WSI Fact Sheet #5

PTSD (Supporting Ontario’s First Responders Act) and Workplace Safety and Insurance

Posttraumatic Stress Disorder (PTSD)

Posttraumatic Stress Disorder (PTSD) is a mental illness. It involves exposure to trauma involving death or the threat of death, serious injury or violence. Traumatic events may include crimes, natural disasters, accidents or other threats to life. It could be an event or situation that you experience yourself or something that happens to others in the course of your employment. Sometimes it may take several traumatic events before PTSD is diagnosed. This is often referred to as Cumulative PTSD.

PSTD and Supporting First Responders Act

The Act is in effect as of April 6, 2016. The legislation and the WSIB Policy 15-03-13 lists the covered workers and is attached. The WSIB policy will apply to decisions made on or after April 6, 2016, for accidents that have occurred on or after January 1, 1998.

If you are a listed worker covered by this Act, there is a rebuttable presumption that your PTSD arose from the workplace. If a listed worker is diagnosed with PTSD, it will be presumed to have arisen out of and in the course of their employment, unless the contrary is shown. The claimant will still have to meet the WSIB specific employment and diagnostic criteria. The diagnosis of PTSD must be made by a psychiatrist or psychologist and must be consistent with the description in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). 

Workers Not Included in the Supporting First Responders Act

Not all workers are covered by this Act. Many of our members are not covered by the new legislation but OPSEU continues to lobby to include more workers. This means that when a claim is filed for work-related PTSD, the presumption clause will not apply. However, workers can still file a claim under the Traumatic Mental Stress policy. The policy is available on the WSIB website. Workers need to still be seen by a psychologist or psychiatrist.

Making a New Claim for PTSD

You must file a claim with WSIB, as soon as possible, but no later than six (6) months. To support your claim, you will need to be diagnosed with PTSD by a psychologist or psychiatrist. You cannot make a new claim if you cease to be a listed worker in the Act prior to 24 months or when the Act comes into effect.

The three criteria are:

  • Date of employment – must be employed as a listed worker for at least one day on or after April 6, 2014
  • Date of diagnosis – must be diagnosed with PTSD by a psychologist or psychiatrist on or after April 6, 2014 and no later than 24 months after the day he or she ceases to be employed as a listed worker if they cease to be employed as first responder on and after April 6, 2016
  • Type of diagnosis – must be diagnosed by a psychologist or psychiatrist with PTSD, as described in the DSM-5. However, for new claims filed after April 6, 2016 and up to October 6, 2016, diagnosis can be made under the DSM-4.

For Existing and Pending PTSD Claims

If you made a PTSD claim prior to when the Act comes into effect, you do not have to file a new claim. You will still need a PTSD diagnosis from a psychologist or psychiatrist, either under DSM-4 or DSM-5. If your claim is pending a decision or is under appeal, including up to the Workplace Safety and Insurance Appeals Tribunal (WSIAT), your claim will be reviewed by WSIB if you are covered by the Act. If there is a final WSIAT decision, there is no ability for reconsideration.

When You are on an Allowed PTSD Claim

WSIB will look at two main issues while you are on claim - Return to Work and Ongoing Medical information.

Return to Work

Regardless of the type of injury/illness, workers have an obligation to participate in the return to work process. The Employer will likely initiate a return to work offer to reduce and minimize WSIB costs. This may include a letter to you and your health care provider, outlining a willingness to accommodate your PTSD restrictions and/or a modified job description. It will not suffice for your health care provider to provide a note saying you cannot return to work due to your PTSD condition. 

Ongoing Requirement for Medical Information

You need to be under the continuous care of your psychiatrist or psychologist for PTSD. WSIB will require ongoing medical information while you are claiming benefits.

What if your PTSD Claim is Denied or Benefits have Stopped

You have the right to appeal the negative WSIB decision and you must file an Intent to Object form with WSIB in writing, no later than six (6) months of the written decision. 

While you are waiting for your claim to be accepted, you can access your Short Term or Long Term Income Benefits, as outlined in your Collective Agreement. 

If you do not have benefits or your benefits are limited, you can apply for Employment Insurance (EI) Sickness Benefits. If you do not qualify for EI benefits, you can apply for social assistance benefits.

Contact your OPSEU staff representative to arrange a workplace accommodation, if you are able to return to alternative work.

If you need help with reporting and filing your WSIB claim, contact your Local union or your worker health and safety representatives.

If you wish to dispute a WSIB decision or need assistance, contact OPSEU’s Pension and Benefits Unit to discuss your claim at [email protected] or 1-800-268-7376 Ext 5561.

This publication contains general information and is intended as a reference only. It is not intended as a substitute for independent legal advice regarding your particular situation.

Pensions and Benefits Index Page

Publication Date: 

Wednesday, May 18, 2016 - 11:00am