Document name

Psychological Injuries – Psychological Injury Presumption (Section 28.1)

Document number

PRO 11/2025

1. POL 11/2025, Psychological Injuries – Psychological Injury Presumption (Section 28.1), provides adjudication guidelines for psychological injury claims that 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 if the injury claim meets the criteria of 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 work-related 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 this procedure and corresponding policy.
   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 POL & PRO 12/2025, Psychological Injuries – General Injury Presumption (Section 27).

Claim decisions

3. What information will Operations staff consider to help make a claim decision?
   1. Operations staff may examine, and weigh evidence at any point in the adjudicative process to make, or help make, a decision. Such evidence may include:
      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. When the relationship between the traumatic work-related event(s) and injury is not clear, medical reports or medical opinions of the diagnosed condition or disorder.
      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).
         1. In sensitive situations when it may be difficult for the worker to discuss a traumatic work-related event(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 work-related event(s) occurred, and
   2. A traumatic work-related event(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)

6. What information will Operations staff consider to help determine if a traumatic work-related event(s) occurred?
   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, injury reports or police reports that demonstrate targeted malicious behaviour with the intent to harm.
7. How can Operations staff determine if a work-related incident may be considered a traumatic work-related event(s)?
   1. Operations staff will verify that all of the following conditions have been met:
      1. There is objective confirmation of the event(s) as reported,
      2. There was exposure to the event(s) through direct personal experience or being a direct personal witness,
      3. The event(s) occurred at a specific time and place (or at a number of specific times and places in the case of a series of traumatic events), was sudden and typically unexpected, and
      4. The event(s) would be objectively considered emotionally shocking or horrific.
8. What does objective confirmation of the event(s) mean?
   1. Objective confirmation means that evidence exists which confirms the event(s) occurred as reported. While a worker’s personal feelings, perceptions, or assumptions of an event(s) may be upsetting or harmful, for claim adjudication purposes, Operations staff must be able to obtain verifiable evidence of the event(s) as reported.
   2. Operations staff will consider evidence from others (e.g., employer, co-workers) with direct knowledge of the event(s) as they occurred.
9. What does objectively considered emotionally shocking or horrific 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 event(s) emotionally shocking or horrific.
10. What are some examples of a traumatic work-related event(s)?
    1. Examples of a traumatic work-related event(s) may include, but is not limited to:
       1. Being the victim of a robbery or hostage-taking incident,
       2. Witnessing the death or severe injury of a co-worker,
       3. Providing first response to victims of severe physical trauma, or
       4. Being subjected to physical or sexual violence.
11. How do other factors such as a series of traumatic events, delayed onset of symptoms, and pre-existing conditions impact the psychological injury presumption?
    1. Due to the nature of particular occupations, some workers may be exposed to a series of traumatic work-related events over a period of time. If a worker was exposed to a series of traumatic events through their employment, the presumption will apply regardless of the existence of non-work-related psychological symptoms that may have contributed to an injury.
    2. If a worker was exposed to a traumatic work-related event(s), but there was a delayed onset of trauma-based symptoms (i.e., when full diagnostic criteria in accordance with the DSM is not met approximate in time to the traumatic work-related event(s)), the presumption applies, regardless of the existence of non-work-related issues in the timeframe after the traumatic work-related event(s) occurred.
    3. The presumption applies regardless of the existence of a pre-existing psychological condition; however, the WCB does not assume any responsibility for a worker’s pre-existing condition.
12. How can Operations staff determine if a traumatic work-related event(s) contributed to, or caused, a psychological injury?
    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 need not 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 their regular 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)?

Date of injury

13. 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)

14. What happens when a DSM diagnosis is provided by a licensed psychiatrist or psychologist?
    1. When a worker receives a DSM diagnosis, Operations staff will confirm the DSM diagnosis was completed by a psychiatrist or psychologist licensed to practice and make diagnoses.
    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 contains the relevant clinical (e.g., history, presentation, functioning levels) and psychological testing information.

15. 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 to confirm a DSM diagnosis 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, or
       4. The DSM diagnosis provided would not typically be expected following a traumatic work-related event(s) (i.e., a non-traumatic psychological diagnosis such as attention deficit disorder).
16. 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.
17. 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.

File development

18. 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.
19. 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.
20. What happens when a psychological injury claim is accepted?
    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 providers, 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.

Recurrence

21. 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 work-related psychological injury.

Permanent Functional Impairment (PFI)

22. 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

23. 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 care provider on a case-by-case basis.

Critical incident response information sessions

24. 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 sessions 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.