The Appeal CommissionThe Workers Compensation Act of Manitoba

Preamble

The worker is appealing the decision made by the Workers Compensation Board ("WCB") that the claim is not acceptable. A hearing was held on August 1, 2019 to consider the worker's appeal.

Issue

Whether or not the claim is acceptable.

Decision

The claim is acceptable.

Background

The worker filed a Worker Incident Report with the WCB on June 21, 2018 indicating that she suffered a psychological injury at work on June 19, 2018. The worker noted that she worked in a high risk environment, dealing with verbal and physical abuse. She noted as well that she had experienced bullying from senior management. She also commented that a colleague recently committed suicide and she was dealing with that. The worker described her symptoms, including anxiety, dizziness, feeling overwhelmed and angry. She noted she had not reported her injury to her employer and was scheduled to see her doctor the same day.

When the worker saw her family physician on June 21, 2018, she was diagnosed with acute stress. In the report from that visit, the physician described the worker as anxious, stressed and unable to concentrate. The physician noted the worker was not suicidal, but reported that her co worker had committed suicide. A pre-existing condition of Generalized Anxiety Disorder was noted to be stable. The physician prescribed medication for the anxiety, recommended counselling and further medical attention, and said that the worker was disabled from work.

In a conversation with the WCB case manager on July 4, 2018, the worker identified two incidents at work where residents had passed away. She advised that she was present for one of the incidents, while for the other, she was with the resident on a daily basis before the death and it affected her as she had been working closely with this resident. She noted that she was involved with a health and safety committee at work and as a result, had been helping a co worker with workplace issues. That co-worker had recently committed suicide and the worker felt that this was weighing on her. The worker also confirmed that she had been treated for anxiety over the previous five years.

On July 6, 2018, the worker was seen by a second physician. The physician noted that the worker was stressed since November, and that she was struggling to deal with the suicide of a colleague. The physician recommended psychotherapy or counselling, prescribed a different medication and recommended she remain off work for a further two weeks. The physician noted that the worker reported being off work was helping.

The employer filed an Employer's Incident Report with the WCB on July 10, 2018 noting that "No information was provided by the employee to the employer." The Report further noted that the worker called in sick on June 22, 2018 until July 5, 2018, then again on July 6, 2018 to July 20, 2018 and that no incidents were reported to the employer.

The WCB case manager spoke with the worker again on July 19, 2018. At that time, the worker confirmed that her stress at work began with the deaths of two residents. One death occurred in 2016, where she was not close to the resident when they passed but became stressed and experienced anxiety due to possibly having to testify at an inquiry into the resident's death. The second resident death, also in 2016, was an individual she had direct contact with. The worker advised the WCB that the deaths had bothered her but she had not sought medical attention for either as she preferred to deal with the issues on her own. She advised that she began to feel stress related to her participation in a health and safety committee at her work in that speaking with other workers and hearing about their difficulties added to her anxiety at work. She confirmed she was affected by the suicide of a co-worker who she knew through her work on the health and safety committee. The worker advised that she had been treated for mild anxiety in the past, noting that her physician was away on a leave and she had found a new physician.

On July 25, 2018, the WCB received chart notes from the worker's previous healthcare provider noting that she had a pre-existing anxiety condition that she had been treated for since 2015.

When the WCB spoke to the employer on August 3, 2018, the employer advised that there was no documentation to confirm the worker's involvement in either of the residents' deaths as described by the worker in discussions with the WCB. Further, the employer was not aware of any work-related connection between the worker and the co-worker who committed suicide and noted that the death was not work-related. Finally, the employer noted that the worker had not indicated that any of the difficulties she was suffering from were related to work, but only that she was taking sick leave.

The WCB received a report from the worker's treating psychologist on August 22, 2018. The psychologist opined that the worker met the mental threshold criteria for Posttraumatic Stress Disorder (PTSD) with dissociative symptoms and panic episodes according to the DSM-5. The psychologist further noted that the worker reported:

…experiencing repeated or extreme exposure to aversive details of traumatic events including, but not limited to, two workplace incidents involving death: One of these incidents which she witnessed directly, the second incident which involved watching the patient for an extended period of time with the death following her departure. The third incident involved a co-worker's death by suicide and although this was not directly at the workplace, psychologically [the worker] viewed the workplace as a contributing factor.

The WCB requested additional information from the worker and employer about the May 1, 2016 death witnessed by the worker. On August 30, 2018, the employer advised the WCB that the worker "…did not have any involvement in the situation" and further noted that the worker had "refused to go into the Unit." The employer confirmed that the worker was asked to provide an email with a general description of the incident. Later, on September 11, 2018, the employer advised that they were not aware of the worker's having "…any significant involvement…" in either the May 1, 2016 incident or the death of the resident who the worker had been watching. The employer noted that the worker was requested to write a brief email of the May 1, 2016 death but she did not write a report "…or have any confirmed or documented dealings…" with the resident while at her workplace.

On September 13, 2018, the worker's file was reviewed by a WCB psychological consultant. The WCB psychological consultant noted that the PTSD diagnosis provided by the worker's treating psychologist is based on the worker's subjective report of symptoms and is related to the worker's reports of three traumatic events, including two resident deaths and the suicide of a co-worker. The psychological consultant noted that the diagnosis "…would be appropriate if [the worker] has had this type of experience…and would be appropriate in relation to a workplace injury if these events are deemed to be work-related events." The WCB psychological consultant opined that at least two of the events described by the worker are workplace events, but, based on a review of the information obtained from the employer, the worker did not experience the two work-related deaths "…in the fashion described under Criterion A for the diagnosis of PTSD."

On September 24, 2018, the WCB spoke with a co-worker who was also present with the worker on May 1, 2016. The co-worker stated that worker was not directly involved in the incident but did witness it. The co-worker further stated that they had discussed the incident after and the worker mentioned that the incident "messed with her head a little bit".

The WCB advised the worker that her claim was not acceptable on October 10, 2018, acknowledging that the worker worked closely with two of the residents and a co-worker who passed away; however, the WCB could not establish a relationship between those events and the worker's current difficulties. As well, a relationship between the worker's current psychological difficulties and her job duties could also not be established.

The worker's representative requested reconsideration of the WCB's decision to Review Office on October 29, 2018 and provided a written submission outlining the reasons for the request. The employer submitted a response in support of the WCB's decision on December 19, 2018 and the worker's representative responded further on December 21, 2018. Copies of each submission were provided to the parties.

On December 27, 2018, Review Office determined the worker's claim was not acceptable. Review Office stated that the worker had documented several reasons for her increased stress and anxiety, including reporting work in a high risk unit with verbally and physically abusive residents as well as participating in a health and safety committee where discussion of other workers' difficulties was noted to be stressful. Review Office further found that the worker was present and did witness the death that occurred on May 1, 2016 but declined counselling that was offered after the incident and did not mention the incident to her family physician, who had been treating her for stress and anxiety previously. As such, Review Office determined that the worker did not have an "acute" reaction to the incident. Review Office concurred with the worker's representative's opinion that the second death of a resident was not considered a traumatic event as the worker was not working or present at the time of the death. Review Office further determined that the decline in the worker's mental health, seeking medical treatment and missing work in June 2018 was as a result of her response to the death of a co-worker and would not be considered a work-related accident under the Act. Accordingly, Review Office could not determine that any of the incidents noted by the worker met the definition of an accident under The Workers Compensation Act (the "Act") or met the criteria under the WCB policies.

The worker's representative filed an appeal with the Appeal Commission on January 15, 2019. An oral hearing was arranged.

Reasons

Applicable Legislation and Policy

The Appeal Commission and its panels are bound by The Workers Compensation Act ("the Act"), regulations and policies of the WCB's Board of Directors.

Section 4(1) of the Act provides that where a worker suffers personal injury by accident arising out of and in the course of employment, compensation shall be paid to the worker. "Accident" is defined in s 1(1) of the Act as follows:

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

(a) a wilful 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 the 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.

In the same section, "occupational disease" is defined as:

…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; 

(b) peculiar to the particular employment; or 

(b.1) that trigger post-traumatic stress disorder; 

but does not include 

(c) an ordinary disease of life; and 

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

The Act addresses causation of occupational disease in s 4(4) which reads as follows:

Cause of occupational disease 

4(4) Where an injury consists of an occupational disease that is, in the opinion of the board, due in part to the employment of the worker and in part to a cause or causes other than the employment, the board may determine that the injury is the result of an accident arising out of and in the course of employment only where, in its opinion, the employment is the dominant cause of the occupational disease.

WCB Policy 44.05.30, Adjudication of Psychological Injuries ("the Psychological Injuries Policy") sets out guidelines applicable to claims for psychological injuries. Relevant portions of this policy are as follows:

Accident 

The definition of accident in The Workers Compensation Act…has various components. A psychological injury can be caused by: 

• a chance event; 

• a wilful and intentional act; or 

• the injury can be an occupational disease (an acute reaction to a traumatic event or post traumatic stress disorder).

Any of these events can injure a worker physically. However, they can also injure a worker psychologically without injuring the worker physically. 

…

Non-Compensable Psychological Injuries 

Psychological injuries that occur as a result of burn-out or the daily pressures or stressors of work will not give rise to a compensable claim. The daily pressures or stressors of work do not fall within any part of the definition of accident because there is no chance event, no wilful and intentional act and no traumatic event.

Discipline, promotion, demotion, transfer or other employment related matters are specifically excluded from the definition of accident.

WCB Policy 44.10.20.10, Pre-existing Conditions addresses the issue of pre-existing conditions when administering benefits. The policy states that:

When a worker's loss of earning capacity is caused in part by a compensable injury and in part by a non compensable pre-existing condition or the relationship between them, the WCB will accept responsibility for the full injurious result of the compensable injury.

WCB Policy 44.20, Disease/General deals with the adjudication of claims that involve disease. The relevant provisions of this policy are as follows:

2. DEFINITIONS RELEVANT TO OCCUPATIONAL DISEASE

A number of terms arise directly from the legislation that requires operational definition. For the purpose of this policy the following definitions apply….

d) "acute reaction to a traumatic event"

Referring to stress, an acute reaction is a reaction that creates a condition in the worker that is clearly discrete from the condition previous to the event. The traumatic event is an identifiable physical or psychological occurrence, occurs in an identifiable time frame that is normally of brief duration, is not a series of minor occurrences, and is capable of causing serious physical or psychological harm consistent with the acute reaction.

e) "dominant cause of the occupational disease"

If the combined effect of the employment causes exceeds the combined effect of the non-employment causes then the work will be deemed to be the dominant cause of the disease.

3. POLICY APPLICATION

a) The WCB will determine: 

1. the existence of a disease, 

2. the nature of the disease in question, 

3. the circumstances surrounding the manner in which the disease arose.

b) The WCB will then determine if the disease is an occupational disease by applying the criteria in The Workers' Compensation Act and this policy. To be an occupational disease the disease must be: 

i. particular to or characteristic of a particular trade or occupation, or, 

ii. peculiar to the particular employment (of the worker) 

As well the disease must be neither: 

i. an ordinary disease of life, nor, 

ii. stress, unless that stress is an acute reaction to a traumatic event…. 

c) If it is determined that the disease is an occupational disease the following steps apply: 

1. If the WCB determines that there are multiple causes that contributed to the disease, compensability will be contingent upon the worker’s employment, on the balance of probabilities, being the dominant cause of the disease. (The dominant cause requirement, in the Act, applies only to the compensability of occupational disease. It does not apply to the claims attributed to workplace accidents even when the accident involves a disease as a pre-existing condition or a disease as a result of an accident.) 

2. The disease is not compensable if caused by any change in respect of employment, including promotion, transfer, demotion, lay-off, or termination. 

3. Synergistic effects will be considered in the determination of dominant cause. If the synergy is between similar sources (work or non-work), the entire increased effect will be attributed entirely to work or non-work, as the case may be. If the synergy is a combination of work and non-work sources, the WCB will assess the case on the merits of available medical and scientific evidence.

Worker's Position

The worker was represented in the hearing by a union representative who provided a submission to the panel. The worker responded to questions from her representative and the panel.

The worker's position, as outlined by the worker's representative, was that the claim is acceptable because the evidence supports that the worker developed a psychological injury as a result of her exposure to trauma in the workplace. The worker's representative acknowledged that a number of incidents and factors contributed to the development of the worker's psychological injury but stated that the dominant cause was the witnessing of the resident's death on May 1, 2016. While the onset of debilitating symptoms was not until after the worker learned of the death of a colleague in June 2018, the worker's representative submitted that this death would not have caused the psychological injury had the worker not already experienced an acute reaction to the resident's death in May, 2016.

The worker's representative noted that an acute reaction to a traumatic event need not be evident immediately after the event, but that Policy 44.05.30, in the administrative guidelines, sets out that "…acute refers to the severity of the reaction, whenever it occurs."

The worker confirmed that she did not accept the counselling offered in May 2016, noting that she believed she could handle the associated stress on her own. The worker's representative submitted that the worker was able to manage the psychological distress she experienced until learning of the death of her colleague in June 2018. The worker's representative acknowledged that this event in June 2018 is unlikely to be accepted as a workplace accident under the provisions of the Act, but suggested that this event triggered the manifestation of the worker's latent injury. In the result, in June 2018, the symptoms associated with her underlying compensable injury appeared and were recognized by the worker although the injury itself occurred in 2016.

On this basis, the worker seeks to have WCB accept responsibility for the claim.

Employer's Position

The employer was represented by its Workers Compensation Specialist who made a submission to the panel on behalf of the employer. The employer representative's position was that the circumstances surrounding the establishment of this claim do not meet the definition of an accident. In particular, the diagnosis of PTSD has not been established in accordance with Criterion A, and is in any event not related to the worker's employment.

The representative noted that under the Act and Policy, daily pressures and stressors do not qualify as there is no chance event, no wilful and intentional act, and no traumatic event. As well, discipline, promotion, demotion, transfers and other employment related matters are also excluded from the definition of an accident.

The representative focused on the June 17, 2018 death of a colleague as a non-work-related event that generated the worker's claim, as well as other examples of avoidance behaviors and negative cognition set out in the report from the worker's psychologist noting that none of these met the criteria to establish the diagnosis of PTSD according to Criterion A of the DSM-V. None of these events or incidents took place in the course of employment.

The employer's representative noted that the worker had already been treated for anxiety for at least 5 years at the time of making this claim, beginning prior to the May 1, 2016 incident and likely beginning shortly after she began her current employment. The representative pointed to the worker's incident report which noted a difficult work environment, as well as the Doctors First Report dated June 21, 2018 which noted complaints related to bullying at work and verbal abuse by residents.

Further, the employer's representative noted that the worker was not present when the resident passed away in hospital in 2016, nor did she witness the death of the resident in the facility on May 1, 2016, as the evidence is clear that the resident did not die in the facility.

The representative's stated position is that the dominant cause of the worker's psychological difficulties was not the 2016 death of the resident that the worker cared for nor the May 1, 2016 incident in the workplace. Rather, the worker's psychological difficulties arose out of the June 2018 death of her colleague, which was not a work-related incident. The worker's response to this event resulted in her seeking medical attention for her symptoms of anxiety and led to the claim under consideration.

Analysis

The issue before the panel is whether the worker's claim is acceptable. For the worker's appeal to be successful, the panel must find, on a balance of probabilities, that the worker suffered a personal injury by accident arising out of and in the course of employment. The panel is able to make that finding.

The first question for the panel to determine is whether there was an accident arising out of and in the course of employment. If there was no accident, there is no basis for the claim. The second question for the panel is whether the worker was injured as a result of the accident.

Was There An Accident Arising Out Of And In The Course of Employment?

In determining whether there was an accident, as defined in the Act, the panel must consider each part of the definition in turn. Was there a chance event occasioned by a physical or natural cause, including a wilful and intentional act that is not the act of the worker, or an occupational disease as a result of which the worker was injured?

The definition of occupational disease set out in the Act includes:

…a disease arising out of and in the course of employment and resulting from causes and conditions…that trigger post-traumatic stress disorder; but does not include (c) an ordinary disease of life; and (d) stress, other than an acute reaction to a traumatic event.

In the case of psychological injuries, the Psychological Injuries Policy sets out that a claim cannot arise under the part of the definition of accident that refers to any event arising out of, and in the course of, employment, or thing that is done and the doing of which arises out of, and in the course of, employment.

The Psychological Injuries Policy confirms that events can injure a worker psychologically without injuring the worker physically but excludes psychological injuries that occur as a result of burn-out or the daily pressures or stressors of work because there is no chance event, no wilful and intentional act and no traumatic event. Further, discipline, promotion, demotion, transfer or other employment related matters are specifically excluded from the definition of accident.

The Psychological Injuries Policy relies upon the definition of traumatic event provided in WCB Policy 44.20, Disease/General as an identifiable physical or psychological occurrence that occurs in an identifiable time frame that is normally of brief duration, is not a series of minor occurrences, and is capable of causing serious physical or psychological harm consistent with the acute reaction.

Here the worker's representative pointed the panel to the occupational disease aspect of the definition of accident, taking the position that the worker experienced causes and conditions that either triggered PTSD or that triggered an acute reaction to a traumatic event. The employer's representative likewise relied on that part of the definition in arguing that the worker's diagnosis of PTSD, if it could be established at all, did not arise out of and in the course of employment but was triggered by an event that was not work-related.

The worker and her representative presented the panel with information about several events.

First, there was the death in 2016 of an ill resident that the worker had spent some time looking after in the course of her employment. The evidence is that although the worker was present with the individual less than 12 hours before death, the worker was not present at the time of the death. The worker testified that she felt horrible and sad when she learned of the death and helpless as an employee. The employer confirmed that the worker was not present at the time of this individual's death and did not raise it as an issue of concern. The worker did not provide any evidence of having discussed this event or her reaction to it with co-workers or her employer.

Second, there was the incident of May 1, 2016 in which the resident suffered a seizure and the worker witnessed, together with many of her co-workers, efforts by colleagues to subdue and attend to the resident and then, attendance by emergency medical personnel and finally, the removal of the resident from the facility on a stretcher, still in the care of the emergency services personnel. The written submission from the worker's representative included a copy of the Report on Inquest and Recommendations of the Inquest Judge, which outlined the details of the incident on May 1, 2016. The testimony from the Inquest into this death provides some independent verification of the facts and circumstances described by the worker. The panel noted that this report confirmed that employee assistance support was offered to the staff present immediately after this incident. The report further notes that:

Some staff were significantly affected by [the resident]’s passing, and at the time of [the supervisor's] evidence, January 31, 2018, some staff were still off work as a consequence.

The report goes on to note that the worker's supervisor on that shift indicated in testimony that "…this incident was extremely traumatic for herself" although the supervisor stated she had been present in many other situations where a resident had a seizure.

While the report from the Inquest does not reference the worker specifically, it does confirm to the panel that the circumstances of the incident of May 1, 2016 were such that a number of staff were significantly affected by it, providing support for the position taken by the worker that this event was traumatic in nature.

Third, there was the death by suicide of the worker's colleague that occurred on or about June 17, 2018 and which appears to have precipitated the worker's claim. The worker's representative confirmed in his submission the position that this unfortunate event was not work-related although the worker had a working relationship with the deceased individual.

The worker's treating psychologist, in the August 22, 2018 report, described each of these events as a traumatic event and noted that each was connected to the workplace, although only the May 1, 2016 event occurred in the workplace.

Based upon the totality of evidence on the file and heard in the hearing, the panel is satisfied on a balance of probabilities that the events of May 1, 2016 resulting in the death of a resident meets the definition of a traumatic event as set out in WCB Policy 44.20 as a discrete, time-limited event capable of causing serious physical or psychological harm consistent with the acute reaction. These events witnessed by the worker in the course of her employment therefore fall within the definition of an accident.

With respect to the second resident death, also occurring in 2016, the panel considered that the worker was not present at or near the time of the death but notes that learning of that death was upsetting to the worker. While this event was considered by the treating psychologist as a potential traumatic event, the panel was unable to find, on a balance of probabilities, that this event meets the definition of a traumatic event set out in WCB Policy 44.20.

With respect to the June 2018 death by suicide of the worker's colleague, the panel considered that event did not occur in the workplace and that the worker was not present at the time, but only heard of it through a message from another colleague. Further, the panel noted the worker's representative's acknowledgement that this was likely not an event that could be defined as a workplace accident. On considering the evidence before the panel, and on a balance of probabilities, the panel finds that the June 2018 death of the worker's colleague does not meet the definition of a traumatic event set out in WCB Policy 44.20.

Was the Worker Injured As A Result Of The Accident?

Next the panel has to consider whether there was a personal injury as a result of the accident. More specifically, was there a psychological injury, or acute reaction to a traumatic event arising out of the workplace accident of May 1, 2016.

In considering this question the panel gave careful consideration to the following evidence from the medical reports and findings on file:

• The worker did not report any of these events to her treating physician until after the co worker's death in June 2018. 

• While the worker's physician notes a pre-existing diagnosis of generalized anxiety disorder, the physician also notes that this was stable prior to June 2018. 

• The worker was managing her psychological condition prior to June 2018 through self-management, use of massage therapy and occasional use of medication for anxiety. 

• The psychological symptoms noted by the psychologist in the August 22, 2018 report are substantially different in both kind and severity than were previously reported by the worker's treating physician. 

• The August 22, 2018 report of the clinical psychologist outlines symptoms that meet the DSM-V definition of PTSD in many if not all respects. 

• The WCB Psychological Consultant concurs, in the September 13, 2018 report, that the symptoms noted by the treating psychologist "…would meet criteria for the DSM-V diagnosis of PTSD" although there remains a difference of opinion between the psychologists as to whether or not Criteria A is established.

The question of whether or not the worker meets all the DSM-V criteria for a diagnosis of PTSD need not be answered by the panel in determining whether or not the worker suffered an acute reaction to a traumatic event. An acute psychological reaction need not amount to a confirmed diagnosis of PTSD in order to fall within the definition of an occupational disease.

As defined in WCB Policy 44.20, Disease/General, an acute reaction is a reaction that creates a condition in the worker that is clearly discrete from the condition previous to the event.

While the employer's representative relied on the worker's pre-existing diagnosis of generalized anxiety disorder to suggest that the psychological injury was not the result of an acute trauma but rather the result of the daily pressures or stressors of work going back to shortly after the worker began this job, the panel was not persuaded by this argument. Neither of the psychologists consulted suggests that the symptoms and manifestations of the psychological injury are tied to the earlier diagnosis of general anxiety disorder.

The employer's representative also argued that the worker's psychological injury was the result of learning of the death by suicide of her colleague in June 2018. The panel notes that it was at this point that the worker sought further medical assistance and made her claim to the WCB. The employer's representative argued that the timing of the claim and seeking of medical attention suggests that this death was the event that caused the acute response.

The worker's representative argued rather that the June 2018 death of the worker's colleague was a triggering event, but not the cause of the trauma.

The report of the treating psychologist refers to the events of June 17, 2018 as triggering cumulative harms. The treating psychologist references the prior incidents as aggravating factors, or "triggers culminating in her ultimate absence from the workplace."

The Act, in Section 4(4) sets out that where an injury is an occupational disease due in part to a cause or causes other than the employment, causation of the injury arising out of and in the course of employment can only be found where employment is the dominant cause of the occupational disease.

This is the crux of the issue before the panel, with the worker's representative urging the panel to find that the event of May 1, 2016 was the dominant cause of the worker's psychological injury and the employer's representative urging the panel to find that the colleague's non-work-related death in June 2018 was the dominant cause of the worker's current state.

The panel is persuaded by the report of the treating psychologist that links the 2016 workplace events to the current diagnosis and by the comments of the WCB psychological consultant who noted that the diagnosis of PTSD would be appropriate if the evidence was that the worker had direct experience of the traumatic event or witnessed the traumatic event.

The panel therefore finds, on a balance of probabilities, that the worker did experience an acute reaction to the May 1, 2016 traumatic event in the workplace, which did not fully manifest until on or after June 17, 2018 when it was triggered by learning of the suicide death of her colleague.

The panel further finds, on a balance of probabilities, that the dominant cause of the psychological injury to the worker was her acute reaction to witnessing the May 1, 2016 traumatic event in her workplace, although the acute response was not evident until triggered by the June 2018 death of her colleague.

The claim is therefore acceptable.

Panel Members

K. Dyck, Presiding Officer
P. Challoner, Commissioner
D. Neal, Commissioner

Recording Secretary, J. Lee

K. Dyck - Presiding Officer
(on behalf of the panel)

Signed at Winnipeg this 21st day of August, 2019