WORKPLACE SAFETY AND INSURANCE BOARD
APPEALS RESOLUTION OFFICER DECISION
DECISION NUMBER: 20210024
OBJECTING PARTY: Worker
REPRESENTED by: Worker Representative
RESPONDENT: Employer
REPRESENTED by: Employer Representative
HEARING: Oral Hearing May 5, 2021 (videoconference)
HEARD by: C. Goegan, Appeals Resolution Officer
DATED: May 17, 2021
ISSUES
The worker is objecting to the following decisions of the Case Manager:
The September 8, 2016 decision denying initial entitlement for traumatic mental stress (TMS) and subsequent reconsiderations of the decision on November 7, 2016 and February 7, 2018.
The February 20, 2020 decision denying entitlement to post-traumatic stress disorder (PTSD) for first responders and other designated workers and chronic mental stress (CMS).
BACKGROUND
This former paramedic, now in his 50s, had worked for the employer from 2004 to 2013 in different paramedic services positions including operations supervisor, quality assurance manager, training specialist and public access defibrillator (PAD) program coordinator. He resigned from the employer in 2013 and did not return to work in paramedic services.
In 2013, the worker began working at a bank. In May 2016, he had an argument with his supervisor at the bank about work processes. He became irritated, left work and did not return. He sought medical attention and was diagnosed with post-traumatic stress disorder (PTSD). On May 25, 2016, the worker registered his claim with the WSIB. The worker related the PTSD to his exposure to multiple traumatic events over the course of his career in paramedic services.
In a decision dated September 8, 2016, the Case Manager denied initial entitlement to traumatic mental stress (TMS) as the Case Manager determined there was no indication the worker had experienced a psychological reaction to exposure to traumatic events. The Case Manager also concluded the trigger for the worker’s psychological reaction and absence from work from May 2016 onward was unrelated his former work in paramedic services.
The Case Manager reconsidered and upheld the September 8, 2016 decision denying entitlement to TMS on November 7, 2016 and February 7, 2018. The Case Manager acknowledged that while the worker had been exposed to traumatic events during his career in paramedic services and was diagnosed with PTSD, the exposure to the traumatic events did not contribute significantly to the worker’s psychological condition and absence from work from May 11, 2016.
In a decision dated February 20, 2020, the Case Manager again reconsidered and upheld the September 8, 2016 decision. The Case Manager reconsidered and upheld the TMS decision, applying the amended TMS policy that came into effect on January 1, 2018. The Case Manager also determined the worker did not meet the presumptive criteria for entitlement to PTSD for first responders and other designated workers. Furthermore, the Case Manager denied entitlement to chronic mental stress (CMS) as the Case Manager concluded the stress was the result of interpersonal conflict in the workplace that did not rise to the level of a substantial workplace stressor.
The worker objected to the September 8, 2016, November 7, 2016, February 7, 2018 and
February 20, 2020 decisions and the matter was referred to the Appeals Services Division for consideration.
AUTHORITY
Operational Policies:
11-01-01 – Adjudicative Process – published November 3, 2008
11-01-03 – Merits and Justice – published October 12, 2004
15-03-02 – Traumatic Mental Stress – published January 2, 2018
15-03-13 – Posttraumatic Stress Disorder in First Responders and Other Designated Workers -
published September 7, 2018
15-03-14 – Chronic Mental Stress – published January 2, 2018
ANALYSIS
I considered the available information, legislation and relevant operational policies in reaching these decisions. For the reasons set out below, I find the worker does not meet the entitlement criteria for PTSD in first responders and other designated workers, traumatic mental stress (TMS) or chronic mental stress (CMS).
Worker Position
The worker’s representative submitted that over the course of the worker’s career in paramedic services, he attended the scenes of numerous objectively traumatic accidents both as a front line paramedic and as a manager in paramedic services. She maintained he met the criteria for initial entitlement under Policy 15-03-13 (PTSD in First Responders and Other Designated Workers) or alternatively under Policy 15-03-02 (Traumatic Mental Stress) as the cumulative result of exposure to multiple traumatic events.
The representative also submitted the worker should have the benefit of the presumption of causation afforded to first responders and other designated workers under Policy 15-03-13 (PTSD in First Responders and Other Designated Workers) based on the merits and justice of the case.
With respect to TMS, the representative noted that Policy 15-03-02 (Traumatic Mental Stress) provides for the consideration and allowance of benefits to workers who have a delayed onset of PTSD after a cumulative exposure to multiple sudden and unexpected traumatic events. She submitted the worker witnessed numerous traumatic events and assisted people who sustained catastrophic injuries over the course of his career in para-medicine. She maintained he developed a delayed onset of PTSD as a direct result of the cumulative effect of the traumatic events he experienced and she noted that reports from two psychiatrists, Dr. Fairbairn and Dr. Lanius confirmed the worker’s PTSD symptoms resulted from exposure to traumatic events over the course of his career in paramedic services.
The representative also argued the worker meets the criteria for entitlement to CMS under Policy
15-03-14 (Chronic Mental Stress). She submitted he was exposed to extraordinary levels of stress and stressful situations during the time he held supervisory and management level positions in paramedic services with the employer. She argued the primary reason the worker resigned his employment with the employer was substantial workplace stress.
Employer Position
The employer’s representative argued the worker does not meet the criteria for initial entitlement to a mental stress injury under either Policy 15-03-02 (Traumatic Mental Stress), Policy 15-03-13 (PTSD in First Responders and Other Designated Workers) or Policy 15-03-14 (Chronic Mental Stress).
With respect to the presumption of the causation of PTSD in first responders and other designated workers described in Policy 15-03-13 (PTSD in First Responders and Other Designated Workers), the employer’s representative submitted the worker was not employed as a first responder after he resigned in January 2013. She argued that because the worker was not employed as a first responder on or after April 6, 2014, the presumption afforded to first responders does not apply.
The employer’s representative also submitted that while the worker was a front-line paramedic from 2001 to 2003, he did not work for the employer as a front-line paramedic during that time. She noted that several of the traumatic events the worker claimed he was exposed to during his career did not occur while he was working for the employer. She also noted the worker did not experience an acute mental stress reaction to work as a front-line paramedic.
The employer’s representative argued that following the worker’s appointment to managerial positions with the employer beginning in 2004, he was not required to act as a frontline paramedic and his exposure to trauma was significantly reduced. She submitted that the workplace stress the worker claimed he was exposed to while working for the employer pertained to interpersonal conflicts in the workplace and decisions and actions by the employer relating to the worker’s employment, neither of which are considered substantial work-related stressors under Policy 15-03-14 (Chronic Mental Stress).
The Worker’s Testimony
The worker testified that in 2001, the provincial government downloaded the responsibility for six or seven different land ambulance services in the county to the employer. He explained that initially, a management company was responsible for the operations of the ambulance services. From 2001 to 2003, the worker testified that he worked as a front-line paramedic. He testified that the employer later took over the operations of the ambulance service directly in 2004 and he was hired as a paramedic operations supervisor. He confirmed that he became an acting manager of quality assurance in paramedic services in September 2004 and the job became permanent in 2005.
The worker testified that after he became a permanent manager of quality assurance, the employer took two positions and amalgamated them into one job that he described as a quality programs and professional development role. He stated he remained in that job until 2008 when he voluntarily transferred into a training specialist/PAD coordinator job because he could no longer handle the workload. He testified that while working in the quality programs/professional development role, the stress and the hours were “unbelievable” and that he had no staff working directly for him. He stated the chief of paramedic services directed him to use operations supervisors for assistance in completing his job tasks but testified the supervisors reported to the operations manager. The worker explained that he would often delegate tasks to the operations supervisors; however, they would prioritize work assigned by the operations manager as they reported directly to him. The worker described this as stressful as it required him to complete many of the tasks he delegated by himself.
Under questioning by his representative, the worker testified about several incidents he attended that stood out to him during the period of time he worked as a front-line paramedic from 2001 to 2003.
He described an incident where a young boy on a bike was struck by a car outside of the emergency department of the hospital. The worker and his paramedic partner responded to the scene and the worker explained that he remembered the incident quite vividly because the young boy had sustained a severe fracture of his leg that the paramedics did not expect.
The worker testified that while he worked as a paramedic, paramedic supervisor and training coordinator, he responded to numerous highway motor vehicle accidents. One incident he found particularly disturbing involved a small red car where a man was fatally injured. The worker explained he found the incident particularly traumatic because the individual reminded him of his father.
The worker testified that while he worked as a paramedic, he responded to a couple of school bus incidents where children were critically injured. He explained that he found these calls distressing because he had young children of his own at the time and injuries to children are more distressing than injuries to adults for most first responders.
The worker became emotional when testifying about a call he responded to while he was a paramedic supervisor that involved the death of a firefighter. He explained the firefighter was trapped inside a burning house and was badly burned. When the firefighter was extricated from the fire, the worker was responsible for clearing the firefighter’s airway and trying to resuscitate him before an air ambulance arrived. The firefighter did not survive his injuries and the worker explained that he continued to have night terrors about the incident. He stated that a co-worker who is currently the fire chief in Wasaga Beach was present at this event.
The worker also described responding to the suicide of a young boy in a public park and explained he found this distressing because the boy was the approximate age of one of his own children.
The worker described attending the scene of a plane crash where a small plane crashed into the middle of a bay at a lake. The worker indicated he found the incident stressful because a large public crowd had gathered in the area. He explained that the plane fuel was on fire and there were significant difficulties with the police boat that hampered the paramedics’ ability to respond to the plane crash. The worker explained that he did not actually go out on the water to the accident site, but found it stressful trying to deal with the public and the media because he was a supervisor on site at the time.
The worker’s representative questioned the worker about the contents of an August 30, 2016 claims investigation report. The worker testified that he was present at the scene of a train derailment incident causing a sulphuric acid spill and was responsible for rotating paramedic crews in and out of the site during a three-day clean up. The worker subsequently clarified that there were no casualties from the train derailment or the spill and rotating the crews in and out of the site was part of his regular job duties as a supervisor. The worker also testified he was present as a site supervisor during an incident where a local school was evacuated for a possible chemical exposure. He described the students as being scrubbed down with chemicals as a precautionary measure.
Under questioning by his representative, the worker testified that he initially began experiencing psychological symptoms in 2007. He described his symptoms as irritability, an inability to concentrate and difficulty sleeping due to nightmares. He indicated he experienced the nightmares a couple of times per week. He stated that he was also diagnosed with depression due to workplace stress.
He testified that his nightmares were about bad “calls at the time” but he did not have daytime flashbacks in 2007. The worker stated he could not remember whether his nightmares were about specific calls that he had attended. He indicated he began seeing a therapist in 2007 and separated from his wife in 2008. He and his wife divorced in 2010 and the worker stated the reason for his divorce was entirely workplace stress. He indicated he was taking work home with him and putting in long hours that took its toll on the marriage.
The worker testified he began having daytime flashbacks in 2015. He indicated there was nothing traumatic or unexpected in 2015 that precipitated the onset of the daytime flashbacks. He also testified his nightmares turned into night terrors in 2015, he began experiencing significant anxiety and became hyper-vigilant. He described his mood as depressed and stated he currently takes a number of medications for his mood. The worker indicated that his personal hygiene has deteriorated and noted he sleeps 12 to 14 hours per day as he is frequently awakened by night terrors. The worker’s representative asked whether the worker had ever thought of suicide and the worker indicated he had thought about it once shortly after his resignation from the employer.
When questioned about the workplace, the worker testified that his difficulties at work began in January 2004 when he became the manager of quality programs and professional development. He explained the employer hired a new chief of paramedic services that the worker stated was allowed to select his entire management team with the exception of the worker. The worker described his job duties as considerable and stated he was responsible for many tasks including developing all of the annual training for 250 paramedics, doing “ride outs” with the paramedics, dealing with public complaints and requests for information, reviewing Ministry of Health audits, analysing data and preparing spreadsheets and reports for the chief. The worker also sat on a number of committees. He stated he worked at least 60 hours per week. The worker indicated that a significant stressor for him involved preparing reports at the chief’s request only to be told that the chief needed different information. He described the work environment as like walking on egg shells. He stated one of the managers in the human resources department constantly called it a poisoned work environment for the entire time he worked for the employer.
The worker described the chief as very adversarial and stated the chief was often in conflict with other departments, outside agencies and the union. When questioned about his working relationship with the chief, the worker responded that after he began working in the training job he was quickly becoming the public face of paramedic services in the county and felt the chief was becoming jealous of him. As an example, the worker stated the chief would become upset when other municipalities would call to talk to him about public defibrillators instead of asking the chief. The worker’s representative asked the worker if he argued with the chief. The worker stated they did not argue but would often disagree on various business issues.
The worker testified that in his view, there were three main stressors associated with the quality assurance manager job. First, the expectations of the chief were unclear. The worker cited the chief regularly changing his mind about reports the worker had prepared as an example. Second, the worker reiterated he had no direct staff working for him to assist him with his many job duties resulting in him having to complete much of the work himself. Third, the worker testified that as a manager, he could respond to a call but was not allowed to transport patients to hospital in an ambulance as that was considered union work.
He described a situation where he responded to a call as a supervisor involving a domestic dispute. He assisted a female paramedic who tended to a female casualty in the ambulance while the worker drove the ambulance to the hospital. The union immediately filed a grievance against the worker for driving the ambulance.
The worker testified that after he moved to the training/PAD program coordinator job in 2008, his former job as a quality manager was broken up into different jobs where people were given support staff. He stated the new quality manager was not required to maintain active duty status as a paramedic. When he moved to the training job in 2008, the worker indicated his symptoms did not improve. He stated while he was no longer reporting directly to the chief of paramedic services, his new manager was just as bad.
The worker testified about the sequence of events that led up to his resignation from the employer in 2013. He stated he was off work on a stress leave and attending counselling in December 2012. He described being very stressed and experiencing night terrors. He stated he finally decided to quit his job because he felt incapable of returning to work and facing the management. He indicated when he returned to work in January 2013, his supervisor told him to meet with human resources as the employer was terminating him for cause.
The worker indicated the reason for termination was the employer accused him of training the fire department to dispense medications to people. The worker met with the director of human resources and they discussed the termination. The worker stated he told the director of human resources there were no grounds for the termination because he was training the fire department how to assist patients with administering their own medications based on a program the chief of paramedic services wanted him to teach. He was not teaching firefighters to administer medications. The worker testified that rather than pursue legal action against the employer, just wanted to resign. The employer agreed to accept his resignation rather than terminate his job and provided him with one-year salary and a letter of reference.
The worker testified he is a past recipient an award for exemplary service as a paramedic. When questioned about a being disciplined by the employer in 2010, the worker explained he received a five-day suspension without pay for selling a defibrillator cabinet to a charitable organization.
When he resigned from the employer, the worker described being irritable, experiencing insomnia and having nightmares and night terrors. He described the nightmares as recurring dreams about the firefighter’s death, multiple motor vehicle accidents and plane crashes. He indicated he saw a psychologist but could not recall how often. He stated took medications for anxiety, depression and insomnia.
The worker stated he later saw Dr. Fairbairn, a psychiatrist, but could not remember the first time he saw him. He testified he continues to take different medications and attend therapy but his symptoms have not significantly improved. Triggers for his symptoms include the sound of an ambulance siren or images on television involving trauma or death. The worker explained that he also experiences chronic pain and depression that he was told may be from fibromyalgia although he does not have the appropriate fibromyalgia markers. He sees a pain specialist on a monthly basis and testified that his current source of income is Canada Pension Plan disability benefits.
Under cross questioning by the employer’s representative, the worker testified that when he worked for the employer from January 2004 until his resignation in 2013, he worked in a management role and did not pay union dues because he was not a member of the paramedic union. He also testified that he volunteered for a number of special events in the community and came into work extra hours to catch up on work he was behind on.
The worker testified that when he began seeing a therapist in 2007, it was because of workplace stress and not the breakdown of his marriage. When asked to clarify the nature of the workplace stress by the employer’s representative, the worker indicated the workplace stress was due to his work in the paramedic services department as a while. The worker testified that he got along with some of his co-workers but not others. He stated he got along well with most of the supervisors and paramedics. He got along well with the general manager of the employer but not the chief of paramedic services.
The worker testified that at the beginning of his career with the employer, his performance reviews were good but towards the end, he was not meeting job expectations. He indicated that none of the other managers in the paramedic services department were meeting expectations for their departments either.
When describing the conflict with his supervisor at the bank, the worker indicated he was expected to sell many different financial products to customers whom he felt did not need them. He stated that he had a disagreement with his supervisor who was yelling at him because he refused to try to sell an elderly customer an investment that he felt the customer did not want. He testified that he refused to do what the supervisor demanded so he walked off the job and did not return to work.
The Evidence
A series of clinic notes dated December 12, 2011 to October 15, 2012 from a Nurse Practitioner Led Clinic indicated the worker described his job as stressful. On February 6, 2012, a nurse practitioner counselled the worker regarding options to reduce stress but he informed the nurse practitioner he was unable to reduce his workload and had to remain available after hours. The worker reported there was no way to reduce stress or change positions.
According to a social work assessment dated April 19, 2012, the worker reported working 60 hours per week to keep up with job expectations and quality assurance requirements. The worker indicated he enjoyed his job but was working many overtime hours to keep up with workload. The worker informed the social worker his past behaviour on the job was discussed with him and a conflict arose when an assistant reported the worker’s behaviour as inappropriate. The social worker indicated the worker was experiencing anxiety related to stress from his job.
In a report dated December 5, 2012, the social worker indicated the worker presented with a distressing event with his supervisor at work questioning his ability to do his job and questioning job performance with training fire teams in the county in regards to medication administration. The worker informed the social worker it was his belief the employer was building a case to fire him. The social worker described the worker as struggling with anxiety nearly every day over returning to work and accepting he no longer wanted to work for the employer.
On December 14, 2012, the social worker described the worker as feeling better and able to cope with whatever happened at work. The worker indicated he had spoken with people at work and decided he was being used as a “political pawn” for communication with the fire service. The worker indicated he was comfortable with the employer giving him a severance package when he returned to work in January 2013.
According to a Terms of Settlement letter dated January 7, 2013, the worker’s resignation from the employer became effective on January 4, 2013.
In a series of chart notes between October 28, 2013 and January 15, 2015, Ms. S-M, a nurse practitioner, described the worker’s mood as euthymic and his affect as full. The worker denied experiencing any mental health issues.
In a chart note dated July 5, 2015 Ms. S-M indicated the worker had chronic generalized pain that affected his function at work and was associated with depressive and anxiety symptoms.
In a chart note dated April 19, 2016, Ms. S-M examined the worker for chronic pain in the presence of the worker’s wife who had accompanied him to the appointment. The worker’s wife inquired about depression and Ms. S-M described the worker as being in denial and not wanting to discuss it. The worker confirmed he was sleeping restlessly and experiencing frequent nightmares with early awakening. He also admitted to crying easily at times and feeling more emotional. The worker indicated he had recently moved his father into a nursing home that was affecting him. Ms. S-M prescribed anti-depressant medication.
According to a chart note dated May 3, 2016, the worker was having nightmares, flashbacks and anxiety. Ms. S-M indicated the worker had worked as a paramedic for 27 years and continued to have dreams about it that awakened him. She indicated the worker had to place his father in a nursing home and found this quite unsettling. The worker also described issues at work. Ms. S-M suspected the worker may have PTSD and referred the worker for counselling.
A chart note dated May 11, 2016 described the worker experiencing a “melt down” at work and requesting a note.
According to the May 17, 2016 Worker’s Report of Injury (Form 6), he began having nightmares and flashbacks three weeks earlier following stress at work. The worker related the nightmares and flashbacks to calls he attended during his 28-year career as a paramedic.
In a chart note dated May 17, 2016, Ms. S-M described the worker experiencing a lack of motivation, energy and crying spells. She indicated the worker had a history of depression that started in 2008 after a marital separation and lasted about two years. The worker advised Ms. S-M he felt his work as a paramedic was contributing to his present symptoms as he recently started having nightmares for the past few months. On June 2, 2016, the worker advised Ms. S-M his psychological symptoms were getting worse.
In the June 1, 2017 Employer’s Report of Injury (Form 7), the employer provided information about the worker’s employment history from 2004 to 2013 that included the following:
The worker began working in an administrative role in 2004 and was no longer working as a front-line paramedic.
In July 2008, the worker was demoted to a training position due to performance issues.
In September 2010, the worker served a five-day suspension without pay.
On January 3, 2013 the worker was terminated due to performance issues and the employer agreed to accept the worker’s resignation rather than proceed with termination.
The employer indicating during the last year or two of employment the worker was going through a divorce.
The worker was certified as a primary care paramedic from 2004 to 2012. The base hospital searched ambulance call reports from 2008 to 2016 and confirmed the worker was involved in one cancelled call where he was riding as a third person. From 2004 to 2012 the employer had no record of the worker attending any calls.
A June 15, 2016 Mental Health and Addictions Program Psychological Pre-assessment from Ms. K, a registered nurse, indicated the worker had been experiencing symptoms over the last 6-months including worsening flashbacks that were now occurring on a daily basis. She stated the worker was able to give a very accurate account of the PTSD symptoms he was experiencing and noted the worker had worked as a paramedic for over 28 years. Ms. K diagnosed depression, anxiety and PTSD.
A report dated July 5, 2016 from Dr. Fairbairn, a psychiatrist, had the diagnoses of major depressive disorder with secondary anxiety and PTSD. Dr. Fairbairn indicated the worker clearly described nightmares but specifically daytime episodes of imagery with affect laden consequences derived from his days working as a paramedic. Dr. Fairbairn also noted the worker’s coexisting pain and need to use medication significantly complicated the presenting symptoms.
A July 21, 2016 report from Dr. Lanius, a psychiatrist at the WSIB Traumatic Stress Workplace Program described the worker’s argument with the supervisor at the bank in May 2016 after which he stopped working. With respect to the worker’s previous job as a paramedic, the worker described interpersonal difficulties, pain and stress associated with prior WSIB claims as factors that contributed to his departure from the employer.
Dr. Lanius questioned the worker about traumatic events he had experienced in the course of his career as a paramedic and noted the worker had difficulty providing specific dates for the events. She indicated the worker described several types of incidents involving mutilated bodies, a number of suicides by hanging and a plane crash. Dr. Lanius stated it was difficult to determine an exact timeline of the events but noted they appeared to have occurred during the worker’s time “on the road” as a paramedic.
The worker recalled a call involving a school bus accident possibly toward the middle or end or his paramedic career with multiple children with traumatic injuries. Another specific event was described as a transport truck versus a small red car resulting in a catastrophic fatality. Calls described as particularly distressing where the ones involving infants and children, such as highway 400 multi-vehicle accidents. The worker described an incident involving the discovery of Claymore mines in front of an armoury and a plane crash. The worker described the 2008 demotion listed on the Form 7 as a choice to move to a less stressful position during a marital separation while the 2010 suspension was described as the worker being suspended after selling a personal defibrillator to a charity.
Dr. Lanius diagnosed the worker with PTSD and indicated it emerged under a condition of interpersonal conflict to the point where it affected functioning. She stated the timeline of the worker’s PTSD symptoms was difficult to trace but noted it had worsened in the past six months. Dr. Lanius indicated the worker’s PTSD symptoms appeared to have resulted from exposure to traumatic events witnessed while working as a paramedic over the course of his career and stated that serious consideration should also be given to a multifactorial etiology. Other factors included pain from self-described workplace injuries that may have worsened and been manifested due to psychological stress and interpersonal conflicts outside of the work environment.
Dr. Lanius was specifically asked to comment on the relationship between the worker’s psychological presentation and work. In response, she indicated:
[The worker] clearly experienced exposure to traumatic situations during his career as a paramedic where he was exposed to incidents involving death and dismemberment. It is likely that these contributed in part to his difficulties at work and ongoing performance issues. His pain also represents a significant component of his reasons for stopping working. Interpersonal stressors within the work environment as well as external interpersonal stressors involving the dissolution of his marriage also appear to contribute to ongoing anxiety and negative mood alterations which contributed to leaving work as a paramedic.
There does not appear to have been a specific, separate traumatic work-related incident at the bank that precipitated him from stopping working. It appears that interpersonal conflict with a superior at his most recent job at [the bank] appear to have been a source of ongoing stress which contributed to a re-emergence and gradual worsening of PTSD symptoms in the last 6-months.
In correspondence dated August 19, 2016, the worker provided a list of calls he attended during the course of his career as a paramedic that he found to be traumatic. The list included an incident involving the death of a firefighter, a train derailment, an incident involving a young child with a fractured leg, a plane crash, a bomb call and a chemical spill. The worker provided a number of other incidents including multiple motor vehicle accidents, the SIDS death of a baby and an accident involving a car and a transport where he could not recall the exact date.
In a case file memo dated August 19, 2016, the worker spoke with the Case Manager regarding the list of traumatic incidents and provided the names of several co-workers who might recall his involvement in the incidents.
In a case file memo dated August 19, 2016, a Claims Investigator researched some of the incidents referenced by the worker and confirmed the occurrences of the death of the firefighter, the train derailment, the plane crash and the chemical release.
According to an August 30, 2016 claims investigation report, the employer’s ambulance call records dated back to 2008. The Claims Investigator spoke with the employer and they advised him the worker’s name did not appear on any of the ambulance records from 2008 onward. The employer clarified that did not mean the worker was not present at the scenes of incidents, only that he was not listed as a paramedic providing health care assistance.
The Claims Investigator contacted several of the individuals the worker had provided as witnesses. The first witness remembered the boy on the bike incident and described it as disturbing but could not recall specifically if the worker was at the scene. The Claims Investigator went through some of the other incidents from the worker’s list including the firefighter’s death but could not recall the worker being present at the scenes. The second witness advised the Claims Investigator he knew the worker but could not recall ever attending a live call with him as a paramedic. The second witness did not recall ever speaking with the worker about any specific issues relating to overtly traumatic calls. The third witness did not return the Claims Investigator’s phone call and the Claims Investigator was unable to contact the fourth witness.
On October 25, 2016, the worker provided the Case Manager with correspondence from three additional individuals who may have been aware of his involvement in traumatic incidents. In a September 15, 2016 e-mail exchange with a former human resources contact at the employer, the first individual he recalled the worker mentioning something about sleeping issues either at an arbitration or during negotiations. The former human resources contact provided no further details.
In correspondence dated September 21, 2016, the former director of paramedic services for the county indicated he briefly recalled discussing the death of a firefighter with the worker as he noted the worker attended the scene and was genuinely bothered by the event. The former director of paramedic services stated the worker showed no visible effects at the time of the incident and was able to continue with his job. The former director noted he recalled the train derailment incident causing a chemical spill and noted the worker was responsible for rotating paramedics on site during a three-day period while the site was cleaned up. He also recalled the landmine incident and reported the worker was responsible for coordinating evacuation of the public and sending paramedic crews to and from the area. The former director indicated during his time with the employer he was also routinely made aware of multiple traumatic motor vehicle accidents on the 400 highway that the worker and other supervisory personnel were required to attend. The former director also recalled the worker attending the scene of the suicide of a young boy at a public park.
In correspondence dated September 28, 2016, the deputy fire chief for a nearby town indicated he had worked with the worker between approximately 2002 and 2013. The deputy fire chief indicated he attended the incident along with the worker where a firefighter died in the line of duty. The deputy fire chief indicated this was a traumatic call and although he could not recall the specific details of his conversation with the worker after the event, he did recall the worker mentioning the call was particularly difficult given it involved another first responder.
In a January 18, 2018 letter to the worker’s representative, Dr. Fairbairn indicated the worker had PTSD, related to trauma in association with his duties as a paramedic. With respect to change over time, Dr. Fairbairn stated it was a delayed onset illness that re-emerged under interpersonal conflict directly related to work over time. Dr. Fairbairn noted it had worsened over time and was related to stress and conflict in the workplace that was clearly, though indirectly related to trauma and had worsened through chronic pain.
PTSD for First Responders and Other Designated Workers
For the reasons that follow, I find the worker is not entitled to benefits for PTSD under Policy
15-03-13.
Policy 15-03-13 (PTSD in First Responders and Other Designated Workers) states that if a first responder other designated worker is diagnosed with PTSD and meets specific employment and diagnostic criteria, the first responder or other designated worker’s PTSD is presumed to have arisen out of and in the course of his or her employment, unless the contrary is shown.
The policy contains a list of workers who are classified as “first responders and other designated workers” for the purposes of applying the presumption.
In order for the presumption to apply to a first responder diagnosed with PTSD by a psychiatrist or psychologist, the policy requires the following three specific criteria:
The first responder must have been employed as a first responder for at least one day on or after April 6, 2014.
The first responder must have been diagnosed with PTSD by a psychologist or a psychiatrist:
On or after April 6, 2014, and
No later than 24 months after the day they cease to be employed as a first responder if they cease to be employed as a first responder on or after April 6, 2016.
- The first responder must have been diagnosed by a psychologist or psychiatrist with PTSD as described in the DSM-5.
In this case, the worker resigned from the employer on January 4, 2013 and was not employed as a first responder on or after April 6, 2014. Therefore, the first criterion in the policy is not met and initial entitlement cannot be granted under Policy 15-03-013 (PTSD in First Responders and Other Designated Workers).
The worker submitted a September 8, 2016 letter from the chair of local Business Improvement Association indicating he volunteered as an emergency first responder at a number of events in 2014. The letter stated “[the worker] has volunteered for the [local] Business Improvement Association, a not-for-profit organization as a medic/emergency first responder for a number of our events”.
The definition of a paramedic under Policy 15-03-13 (PTSD in First Responders and Other Designated Workers) can be found in section 1(1) of the Ambulance Act. Section 1(1) defines a paramedic as:
A person employed by or a volunteer in an ambulance service who meets the qualifications for an emergency medical attendant as set out in the regulations, and who is authorized to perform one or more controlled medical acts under the authority of a base hospital medical director, but does not include a physician, nurse or other health care provider who attends on a call for an ambulance;
Section 1(1) of the Ambulance Act defines and ambulance service as:
A service that is held out to the public as available for the conveyance of persons by ambulance;
In order to be considered a paramedic under the policy, the worker must fulfil the duties of paramedic and be employed by, or a volunteer for, an ambulance service. The letter the worker provided indicates he provided medic services, however, the local Business Improvement Association, as a non-profit business improvement association, does not meet the definition of an ambulance service.
The volunteer services that the worker provided do not satisfy the employment requirements under the policy.
I acknowledge the worker representative’s argument that the worker should be afforded the benefit of the presumption because he resigned shortly before the April 6, 2014 effective date of the policy. However, I must point out that the policy provides a specific date of employment and does not permit decision-makers to extend the employment date at their discretion. Policy 11-01-03 (Merits and Justice) directs that decision-makers must apply the relevant policies and provisions of the Workplace Safety and Insurance Act. In rare cases the decision-maker may depart from the policy if the result would be absurd or unintended. In this case, the dates of employment were legislated and are clear and unequivocal. I see no compelling reasons to depart from the policy in this case.
Traumatic Mental Stress
Policy 15-03-02 (Traumatic Mental Stress) states that a worker is entitled to benefits for traumatic mental stress arising out of and in the course of employment. The policy describes specific criteria that must be met in order for a worker to be entitled to benefits for a traumatic mental stress injury.
First, the worker must have direct exposure to one or more objectively traumatic events at work. The event or events must be both clearly identifiable and objectively traumatic. Clearly and precisely identifiable means that the event(s) can be established through information or knowledge of the event(s) provided by co-workers, supervisory staff, or others.
The term “objectively traumatic” generally means that the event must be traumatic when considered not from the worker’s unique perspective, but from a perspective independent of the worker’s perception of the event, personal feelings and experiences.
Workers are not entitled to benefits for traumatic mental stress caused by decisions or actions of an employer relating to a worker’s employment such as terminations, demotions, transfers, discipline or changes in work hours and productivity expectations.
Due to the nature of their occupation, some workers may be exposed to multiple traumatic events over a period of time. If a worker experiences traumatic mental stress because of the most recent traumatic event in a series of events, entitlement can be in order for the cumulative effect even if the worker was able to tolerate exposure to past traumatic events.
In all cases, a decision-maker must be satisfied, on a balance of probabilities, that the traumatic event, or the cumulative effect of a series of traumatic events arose out of and in the course of the worker’s employment and caused, or significantly contributed to, an appropriately diagnosed mental stress injury.
Given the evidence before me, I accept the worker was exposed to several identifiable and objectively traumatic events during the course of his career in paramedic services. However, I am not persuaded the worker’s exposure to traumatic events contributed significantly to his psychological condition either when he resigned from the employer on January 4, 2013 or when he stopped working at the bank on May 11, 2016.
The worker testified about several objectively traumatic incidents that he attended while working as a paramedic from 2001 to 2003. He explained the death of the firefighter, the incident involving the boy on the bike, the suicide of a young boy and the red car accident were particularly difficult calls for him.
He also testified that his psychological symptoms began in 2007 and continued after he moved to the training/PAD program coordinator. He testified he began experiencing nightmares about the “bad calls” he attended and began seeing a psychologist. He also testified that he experienced psychological symptoms and night terrors during the period that culminated in his resignation from the employer in 2013.
There is no medical information in the record from 2007 or 2008. The contemporaneous medical chart notes prior to the worker’s resignation from the employer on January 4, 2013 describe job stress related to workload, discussions about the worker’s behaviour in the workplace, job performance issues and the worker’s belief the employer was building a case to fire him. There was no mention of the worker having nightmares, night terrors, flashbacks or intrusive thoughts pertaining to exposure to any traumatic events. Policy 15-03-02 (Traumatic Mental Stress) confirms there is no entitlement for traumatic mental stress caused by an employer’s decisions or actions that are part of the employment function, such as changes in productivity expectations, progressive discipline or terminations.
I acknowledge Dr. Lanius’ opinion it was likely the worker’s exposure to traumatic situations contributed to his difficulty at work but I find that opinion is speculative. Dr. Lanius did not review the contemporaneous chart notes from 2012 that do not describe any of the symptoms commonly associated with PTSD such as nightmares, flashbacks or intrusive thoughts about traumatic events. Similarly,
Dr. Fairbairn noted the onset of the PTSD was related to trauma in association with the worker’s duties as a paramedic but indicated it emerged because of stress and interpersonal conflicts in the workplace.
As noted previously, the contemporaneous chart notes describe stress related to workload, the worker’s behaviour and the possibility of job termination. Dr. Lanius identified internal and external interpersonal stressors and pain from organic injuries as factors that contributed to the worker resigning from his job with the employer. Dr. Fairbairn confirmed that onset of the PTSD emerged under interpersonal conflict and stress in the workplace. Accordingly, while I do not doubt the worker had a remote exposure to traumatic events while working in paramedic services, I do not find his exposure to traumatic events contributed significantly to his psychological condition at the time he resigned from the employer on January 4, 2013.
After the worker resigned from the employer, there was no mention of psychological symptoms related to trauma until the April 19, 2016 chart note from Ms. S-M. The May 3, 2016 chart note described the worker as being unsettled after placing his father in a nursing home and experiencing issues at work. The worker then continued working at the bank until he had an argument with his supervisor on May 11, 2016.
Noting the PTSD emerged under the condition of interpersonal conflict with the worker’s supervisor at the bank and culminated in functional impairment, I find the interpersonal conflict and the argument with the supervisor at the bank were factors that contributed significantly to the worker’s psychological condition in May 2016. I again acknowledge the remote history of exposure to traumatic events and the diagnosis of PTSD. However, given the remote history of exposure to traumatic events and the worker’s ability to continue functioning at work until the interpersonal conflict and argument, I do not find the exposure to the traumatic events contributed significantly to the worker’s psychological condition and inability to work in May 2016.
Chronic Mental Stress
Policy 15-03-14 (Chronic Mental Stress) came in effect on January 2, 2018. Claims for CMS occurring before the application date of the policy can be considered provided the case was considered a “pending claim” on January 1, 2018.
For the purposes of this policy, "pending claims" means claims for chronic mental stress that are pending before the Workplace Safety and Insurance Board (WSIB) or the Workplace Safety and Insurance Appeals Tribunal (WSIAT) on January 1, 2018. For further clarity, these are claims in which, as of January 1, 2018,
a chronic mental stress claim has been filed, but the WSIB has not yet made a decision
there is a right to file a notice of objection in respect of a chronic mental stress claim following an initial entitlement decision and the notice of objection is or has been filed within the appropriate time frame
there is a right to file a notice of appeal to the WSIAT in respect of a chronic mental stress claim following a final decision of the WSIB, and the notice of appeal is or has been filed within the appropriate time frame, or
the worker has filed a notice of appeal to WSIAT and a chronic mental stress claim is pending before the WSIAT.
The WSIB applies this policy and makes a decision in all pending chronic mental stress claims, regardless of when the worker's chronic mental stress occurred.
Based on the circumstances, this case is considered a “pending claim” for the purpose of the CMS policy
Policy 15-03-14 (Chronic Mental Stress) indicates that a worker will generally be entitled to benefits for chronic mental stress if an appropriately diagnosed mental stress injury is caused by a substantial work-related stressor arising out of and in the course of the worker’s employment.
A work-related stressor is generally considered substantial if it is excessive in intensity and/or duration in comparison to the normal pressures and tensions experienced by workers in similar circumstances. In all cases, the substantial stressor must be the predominant cause of the mental stress injury. The predominant cause means that the substantial stressor is the main cause of the mental stress injury, when compared to other individual stressors.
The policy confirms there is no entitlement to chronic mental stress caused by an employer’s decisions or actions that are part of the employment function, such as:
Terminations
Demotions
Transfers
Discipline
Changes in working hours, or
Changes in productivity expectations
An employer’s decisions or actions that are not part of the employment function such as workplace harassment or conduct that a reasonable person would perceive as egregious or abusive may be considered as substantial stressors.
Policy 15-03-14 (Chronic Mental Stress) also states that interpersonal conflicts between workers and their supervisors, co-workers or customers are generally considered to be a typical feature of normal employment. Consequently, such interpersonal conflicts are not generally considered to be a substantial stressor, unless the conflict amounts to workplace harassment or conduct that a reasonable person would perceive as egregious or abusive.
With respect to workplace stress, the worker testified that his difficulties at work began in January 2004 when he became a manager and there were essentially three elements of stress in the workplace.
First, the worker described his working relationship with the chief of paramedic services as a source of stress and gave examples of the chief not being clear with requests for information and taking an adversarial position with other departments. While I can appreciate that preparing detailed reports at a manager’s request only to be told different information is required is stressful, it is a routine feature of employment that does not rise to the level of a substantial stressor. The worker did not describe any workplace behaviour by the chief of paramedic services he was subjected to with the employer that would rise to the level of a substantial stressor such as workplace harassment. When questioned specifically about his interactions with the chief the worker testified that they did not argue but disagreed over business decisions.
The worker described the work environment as poisoned, but confirmed there were no investigations into workplace conduct. Accordingly, I do not consider the worker’s described interactions with the chief of paramedic services to be a substantial workplace stressor.
Second, he described not having assistance and working long hours as stressful. However, the assignment of work and longer hours of work in a management role are typical features of normal employment. I also acknowledge it may have been frustrating for the worker when trying to delegate work to individuals not reporting to him and being told work assigned by their manager took precedence. In my view, however, the conduct the worker described is reflective of the typical tensions that arise in any workplace and not a substantial stressor.
Third, I do not find the situation the worker described where the union filed a grievance against him for performing union work is a substantial stressor. In my view, it is not unusual for a union to file a grievance over a manager doing bargaining unit work no matter what the circumstance.
It is clear that the demands of the worker’s job, interpersonal conflicts in the workplace and his decision to resign rather than having the employer proceed with the termination of his employment all contributed to the worker’s psychological condition in 2013. However, all of those elements are typical features of normal employment and are not considered substantial stressors.
Based on the medical evidence, the diagnosis of PTSD and the worker’s inability to function in a work setting clearly emerged in an environment of interpersonal conflict while working at the bank. The worker’s interpersonal conflict with his supervisor at the bank in 2016 is not a work-related substantial stressor since the bank is not an employer covered under the Workplace Safety and Insurance Act. Therefore, I conclude the worker’s psychological condition did not result from substantial work-related stressors and entitlement under Policy 15-03-14 (Chronic Mental Stress) is denied.
CONCLUSION
I conclude the following:
The worker does not meet the criteria for entitlement to PTSD under Policy 15-03-13 (PTSD in First Responders and Other Designated Workers).
The worker is not entitled to traumatic mental stress.
The worker is not entitled to chronic mental stress.
The worker’s objection is denied.
DATED May 17, 2021
C. Goegan
Appeals Resolution Officer
Appeals Services Division