Document name

Psychological Injuries – Psychological Injury Presumption (Section 28.1)

Document number

POL 11/2025

Accredited health care provider means a provider who has applied for accreditation with WCB and, following review of their credentials, WCB accepts their request for accreditation. Once accreditation is in place, the accredited health care provider can bill the WCB directly for services provided to workers.

DSM means the Diagnostic and Statistical Manual of Mental Disorders (DSM) published by the American Psychiatric Association to help mental health providers diagnose mental health disorders. The fifth edition (DSM-5) is to be used as prescribed by The Workers’ Compensation Miscellaneous Regulations. The DSM does not include guidelines for the treatment of a disorder.

DSM diagnosis, for the purpose of this policy, means a diagnosis that meets all diagnostic criteria for a disorder in accordance with the DSM, completed by a psychologist or psychiatrist licensed to practice and make diagnoses.

Mental Health Assessment (MHA) is a psychological evaluation completed by a Workers’ Compensation Board (WCB) accredited psychologist or psychiatrist and includes:

• An assessment and diagnosis of a disorder, or confirmation of a diagnosis, in accordance with the DSM,
• Recommended treatment, and
• Recommended return-to-work (RTW) planning.

Psychological injury means a psychological disorder or condition that meets the DSM diagnostic criteria (e.g., acute stress disorder or post-traumatic stress disorder) and has arisen, or is presumed to have arisen, out of and in the course of employment (Section 28.1(1)(a)).

Traumatic work-related event(s) means exposure through direct personal experience or being a direct personal witness to an event, or series of events, arising out of and in the course of employment that may give rise to a psychological injury, including:

• Actual or threatened death or serious injury to a worker or others,
• Event(s) that are sudden and typically unexpected, occurring at a specific time and place, or
• Event(s) that would be objectively considered emotionally shocking or horrific (i.e., physical or sexual violence).

1. On December 20, 2016, The Workers’ Compensation Act, 2013 (the Act) was amended to establish a rebuttable presumptive clause for psychological injuries:
   1. Section 28.1(2) of the Act directs that, “unless the contrary is proven, if a worker or former worker is diagnosed with a psychological injury by a psychiatrist or psychologist, that injury is presumed to be an injury that arose out of and in the course of the worker’s employment”.
   2. Section 28.1(1)(b) defines a worker (or a former worker) as a person who works (or worked) and is or has been:
      1. Exposed to a traumatic event(s), or
      2. Is in an occupation that is prescribed in the regulations.
2. As there are no occupations currently prescribed in the regulations, the presumptive criteria for a psychological injury applies to all workers covered under the Act.
3. The WCB has the exclusive jurisdiction to examine, hear and determine:
   1. All matters and questions arising pursuant to this Act,
   2. Whether any condition or death was caused by an injury,
   3. Whether an injury has arisen out of and in the course of employment, and
   4. The existence, degree and permanence of any functional impairment resulting from an injury (Section 20).
4. The WCB may make inquiries (Section 25) and request any evidence (Sections 21 and 22) it considers necessary.
5. The various circumstances where coverage applies cannot be addressed under one policy. This policy and procedure are intended as general guidelines only. The WCB will make its decisions on the real merits and justice of each case and is not bound to follow any legal precedent. In making its decisions, the Board may have regard to its policy directives (Section 23).

Psychological injury presumption

1. A psychological injury is presumed to be an injury arising out of and in the course of a worker’s employment when:
   1. The worker or former worker suffers from a psychological disorder, including post-traumatic stress disorder, that is diagnosed in accordance with the DSM by a psychologist or psychiatrist licensed to practice and make diagnoses, and
   2. The worker or former worker was exposed to a traumatic work-related event(s).

If both criteria are met, the causal link between the traumatic work-related event(s) and a psychological injury is presumed and will be adjudicated in accordance with this policy and corresponding procedure.

Claims outside the psychological injury presumption

2. If the criteria for the psychological injury presumption (point 1(a) and (b)) is not met, the claim will be adjudicated in accordance with POL 12/2025, Psychological Injuries – General Injury Presumption (Section 27).

Claim decisions

3. The WCB operates under an inquiry model which means that evidence can be requested at any point to make, or help make, a decision.
4. Considering the merits and justice of each case, when evidence shows that more than one conclusion is possible, a decision will be made based on the conclusion that is more likely (i.e., standard of proof). POL 02/2019, Decision Making, will apply.
5. If evidence in support of both sides of an issue is approximately equal, the WCB will resolve the issue in favour of the worker (Section 23 of the Act and POL 02/2019, Decision Making).
6. When a traumatic work-related event(s) has occurred, the claim for a psychological injury will not automatically be denied based solely on the following contributing factors, as these are not considered sufficient to rebut the psychological injury presumption:
   1. There are non-work-related factors in addition to the traumatic work-related event(s),
   2. There are multiple contributing factors to an injury (e.g., non-traumatic or personal stressors),
   3. The worker or former worker was exposed to a series of traumatic work-related events over a period of time,
   4. There is a delay in the onset of trauma-based symptoms (i.e., where full diagnostic criteria in accordance with the DSM is not met approximate in time to the traumatic work-related event or series of traumatic events), or
   5. The worker or former worker has/had a pre-existing psychological condition (points 15 to 17).
7. When evidence has been provided to WCB that may rebut the psychological presumption, the WCB will examine and weigh evidence to determine if a worker’s injury arose out of and in the course of employment. Evidence may include, but is not limited to:
   1. Objective confirmation of the event(s) that caused or contributed to a worker’s psychological symptoms (i.e., injury reports, witness statements, medical information, etc.),
   2. When the relationship between the traumatic work-related event(s) and injury is not clear, medical reports or medical opinions of the diagnosed condition or disorder, or
   3. Relevant information from the worker, employer, co-workers, and/or health care providers to gain an understanding of the conditions or details of the traumatic work-related event(s).
8. To rebut the psychological injury presumption, there must be sufficient evidence that proves it is more likely than not (i.e., standard of proof) a traumatic work-related event(s) is not one that contributed to, or caused, a psychological injury arising out of and in the course of employment. POL 07/2021, Arising Out of and In the Course of Employment, will apply.

DSM diagnosis and Mental Health Assessments (MHA)

9. A DSM diagnosis provided by a worker or former worker’s health care provider will be reviewed to determine if it meets all of the diagnostic criteria in accordance with the DSM. This includes both clinical and psychological testing information from a psychologist or psychiatrist.
10. The WCB may require an MHA completed by a WCB-accredited psychologist or psychiatrist for assessment and review of a DSM diagnosis when:
    1. The diagnostic criteria in accordance with the DSM was not provided by the health care provider, or
    2. The DSM diagnosis does not include both clinical (e.g., history, presentation, functioning levels) and psychological testing information.
11. Following a suicide, when there is no MHA or DSM diagnosis available and a WCB claim is submitted for a psychological injury, the WCB will consider the opinions or evaluations of any health care provider and all other available information to use as evidence to determine if the worker or former worker had a DSM diagnosis. WCB will then determine whether or not the deceased worker may have had a work-related psychological injury.

Entitlement

12. The WCB may provide coverage for counselling services and essential prescribed medications while a claim decision is being adjudicated. If, after adjudication, the claim is not accepted, medical costs will not be charged to the employer.
13. If a psychological injury claim is accepted, the WCB will provide ongoing medical treatment and earnings loss benefits resulting from the work injury. The WCB will also develop a recovery and return-to-work plan in consultation with the worker, the employer, and health care providers.
14. WCB benefits may coincide with a worker’s disability insurance entitlement. It is the responsibility of the worker to notify their disability insurance provider of the WCB benefits they are receiving.

Pre-existing conditions

15. Entitlement for a psychological injury will not be denied based on the existence of a pre-existing psychological condition. However, the WCB does not assume any responsibility for a worker’s pre-existing condition.
16. The WCB will determine if a psychological injury resulted in either an aggravation or acceleration of a worker’s pre-existing condition (POL 12/2017, Pre-Existing Conditions – Aggravation or Acceleration).
17. An employer may be eligible for cost relief for claims involving a pre-existing condition in accordance with POL 03/2021, Second Injury and Re-employment Reserve.

Recurrence

18. A worker may be entitled to medical treatment and earnings loss benefits resulting from the recurrence of a psychological injury. The WCB will review evidence to determine whether the worker’s psychological condition is a recurrence of the psychological injury.

Permanent Functional Impairment (PFI)

19. The WCB will review a psychological injury for any measurable permanent functional impairment when medically appropriate (POL 33/2024, Permanent Functional Impairment (PFI) Awards).

Appeals

20. A worker may ask the WCB to reconsider any decision made on a psychological injury claim.
    1. For claims denied prior to December 20, 2016 (the date the psychological injury presumption came into force), a decision may be reconsidered if new information is provided.
    2. For claims denied on or after December 20, 2016, pursuant to the previous policy (POL 02/2017, Injuries – Psychological), a decision may be reconsidered without the need for new information being provided.
21. If a worker or employer disagrees with the reconsideration decision, they may submit an appeal. POL 23/2014, Reversing Decisions, POL 21/2013, Appeals – Claims, and POL 13/2024, Appeals – Board Appeal Tribunal, will apply.

Critical incident response information sessions

22. To address and respond to the emotional and psychological consequences resulting from exposure to a traumatic work-related incident, preventative or post-incident response information sessions may be made available.