PSYCHIATRIC AND PSYCHOLOGICAL DISABILITY

1. PSYCHIATRIC AND PSYCHOLOGICAL DISABILITY

2. POLICY STATEMENT • The Workers’ Safety and Compensation Commission (WSCC) may provide • compensation benefits to workers who develop a psychiatric or psychological disability • arising out of and during the course of employment. To be considered for compensation • benefits, a claimant must have a work-related disability resulting from a disorder • diagnosed by a psychiatrist or psychologist according to the Diagnostic and Statistical • Manual of Mental Disorders, Fourth Edition (DSM-IV), published by the American • Psychiatric Association. Diagnoses may include, but are not limited to: •  acute stress disorder; •  post traumatic stress disorder; •  adjustment disorder; or •  an anxiety or depressive disorder. • A worker is not entitled to benefits for a psychiatric or psychological disability that • results from usual work pressures or an employer’s employment decisions or actions.

3. DEFINITIONS • Acute reaction: A sudden and severe reaction by a worker to a single • or a series of work-related, traumatic events that have • a psychiatric or psychological response. • Anoxia: A severe deficiency of oxygen reaching the tissues of • body and, when prolonged, resulting in permanent • damage. • Mental Stress: An individual’s non-specific physical and • psychological response to events or changes (stressors) • in life. Distress occurs when a person’s ability to cope • with the stressors is overwhelmed and can result in • diagnosable psychiatric or psychological disorders. • Psychiatry: A branch of medicine relating to causes treatment and • prevention of mental, emotional and behavioural • disorders. Psychiatrists have attained a medical degree • and can administer prescription drugs. • Psychology: The study of functions of the mind, especially in • relation to the social and physical environment. • Psychologists do not possess a medical degree. • Traumatic Event: An event generally recognized as being horrific, or • having elements of actual or threatened violence or • substantial harm to the worker or others.

4. POLICYPrecipitating Event • In the course of employment, a worker may experience an event or series of events • causing mental stress that leads to psychiatric or psychological disability. The • precipitating event may be: •  an injury; •  a sudden and unexpected traumatic event; or •  a series of traumatic events – identified as a cumulative effect. • The event must arise out of and during the course of employment and be: •  based on reasonable and credible evidence; •  objectively traumatic; •  unexpected in the usual or daily course of the worker’s employment or work • environment; and •  established by the WSCC through information or knowledge of the event provided by • co-workers, supervisors or others, or the media.

5. POLICYPrecipitating Event • Sudden and unexpected traumatic events may include: •  witnessing a fatality or horrific accident; •  witnessing or being the object of an armed robbery; •  witnessing or being the object of a hostage-taking; •  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 (e.g., bomb threats or being confronted with a weapon); •  being the object of harassment that includes physical violence or threats of physical • violence (e.g., the escalation of verbal abuse into physical abuse); •  being the object of harassment that includes being placed in a life-threatening or • potentially life-threatening situation (e.g., tampering with safety equipment, causing • the worker to do something dangerous); or •  a natural disaster. • The worker must have suffered or witnessed the traumatic event first hand, or heard the • event first hand through direct contact with the traumatized individual(s) (e.g., speaking • with the victims on the radio or telephone during the traumatic event).

6. Cause • To be compensated, a claimant must be diagnosed by a psychiatrist or psychologist with • a disorder that leads to a disability and results from one or more of the following: • 1. A work-related head injury, exposure to toxic chemicals or gases, anoxia, or any other • work-related injury, disease or condition casually connected to organic brain damage. • This also includes mental disorders resulting from medication used to treat a workrelated • injury. • 2. An emotional reaction to a work-related physical disability. • 3. An emotional reaction to a treatment process. • 4. An emotional reaction in response to a sudden, single, traumatic, work-related • incident that is frightening or shocking to the worker, and has a specific time and • place. • 5. An emotional reaction to an accumulation of a number of work-related traumatic • events over time. • Work-related traumatic events do not include the usual pressures and tensions reasonably • expected by the nature of the worker’s occupation and duties.

7. Onset, Reaction and Diagnosis • Psychiatric and psychological disorders, resulting from trauma, can have an acute or • chronic onset. • Acute Onset Stress occurs in response to a single incident that is sudden, shocking and • specific. Acute Stress Disorder and Post-Traumatic Stress Disorder can result. A • worker’s acute reaction to a traumatic event may be immediate, delayed or the result of a • cumulative effect. • Acute Reaction •  An acute reaction is said to be immediate if it occurs within four weeks of the • traumatic event. •  An acute reaction is said to be delayed if it occurs more than four weeks after the • traumatic event. •  Diagnosis of an acute reaction may include, but are not limited to, acute stress • disorder (developed within four weeks), post-traumatic stress disorder (developed • after four weeks), adjustment disorder, or an anxiety or depressive disorder.

8. Cumulative Effect •  Over time, some workers may be exposed to multiple, sudden, and unexpected • traumatic events, due to the nature of their occupation. If a worker has an acute • reaction to the most recent traumatic event, entitlement may be in order even if the • worker may experience these traumatic events as part of the employment and was • able to tolerate the past traumatic events. A final reaction to a series of sudden and • traumatic events is considered to be the cumulative effect. • Chronic Onset Stress occurs in response to an accumulation of a number of work-related • traumatic events over time and/or to a significant event that has lasted for a long time.

9. Consideration of Claims for Psychiatric and PsychologicalDisability • Mental stress caused by ongoing personal conditions or normal workplace, employment • and management-labour relations is not compensable. • The WSCC will consider a claim for psychiatric or psychological disability arising out of • and during the course of employment under the following conditions. • 1. The circumstances giving rise to the claim do not result from the usual pressures and • tensions reasonably expected by the nature of the worker’s occupation and duties; for • example, interpersonal relations and conflicts, health and safety concerns, union • issues, routine labour relations actions taken by the employer including workload and • deadlines, work evaluation, performance management (discipline), transfers, changes • in job duties, lay-offs, demotions terminations, and reorganizations, to which all • workers may be subject from time to time. • 2. A psychiatrist or psychologist makes a diagnosis according to the Diagnostic and • Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) published by the • American Psychiatric Association. • 3. In the case of delayed acute reaction to a work-related traumatic event, there must be • evidence linking the worker’s psychiatric or psychological disability to the traumatic • event. • 4. In the case of a cumulative effect to a series of traumatic events, the WSCC • recognizes that each event may affect a worker psychologically. This is true even if • the worker does not show the effects until the most recent event. As a result, • entitlement may be accepted because of the cumulative effect, even if the last event is • not the most significant.

10. Cumulative Effect • 4. In the case of a cumulative effect to a series of traumatic events, the WSCC • recognizes that each event may affect a worker psychologically. This is true even if • the worker does not show the effects until the most recent event. As a result, • entitlement may be accepted because of the cumulative effect, even if the last event is • not the most significant. 5. In considering entitlement for the cumulative effect, the Adjudicator/Case Manager • will rely on clinical and other information supporting that multiple traumatic events • led to the worker’s current psychiatric or psychological state. Also, there may be • evidence showing that each event had some effect or life disruption on the worker, • even if the worker was not functionally impaired by the effect or life disruption. • 6. Claims are acceptable when all of the following criteria are met: •  The work-related traumatic events are the predominant cause of the disability; •  The work-related traumatic events are excessive or unusual in comparison to the • usual pressures and tensions experienced by the average worker in a similar • occupation; and •  There is objective confirmation of the work-related traumatic event(s). • 7. The WSCC may consider an event traumatic even if the worker was exposed to • similar events in the past and exhibited no ill effects, or even if other workers exposed • to the same event do not experience ill effects. • 8. Work-related harassment, which leads to a worker filing a claim for psychiatric or • psychological disability, should be verified by an external investigation before the • claim is considered for entitlement. The WSCC assumes no responsibility for this • investigation.

11. LEGISLATIVE AUTHORITIES POLICY RELATED DOCUMENTS • Nunavut Workers’ Compensation Act: Section 37 • subsection 13(2); 40(1) • NWT Workers’ Compensation Act: Section 37 • subsection 13(2); 40(1) • Interjurisdictional Agreement on • Worker’s Compensation • Policy 03.02 Entitlement • Policy 03.03 Arising Out Of and During the Course of Employment • Policy 03.04 Decision Making – Benefit of Doubt and Presumption • Policy 03.06 Occupational Disease • Policy 04.09 Non-Work Related Conditions