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. POLICY Precipitating 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. POLICY Precipitating 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 Psychological Disability 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