DECISION NUMBER:

20240047

OBJECTING PARTY:

WORKER

REPRESENTED by:

WORKER REPRESENTATIVE

RESPONDENT:

EMPLOYER (NOT PARTICIPATING)

HEARING:

VIDEOCONFERENCE – APRIL 4, 2024

HEARD by:

SUJETHRA NADARAJAH, APPEALS RESOLUTION OFFICER

ADDITIONAL ATTENDEES:

DATED:

WSIB OBSERVER

MAY 9, 2024

ISSUES

The worker objects to the following two decisions:

1. The May 18, 2022 Case Manager (CM) decision that denied entitlement to loss of earnings (LOE) benefits starting March 4, 2022; and

2. The September 20, 2023 CM decision that denied entitlement to Alcohol Use Disorder as a secondary condition.

BACKGROUND

This worker, a police officer, began working with the employer on May 30, 2000. The worker was involved in a non-compensable motor vehicle accident in March 2022, which resulted in criminal charges and a suspension by the employer effective March 4, 2022. The worker sought medical attention and on May 17, 2022, a psychologist diagnosed the worker with Post-Traumatic Stress Disorder (PTSD) and Alcohol Use Disorder.

The May 18, 2022 decision granted healthcare entitlement to PTSD in this claim. This decision however denied entitlement to LOE benefits as the predominant reason the worker was off work was due to employer related decisions (suspension) and a non-compensable motor-vehicle accident. The worker representative (WR) objected to this decision and on reconsideration, the decision was upheld.

The September 20, 2023 decision determined the worker was not entitled to benefits for Alcohol Use Disorder as a secondary condition. The WR objected to this decision and on reconsideration, the decision was upheld.

On December 28, 2023, the worker submitted the Appeal Readiness Form (ARF). The worker’s objection to the denial of entitlement to Alcohol Use Disorder and LOE benefits form the basis of this appeal.

AUTHORITY

Operational Policy Manual

Published

15-05-01 – Resulting from Work Related Disability/Impairment

18-03-02 – Payment and Reviewing LOE Benefits (Prior to Final Review)

April 9, 2021

September 1, 2021

ANALYSIS

I have carefully considered all of the available information, legislation and relevant operational policies in reaching this decision. I find partially in favour of the worker. As I will explain, while the worker does not have entitlement to Alcohol Use Disorder, the worker is entitled to LOE benefits starting March 4, 2022.

Worker Position

In reaching my conclusion, I reviewed the WR ARF and December 28, 2023 submission. It is opined that entitlement be granted for Alcohol Use Disorder and LOE benefits starting March 4, 2022. The WR stated the worker’s PTSD, dating back to 2007, is based on a cumulative exposure to their regular job duties.

Accordingly, the worker used alcohol as a coping mechanism to manage their exposure to trauma and it should be a compensable condition. If accepted as a compensable condition, the WR argued it was related to the motor-vehicle accident that led to the worker’s suspension, and therefore the accident itself is a compensable factor in the worker’s current claim. In the event Alcohol Use Disorder remains a denied condition, the WR argued the medical information on file continues to support the worker was unable to perform the daily sign-in requirement at a police station due to their PTSD symptoms, and therefore LOE benefits should be in order starting March 4, 2022.

Employer Position

The employer was not a participant in the appeal; thus, no information was submitted for consideration.

Worker Testimony

The worker provided sworn testimony at the hearing. I find the worker to be a credible witness who provided their testimony in an honest and forthright manner.

The worker began working for the employer in May 2000 as a police constable. The worker responded to 911 calls, harassment complaints, homicide investigations and took part in traffic enforcement. The worker advised that they could work up to eighty hours per week. In 2007, they switched teams to the drug unit. The worker would attend court in the mornings and worked generally from 2 – 12 am. The worker advised that they regularly slept in their truck as the commute to their home was too far. The worker worked as a sergeant for some time and then went to the investigation department in 2016.

The onset of PTSD symptoms started early in the worker’s career. The worker recalled their first traumatic experience was when they had been on the job for two weeks. The worker responded to a 911 call where a female’s head was cut off and the kids in the home were drugged. The worker then attended another homicide call about three months into the job. As the policing culture did not encourage police officers to show emotion, the worker felt they were unable to share their concerns or seek medical attention.

The worker attempted to ignore their symptoms and focused on doing their job. The worker noticed they were angrier, experiencing nightmares, sleep disturbances, and their alcohol use increased slowly starting in 2007 (prior to this, the worker was only a social drinker, drinking at social events or weekends).

The worker found their symptoms increased when they joined as an undercover member of the drug unit. The worker found that to calm their emotions and handle the pressures of the new job, they would drink alcohol before their shift started. The worker found they frequently drank prior to, during and after their shifts to continue to perform their job duties.

As time passed, the worker avoided speaking to people who were not police officers. The worker did not want to speak to anyone about policing and the traumatic experiences of being a police officer.

On March 4, 2022, the worker drove after drinking alcohol at a retirement party and was involved in a motor-vehicle accident. Consequently, the worker sought psychological counselling, where they were diagnosed with PTSD and Alcohol Use Disorder.

Following the motor-vehicle accident, the worker was suspended by the employer and criminal charges were laid against the worker. The employer notified the worker they had to sign-in to a police station daily to continue to receive their wages. The worker attempted to complete the sign-in procedure, but because they had lost their license, it was very difficult for them. In addition, they found that their anxiety increased significantly before, during and after the sign-in process. The worker felt it took them hours to deescalate their anxiety and stress levels. At that point, to protect their own mental-health, the worker stopped the sign-in process and has not resumed it to date.

1. Entitlement to LOE benefits starting March 4, 2022

Policy 18-03-02, Payment and Reviewing LOE Benefits (Prior to Final Review), states in part:

Full LOE

If the nature or seriousness of the injury/disease completely prevents a worker from returning to any type of work, or if the worker is able to return to some form of work but the WSIB determines no suitable work is available, the worker is generally entitled to full LOE benefits providing the worker co-operates in health care measures and all aspects of the work reintegration process.

This policy indicates LOE benefits are approved and continue if the worker is prevented from returning to any type of work because of their work-related injury or if it is determined that no suitable work is available.

I have reviewed the relevant medical reports and summarized them as follows:

• The May 17, 2022 Community Mental Health Program Assessment Form provided the worker was “currently unable to return to work due to the severity of his symptoms”. The worker was to “limit his exposure to stress”. The worker was recommended to receive further treatment before discussions of return to work took place.

• The July 18, 2022 Community Mental Health Program Progress Form noted that following the worker’s accident, “he was required to report in daily and the more time he had on his own the more memories flooded back. It appears that [the worker] dealt with his emotions in the past by focusing on work, focusing on the next task ahead and therefore supressed many of his thoughts

and feelings. Now he has become more aware and often feels overwhelmed. His natural reaction is to avoid”. This report continued to recommend the worker remain off work due their PTSD symptoms.

• The September 15, 2022 Community Mental Health Program Progress Form stated “it continues to be uncertain from a psychological perspective when [the worker] could return to work even if his legal matters would be resolved”. This report continued to recommend the worker remain off work due their PTSD symptoms.

Upon review of the medical information above, I find these reports support the worker’s PTSD symptoms were a significant contributing factor to why they were unable to return to the policing environment and unable to continue to complete the sign-in process while suspended. All psychologists that assessed the worker agreed the worker was not able to return to work due to their ongoing PTSD symptoms.

Although I acknowledge the worker was suspended from their job because of a non-compensable incident, they remained an employee and their job requirements at the time of their suspension was to sign-in to a police station daily to receive their wages. Accordingly, on a balance of probabilities, I can establish that the worker’s PTSD diagnosis remained a significant factor in their inability to perform the sign-in requirement. I do not disagree that the worker’s non-compensable factors (worker’s motor vehicle accident, suspension and criminal charges) play a role in the worker’s symptoms or their inability to return to work, however, I cannot disregard the medical opinion on file that continues to support the worker’s PTSD diagnosis, their ongoing symptomology, and their restrictions play a significant contributing factor in their inability to return to work in any capacity. Further, I note the worker continued to cooperate in healthcare measures as recommended by the policy. Therefore, I find the worker is entitled to LOE benefits starting March 4, 2022. I remit the issue of length and duration of entitlement to LOE benefits to the operating area for further review and further adjudication. The operating area is also to confirm when the worker’s wage loss began, as the worker initially completed the sign-in process for a short duration.

2. Entitlement to Alcohol Use Disorder

Policy 15-05-01, Resulting from Work-Related Disability/Impairment, states, in part:

Workers sustaining secondary conditions that are causally linked to the work-related injury will derive benefits to compensate for the further aggravation of the work-related impairment or for new injuries.

This policy grants entitlement to a secondary condition when there is a causal link established between the work injury and the new diagnosis. With the information available to me, I find Alcohol Use Disorder predated the worker’s PTSD diagnosis and therefore entitlement as a secondary condition is denied.

I note the medical information on file in this claim is limited. Accordingly, I have reviewed the relevant medical reports and summarized them as follows:

• A new patient family physician assessment on December 13, 2019 noted the worker’s issues with alcohol under the medical history section. The family physician noted the worker was at moderate risk.

• The May 17, 2022 Community Mental Health Program Assessment Form reported the worker’s alcohol issues began around 2007.

• The July 12, 2022 Health Professional’s Report (Form 8) noted the worker’s Alcohol Use Disorder was a pre-existing condition.

Based on the medical information on file, the medical documents support the worker’s alcohol issues pre- dated their PTSD diagnosis by fifteen years. The contemporaneous medical information on file does not support the worker had complained to healthcare practitioners of any PTSD symptoms or concerns prior to their non-compensable motor-vehicle accident or related their alcohol use to their work duties.

Accordingly, on a balance of probabilities, with the information on file, I am unable to provide entitlement to Alcohol Use Disorder as a secondary condition.

CONCLUSION

The issues are concluded as follows:

1. LOE benefits are in order starting March 4, 2022. The operating area is to confirm the start of LOE benefit date.

2. Entitlement to Alcohol Use Disorder is denied.

The worker’s objection is allowed in part.

DATED May 9, 2024

Sujethra Nadarajah Appeals Resolution Officer Appeals Services Division