APPEALS RESOLUTION OFFICER DECISION
DECISION NUMBER:
20230071
OBJECTING PARTY:
worker
REPRESENTED by:
WORKER REPRESENTATIVE
RESPONDENT:
employer
REPRESENTED by:
self
HEARING:
HEARING IN WRITING
HEARD by:
l. mansueti, appeals resolution officer
APRIL 14, 2023
ISSUE
The worker objects to the Case Manager (CM) decision dated October 25, 2021 denying entitlement to benefits for Posttraumatic Stress Disorder (PTSD) in First Responders and Other Designated Workers, under operational policy 15-03-13.
BACKGROUND
On August 24, 2021, the worker completed a Worker’s Report of Injury (Form 6) claiming they attributed their PTSD to cumulative traumatic workplace experiences throughout their career as a first responder. The worker was working as a Senior Communications Operator at the time of injury, and they had worked with the employer for approximately 14 years. The worker sought medical attention on May 27, 2021 and they reported it to the employer that day. The worker remained off work effective May 28, 2021.
The decision letter dated October 25, 2021 communicated there was no entitlement to benefits for PTSD under operational policy 15-03-13 as the CM identified the employer’s actions and decisions were determined to be the significant contributing factors informing their mental stress diagnosis.
The worker objected to the October 25, 2021 decision. The reconsideration letter dated January 19, 2023 upheld the decision to deny entitlement to benefits under this claim. The worker continued to object to the October 25, 2021 decision, and this is now the issue before the Appeals Services Division (ASD).
AUTHORITY
Section 2(1), 13 and 14 of the Workplace Safety and Insurance Act (WSIA), 1997, as amended
Operational Policy Manual
Published
15-03-13 Posttraumatic Stress Disorder in First Responders and Other Designated Workers
September 7, 2018
ANALYSIS
I have carefully considered all of the available information, legislation and relevant operational policy in reaching this decision. For the reasons that follow, I find the worker is entitled to benefits for PTSD under this claim.
Review of the Evidence
On May 27, 2021, C. Blair, Nurse Practitioner (NP), assessed the worker via telephone consultation. The clinical chart note for this visit indicated the worker booked the appointment to discuss ongoing work-related stress. The worker was initially unable to speak as they were overwhelmed with emotion and were teary. The worker advised they had recently learned that the location where they work would be closing, and they would be relocated to another site in either A or B, a considerable distance from their home, 8 hours away. They advanced they were constantly “running up hills” with work, and no matter how much they give, it feels like it was never enough. The worker endorsed feeling angry and overwhelmed. They advised they did not want to move or change jobs at this point in their life. The worker indicated this was the “tipping point” for them, as overall, they advised work was very stressful and they did not feel supported. The worker was recommended to remain off work, and a medical note was provided to this effect.
A clinical chart note dated June 9, 2021 completed by C. Blair indicated the worker presented feeling more “settled” after taking some time off work. They indicated the news about the location closing felt less raw. The worker endorsed feeling angry and reported they were self-isolating. They indicated they experienced panic attacks waking them from sleep, and they reported having a racing heartbeat and a sense of doom. The worker indicated they were working with a Peer Support program with the Volunteer Fire Department, and reached out to some colleagues for support. They indicated they had planned to finish out their career and ultimately retire; however, they were now faced with a different decision. The worker was prescribed Cymbalta for anxiety and pain.
G. Poapsi, NP, met with the worker on July 7, 2021 via telephone appointment. The clinic chart note indicated the worker was exposed to traumatic situations due to their employment as a 911 Dispatcher, and several of these events continued to haunt them, which they referred to as “ghosts.” The worker reported experiencing nightmares, flashbacks, and panic attacks. The worker described the workplace environment as stressful, citing there was no downtime allowed after a traumatic call. G. Poapsi indicated the worker’s symptoms were consistent with anxiety, depression, and probable PTSD.
The employer issued a letter to the worker’s Health Care Practitioner dated August 10, 2021 indicating they would like to start planning a return-to-work (RTW) program for the worker and requested updated restrictions. The employer indicated they could make accommodations for the worker with respect to duties, scheduling and/or ergonomics. It was noted that Communication Operators at the Communication Centre were advised their location would be closing effective February 2022, which may cause additional stressors for those affected, including the worker. The employer indicated resources were available to all Communication Operators to assist them with the transition. G. Poapsi responded to the correspondence on August 30, 2021, indicating the worker was unable to return to work due to the severity of their mental health symptoms, which included nightmares, flashbacks, anxiety and panic.
The record contains an August 2021 email from the worker indicating that a few weeks prior to going off on medical leave, they filed a Health and Safety complaint regarding a staffing concern. The worker indicated a reader board emits a loud audible tone whenever a 911 call is unanswered in the queue which serves as a reminder to staff to speed up their calls or delay a break. This had become problematic because of staffing shortages, thus, the reader board rings almost all day, every day. The worker advanced this served as a constant a very stressful reminder that there were not enough resources to perform their job well. The worker recommended having the reader board shut off to eliminate the constant noise and distraction as it was clear Communication Operators could not keep up with the workload on most days, and they also suggested the creation of a separate call queue to prioritize 911 calls, but both suggestions were refused.
A Health Professional’s Report (Form 8) dated August 23, 2021 completed by G. Poapsi indicated the worker’s diagnosis was PTSD due to ongoing exposure to traumatic situations. The worker was determined to be unable to work. The record indicates the worker submitted a claim for long-term disability (LTD) benefits. The August 24, 2021 insurance form indicated the nature of the condition preventing them from returning to work was the PTSD diagnosis related to long-term traumatic exposures at work.
The CM spoke with the employer on August 31, 2021, as documented in memorandum A1. The employer indicated the worker went off work in May 2021 due to non-compensable medical reasons around the time it was announced that the department the worker was working in would be closing. The employer indicated they were unaware of any past incidents or reports of any work-related mental stress issues or injuries being reported in the past. They indicated the worker had been doing their regular job duties without issues or complaints.
The CM spoke with the worker on September 1, 2021 as documented in memorandum A2. The worker indicated the were working as a 911 Dispatcher for over 12 years, and in the last 3 years they had worked as a Team Lead which involved the supervision and management of workload as well as take some calls. The worker indicated they had been off work since May 27, 2021 due to their psychological symptomology. They indicated they delayed in reporting their mental stress injury as work-related because they were not aware of the process and they did not realize they could file a WSIB claim until their psychologist mentioned it. The worker confirmed they were claiming entitlement to benefits for a mental stress injury as a result of their exposure to cumulative traumatic events in keeping with their work as a Dispatcher.
The worker was referred to Dr. E. Murray, Clinical Psychologist. The report dated September 8, 2021 indicated the worker was first seen on June 18, 2021. Dr. Murray indicated the worker experienced numerous operational traumatic and critical incidents through the course of their employment as a Communications Operator and Volunteer Firefighter. The worker presented with symptoms of anxiety, depression, sleep disturbances, difficulties in concentration, memory difficulties, loss of interest in previously enjoyed activities, irritability, social withdrawal, and feelings of emotional detachment. The worker endorsed having recurrent intrusive memories of traumatic events that they experienced as a Communications Officer and Volunteer Firefighter, and they had a restricted range of affect, feelings of detachment, thought avoidance, and experienced hypervigilance. They indicated they preferred not to talk about these traumatic events as it could lead to triggering disturbing memories, dreams, flashbacks, and intense psychological and physiological distress. These symptoms had a significant negative impact on their personal and social relationships as well as their occupational functioning. The traumatic incidents in question involved the serious harm or death to individuals. Dr. Murray advanced that in additional to experiencing shock and brief periods of dissociation, the worker reported these various traumatic incidents as part of their job duties flooded them with “concomitant feelings of intense horror, profound disgust, and helplessness.” The report highlights specific work-related traumatic events from 2009 to 2020 involving fatal deaths, homicides and suicides. Dr. Murray diagnosed the worker with PTSD. The record indicated Dr. Murray recommended the worker apply for WSIB benefits.
Dr. D. Bakish, Psychiatrist, assessed the worker on February 17, 2022. The report indicated the worker had mild symptoms of depression and significant anxiety. Dr. Bakish indicated the worker’s diagnosis was severe PTSD. Pharmacological recommendations were made.
Assessment of the Evidence
Operational policy 15-03-13 states, in part:
If a first responder or other designated worker is diagnosed with posttraumatic stress disorder (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 worker in this case meets the definition of a first responder under section 14 of WSIA, and they have been diagnosed with PTSD. In cases such as these, if a first responder files a PTSD claim within the time limits for filing a claim and if the following criteria is met, the PTSD is presumed to have arisen out of and in the course of employment, unless the contrary is shown. The presumption criteria is as follows:
The first responder must have been employed as a first responder for at least one day on or about April 6, 2014
The first responder must have been diagnosed with PTSD by a psychologist or psychiatrist
o On or after April 6, 2014, and
o No later than 24 months after the day he or she ceases to be employed as a first responder if he/she ceases 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 review of the evidence in this case, I find the presumption criteria has been satisfied. However, the policy further indicates the presumption may be rebutted if it is established that the employment was not a significant contributing factor in causing the first responder’s PTSD.
In this case, the employer has rebutted the presumption. The employer submitted the worker did not seek medical attention for their mental stress injury prior to May 27, 2021, and they did not make any complaints or comments to the employer regarding having any work-related mental health issues prior to this time. The employer points to the fact the worker sought medical attention and began losing time from work only after learning the location would be closed, and they would be relocated to another site 8 hours away. It is the position of the employer the worker is not entitled to benefits for PTSD as the medical evidence supports the mental stress injury was caused by the employer’s decisions or actions to close the location and relocate the worker to another site.
The worker representative submitted the worker’s PTSD did in fact result from their exposure to traumatic events arising from their work duties, even if they did not seek immediate medical treatment. Additionally, the worker representative is not in agreement with the denial of entitlement on the basis their employment situation was determined to be the main cause of their mental stress injury.
I agree with the position of the worker representative. While I acknowledge the worker sought medical attention after learning about the change in job location, I find the overwhelming medical evidence in the record supports the worker’s PTSD is largely related to traumatic workplace events experienced throughout the course of their career as a first responder.
The initial medical chart note dated May 27, 2021 indicates the worker had booked the appointment to discuss ongoing work-related stress supports this finding. It was at this visit that the worker mentioned the location they worked at would be closing, and they would need to transfer to another site, 8 hours away. The worker endorsed feeling angry and overwhelmed. It is clear the worker was upset with the news of the closure of the location, as this news was described as the “tipping point” for them to seek medical attention for the longstanding workplace stress they were experiencing. While the news of the location closing was likely the catalyst that prompted them to seek medical attention in the first place, the subsequent medical reporting provides supportive evidence that their workplace stress is complex and multi-faceted, evidenced by their long-standing concerns regarding job demands, staffing shortages, lack of employer support, and most notably, traumatic workplace events.
Section 14 and the associated policy provide a presumption for first responders diagnosed with PTSD in recognition of the traumatic experiences to which this group of workers is routinely exposed. With this in mind, the presumption can only be rebutted when work is shown not to be a significant contributing factor in the development of PTSD. The test for determining causation in WSIB claims is that of a significant or material contribution. A significant or material contributing factor is one of considerable effect or importance. It need not be the sole contributing factor. The standard of proof applied is the “balance of probabilities.” While I agree the employer’s decision to close the location was likely the catalyst that prompted the worker to seek medical attention and may have partially contributed to their mental stress injury, I accept their PTSD diagnosis is more likely related to the cumulative workplace trauma they experienced as a first responder, as confirmed by Dr. Murray. In fact, the relocation was not mentioned in the subsequent medical reporting, nor was it identified as a significant factor contributing to their PTSD diagnosis. This is evidenced by the June 9, 2021 clinical chart entry wherein it was indicated the worker reported feeling more settled, and the news of the location closing felt “less raw.”
In summation, I find the entitlement criteria under operational policy 15-03-13 has been satisfied in this case. I accept on a balance of probabilities the traumatic workplace events the worker experienced as a first responder significantly contributed to the development of their PTSD. While I acknowledge the employer’s decision to close the location likely prompted the worker to seek medical attention in the first place, the medical evidence in the record supports the traumatic workplace events materially contributed to the PTSD diagnosis. As such, I find the presumption set out in the First Responders policy is not rebutted. For these reasons, I find the worker is entitled to benefits for PTSD under operational policy 15-03-13. The nature and duration of the benefits flowing from this decision are remitted to the operating area for further adjudication subject to the usual rights of appeal.
CONCLUSION
I conclude the worker is entitled to benefits for PTSD.
The worker’s objection is allowed.
DATED April 14, 2023
L. Mansueti
Appeals Resolution Officer
Appeals Services Division