Document name

Psychological Injuries – General Injury Presumption (Section 27)

Document number

PRO 12/2025

1. POL 12/2025, Psychological Injuries – General Injury Presumption (Section 27), provides adjudication guidelines for psychological injury claims that do not meet the legislated criteria of the psychological injury presumption under Section 28.1 of The Workers’ Compensation Act, 2013 (the Act).
2. Any health care provider who provides health care services to an injured worker will provide the Workers’ Compensation Board (WCB) with any reports that are relevant to the injury for which compensation is claimed (Section 55).

Psychological injury presumption

1. What happens when a psychological injury claim is submitted to the WCB?
   1. Operations staff will first determine whether the injury claim meets the criteria for the psychological injury presumption:
      1. Is the worker or was the former worker diagnosed with a psychological disorder in accordance with the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM) by a licensed psychologist or psychiatrist?
      2. Is the worker or was the former worker exposed to a traumatic event(s)?
   2. If the answer is “yes” to both questions, the claim meets the criteria of the psychological injury presumption and will be adjudicated in accordance with POL & PRO 11/2025, Psychological Injuries – Psychological Injury Presumption (Section 28.1).
   3. If the answer to either question is “no”, the claim does not meet the criteria of the psychological injury presumption.

Claims outside the psychological injury presumption

2. If the criteria for the psychological injury presumption (point 1(a)) is not met, the claim will be adjudicated in accordance with this procedure and corresponding policy.

Claim decisions

3. What information will Operations staff consider to help make a claim decision?
   1. Workplace incidents or events may occur they but do not always result in an injury. Operations staff will first need to determine if the incident(s) or event(s) caused or contributed to an injury. To make this determination, Operations still will consider whether of any the following apply to the claim:
      1. There was a wilful and intentional act not being the act of the worker which would constitute a traumatic work-related event(s) or a substantial work-related stressor(s) and occurred in the course of employment (at a time and place linked to employment and the worker was performing an activity that is part of their employment duties),
      2. There was a wilful and intentional act not being the act of the worker which would constitute a traumatic work-related event(s) or a substantial work-related stressor(s) and arose out of the worker’s employment (meaning it is the result of an activity that is reasonably related to, originated from, or is the result of the worker’s employment duties),
      3. There was a chance event(s) of a physical or natural cause which would constitute a traumatic work-related event(s) or a substantial work-related stressor(s) and arose out of or in the course of the worker’s employment, or
      4. There was a disablement which arose out of or in the course of the worker’s employment.
   2. Operations staff may examine and weigh evidence at any point in the adjudicative process to determine whether a psychological injury has arisen out of or in the course of the worker’s employment. Such evidence may include:
      1. Objective confirmation of the event(s) that caused or contributed to the worker’s psychological symptoms (e.g., 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 substantial work-related stressor(s).
         1. In sensitive situations when it may be difficult for the worker to discuss a traumatic event(s) or substantial work-related stressor(s), Operations staff may request information from the worker’s health care providers, employer and/or co-workers.
4. Operations staff will use evidence to help determine whether it is more likely than not (i.e., standard of proof):
   1. A traumatic event(s) or substantial work-related stressor(s) occurred, and
   2. A traumatic event(s) or substantial work-related stressor(s) contributed to, or caused, a psychological injury arising out of and in the course employment.
5. In accordance with Section 23 of the Act, if the evidence is support of both sides of the decision if approximately equal, the WCB will decide the issue in favour of the worker.

Traumatic work-related event(s) or substantial work-related stressor(s)

6. What information will Operations staff consider to help determine if a traumatic event(s) or a substantial work-related stressor(s) occurred and has led to a psychological injury?
   1. Operations staff will review evidence that provides objective confirmation of the event(s) from the worker, employer, co-workers, health care providers, or any other person with knowledge of the event(s) that gave rise to the psychological symptoms. This may include, but is not limited to:
      1. Taking statements,
      2. Interviewing witnesses,
      3. Reviewing:
         1. Employment records,
         2. Relevant/available medical information, including any history of psychological health issues and medical evidence from the attending physician, and
         3. Any other evidence relating to the reported event(s) including emails, text messages, investigative reports completed by the employer, injury reports or police reports that demonstrate targeted malicious behaviour with the intent to harm.

Work-related interpersonal incidents

7. How can Operations staff determine if a work-related interpersonal incident may be considered a substantial work-related stressor(s)?
   1. Operations staff will verify that all of the following conditions have been met:
      1. There is objective confirmation of the incident(s) as reported,
      2. The incident(s) were wilful and intentional meaning they could reasonably be seen as intended to cause harm to the worker,
      3. The incident(s) would be objectively considered beyond the normal pressures and tensions experienced within employment, and
      4. The incident(s) constitute a threat or a lasting harmful effect to the worker’s health or safety.
8. What does objective confirmation of the incident(s) mean?
   1. Objective confirmation means that evidence exists which confirms the incident(s) occurred as reported. While a worker’s personal feelings, perceptions, or assumptions related to an incident may be upsetting, for claim adjudication purposes, Operations staff must be able to obtain verifiable evidence of the incident(s) as reported.
   2. Operations staff will consider evidence from others (e.g., employer, co-workers) with direct knowledge of the incident(s) as they occurred.
9. What does objectively considered beyond the normal pressures and tensions experienced within employment mean?
   1. The objective standard means that a reasonable person, in the worker’s situation and with the general characteristics of the worker, would find the incident(s) beyond the normal pressures and tensions experienced within employment.
10. When determining whether there was discrimination, bullying, or harassment, Operations staff must establish that it is more likely than not (i.e., standard of proof) all of the following conditions have been met:
    1. The worker experienced an occurrence of aggressive or threatening conduct, comment, display, action, or gesture in relation to a prohibited ground of discrimination under The Saskatchewan Human Rights Code, 2018,
    2. There was a series of incidents or a single serious or severe incident, which had a lasting impact on the health or safety of the worker,
    3. The behaviour occurred in the workplace or at a location or event related to employment,
    4. The behaviour was directed at the worker,
    5. The worker was offended, harmed, excluded, threatened, humiliated, or intimidated, and
    6. The perpetrator knew or reasonably ought to have known (wilful) that such behaviour would cause offence or harm.

The Appendix includes examples of what may or may not be considered harassment.

11. What are some examples of interpersonal incidents that would not be considered substantial work-related stressors?
    1. Examples may include, but are not limited to:
       1. Incidents that do not cause the worker to suffer from a medically confirmed psychological condition,
       2. Incidents that do not result from activities reasonably related to, originating from, or the direct result of the worker’s employment (i.e., arising out of employment),
       3. Incidents that do not constitute a threat or that have a lasting harmful effect to the worker’s health or safety,
       4. Incidents that would not be reasonably seen as being done with the wilful intent to cause harm (i.e., disagreements or differences of opinion would not generally have any intent to cause harm),
       5. Incidents that do not escalate to the point of discrimination, bullying or harassment,
       6. Incidents that are a result of voluntary personal relationships and/or their breakdown within the workplace, an
       7. Mental stress that may develop over time due to general workplace conditions or stressors.
12. How can Operations staff determine if a work-related interpersonal incident(s) contributed to, or caused, a psychological injury arising out of employment?
    1. Psychological injuries are often complex and may involve multiple contributing factors. When there are both work-related and non-work-related factors that contribute to a psychological injury, the work-related contribution must be of material significance in the occurrence of the injury, meaning more than a trivial or insignificant aspect of the injury or disease.
    2. The work-related contribution does not need to be the only cause or the dominant cause of the worker’s injury, rather, the work-related factors must have contributed in a meaningful way for the psychological injury to be accepted.
    3. When there are work-related and non-work-related factors and it is not clear whether the work-related factors are more than a trivial or insignificant aspect of the worker’s psychological symptoms, Operations staff may use the “but for” test to determine causation. Examples of the “but for” test may include:
       1. “But for” (or in the absence of) the work-related factors, would the psychological injury have occurred?
       2. “But for” (or in the absence of) the work-related factors, would the worker have been able to continue with employment duties?
       3. “But for” (or in the absence of) the work-related factors, would the worker’s pre-existing psychological symptoms have worsened or increased (e.g., increase in prescribed medications or an increase in the frequency of medical treatment)?

Excessive workload

13. What information will Operations staff consider to help determine if excessive workload issues led to a psychological injury that arose out of and in the course of employment?
    1. For claims related to excessive workload issues, Operations staff will obtain the following information from the worker, employer, and/or co-worker(s):
       1. Normal hours of work (e.g., regular shift schedule, days of work, rest days, shift rotation),
       2. Job description and employer expectations (e.g., requirement to be on call after regular work hours),
       3. Employment history (e.g., length of service in current job, previous work history),
       4. Schedule changes (e.g., additional shifts assigned outside of regular work schedule, temporary or permanent),
       5. Nature, frequency and duration of additional shifts or overtime outside regular work schedule (e.g., voluntary/mandatory, temporary/permanent, length of overtime),
       6. If voluntary, the reasons for working overtime and the impact if the worker chooses not to work overtime (e.g., workload piles up, affects customers),
       7. If not voluntary, whether there are consequences for refusing overtime or additional shifts,
       8. Details of duties performed that results in additional shifts/hours (e.g., if a worker says they are doing the job of three people, what does that look like?),
       9. Current staffing capacity (e.g. vacant positions, other roles that could take on additional workload, any opportunity to delegate tasks), or
       10. Any prior discussions with the employer regarding workload, including any plans they have in place to lessen workload.
14. How can Operations staff determine if excessive workload issues may be considered a substantial work-related stressor which contributed to, or caused, a psychological injury arising out of employment?
    1. Operations staff will determine if a worker’s excessive workload is objectively beyond the normal pressures and tensions experienced within employment and constitutes a threat or a lasting harmful effect to the worker’s health or safety. Operations staff will determine whether:
       1. The worker’s workload is significantly different from that of a co-worker’s usual workload and beyond the normal scope of maintaining employment (e.g., amount or type of tasks, etc.),
       2. The workload pressure is prolonged and unusually excessive in intensity and duration and
       3. The employer has taken any steps to mitigate or reduce the worker's excessive workload and, if so, how long alternate plans have been in place.

Date of injury

15. How can Operations staff determine the date of injury if there have been a series of traumatic events that are considered the cause of the psychological injury?
    1. The date of injury for claims with a series of traumatic events is the date the worker initially:
       1. Sought medical care for the injury, or
       2. Reported the injury to the WCB;

                    whichever occurs first.

DSM diagnosis and Mental Health Assessments (MHA)

16. What happens when a DSM diagnosis is provided to the WCB by a health care provider other than a licensed psychologist or psychiatrist?
    1. When a worker receives a DSM diagnosis, Operations staff will confirm the DSM diagnosis was completed by a WCB accredited mental health service provider, which may include a social worker who holds the Authorized Practice Endorsement (APE).
    2. Operations staff will obtain all relevant information from the worker’s health care provider (e.g., name and location of health care provider, DSM diagnosis, treatment dates, treatment plan, etc.).
       1. Operations staff may ask the worker to complete a Worker Medical Release of Information Request form (WMROI) to authorize their health care provider to release information to the WCB (e.g., if the health care provider is hesitant to provide the medical report or if the DSM diagnosis was provided by an out-of-province health care provider).
    3. Operations staff may request a review from the WCB’s Psychological Consultant to confirm whether the DSM diagnosis provided contains the relevant clinical (e.g., history, presentation, functioning levels) and psychological testing information.

17. When could an MHA be arranged by Operations staff?

    The decision to request an MHA is at the discretion of the decision maker. The examples below are intended as guidelines and not as an extensive list.

    1. Operations staff may decide to contact the WCB’s Health Care Services Department (HCS) to arrange an MHA when:

       1. There is insufficient evidence in the diagnosis provided to make a decision such as incomplete clinical (e.g., history, presentation, functioning levels) or psychological testing information,
       2. The DSM diagnosis is from a previous version of the DSM,
       3. There are multiple contributing factors that are both work-related and non-work-related and it is unclear whether the work-related factors are more than a trivial or insignificant aspect of the psychological symptoms,
       4. A DSM diagnosis has not been provided and the causal relationship between the worker’s employment and the injury is not evident, or
       5. The DSM diagnosis provided would not typically be expected following a traumatic work-related event(s) or substantial work-related stressor(s) (i.e., a non-traumatic psychological diagnosis such as attention deficit disorder).

18. What is the purpose of an MHA?
    1. An MHA may help to determine:
       1. A current DSM diagnosis,
       2. Contributing factors to the psychological symptoms,
       3. The ongoing effects of the psychological symptoms,
       4. The level and expected duration of appropriate care, and
       5. An appropriate treatment and return-to-work (RTW) plan.
19. Who performs an MHA?
    1. Licensed psychologists, accredited by the WCB, will perform an MHA in accordance with the DSM published by the American Psychiatric Association, and the Mental Health Assessment template provided by the WCB’s HCS department.
20. Under what circumstances may Operations staff proceed with file development and adjudication without a DSM diagnosis or MHA?
    1. Operations staff may proceed with file development and adjudication when the causal relationship between the worker’s employment and the injury is determined to be evident. This applies to:
       1. Workers or former workers who are/were in occupations that are often exposed to traumatic events by way of their employment (e.g., first responders, including, but not limited to; police officers, firefighters, paramedics, correctional officers, parole officers or probation officers) or
       2. Workers or former workers who experience a traumatic event(s) arising out of and in the course of employment (e.g., being the victim of a robbery, witnessing the death of a co-worker) and it is more likely than not (i.e., standard of proof) the traumatic work-related event(s) contributed to, or caused, a psychological injury.
    2. If Operations staff determine that a DSM diagnosis or an MHA is not required, they will:
       1. Document the reason on the claim file, and
       2. Ensure that the psychological injury is supported by a working diagnosis, meaning a likely or presumed diagnosis from a health care provider during the initial stages of treatment (e.g., medical report, psychological counselling report, and/or substantiation from the worker or employer). A working diagnosis may be interview-based and may not include any formal testing.

Secondary psychological injuries

21. What happens when psychological symptoms occur because of an initial work-related injury?
    1. Psychological symptoms may occur because of an initial work-related physical injury or occupational disease. For example, a worker with a physical injury develops major depression due to a slow and difficult recovery.
    2. Operations staff will determine whether it is more likely than not (i.e., standard of proof) the effects of an initial work-related physical injury or occupational disease have contributed to, or caused, a secondary psychological injury.
    3. If there are both work-related and non-work-related factors that contribute to a secondary psychological injury, the work-related factors must be of material significance in the occurrence of the injury, meaning more than a trivial or insignificant aspect of the injury or disease.
       1. When it is not clear whether the work-related factors are more than a trivial or insignificant aspect of the worker’s overall psychological symptoms, Operations staff may use the “but for” test to determine causation (point 12 (c)).
    4. The WCB supports mental health services during treatment for physical injury claims (e.g., during tertiary programming. When the worker’s psychological symptoms worsen or extend beyond the length of the recovery for the physical injury, Operations staff will review information from the worker’s health care provider to determine if there is a verifiable history of psychological symptoms connected to the initial work-related injury.
    5. If there is insufficient evidence to determine if the psychological symptoms have occurred because of an initial work-related injury, or if there is a lack of clarity on the effects of a work-injury in comparison to other non-work-related factors (e.g., personal stressors that may have contributed to an injury) Operations staff may:
       1. Request a review by the WCB’s Psychological Consultant, or
       2. Contact the HCS department to arrange an MHA.

File development

22. What if Operations staff are unable to make a decision at the time of initial review?
    1. If Operations staff are unable to make a decision at the time of initial review, they will contact the worker to explain:
       1. What information is needed or outstanding,
       2. What information the worker can provide to help the decision maker render a decision,
       3. How long it may take for staff to be able to determine entitlement (if applicable), and
       4. Options for alternate support or alternate financial resources until Operations staff can determine entitlement.
    2. Operations staff may request the assistance of the WCB’s Psychological Consultant at any time during the review or development of a claim.
23. Can a worker receive coverage for medication or counselling services while waiting for an initial claim decision?
    1. Operations staff may provide coverage for counselling services and essential prescribed medications while the worker is waiting for a claim decision. PRO 02/2021, Mental Health Service Providers, will apply.
       1. Operations staff will obtain consent from the worker to request counselling reports from their health care provider. These reports may help Operations staff in determining whether a claim is acceptable.
       2. If Operations staff determine that a psychological injury claim is not acceptable, the medication and counselling services will be covered up to the date the worker is notified of the decision. In this situation, the costs of medication and counselling services will not be charged to the employer.
24. What happens when a psychological injury claim is accepted due to a traumatic work-related event(s) or a substantial work-related stressor(s)?
    1. If Operations staff accept a psychological injury claim, they will:
       1. Notify the worker and employer of the decision by telephone and in writing,
       2. If applicable, arrange for the payment of earnings loss benefits and other expenses,
       3. Develop an initial recovery and return-to-work plan in collaboration with the worker, the employer and the worker’s health care provider, and
       4. If applicable, attempt to work with other providers (private insurance, public system) to help address any non-work-related issues that could be impacting progress with rehabilitation and/or RTW.
25. What happens if the criteria for the psychological injury presumption under Section 28.1 is met during the adjudication of a claim?
    1. If a worker meets the requirements of the psychological injury presumption, the claim file will be reviewed in accordance with POL & PRO 11/2025, Psychological Injuries – Psychological Injury Presumption (Section 28.1). Operations staff will document any changes on the claim file.

Recurrence

26. What if the worker recovers from a psychological injury and a recurrence of the injury occurs?
    1. To help determine if the worker’s current condition is a recurrence of a previous work-related injury, Operations staff will:
       1. Review supporting information (e.g., statements, medical reports) from the worker, employer, co-workers, or health care provider(s), and
       2. Review the relationship between the worker’s current condition(s) and the previous compensable psychological injury.

Permanent Functional Impairment (PFI)

27. Is a worker who sustains a psychological injury eligible for a PFI award?
    1. If a worker’s health care provider determines that the psychological injury is unlikely to improve, Operations staff will contact the WCB’s Psychological Consultant to confirm whether the worker has reached their Maximum Medical Improvement (MMI).
    2. If the Psychological Consultant determines that the worker has reached their MMI, HCS will arrange an MHA with a health care provider who has experience providing DSM diagnoses and determining scores associated with the Brief Psychiatric Rating Scale (BPRS) and the Psychiatric Impairment Rating Scale (PIRS).
    3. The WCB’s Psychological Consultant will review the file, including the MHA to complete the PFI assessment and provide the impairment rating. POL 33/2024, Permanent Functional Impairment (PFI) Awards will apply.

Providing treatment – accreditation requirements

28. What are the accreditation requirements for mental health care providers treating WCB workers?
    1. Accreditation requirements for mental health care providers are outlined in PRO 02/2021, Mental Health Service Providers.
    2. If the mental health care provider does not meet the accreditation requirements, Operations staff may approve up to eight weeks of treatment with the health care provider.
       1. If a return to work does not occur within eight weeks or if the worker is not progressing satisfactorily in their treatment, Operations staff may ask the HCS department to arrange treatment with a WCB accredited provider.
       2. If a return to work or recovery is progressing satisfactory, Operations staff may extend treatment with the non-accredited mental health service provider on a case-by-case basis.

Critical incident response information sessions

29. Does the WCB provide critical incident response information sessions to employers?
    1. To address and respond to the emotional and psychological consequences resulting from exposure to a traumatic work-related event, the WCB offers preventative or post-incident response information sessions to employers.
    2. Employers may contact the manager of the WCB’s Psychological Injuries Unit to discuss options for critical incident response information sessions. If the WCB is unable to arrange information sessions with an approved psychologist, funding may be provided to an employer to arrange appropriate sessions.
    3. Staff will determine the appropriate response in consultation with a WCB Medical Officer or Psychological Consultant and will complete any needed referrals to a WCB approved psychologist.
    4. The purpose of critical incident response session is to focus on the well‑being of the worker(s). Non-incident related emotional issues or labour relations concerns are not discussed during a session.