The Appeal CommissionThe Workers Compensation Act of Manitoba

Preamble

The worker appealed the Workers Compensation Board ("WCB") decision that they are not entitled to benefits for a diagnosis of Post-Traumatic Stress Disorder (PTSD). A hearing took place on October 30, 2025 to consider the appeal.

Issue

Is the worker entitled to benefits for a diagnosis of PTSD?

Decision

The worker is entitled to benefits for a diagnosis of PTSD.

Background

On January 26, 2017, the worker provided a Worker Incident Report to the WCB reporting they sustained a psychological injury at work on September 12, 2016. The worker described various incidents at work that they perceived as traumatic or that reminded them of previous traumatic incidents they were exposed to at work over the period from 2008 through 2016. The worker set out that they were making a claim for cumulative psychological injury arising out of their workplace exposures to traumatic events and incidents. They reported they did not at first seek medical attention as they believed they could cope with the symptoms on their own.

When the WCB contacted the worker on February 8, 2017, the worker provided details of their job duties and confirmed they were exposed to traumatic incidents and sought counselling through their employer’s assistance program and advised their treating family physician of their concerns. The worker described difficulty sleeping, flashbacks, mood swings and depression symptoms that were sporadic. The worker described job duties that triggered their symptoms and caused worsening difficulties. The worker advised they were prescribed anxiety medication in approximately the fall 2016, and that they were off work from September 12, 2017 to October 3, 2017 and felt better while away from work. The worker confirmed they were currently working regular duties with ongoing symptoms that their superiors were aware of.

In a report dated February 28, 2017, the treating family physician noted they started treating the worker in 2014 but had reviewed their medical chart from 2009 and noted that in October 2009, the worker reported decreased mood and was considering reducing their hours at work. In March 2010, the chart noted the worker sought treatment for insomnia, which they related to shift work. The physician noted they referred the worker to a psychiatrist.

The treating psychiatrist reported to the WCB on February17, 2017 that the worker reported experiencing a traumatic event shortly after beginning their job in 2008, described as “…very upsetting and traumatic…”, and the worker advised they have anxiety and flashbacks of the event. The psychiatrist also advised the worker reported other “horrific incidents” while working in that role and that they sought counselling in 2014. The psychiatrist noted the worker reported that approximately eight months earlier, they began to experience mood swings, irritability, were easily angered and frustrated, hypervigilant and anxious, and experienced panic attacks and had nightmares approximately once per week with decreased energy. The psychiatrist also noted the worker continued working at their regular duties and their prognosis was moderately good. The psychiatrist recommended counselling and a change in medication and provided their diagnosis of PTSD and generalized anxiety disorder with depressive symptoms.

The worker contacted the WCB on March 16, 2017 to advise they experienced another triggering incident at work on March 14, 2017, resulting in flashbacks.

On March 23, 2017, the employer confirmed to the WCB that the worker’s direct supervisor recalled that in late summer of 2016, the worker spoke with them and advised they were struggling with mental health issues, were seeking counselling and may need to take some time off due to their symptoms. The supervisor confirmed the worker was off work for a period and when they returned, appeared happier and more themselves. The supervisor noted there may have been another later traumatic exposure, but the worker declined to talk about it. The supervisor also noted the worker recently advised that they would be making a WCB claim but did not relate it to a specific incident. The employer noted their belief that the worker’s difficulties began with an incident in their previous employment and noted it was likely the worker would be exposed to similar incidents in their current position.

On April 12, 2017, the WCB advised the worker that the claim was accepted, and they would receive wage loss benefits for when they were off work in September 2016, as well as medical aid benefits.

The WCB received a May 5, 2017 report from the treating counsellor recording the worker’s report of a traumatic event that occurred at work in September 2008 while they were in a different job. Afterward, the worker continued working until 2014 when they transferred to their current position. The counsellor noted the worker continued to struggle with the September 2008 event and experienced frequent flashbacks, and that the worker described a persistent, nagging anxiety in anticipation of being reminded of the September 2008 incident through their current job duties. The counsellor described the worker’s symptoms of heightened irritability, mood swings, short temper and tension headaches and noted the worker was receiving treatment from a psychiatrist and their family physician. The counsellor recommended cognitive behaviour therapy along with Eye Movement Desensitization and Reprocessing.

The WCB received a May 12, 2017 report from the treating psychiatrist noting the worker’s report of a triggering event at work on April 30, 2017 which resulted in an increase in symptoms. The psychiatrist described the worker’s report of more anxiety, decreased sleep and panic attacks, along with difficulty focusing and inability to function at work. The psychiatrist noted the worker wanted to work parttime to help manage their symptoms but there were no parttime positions available. As such, the psychiatrist recommended two weeks off work. On May 19, 2017, the treating psychiatrist recommended the worker return to work on a graduated schedule beginning on May 29, 2017, and then be reassessed. The worker returned to work on June 2, 2017.

A WCB psychological advisor reviewed the worker's file on June 8, 2017, including the medical reports provided by the treating family physician, counsellor and psychiatrist. The WCB psychological advisor provided an opinion that the worker's reported symptoms did not meet criteria for a diagnosis of PTSD nor for generalized anxiety disorder. Rather, the WCB advisor concluded the worker’s current diagnosis was some form of adjustment disorder with anxiety, with a possibility of generalized anxiety disorder, in response to work stress and coping strategies.

On June 21, 2017, the WCB wrote to the worker advising the claim was accepted for symptoms of anxiety, but they did not meet the criteria for a diagnosis of PTSD. As the medical information on file indicated they could return to regular duties, entitlement to wage loss benefits would end on June 28, 2017.

The worker’s representative submitted additional medical information and requested the WCB reconsider its decision that the worker was not entitled to benefits in relation to a diagnosis of PTSD. The representative provided a further (undated) report from the treating psychiatrist who confirmed their diagnosis of generalized anxiety with depressive symptoms and PTSD. The psychiatrist indicated their diagnosis was based on the worker’s report of witnessing a traumatic incident in 2008 and that since that time, the worker experienced anxiety symptoms, nightmares and flashbacks. They noted the worker reported nightmares 1 to 2 nights per week and stated that “PTSD and anxiety are intertwined. It is usually common having anxiety after experiencing or witnessing traumatic events.” The representative submitted that as the treating psychiatrist provided a diagnosis of PTSD, the worker should be entitled to benefits related to that diagnosis.

A WCB psychological advisor reviewed the new medical information on August 24, 2017 and concluded it was insufficient for them to change their earlier opinion. They recommended a call-in examination of the worker with a WCB psychiatry advisor to assess and provide a second opinion. A WCB psychiatric advisor reviewed the file information on September 5, 2017 and agreed with the opinion of the WCB psychological advisor that the likely diagnosis was adjustment disorder with anxiety symptoms.

On September 11, 2017, the WCB advised the worker there was no change to the decision they were not entitled to benefits in relation to a diagnosis of PTSD.

On July 28, 2025, the worker requested Review Office reconsider the WCB’s decision, noting their disagreement with the adjudication of their claim. Review Office determined on August 22, 2025 that the worker was not entitled to benefits for a diagnosis of PTSD.

The worker appealed to the Appeal Commission on August 27, 2025 and a hearing took place.

Reasons

Applicable Legislation

The Appeal Commission and its panels are bound by the provisions of The Workers Compensation Act, regulations under the Act and the policies established by the WCB's Board of Directors. The applicable provisions of the Act and policies are those in effect as of the dates of accident.

Section 4(1) of the Act provides for compensation to be paid by the WCB where a worker has sustained personal injury by accident arising out of and in the course of employment. Accident is defined in s 1(1) of the Act as a chance event occasioned by a physical or natural cause, which includes 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, and an occupational disease, as a result of which a worker is injured.

Section 4(2) outlines that wage loss benefits are payable to an injured worker for the loss of earning capacity resulting from the accident. Section 4(4) sets out that where an injury consists of an occupational disease that is due in part to the employment and in part to a cause or causes other than the employment, the WCB may determine that the injury is the result of an accident arising out of and in the course of employment only where the employment is the dominant cause of the occupational disease. In respect of the diagnosis of PTSD in particular, s 4(5.8) of the Act provides that:

Presumption re post-traumatic stress disorder 

4(5.8) If a worker 

(a) is exposed to a traumatic event or events of a type specified in the Diagnostic and Statistical Manual of Mental Disorders as a trigger for post-traumatic stress disorder; and 

(b) is diagnosed with post-traumatic stress disorder by a physician or psychologist; 

the post-traumatic stress disorder must be presumed to be an occupational disease the dominant cause of which is the employment, unless the contrary is proven.

The WCB has established Policy 44.05.30, Adjudication of Psychological Injuries, (the “Policy”) to outline how the WCB will decide claims for psychological injury. The Policy confirms that such claims are determined in the same way as claims for physical injuries. The WCB will first determine whether there has been an accident arising out of and in the course of employment and if so, whether the worker has suffered an injury, and if the accident caused the injury.

Worker's Position

The worker appeared in the hearing on their own behalf, providing an oral submission and testimony through answers to questions from the appeal panel.

The worker's position is that the evidence, including the medical reporting provided to the WCB and the recent psychiatric and medical reports submitted in preparation for this appeal support a finding that the worker developed PTSD as a result of their workplace exposures to traumatic incidents. The worker therefore submits they are entitled to benefits in relation to that diagnosis, including further treatment, medication, and counselling.

The worker submitted that the statutory PTSD presumption should apply as they had a PTSD diagnosis when they submitted their claim and there is no evidence that this condition is not the result of their occupational exposures. The worker submitted that their claim is based on the cumulative effects of their exposure to traumatic incidents in the course of work over many years as supported by the reports from their treatment providers.

Employer's Position

The employer did not participate in the appeal.

Analysis

The issue in this appeal is whether the worker is entitled to benefits in relation to the diagnosis of PTSD. For the worker's appeal to succeed, the panel would have to determine that the accepted workplace accident, which is based on a cumulative series of incidents arising out of and in the course of the worker's employment, caused the worker to sustain injuries that include PTSD. In other words, the panel would have to find that the worker developed PTSD, and that this diagnosis can be causally related to the compensable accident. As detailed in the reasons that follow, the panel was able to make such a finding and therefore the worker's appeal is granted.

The file evidence indicates that the treating psychiatrist provided a diagnosis of PTSD in February 2017 and confirmed this in later correspondence with the worker's union representative, provided to the WCB in August 2017. The panel noted that while the WCB accepted that the worker sustained a psychological injury as a result of an accident arising out of and in the course of their employment, it did not accept the diagnosis of PTSD. The WCB psychological advisor and psychiatric advisor each provided opinions based on the limited medical reporting provided by the treatment providers that the diagnosis of PTSD was not appropriate. These opinions were not based on any examination of the worker nor on any discussion or conversation with the treatment providers. In fact, while the WCB psychological advisor recommended the worker undergo a psychological call-in examination, the WCB failed to follow up on that recommendation. Further, despite noting disagreement with the treating psychiatrist, neither the WCB psychological advisor nor the psychiatric advisor made any effort to inquire further of the psychiatrist as to the basis for their diagnosis. In the result, based on limited evidence, the WCB determined the worker did not have PTSD, contrary to the opinions of the treatment providers. In these circumstances, the panel prefers the opinion of the treatment providers and gives less weight to the WCB advisor opinions.

The panel considered also that the recent psychiatric assessment obtained by the worker in preparation for their appeal, dated October 14, 2025, confirms the worker currently meets the criteria for diagnosis of PTSD arising out of their past workplace exposures to traumatic incidents. These are the same incidents reported in 2017. The psychiatrist confirmed the worker's report of symptoms beginning in 2008 and treated since then, noting that the psychological measurement tools administered "…all indicate that [the worker] is struggling significantly with past trauma and mood" and the psychiatrist concludes that the worker is experiencing PTSD related to the initial event in 2008 as reported by the worker and subsequent, repeated exposure to other traumas in the course of their work.

As such, the panel is satisfied that the evidence supports the diagnosis of PTSD.

The panel finds that the statutory presumption in s 4(5.8) of the Act applies to the worker's claim. The treating psychiatrist in 2017 related the worker's diagnosis and development of symptoms to the worker's occupational exposures to trauma, and this causal relationship is further supported by the 2025 psychiatric assessment. As such, given our acceptance of the diagnosis of PTSD, we must presume the dominant cause of the worker's PTSD is their occupational exposure to trauma, unless there is evidence to the contrary. The panel noted the absence of any evidence from the previous or current employers to the contrary. Further, the treating psychiatrist confirmed there were no relevant pre-existing factors in relation to the diagnosis provided. As such, the panel is satisfied there is no evidence to the contrary.

Based on the totality of evidence before the panel, and applying the standard of a balance of probabilities, we are satisfied that the worker's PTSD is the result of their occupational exposure to traumatic incidents as part of the accident giving rise to this accepted claim. Therefore, the worker is entitled to benefits for a diagnosis of PTSD. The claim is granted.

Panel Members

K. Dyck, Presiding Officer
J. Peterson, Commissioner
M. Kernaghan, Commissioner

Recording Secretary, J. Lee

R. Lemieux Howard - Presiding Officer
(on behalf of the panel)

Signed at Winnipeg this 6th day of November, 2025