The Appeal CommissionThe Workers Compensation Act of Manitoba

Applicable Legislation:

The Appeal Commission and its panels are bound by The Workers Compensation Act (the “Act”), regulations and policies of the Board of Directors.

Under subsection 4(1) of the Act, where a worker suffers personal injury by accident arising out of and in the course of employment, compensation shall be paid to the worker by the WCB. Subsection 4(1) provides:

4(1) Where, in any industry within the scope of this Part, personal injury by accident arising out of and in the course of the employment is caused to a worker, compensation as provided by this Part shall be paid by the board out of the accident fund, subject to the following subsections.

What constitutes an accident is defined in subsection 1(1) of the Act, which provides as follows:

“accident” means a chance event occasioned by a physical or natural cause; and includes

(a) a willful and intentional act that is not the act of the worker;

(b) any

(i) event arising out of, and in the course of employment, or

(ii) thing that is done and doing of which arises out of, and in the course of, employment, and

(c) an occupational disease,

and as a result of which a worker is injured;

Subsection 1(1.1) of the Act restricts the definition of “accident” by stating the definition: “does not include any change in respect of the employment of a worker, including promotion, transfer, demotion, lay-off or termination.”

Thus, the definition of “accident” provides three general ways in which it may be found that an accident has occurred. A claim may be adjudicated as an accident (in the more traditional sense) under parts (a) and (b) of the definition, or as an occupational disease under part (c) of the definition.

If a claim is adjudicated as an accident under part (c) of the “accident” definition, it must satisfy the definition of “occupational disease” set out in subsection 1(1) as follows:

“occupational disease” means a disease arising out of and in the course of employment and resulting from causes and conditions

(a) peculiar to or characteristic of a particular trade or occupation; or

(b) peculiar to the particular employment;

but does not include

(c) an ordinary disease of life; and

(d) stress, other than as an acute reaction to a traumatic event.

WCB Policy 44.20.60, Psychological Conditions, deals with claims involving psychological conditions. Policy 44.20.60 provides as follows:

1. Where information indicates a psychological condition is a result of an accident arising out of and in the course of employment, the psychological condition attributable to the accident or its consequences shall be considered a personal injury by accident, for which compensation may be paid.

This includes, but is not limited to psychological conditions incurred as a result of the following:

(a) Organic brain damage from a traumatic compensable head injury.

(b) A psychological reaction or condition which is a direct result of a serious compensable life-threatening injury/event (serious in this context means an accident that threatens life or direct involvement in a life threatening incident or event).

(c) Psychosis resulting from exposure to harmful chemicals at the worksite.

(d) Psychosis resulting from the use of drugs used in the treatment of a compensable injury.

2. Accidents prior to January 1, 1992: Stress or psychological conditions said to be a result of a non-specific event or events and, therefore, cumulative in nature are considered to be chronic stress, and in the absence of a specific identifiable compensable event or events are to be adjudicated on the individual merits and circumstances of the case.
   
3. Accidents on or after January 1, 1992: Stress is not an occupational disease as defined under The Workers Compensation Act, except as an acute reaction to a traumatic event.

Analysis:

The issue before the panel is whether or not the claim is acceptable. In order for the worker’s appeal to be successful, the panel must find that either the worker's stress psychosis or schizophrenia arose out of and in the course of his employment and that there is coverage for his psychological condition under the Act. On a balance of probabilities, we are not able to make that finding.

The medical evidence on file is limited to two medical reports. The first report is from February 2000 when the worker was admitted to a Winnipeg hospital on an emergency basis in a distressed state. He was referred for a psychiatric consult for: "psychosis not yet diagnosed." He remained in hospital overnight and was released the next day when his condition stabilized. The diagnosis for the admission indicated: Stress Psychosis (Brief Delusional Psychosis). The consultation report indicated: "I think this was a stress psychosis but the possibility of a first break schizophrenia has to be considered as an outside possibility."

The second report is dated June 19, 2002 and was written by a treating psychiatrist practicing in southeastern Europe. The psychiatrist described occupational and social dysfunction on the part of the worker and identified a diagnosis of schizophrenia (paranoid type).

The panel considered both of the diagnoses attributed to the worker. With respect to the stress psychosis, the panel notes that stress at work is not normally compensable unless there is an acute reaction to a traumatic event. The panel notes the provisions of Policy 44.20.60 as set out above. In the present case, no traumatic event was identified as having occurred while the worker was in the course of his employment in February 2000. During a telephone conversation on June 2, 2011, the worker was asked why he was claiming that work caused him his schizophrenia. The worker identified long work hours through the night from 5:00 p.m. until 9:00 a.m., then attending full time university during the day. The worker also identified having a very small office at his place of employment and that his request for a larger office was refused. The worker made no indication that any traumatic event had occurred. In the absence of a traumatic event, the stress psychosis is not a condition which can be considered an occupational disease for which workers compensation coverage may be afforded.