Document name

Injuries – Following a Work Injury

Document number

PRO 22/2025

POL 22/2025, Injuries – Following a Work Injury, provides guidelines for the adjudication of injuries that occur secondary to an initial work-related injury. The following procedure provides additional guidelines to assist Operations staff when determining if a secondary injury is compensable.

1. What is a secondary injury?
   1. A secondary injury is a separate and distinct clinically diagnosed injury, disease or condition that occurs as a consequence or complication of an initial work-related injury.
   2. A secondary injury does not include new injuries that arise out of and in the course of a worker’s employment. In such cases, Operations staff will consider if the worker has experienced a new work-related injury in accordance with POL 16/2025, Arising Out Of and In the Course Of Employment.
2. What information will Operations staff consider to help make a decision?
   1. Operations staff will gather and review all available and relevant information to use as evidence to help make a decision. This may include:
      1. Medical reports or medical opinions of the diagnosed secondary injury to ensure consistency with the initial work-related injury. This may include requesting an opinion from a WCB Medical Officer, and
      2. Any additional relevant information from the worker, employer, or health care provider(s).
3. How will Operations staff manage a claim involving a secondary injury?
   1. Operations staff will review entitlement and manage a secondary injury on the same claim file as the initial work-related injury.
   2. To promote a worker’s overall recovery, a secondary injury shall be integrated as part of the worker’s recommended health care treatment plan, return to work plan (RTW), or individualized vocational plan (IVP).

Consequence or Complication of an Initial Work-Related Injury

4. How will Operations staff determine if a secondary injury is compensable?
   1. Operations staff will determine whether it is more likely than not (i.e., standard of proof) the effects of an initial work-related injury caused or contributed to the occurrence of a secondary injury.
   2. Decisions will be made on a case-by-case basis considering the merits and justice of each claim.
5. How can Operations staff determine if an initial work-related injury caused, or contributed to, a secondary injury occurring?
   1. An initial work-related injury must have been of material significance in the occurrence of the secondary injury, meaning more than a trivial or insignificant aspect of the injury or disease.
   2. The initial work-related injury contribution does not need to be the only cause or the dominant cause of the worker’s secondary injury, but it must have contributed in a meaningful way in order for the secondary injury to be compensable.
   3. When it is not clear whether the initial work-related injury contribution is more than a trivial or insignificant aspect of the worker’s secondary injury, Operations staff may use the “but for” test to determine causation. The “but for” test may be used when there are multiple contributing factors to an injury (those related to the initial work-related injury and those that are not) and the overall impact of the initial work-related injury contribution is not clear. Examples of the “but for” test may include:
      1. “But for” the initial work-related injury, would the secondary injury have occurred?
      2. “But for” the initial work-related injury, would the worker’s psychological symptoms have occurred?
      3. “But for” the failure of a medical device prescribed for the initial work-related injury; would the secondary injury have occurred?
6. How can Operations staff determine if a worker’s psychological symptoms resulted from an initial work injury?
   1. POL & PRO 12/2025, Psychological Injuries – General Injury Presumption (Section 27), outline the criteria for the acceptance of a secondary psychological injury that results from an initial work-related physical injury or occupational disease.
   2. A Diagnostic and Statistical Manual of Mental Disorders (DSM) diagnosis completed by a WCB mental health service provider may not be required for the acceptance of a secondary psychological injury when the causal relationship between the worker’s initial and secondary injury is determined to be evident.
   3. If there is insufficient evidence to determine if a worker’s psychological symptoms resulted from an initial work-related injury, or if there is a lack of clarity on the effects of a work-related injury in comparison to other non-work-related factors (e.g., personal stressors that may have contributed to an injury) Operations staff may:
      4. Request a review by the WCB’s Psychological Consultant, or
      5. Contact the Health Care Services (HCS) department to arrange a Mental Health Assessment (MHA).
7. How will Operations staff manage a secondary psychological injury claim?
   1. The WCB supports mental health services on physical injury claims (i.e., during tertiary programming). When the worker’s psychological symptoms worsen or go beyond the length of the recovery for the physical injury, Operations staff will review information from the worker’s care provider to determine if there is a verifiable history of psychological symptoms connected to an initial work-related injury.
   2. When a secondary psychological injury becomes the primary or significant barrier to a worker’s recovery or vocational programming, Operations staff will refer the claim to the WCB’s Psychological Injuries Unit (PIU) for ongoing claim management.
8. What are some examples of secondary injuries that would not be compensable?
   1. Operations staff will not accept responsibility for a secondary injury when the evidence does not support a significant contributing relationship between the initial and secondary injury. This includes injuries that occur as a result of:
      1. Performing exercises after a worker is no longer involved in active treatment (i.e., preventative treatment),
      2. Undergoing surgery, testing or other medical treatment for a non-compensable injury, disease or condition, or
      3. A worker’s pre-existing condition, when the initial work-related injury did not result in an aggravation or acceleration of the worker’s pre-existing condition.

Travel or Treatment for Medical Aid or Vocational Programming

9. What factors will Operations staff consider when determining compensability for a secondary injury that occurs during travel for medical aid or vocational programming?
   1. Operations staff will consider the following:
      1. If the worker’s travel was directed by the WCB (i.e., travel for WCB approved treatment).
      2. If the WCB exerted a degree of control over the worker’s travel (i.e., authorized travel expenses outside of the worker’s home community).
      3. If the worker was travelling on a practical and reasonable route.
      4. If the travel occurred at a time and date consistent with a scheduled appointment, class, program, etc.
10. Is coverage provided for injuries that occur while participating in treatment for medical aid or vocational programming?
    1. The WCB will provide coverage for injuries sustained on the premises where the worker is attending medical aid or vocational programming for a work-related injury.
       1. This means that a worker does not necessarily need to be actively involved in treatment or vocational programming at the time the secondary injury occurs.
    2. For vocational programming, the premises may include academic institutions, technical training institutions or an employer’s work premises.

Pre-Existing Conditions

11. Are secondary injuries covered when they are related to a worker’s pre-existing condition?
    1. Entitlement for a secondary injury will not be denied as a result of a worker’s pre-existing condition, even though the pre-existing condition may have increased the possibility of a secondary injury occurring.
    2. While entitlement for a secondary injury will not be denied solely due to a pre-existing condition, Operations staff will determine if a secondary injury resulted in either an aggravation or acceleration of a worker’s pre-existing condition (POL 12/2017, Pre-Existing Conditions – Aggravation or Acceleration).