Worker appeals psychological injury case allegedly caused by workplace

Employee argues injury was 'reaction to work-related stressors'

Worker appeals psychological injury case allegedly caused by workplace

A worker recently filed an appeal before the Appeals Commission for Alberta Workers’ Compensation, arguing that her employer caused her psychological injury due to the workplace’s stressful environment.

In 2020, the worker submitted a claim for a psychological injury to the Workers’ Compensation Board (WCB), attributing it to interpersonal conflicts at her workplace, alleging harassment and bullying from her co-workers.

The claim's date of the incident was determined to be June 3, 2019.

Claim’s initial dismissal

On January 14, 2021, a WCB adjudicator dismissed the worker’s claim for a psychological injury, a decision upheld on August 13, 2021.

A separate claim was filed by the worker for a workplace incident on October 26, 2020, which was accepted for an adjustment disorder with mixed anxiety and depressed mood resulting from a traumatic work event.

Disagreeing with the separation of the October 2020 incident into a distinct claim, the worker argued meeting the criteria for acceptance of a chronic onset psychological injury. On January 14, 2022, the adjudicator upheld her decision to deny the worker’s claim after reviewing additional information.

Subsequently, on May 18, 2022, the Dispute Resolution and Decision Review Body (DRDRB) upheld the denial of a chronic onset psychological injury on this claim.

The worker's Notice of Appeal was filed within the statutory time limit. While the WCB was notified, it did not participate in the appeal.

Governing legislation for appeal

After assessing the evidence presented and considering applicable legislation and policies, the DRDRB concluded that there was insufficient information to determine whether the worker has a valid claim for a chronic onset psychological injury.

The DRDRB deliberated the date of the accident as June 3, 2019, considering the worker's stressors related to events occurring since her reinstatement in 2019, excluding those from before. The focus remained on events within this period, as stipulated by the parties at the outset of the hearing.

Additionally, the worker’s representative affirmed that the appeal pertains solely to a chronic onset psychological injury, narrowing the issue in line with applicable legislation and rules.

The governing legislation for workers’ compensation matters in Alberta is the WCA, empowering the Appeals Commission to make final decisions on appeals from the DRDRB.

In addressing the issue, the DRDRB adhered to the legislation and policies effective at the time of the adjudicator’s decision, considering the worker's June 3, 2019, date of the accident, with relevant excerpts provided in the appendices.

Under the WCA, compensation is provided for personal injury resulting from an accident, with the WCB considering claims for psychiatric or psychological injuries meeting specific criteria, including confirmation of diagnosis as per the Diagnostic and Statistical Manual of Mental Disorders (DSM).

Compensable psychological injury

According to the Commission, chronic onset psychological injury is compensable under defined circumstances, necessitating a confirmed diagnosis, excessive or unusual work-related events, and a predominant causal link between work events and the injury.

To determine the viability of the worker's claim for a chronic onset psychological injury, key questions arise from legislation and policy:

  • Does the worker have a confirmed DSM psychological diagnosis?
  • Is the worker's diagnosed condition a reaction to work-related stressors over time?
  • Are work-related events the predominant cause of the injury?
  • Is there objective confirmation of the events?
  • Are the work-related events excessive or unusual compared to normal occupational pressures?

Confirmed DSM psychological diagnosis

Based on medical reports, the worker has a confirmed DSM diagnosis, encompassing various psychological conditions outlined in the DSM-5-TR, indicating the presence of a confirmed psychological diagnosis as required.

However, while other medical reports noted symptoms, they lacked confirmed DSM diagnoses, necessitating a focus on the reports affirming such diagnoses.

Despite confirming the worker's DSM diagnosis, the DRDRB found insufficient evidence to determine the predominance of work-related events in causing the injury, owing to ambiguities and inadequacies in the evidence.

‘Predominant cause’ and ‘insufficient’ investigation

The panel acknowledged confusion surrounding medical causation due to the WCB's handling of the claims, including the separation of the October 2020 incident into a separate claim. This ambiguity hindered the assessment of whether the worker's injury predominantly resulted from work-related events.

Further, the investigation into the worker’s allegations was deemed inadequate, with discrepancies and omissions in the WCB and SIU inquiries, including a narrow focus on formal documentation and a lack of broader inquiry into the alleged events.

Given the lack of clarity and inadequacies in the evidence and investigations, the Commission sent the matter back to the WCB for comprehensive re-examination and adjudication, guided by specified directions aimed at addressing the deficiencies identified.

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