Worker v. Employer, 2023 CanLII 74903

APPEALS RESOLUTION OFFICER DECISION

DECISION NUMBER: 20230087

OBJECTING PARTY: Worker

REPRESENTED BY: Worker Representative

RESPONDENT: Employer

REPRESENTED BY: Employer Representative

HEARING: Videoconference – May 3, 2023

HEARD BY: Neil Clark, Appeals Resolution Officer

ADDITIONAL ATTENDEES: Employer Observer

DATED: June 8, 2023

ISSUES

The worker, through their representative, objects to the Case Manager’s April 14, 2021 decision, which determined that:

1. The worker did not have entitlement to benefits for post-traumatic stress disorder (PTSD) for first responders and other designated workers.
2. The worker did not have entitlement to benefits for a traumatic mental stress injury.
3. The worker did not have entitlement to benefits for a chronic mental stress injury.

BACKGROUND

On June 11, 2020, the worker submitted a Worker’s Report of Injury (F6), which identified that they had developed a mental stress injury, as a result of their regular job duties as a Paramedic. They stated their injury initially arose in 2014 and that they have remained off work as of 2020 due to their mental stress injury.

In their decision dated April 14, 2021, the Case Manager determined that the worker did not have entitlement to benefits for a work-related mental stress injury. Specifically, in regards to entitlement under Operational Policy 15-03-13, Posttraumatic Stress in First Responders and Other Designated Workers, they found that the information on file supported that the worker’s condition resulted from the employer's decisions or actions that are part of the employment function, which are not covered under the policy. When considering entitlement under Operational Policy 15-03-02, Traumatic Mental Stress, the Case Manager found that the worker’s job duties did not significantly contribute to the worker’s mental stress injury and in reviewing entitlement to benefits under Operational Policy 15-03-14, Chronic Mental Stress, they determined that a substantial work-related stressor was not present. This decision was reconsidered on October 5, 2022, and upheld.

The worker, through their representative, objected to the April 14, 2021 decision, which denied entitlement to benefits for a work-related mental stress injury, and these issues forms the basis of the appeal before me.

AUTHORITY

Operational Policy Manual

Published

15-03-13, Posttraumatic Stress Disorder in First Responders and Other Designated Workers September 7, 2018

15-03-02, Traumatic Mental Stress January 2, 2018

15-03-14, Chronic Mental Stress January 2, 2018

ANALYSIS

I have carefully considered all of the available information, legislation, and relevant operational policies in reaching this decision. I find that:

1. The worker does not have entitlement to benefits for PTSD for first responders and other designated workers.
2. The worker does not have entitlement to benefits for a traumatic mental stress injury.
3. The worker does not have entitlement to benefits for a chronic mental stress injury.

Worker’s Position

During their opening statement, the worker, through their representative, outlined the history of the claim. They stated that entitlement to benefits should be in order under Operational Policy, 15-03-13, Posttraumatic Stress Disorder in First Responders and Other Designated Workers, but that, in the alternative, consideration can be given to both Operational Policy 15-03-02, Traumatic Mental Stress, and Operational Policy 15-03-14, Chronic Mental Stress. In summary, the worker submits that the presumption clause within Operational Policy, 15-03-13, Posttraumatic Stress Disorder in First Responders and Other Designated Workers, has not been rebutted and that they should have initial entitlement to benefits for PTSD.

The worker provided extensive testimony concerning their employment, their prior leaves of absence from 2014 to 2020, details concerning distressing calls, their prior medical treatment, and the onset of their current symptoms.

In closing, the worker stated that they do not dispute that they experienced previous mental health issues and had concerns with the employer; however, these co-existing stressors should not deprive them of the presumption under Operational Policy 15-03-13, Posttraumatic Stress Disorder in First Responders and Other Designated Workers. They note this presumption has not been rebutted, two psychologists have diagnosed them with PTSD, and the available evidence supports this diagnosis resulted from the traumatic events they experienced while working as a Paramedic.

Employer’s Position

The employer, through their representative, provided an opening statement in which they identified that the April 14, 2021 entitlement decision should be upheld.

The employer reviewed the Worker’s Report of Injury, previous disability paperwork, prior medical information, the circumstances related to how the worker’s various issues arose between 2014 and 2020, and the worker’s arrest in 2020. The employer questioned the absence of reporting regarding traumatic events during this time and highlighted the events that led to the worker initiating a claim with the Workplace Safety and Insurance Board.

During their closing statement, the employer stated that the evidence supports that the worker’s mental stress injury arose due to non-work-related factors. They identified that weight must be given to the contemporary reporting at the time the injury developed. The employer adds that while the worker would have been exposed to traumatic events during their employment, on a balance of probabilities, the evidence demonstrates that the mental stress injury itself was not caused by the worker’s job duties and, therefore, the presumption has been rebutted.

Assessment of Entitlement

Issue #1- Entitlement to benefits to PTSD for first responders and other designated workers.

I note that the decision before me denied entitlement to benefits for PTSD for first responders and other designated workers, traumatic mental stress, and chronic mental stress, which are three different types of injuries that are considered under three distinct policies. The worker, through their representative, confirmed that it is their primary position that entitlement to benefits should be considered under Operational Policy 15-03-13, Posttraumatic Stress Disorder in First Responders and Other Designated Workers. Therefore, I will first review if the worker has entitlement to benefits under this policy.

Operational Policy 15-03-13, Posttraumatic Stress Disorder in First Responders and Other Designated Workers, states that if a first responder or 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 confirms that the Workplace Safety and Insurance Board presumes someone’s PTSD is work-related if they:

1. were employed in the designated job for at least one day on or after April 6, 2014, and
2. were diagnosed with PTSD on or after April 6, 2014, and
3. were diagnosed with PTSD by a psychologist or psychiatrist as described in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5)

The policy further outlines that 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. A first responder is not entitled to benefits for PTSD if it is shown that his or her PTSD was caused by his or her 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.

In regards to the above, it is not in dispute that the worker has been employed in a designated job for at least one day on or after April 6, 2014, and that a psychologist diagnosed them with PTSD after April 6, 2014. When considering if this presumption has been rebutted, the evidence must demonstrate that the worker’s injury did not arise out of their employment or that the worker’s duties were not a significant contributing factor to the development of their PTSD.

The worker testified that they were hired as a part-time Paramedic in 2011. They confirmed that in 2014, a series of work situations with a difficult co-worker led them to begin to seek mental health treatment through their employee assistance program and their family physician. The worker noted that their partner at that time was challenging and more senior. They felt that they were unsafe at work, as their partner would not follow procedures, would yell, and was receiving regular formal complaints from patients, as well as other “health allies,” such as the police and fire department. The worker worked with this partner for approximately ten to eleven months and then commenced a mental health leave of absence through the employer’s benefits provider.

During the worker’s absence, they became eligible for full-time employment, which also meant that they would no longer have to work with their previous partner. The worker returned to work for a period of time before the passing of their mother in 2017. Following this, the worker testified that they began another leave of absence and also initiated treatment with a psychologist. This leave was approximately three and a half months in length before the worker resumed a graduated return-to-work plan.

In mid-2018, the worker began a third leave of absence due to mental health concerns and returned to work in July 2018. The worker testified that the following year, they began a scheduled paternity leave from October 19, 2019 to April 2, 2020. The worker’s last day worked was October 18, 2019, as they did not return to work following this paternity leave. The worker’s Workplace Safety and Insurance Board claim was then filed in June 2020.

The worker testified that prior to October 19, 2019, they were involved in a number of traumatic incidents while employed as a Paramedic. They stated that while there are more, the most significant events were as follows:

• During their first shift with their difficult partner, the partner stopped the worker from performing CPR, as they wanted to check if the caller wanted resuscitation performed. The worker noted that this is against policy and led to discipline occurring.
• Attending a call in 2014 involving a suicide by hanging. The worker identified that during this call, they were still working with their difficult partner, which resulted in them being at the scene longer than necessary.
• A call in early 2018 in which a school-aged child was found without vital signs.
• A situation in which the worker and their partner were the first to arrive at an unsecured scene where a stabbing had occurred. The worker stated that they did not know if the assailant was still in the vicinity, but that they had to treat the patient. The worker testified that they located the victim, rolled down their window to confirm the person’s identity, allowed the victim to enter the back of the ambulance, and then closed and locked the doors.

While on paternity leave, the worker was involved in an altercation with their spouse on March 22, 2020. The worker’s testimony and the available information on file confirm that on this date, the worker and their spouse first had a verbal argument. The worker testified that when their spouse went into the bathroom to bathe their child, they became concerned that their spouse was going to harm the child. The worker forced their way into the bathroom and testified that they carried their spouse out of the home and called the police. When police arrived at the scene, the worker was arrested for domestic assault. The worker confirmed that while in the holding cell, as per the information on file, they punched walls and bedding, stripped naked, and attempted to drown themselves in the cell’s toilet on two occasions. The worker was then taken to the hospital for further evaluation. The worker testified that following these incidents, they were criminally charged, residing in a hotel, and under investigation by the Children’s Aid Society in regards to access to their children. The worker confirmed that, at the time of the hearing, the criminal charges and Children’s Aid Society investigations had been resolved.

The worker’s paternity leave ended on April 2, 2020, and on June 11, 2020, the worker submitted a Worker’s Report of Injury (F6). The worker sought further medical attention, at which time they were diagnosed with PTSD in July 2020.

Although the worker has reported that traumatic incidents that they experienced while employed, such as the ones outlined above, have resulted in their PTSD, as well as symptoms such as unwanted memories, reliving traumatic experiences, strong negative feelings, and hypervigilance, it is relevant that their Worker’s Report of Injury does not reflect this. When describing what happened and how the incident started, the worker identified that their symptoms started in 2014. They wrote, “I was working with another medic who was mentally unstable in 2014. The other medic was constantly in conflict with patients, hospital staff, and others. This continually built from there. I have been unable to find a coworker that has been suitable to work with since then. I have anxiety and do not feel safe at work and scared of what could happen when at work. I feel I do not have control over my safety as I am reliant on other people and people that do not appear to care. I do not feel supported by my workplace. I have had [two] medical leaves prior.”

Along with their Worker’s Report of Injury, the worker provided an additional four-page statement. During the hearing, the worker verified that they authored this document, in which they wrote “a brief description of some of the stressors which have contributed to my current inability to work [and] to provide context to the situation.”

Within this statement, the worker describes working with the difficult partner in 2014 and notes that while this co-worker was unprofessional, management took no action. They stated that in “late December early January I reached a breaking point where I could no longer cope with the stress of working with her and called my deputy chief to request a leave of absence for mental health issues which she granted.”

The document notes that while the worker was off work, their seniority was still supposed to be accruing; however, this did not occur, they were not offered a full-time position that became available, and the employer attempted to state that they were absent without cause. The worker noted that they grieved this issue successfully. When the worker returned to work as a full-time employee, they stated that they were paired with a partner who was not a strong medic and who would often show up to night shifts without having slept. The worker writes that during this time, management was also “forcing us to make use of an abandoned building for a downtown post which had numerous issues related to health and safety.” The worker outlined the various concerns and noted that these issues “were the subject of numerous complaints to our management who took the position that these concerns were either unfounded or overstated.”

The statement confirms that in May 2017, the worker began a medical leave due to stress after the sudden passing of their mother. The worker states that during this leave, they were “presented with a letter from the [employer] stating that I had abandoned my employment which caused me further anxiety and stress during an already very difficult time in my mental health.”

In 2018, the worker writes that they applied for a Community Paramedic position. The worker was not successful in obtaining the position and when a co-worker left the role during training, the vacancy was still not filled. Also during this period, the worker states they were working with a different partner who had anger issues and would “rage at the most innocuous and banal things throughout a shift which was a significant strain.” The worker then applied for a new position as a Paramedic Educator, which they did not obtain. The worker noted that the employer was not transparent with the process and that “Ultimately [six] medics applied and they took [five] but not me. This made me feel that I was being deliberately excluded from opportunities especially after having been specifically asked to apply.”

The worker further identifies another two to three stressors that occurred in 2018. They stated that while acting as a union steward, it was “demonstrated [that we] had an aggressive and bullying employer and our management was not willing to say or do anything to protect the workers regardless of how egregious.” They noted that in April 2018, they were dealing with mental health issues and were off work, but again received a letter from the employer that they had abandoned their employment, which caused “additional strain and fear.”

The worker then notes the stabbing incident and the unsecured scene that occurred in late 2018 or early 2019. The worker wrote that they had to attend the scene with no other support and that “my partner who was the attending medic for the call was too busy asking about why the person was stabbed and speculating on a possible drug deal instead of providing patient care, assessing the wounds, and asking relevant questions. I was forced to firmly direct her what was appropriate and what was not and following this call I needed to be debriefed by our peer support and went home unable to finish the remainder of my shift, I couldn't work with that paramedic again after she demonstrated profound incompetence during a critical call.”

The worker explained that in 2019, they applied for a supervisory position, but were not chosen for the role. A few weeks later, the worker applied for an acting supervisor position and identified that although they were the only applicant not chosen for the previous supervisory position, they also did not receive the acting supervisor job. This gave the worker the impression that “my management and employer had absolutely no interest in giving me any opportunities.”

In conclusion, the worker ended their statement with the following:

The result of these occurrences has created in me a profound feeling of dread with respect to my workplace. Obviously[,] the job naturally has many characteristics which can be traumatic and I have had to deal with those situations as others do. But on top of that it has been made abundantly clear that my employer and management have taken to making the workplace a toxic environment where I can expect no support or fair treatment. I feel that my safety is in jeopardy working as a paramedic for the City X and I have an existential fear of being placed in continuing situations reflective of the ones I have had to experience over the last 5+ years.

I find it relevant that within this detailed and well-articulated statement, there is no identification of the traumatic events to which the worker now testifies, with the exception of attending the unsecured stabbing scene. Rather, the overwhelming focus is on conflicts they had with various partners and the employer's decisions or actions that are part of the employment function, such as promotions, assignments, discipline, leaves of absence, and union grievances.

In my review of the available medical information from 2015 until the worker’s arrest in March 2020, the worker’s documented issues and concerns, as they relate to their employment or personal life, are consistent with the chronology contained in the statement provided to the Workplace Safety and Insurance Board. Within these medical notes, which are outlined below, there is again no identification of symptoms that the doctors relate to PTSD, nor is there mention of the traumatic events that the worker has now reported.

On January 22, 2015, the worker’s family doctor identified the concerns with the difficult partner and wrote that “a number of complaints [had been] submitted by those partners regarding her attitude, competency and professionalism and a number of complaints have also been laid by police and patients.” The doctor stated that the worker had found this stressful and that they had “full blown depression inhibiting [their] ability to work.”

When a psychiatrist assessed the worker on August 24, 2017, at Hospital Y, it was confirmed that the worker had major depressive disorder with anxious features. Medication was prescribed, and it was noted that the worker felt “unsupported by their workplace,” as the employer continued to ask for medical information to support the worker’s leave of absence. This was “overwhelming and stressful” for the worker. Overall, the doctor felt that the worker’s major depressive disorder had been triggered following the loss of their mother and that they had “significant ongoing stressors in terms of [their] workplace who have cut off financial support[.] Obviously this is quite difficult for [them] as they require these finances yet is not ready to return to work.”

The psychiatrist reassessed the worker on September 20, 2017. At that time, the worker’s mood was improved and they stated that they were having fewer nightmares; however, the report does not relate these nightmares to flashbacks of traumatic events. The worker’s short-term disability application from this time further confirms that the worker was unable to work due to the sudden passing of their mother.

On December 1, 2017, the worker was again seen by the psychiatrist. At the time of this appointment, the worker had returned to work and their mood was improving, although they still reported experiencing “dips.” The report confirms that the worker was maintaining their job duties, but that they remained stressed about their mother and that the workplace “continues to be a stressor, as it seems like there are some difficulties with upper management.” On July 20, 2018, a Functional Abilities Form concerning the worker’s return to work was completed, which noted that the worker continued to suffer from a depressive illness related to the “death of mother.”

I acknowledge that the worker submits that during the above period, they were repressing their symptoms of PTSD, as they did not wish to speak to their doctors about it due to the nature of the trauma. During their testimony, the worker also questioned why prior Workplace Safety and Insurance Board decision-making has focused on their arrest in late March 2020, as they note that they were already attempting to report issues concerning self-identified PTSD before the arrest occurred. In regards to this, they testified that their attempts to report began in early March 2020, and they had already begun to speak to their union and their spouse about their work-related concerns. The worker also testified that it was the thought of returning to work that increased their symptoms prior to their arrest.

When considering the worker’s position that they had repressed symptoms of PTSD before their arrest and were in the process of reporting these symptoms before their arrest occurred, I reviewed the medical assessments that occurred following the worker’s arrests. In addition, I also considered a statement from the worker’s spouse.

When the worker was assessed at the hospital on the date of their arrest, they stated that they had been having increasing fears that their children were not safe with their spouse. The worker confirmed that they were sleeping in the bathtub and had hidden a knife in their bedroom. At that time, the doctor felt that the worker had no insight into their condition or that their behaviour was not normal. A psychiatrist assessment also occurred on the same day. This report confirms that the worker described their mood to be good, although they noted the previous depression diagnosis and ongoing use of medication. In the opinion of the psychiatrist, the worker presented with possible psychosis, to rule out cannabis-induced psychosis, and to rule out schizophreniform disorder. The worker was ultimately found to be medically competent and released back to the custody of the police.

A Crisis Response Coordinator took a statement from the worker’s spouse on March 22, 2020. The worker’s spouse reported that the worker has always had anger issues, but had never been violent towards them or the children until the incident on March 22, 2020. The worker’s spouse stated that the worker had not been doing well since May 2017, when their mother passed away. They noted that the worker had been able to manage day-to-day responsibilities; however, the worker worsened in January 2020, and the two began to argue more. The worker’s spouse identified that, during this time, the worker experienced suicidal ideation and attended the hospital but elected not to be admitted, as they felt they had been treated poorly at the hospital. The worker’s spouse stated that the worker went away for a weekend with friends in February 2020, and returned home in a manic state, “stating that [they] had an awakening and that [they] now had all the answers.” The worker’s spouse confirmed that in the two weeks prior to the worker’s arrest, the worker had returned to their depressive phase and had begun to voice concerns regarding their spouse’s ability to care for their children. The worker then asked their spouse to leave the house on several occasions. The worker’s spouse noted that the worker also stated that they wished to purchase a gun to protect the family from COVID-19. The worker’s spouse confirmed that the worker spent most of their time vaping cannabis, but was also continuing to take their normal medication.

Within the above evidence, there is again no reporting or identification of prior traumatic incidents in the workplace from either the worker or their doctors, even though the worker claims that they were in the process of initiating a Workplace Safety and Insurance Board claim prior to their arrest. I note that while the worker stated that they had been discussing this issue with their spouse, their spouse also does not connect the worker’s psychological deterioration to the workplace, despite the significance of such an issue, as it would have related to the cause of the worker’s symptoms or their arrest.

Following the worker’s release from custody, they were assessed by their family doctor on April 1, 2020. The doctor noted that there was “significant documentation in the chart about some paranoid ideation. Pay specific attention to the March 23rd Emerg note.” The worker admitted to daily cannabis use, which “may well have been what “threw [them] off the rails.” When the worker spoke to their doctor, they were coherent and were “understandably emotional about the complete upheaval in [their] life.” When the worker was reassessed on April 27, 2020, they were focused on reconnecting with their children. At this time, the worker informed the doctor that they “may receive from [Workplace Safety and Insurance Board] a form possibly to do with PTSD contributing to this from an accumulation of psychological stressors work related.”

I note that while the worker had suggested to their doctor that they would be pursuing a Workplace Safety and Insurance Board claim for PTSD, the doctor’s Health Professional’s Report for Occupational Mental Stress, dated June 24, 2020, confirms a DSM diagnosis of major depressive disorder, while also identifying depressed mood, insomnia, fatigue, decreased concentration, and decreased interest. In confirming what work-related situation or situations resulted in the psychological condition, the doctor attached their chart note of January 22, 2015, and wrote “Paramedic. Difficult partner causing [increased] workplace stress and secondary depression.” The doctor also noted the “depressive episode” in March 2020 and the pending assault charges. They stated that due to major depressive disorder, the worker was unable to function in any work environment.

When considering this Health Professional’s Report for Occupational Mental Stress, it is again relevant that PTSD or any symptoms related to the prior workplace trauma, to which the worker has now testified, are not mentioned. I find that this further supports that as of June 24, 2020, the worker’s doctor remained unaware of the worker experiencing issues with workplace trauma, as it would have related to PTSD.

On July 24, 2020, the worker underwent a Workplace Safety and Insurance Board Mental Health Program Assessment with Dr. Jett, a psychologist. The description of injury provided at this time was the stabbing incident in late 2018 to early 2019, in which the scene was unsecured. The psychologist identified that the worker had a “sense of fear and dread” and viewed themselves as “caught between saving my life or losing my job.” In addition, the psychologist also noted that this particular event was one in a history of distressing work events, “including being partnered with paramedics whom [they] viewed as unstable or lacking competence and (2) being passed over for advancement opportunities.” In regards to barriers to return to occupational function, the psychologist identified that the worker described “[their] workplace as toxic and lacking supports. [They] also noted that [they] feel [they have] been “labeled” and that decision-makers are not interested in [their] professional advancement. [They] described some past work partnerships as problematic (e.g. one partner lacked competence and had a limited ability to recognize risk.” The psychologist provided a diagnosis of major depressive disorder, moderate to severe, with anxious distress, and PTSD.

In reviewing this assessment, it should be noted that during the worker’s testimony, they confirmed that they did not report the March 2020 incident to the psychologist or discuss their arrest and current family situation. The worker stated that they felt this was their personal business and that they were instead focusing on the work-related aspect of their condition. I find that this calls into question the validity of the psychologist’s findings and the worker’s reporting, as when the psychologist was performing their testing, they would have been unaware of the significantly traumatic personal event that occurred approximately three months prior, which the worker’s family doctor has described as a “complete upheaval in [the worker’s] life.”

The worker did however undergo further assessment with Dr. Ramsay on July 29, 2022, at which time the worker’s prior medical records, including the period involving their arrest, were made available. It was noted within this report that the worker had been referred by their representative to Dr. Ramsay to complete an assessment to determine the worker’s current level of psychological functioning, as it related to their workplace trauma. Dr. Ramsay stated that the worker is “a paramedic who has experienced several traumatic exposures. [They have] also been exposed to unsettling experiences with colleagues, in a job in which teamwork is required to safeguard the physical and psychological integrity of the employee. [They] feel that [their] psychological and physical safety have not been protected.” Within this report, the same four difficult calls about which the worker testified are specifically referenced. Dr. Ramsay confirmed the diagnoses of PTSD, severe, chronic, and major depressive disorder, recurrent, severe. In addition, the doctor identified that the worker cannot return to work as a first responder and noted that the worker is “bedeviled by frequent intrusive experiences and spends a great deal of mental energy trying to cope with these psychic intrusions through an actively maintained wall of avoidance. This in turn potentiates [their] depression symptoms.”

I acknowledge that the incidents that the worker has testified to and reported to Dr. Ramsay did occur and that they would have been both difficult and upsetting to experience. I also note that no evidence was presented to suggest that these incidents did not occur in the manner in which the worker described them. However, the issue that I must consider is if these incidents, and the events that the worker experienced during their employment as a Paramedic, were a significant contributing factor to their diagnosis of PTSD. This means that they must be of considerable effect or importance.

While the worker reported these difficult calls to Dr. Ramsay a number of years later and has now testified to the traumatic effects of these events, the contemporary medical evidence, as well as the worker’s prior reporting, to which I place significant weight, does not support that the emergence of their PTSD was a result of these calls or events. Rather, in the period before their diagnosis, the worker consistently reported ongoing issues with either their personal life or concerns with the actions of the employer, which are part of the employment function, such as leaves of absence, promotions, and assignments. As previously noted, Operational Policy 15-03-13, Posttraumatic Stress Disorder in First Responders and Other Designated Workers, confirms that a first responder is not entitled to benefits for PTSD if it is shown that their PTSD was caused by their employer's decisions or actions that are part of the employment function.

I recognize that the worker submits that their prior reporting and the previous medical evidence does not reflect what they were actually experiencing, as they found it too difficult to speak about these issues; however, it is relevant that from 2015 onwards, the worker was able to speak about a variety of topics, such as sensitive family situations and suicide. In addition, once the worker had decided to initiate a claim for benefits, their reporting at that time again predominantly focused on issues with their employer, which are part of the employment function, and interpersonal conflicts with their partners. This is further reflected within their family doctor’s report of injury, dated June 2020, which does not identify a diagnosis of PTSD, nor does it describe the accident history that is now being related by the worker. I note that the unsecured stabbing scene is the single call mentioned within the worker’s original report of injury; however, the focus of the worker’s concerns are self-described as their partner’s “profound incompetence,” inappropriateness, and speculation, rather than the call being traumatic in nature.

While ongoing treatment and assessment concerning various mental health issues occurred from 2015 onwards, the July 2020 psychological assessment was the first appointment in which a diagnosis of PTSD was established. Although, as previously discussed, the worker did not report their arrest or current circumstances during this appointment, the testing measures still identified that the worker had PTSD. I find that it is relevant that the emergence of this diagnosis occurred in the short period following the worker’s arrest, suicide attempts, pending criminal charges, separation from their family, and investigation by family services. It is also worthwhile to note that both the worker’s doctor and the psychologist, who completed assessments following this event, did not relate this episode and the worker’s arrest to PTSD, repressed PTSD, or work-related trauma. While the worker’s arrest, which the worker’s doctor described as a “complete upheaval in [their] life,” would be considered objectively traumatic on its own merits, any causal link between this event and the worker’s PTSD diagnosis would not have been able to be explored, as the worker has confirmed that this information was withheld during the psychological assessment.

I find that the available contemporary evidence outweighs the report of Dr. Ramsay, and it supports that the difficult calls now described by the worker were not a significant contributing factor to their diagnosis of PTSD. While other employment factors were reported by the worker, as previously outlined, I find that these primarily concerned promotions, assignments, discipline, leaves of absence, and union grievances, which are excluded from entitlement under Operational Policy 15-03-13, Posttraumatic Stress Disorder in First Responders and Other Designated Workers.

In consideration of all of the above, I find that the presumption of entitlement found within Operational Policy 15-03-13, Posttraumatic Stress Disorder in First Responders and Other Designated Workers, has been rebutted. Therefore, the worker does not have entitlement to PTSD, as a result of their employment duties as a Paramedic.

Issue #2- Entitlement to benefits for traumatic mental stress.

Operational 15-03-02, Traumatic Mental Stress, confirms that a worker will generally be entitled to benefits for traumatic mental stress if an appropriately diagnosed mental stress injury is caused by one or more traumatic events arising out of and in the course of the worker’s employment.

The policy further confirms that a traumatic event may be a result of a criminal act or a horrific accident, and may involve actual or threatened death or serious harm against the worker, a co-worker, a worker’s family member, or others. In most cases, a traumatic event will be sudden and unexpected. Examples of traumatic events include, but are not limited to, being the object of physical violence, being the object of death threats, being the object of threats of physical violence where the worker believes the threats are serious and harmful to self or others, and being the object of workplace harassment that includes physical violence or threats of physical violence.

In all cases, the event(s) must arise out of and occur in the course of the employment, and be

• clearly and precisely identifiable, and
• objectively traumatic.

This means that the event(s)

• can be established by the Workplace Safety and Insurance Board through information or knowledge of the event(s) provided by co-workers, supervisory staff, or others, and
• is/are generally accepted as being traumatic.

In addition, the decision-maker must be satisfied, on a balance of probabilities, that the traumatic event(s), 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.

The policy further confirms that 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 terminations, demotions, transfers, or discipline. However, workers may be entitled to benefits for traumatic mental stress due to an employer’s decisions or actions that are not part of the employment function, such as

• violence or threats of violence, or
• conduct that a reasonable person would perceive as egregious or abusive.

As previously discussed, there is no dispute that the worker has witnessed traumatic events during their employment as a paramedic. However, based on my prior review of the medical evidence and the worker’s reporting, I find that on a balance of probabilities, a single work-related trauma or the cumulative effect of a number of traumatic events, arising out of and in the course of the worker’s employment, did not cause or significantly contribute to the worker’s mental stress injury. Therefore, I find that the worker does not have entitlement to a traumatic mental stress injury, as per Operational 15-03-02, Traumatic Mental Stress.

Issue #3- Entitlement to benefits for chronic mental stress

Operational Policy 15-03-14, Chronic Mental Stress, confirms 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 will generally be considered substantial if it is excessive in intensity and/or duration in comparison to the normal pressures and tensions experienced by workers in similar circumstances. The policy further notes that workplace harassment will generally be considered a substantial work-related stressor. Workplace harassment occurs when a person or persons, while in the course of the employment, engage in a course of vexatious comment or conduct against a worker, including bullying, that is known or ought reasonably to be known to be unwelcome.

In all cases, the decision-maker must be able to identify the event(s), which are alleged to have caused the chronic mental stress. This means that the event(s) can be confirmed through information or knowledge provided by co-workers, supervisory staff, or others. The decision-maker must also be satisfied, on a balance of probabilities, that the substantial work-related stressor

• arose out of and in the course of the worker’s employment, and
• was the predominant cause of an appropriately diagnosed mental stress injury.

In regards to interpersonal conflicts, the policy states that these types of 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 work-related stressor, unless the conflict

• amounts to workplace harassment, or
• results in conduct that a reasonable person would perceive as egregious or abusive.

There is also no entitlement for chronic mental stress caused by an employer’s decisions or actions that are part of the employment function, such as terminations, demotions, transfers, or discipline. However, workers may be entitled to benefits for chronic mental stress due to 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.

The policy also confirms that a claim for chronic mental stress made by a worker employed in an occupation, or a category of jobs within an occupation, reasonably characterized by a high degree of routine stress should not be denied simply because all workers employed in that occupation, or category of jobs within that occupation, are normally exposed to a high level of stress. In some cases, therefore, consistent exposure to a high level of routine stress over time may qualify as a substantial work-related stressor.

When considering entitlement under this policy, I note that the worker has identified several issues with both their employer and partners, which they feel have contributed to their mental stress injury.

The first issue identified is when the worker was hired in 2014 and paired with a difficult partner. The worker states that the employer took no action despite their partner’s unprofessional and erratic behaviour. As previously noted, the worker testified that due to this, they were forced to take a leave of absence, as they felt they could no longer continue working with this partner.

While I accept that this partner may have been difficult to deal with, the policy confirms that interpersonal conflicts between workers and co-workers are generally considered a typical feature of normal employment. Consequently, such interpersonal conflicts are not generally considered to be a substantial work-related stressor, unless the conflict amounts to workplace harassment or results in conduct that a reasonable person would perceive as egregious or abusive. When reviewing this issue, no evidence was provided to support that this co-worker engaged in a course of vexatious comment or conduct against a worker, including bullying, that is known or ought reasonably to be known to be unwelcome. Although the co-worker and the worker had disputes concerning the co-worker’s behaviour or the manner in which they acted on the job, there is also no evidence that this behaviour amounted to egregious or abusive.

The worker also identified that they had concerns with their other partners, including one who did not sleep before shifts, one who would get upset about things and rant, and one who the worker describes as “incompetent.” Similar to the above, there was no evidence offered that any of these partners’ behaviour rose to a level that amounted to workplace harassment or conduct that a reasonable person would perceive as egregious or abusive.

In my review of the above partner-related concerns, I accept that although the worker had difficulties with their partners during the course of their employment as a paramedic, these interactions were not excessive in intensity or duration in comparison to the normal pressures and tensions experienced by workers in similar circumstances. Rather, I find that they were also interpersonal conflicts, which are not generally considered to be a substantial work-related stressor, as per Operational Policy 15-03-14, Chronic Mental Stress.

As previously discussed, the worker has also raised concerns about their employer passing them over for a permanent position; a union grievance; the location of their work; the employer’s conduct during two of their leaves of absence; the worker being the unsuccessful candidate for three positions they applied for; and the employer’s conduct during an HR meeting involving a co-worker.

The policy confirms that there is no entitlement for chronic mental stress caused by an employer’s decisions or actions that are part of the employment function, such as demotions, transfers, and discipline. In my review of these incidents, I find that the worker’s concerns directly relate to this employment function, as per Operational Policy 15-03-14, Chronic Mental Stress. While the worker has expressed strong feelings regarding the employer’s decisions, which they have stated contributed to an “existential fear”, no evidence was offered to demonstrate how the employer’s decisions concerning the worker’s career advancement, location of work, or the resolution of grievances, would amount to workplace harassment or conduct that a reasonable person would perceive as egregious or abusive.

In consideration of the above, I find that the available evidence does not support that the worker developed a chronic mental stress injury caused by a substantial work-related stressor, as per Operational Policy 15-03-14, Chronic Mental Stress. Therefore, I am unable to accept initial entitlement to benefits for a chronic mental stress injury.

CONCLUSION

I find that:

1. The worker does not have entitlement to benefits to PTSD for first responders and other designated workers.
2. The worker does not have entitlement to benefits for a traumatic mental stress injury.
3. The worker does not have entitlement to benefits for a chronic mental stress injury.

The worker’s objection is denied.

DATED June 8, 2023

Neil Clark Appeals Resolution Officer Appeals Services Division