that is diagnosed in accordance with the DSM by a psychologist or psychiatrist licensed to practice and make diagnoses, and
   2. The worker or former worker was exposed to a traumatic work-related event(s).

If both criteria are met, the causal link between the traumatic work-related event(s) and a psychological injury is presumed and will be adjudicated in accordance with POL & PRO 11/2025, Psychological Injuries – Psychological Injury Presumption (Section 28.1).

Claims outside the psychological injury presumption

2. When the criteria for the psychological injury presumption has not been met, the claim will be adjudicated under the general presumption (Section 27) and in accordance with this policy and corresponding procedure.

Claim decisions

3. The WCB operates under an inquiry model which means that evidence can be requested at any point to make, or help make, a decision.
4. Considering the merits and justice of each case, when evidence shows that more than one conclusion is possible, decisions will be made based on the conclusion that is more likely (i.e., standard of proof). POL 02/2019, Decision Making, will apply.
5. If evidence in support of opposite sides of an issue is approximately equal, the WCB will resolve the issue in favour of the worker (Section 23 of the Act and POL 02/2019, Decision Making).
6. As part of its inquiry, the WCB will examine and weigh evidence to determine if a worker’s injury arose out of and in the course of employment. Evidence may include, but is not limited to:
   1. Objective confirmation of the event(s) that caused or contributed to a worker’s psychological symptoms (i.e., injury reports, witness statements, medical information, etc.),
   2. Medical reports or medical opinions of the diagnosed condition or disorder, or
   3. Relevant information from the worker, employer, co-workers and/or health care providers to gain an understanding of the conditions or details of the traumatic work-related event(s) or substantial work-related stressor.
7. The WCB will determine whether there is sufficient evidence that proves that it is more likely than not (i.e., standard of proof) a traumatic work-related event(s) or substantial work-related stressor(s) contributed to or caused a psychological injury that arose out of or in the course of employment. The WCB will also review psychological injury claims that may have occurred as a consequence of or complication of an initial work-related physical injury or occupational disease (i.e., a secondary psychological injury).
8. The WCB does not consider psychological symptoms that result from the normal expectations of employment to be an injury arising out of and in the course of employment. Normal expectations of employment include the following:
   1. Timeline pressures,
   2. Work environment (e.g., poor work culture),
   3. Interpersonal conflicts that would not be considered discrimination, harassment, or bullying,
   4. Periodic workload fluctuations or assignment changes,
   5. Reasonable actions or decisions taken by an employer including:
      1. Hiring and firing employees,
      2. Performance evaluations or performance corrective actions (it is within the employer’s right to manage performance expectations and provide coaching when necessary),
      3. Staff assignments, transfers, or restructuring,
      4. Promotions, demotions, and lay-offs, and
      5. Conflict management (e.g., any reasonable action taken by an employer for the management of interpersonal conflict).
9. When a worker has been exposed to a traumatic work-related event(s), there is medical evidence of a psychological injury, but a psychological diagnosis has not yet been confirmed, the claim must be adjudicated under the general presumption (Section 27) and in accordance with this policy and corresponding procedure (as a DSM diagnosis is required for Section 28.1 of the Act to apply).

DSM diagnosis and Mental Health Assessments (MHA)

10. For a claim to be accepted under the psychological injury presumption (Section 28.1) a DSM diagnosis completed by a licensed psychologist or psychiatrist is required.
11. For a claim to be adjudicated under this policy, consideration may also be given to a DSM diagnosis provided by a social worker who holds the APE designation. PRO 02/2021, Mental Health Service Providers, outlines the WCB’s accreditation requirements for mental health service providers.
12. If a DSM diagnosis has been provided by a worker’s or former worker’s health care provider, the WCB will review the report to determine if it meets all the diagnostic criteria in accordance with the DSM. This includes both clinical and psychological testing information from a psychologist or psychiatrist.
13. A DSM diagnosis may not be required for the acceptance of a psychological injury claim under the general presumption when the causal relationship between the worker’s employment and the injury is determined to be evident. The WCB will still require evidence to determine whether a claim can be accepted however a formal DSM diagnosis may not be required at the beginning of the claim as part of the adjudication process.
14. The WCB may require an MHA completed by a WCB-accredited psychologist or psychiatrist for assessment and review of a DSM diagnosis when:
    1. The diagnostic criteria in accordance with the DSM was not provided by the health care provider, or
    2. The DSM diagnosis does not include both clinical (e.g., history, presentation, functioning levels) and psychological testing information.
15. Following a suicide, when there is no MHA or DSM diagnosis available, the WCB will consider the opinions or evaluations of any health care provider and all other available information as evidence to determine if there is a verifiable history of psychological symptoms connected to a worker’s employment.

Secondary psychological injuries

16. A secondary psychological injury may occur as a consequence of or a complication of an initial work-related physical injury or occupational disease (e.g., a worker with a physical injury who develops depression due to a slow and difficult recovery). For psychological symptoms that occur subsequent to an initial work-related physical injury, the WCB will determine if there is a verifiable history of psychological symptoms that can be connected to the worker’s initial work-related injury.
17. The WCB will determine whether it is more likely than not (i.e., standard of proof) that the effects of an initial work-related physical injury or occupational disease have contributed to, or caused, a secondary psychological injury.

Entitlement

18. The WCB may provide coverage for counselling services and essential prescribed medications while a claim is being adjudicated. If, after adjudication, the claim is not accepted, medical costs will not be charged to the employer.
19. If a psychological injury claim is accepted, the WCB will provide ongoing medical treatment and earnings loss benefits resulting from the work injury. The WCB will also develop a recovery and return-to-work plan in consultation with the worker, the employer and health care providers.
20. WCB benefits may coincide with a worker’s disability insurance entitlement. It is the responsibility of the worker to notify their disability insurance provider of the WCB benefits they are receiving.

Pre-existing conditions

21. Entitlement for a psychological injury will not be denied based on the existence of a pre-existing psychological condition. However, the WCB does not assume any responsibility for a worker’s pre-existing condition.
22. The WCB will determine if a psychological injury resulted in either an aggravation or acceleration of a worker’s pre-existing condition (POL 12/2017, Pre-Existing Conditions – Aggravation or Acceleration).
23. An employer may be eligible for cost relief for claims involving a pre-existing condition in accordance with POL 03/2021, Second Injury and Re-employment Reserve.

Recurrence

24. A worker may be entitled to medical treatment and earnings loss benefits resulting from the recurrence of a psychological injury. The WCB will review evidence to determine whether the worker’s psychological condition is a recurrence of the psychological injury.

Permanent Functional Impairment (PFI)

25. The WCB will review a psychological injury for any measurable permanent functional impairment when medically appropriate (POL 33/2024, Permanent Functional Impairment (PFI) Awards).

Appeals

26. A worker may ask the WCB to reconsider any decision made on a psychological injury claim.
27. If a worker or employer disagrees with the reconsideration decision, they may submit an appeal. POL 23/2014, Reversing Decisions, POL 21/2013, Appeals – Claims, and POL 13/2024, Appeals – Board Appeal Tribunal, will apply.

Critical incident response information sessions

28. To address and respond to the emotional and psychological consequences resulting from exposure to a traumatic work-related incident, preventative or post-incident response information sessions are available.