Policy
If a firefighter or a fire investigator is diagnosed with a prescribed cancer on or after January 1, 1960, and meets the employment duration and additional criteria for the prescribed cancer, then the disease is presumed to be an occupational disease due to the nature of the worker’s employment, unless the contrary is shown.
Purpose
The purpose of this policy is to outline the prescribed cancers and the circumstances under which they will be presumed to be work-related occupational diseases, as set out in the applicable Regulation, as well as to specify the circumstances in which the contrary will be shown and the presumption of work-relatedness rebutted.
Guidelines
Inclusion
The presumption applies to:
- workers who are full-time or volunteer firefighters as defined in Section 1 of the Fire Protection and Prevention Act, 1997
- part-time firefighters, defined as a worker who is a firefighter and is not a volunteer or full-time firefighter
- workers who:
- are employed by a band council and assigned to undertake fire protection services on a reserve [band council and reserve are defined in the Indian Act (Canada)], or
- provide fire protection services on a reserve, either voluntarily or for a nominal consideration, honorarium, training or activity allowance
- fire investigators, defined as a worker:
- to whom the Fire Marshal, appointed under subsection 8(1) of the Fire Protection and Prevention Act, 1997, has delegated the duty to investigate the cause, origin and circumstances of a fire
- who was an inspector appointed under subsection 2(4) of the Fire Marshals Act before that Act was repealed by the Fire Protection and Prevention Act, 1997, or
- who is employed by a band council and assigned to investigate the cause, origin and circumstances of a fire on a reserve.
For the purpose of this policy, the term "firefighter" refers to a full-time firefighter, a part-time firefighter or a volunteer firefighter.
Exclusion
The presumption does not apply to forest or wildland firefighters.
Presumption criteria
The presumption provides that the prescribed cancers are occupational diseases presumed to occur due to the nature of the worker’s employment as a firefighter or fire investigator, unless the contrary is shown.
To qualify for this presumption, a worker must meet the inclusion criteria of this policy and have been:
- diagnosed with a prescribed cancer
- diagnosed after the prescribed minimum employment duration, and
- diagnosed with that cancer on or after January 1, 1960.
A worker diagnosed with primary-site colorectal cancer or primary-site lung cancer must also meet the additional criteria specified in this policy to qualify for the presumption.
Case-by-case
A worker who does not meet these criteria does not qualify for the presumption and instead will have their claim determined on its individual merits.
Prescribed cancers
A medical diagnosis of non-Hodgkin’s lymphoma, multiple myeloma, one of the three specified leukemias, or cancer originating from the specified organ is required for adjudication of claims under the presumption. The prescribed cancers are listed below with their World Health Organization International Classification of Diseases (ICD) codes.
| Prescribed cancer* | ICD-9 code** | Description of ICD-9 code | ICD-10 code** | Description of ICD-10 code |
|---|---|---|---|---|
| Primary-site brain cancer | 191 | Malignant neoplasm of brain | C71 |
Malignant neoplasm of brain |
| Primary-site bladder cancer | 188 | Malignant neoplasm of bladder | C67 | Malignant neoplasm of bladder |
| Primary-site kidney cancer | 189.0 | Malignant neoplasm of kidney, except pelvis | C64 | Malignant neoplasm of kidney, except renal pelvis |
| Primary-site kidney cancer | 189.1 | Malignant neoplasm of renal pelvis | C65 | Malignant neoplasm of renal pelvis |
| Primary-site colorectal cancer | 153 | Malignant neoplasm of colon | C18 | Malignant neoplasm of colon |
| Primary-site colorectal cancer | 153 | Malignant neoplasm of colon | C19 | Malignant neoplasm of rectosigmoid junction |
| Primary-site colorectal cancer | 154 | Malignant neoplasm of rectum, rectosigmoid junction, and anus | C20 | Malignant neoplasm of rectum |
| Primary-site colorectal cancer | 154 | Malignant neoplasm of rectum, rectosigmoid junction, and anus | C21 | Malignant neoplasm of anus and anal canal |
| Primary non-Hodgkin’s lymphoma (NHL) | 200 | Lymphosarcoma and reticulosarcoma | C82 | Follicular lymphoma |
| Primary non-Hodgkin’s lymphoma (NHL) | 200 | Lymphosarcoma and reticulosarcoma | C83 | Non-follicular lymphoma |
| Primary non-Hodgkin’s lymphoma (NHL) | 202 | Other malignant neoplasms of lymphoid and histiocytic tissue | C84 | Mature T/NK-cell lymphomas |
| Primary non-Hodgkin’s lymphoma (NHL) | 202 | Other malignant neoplasms of lymphoid and histiocytic tissue | C85 | Other and unspecified types of NHL |
| Primary acute myeloid leukemia | 205.0 | Acute myeloid leukemia | C92.0 | Acute myeloblastic leukemia |
| Primary acute lymphocytic leukemia | 204.0 | Acute lymphoid leukemia | C91.0 | Acute lymphoblastic leukemia |
| Primary chronic lymphocytic leukemia | 204.1 | Chronic lymphoid leukemia | C91.1 | Chronic lymphocytic leukemia of B-cell type |
| Primary-site ureter cancer | 189.2 | Malignant neoplasm of ureter | C66 | Malignant neoplasm of ureter |
| Primary-site esophageal cancer | 150 | Malignant neoplasm of esophagus | C15 | Malignant neoplasm of esophagus |
| Primary-site breast cancer | 174 | Malignant neoplasm of female breast | C50 | Malignant neoplasm of breast |
| Primary-site breast cancer | 175 | Malignant neoplasm of male breast | C50 | Malignant neoplasm of breast |
| Multiple myeloma | 203.0 | Multiple myeloma | C90.0 | Multiple myeloma |
| Primary-site testicular cancer | 186 | Malignant neoplasm of testis | C62 | Malignant neoplasm of testis |
| Primary-site prostate cancer | 185 | Malignant neoplasm of prostate | C61 | Malignant neoplasm of prostate |
| Primary-site lung cancer | 162 | Malignant neoplasm of trachea, bronchus, and lung | C33 | Malignant neoplasm of trachea |
| Primary-site lung cancer | 162 | Malignant neoplasm of trachea, bronchus, and lung | C34 | Malignant neoplasm of bronchus and lung |
| Primary-site skin cancer | 172 | Malignant melanoma of skin | C43 | Malignant melanoma of skin |
| Primary-site skin cancer | 173 | Other malignant neoplasm of skin | C44 | Other malignant neoplasms of skin |
| Primary-site ovarian cancer | 183.0 | Malignant neoplasm of ovary | C56 | Malignant neoplasm of ovary |
| Primary-site cervical cancer | 180 | Malignant neoplasm of cervix uteri | C53 | Malignant neoplasm of cervix uteri |
| Primary-site penile cancer | 187.1-187.4 | Malignant neoplasm of penis (specifically 187.1, prepuce; 187.2, glans penis; 187.3, body of penis; 187.4, penis, part unspecified) | C60 | Malignant neoplasm of penis |
| Primary-site pancreatic cancer | 157 | Malignant neoplasm of pancreas | C25 | Malignant neoplasm of pancreas |
| Primary-site thyroid cancer | 193 | Malignant neoplasm of thyroid gland | C73 | Malignant neoplasm of thyroid gland |
*The presumption applies to malignant neoplasms and therefore does not apply to in situ neoplasms (e.g., carcinoma in situ)
**ICD-9, International Classification of Diseases, 9th Revision; ICD-10, International Classification of Diseases, 10th Revision
Prescribed duration of employment
Firefighters and fire investigators with the minimum years of eligible Ontario service for the prescribed cancer are presumed to have a work-related occupational disease. The eligible years of service is the sum of all employment periods as a firefighter or fire investigator from the date of hire until the date of diagnosis, whether consecutive or non-consecutive. If a worker served in more than one capacity as a full-time, part-time or volunteer firefighter or fire investigator in the same period, this period will only be counted once towards the eligible years of service.
For band council firefighters and fire investigators, the eligible years of service are those employment periods as described above during which the band council had WSIB coverage, in addition to any periods served in another capacity as defined by the Fire Protection and Prevention Act, 1997.
The minimum durations of employment for the prescribed cancers are listed below.
| Prescribed cancer | Duration of firefighting employment |
|---|---|
| Primary-site brain cancer | 10 years |
| Primary-site bladder cancer | 15 years |
| Primary-site kidney cancer | 20 years |
| Primary-site colorectal cancer | 10 years |
| Primary non-Hodgkin’s lymphoma | 20 years |
| Primary acute myeloid leukemia | 15 years |
| Primary chronic lymphocytic leukemia | 15 years |
| Primary acute lymphocytic leukemia | 15 years |
| Primary-site ureter cancer | 15 years |
| Primary-site esophageal cancer | 25 years |
| Primary-site breast cancer | 10 years |
| Multiple Myeloma | 15 years |
| Primary-site testicular cancer | 10 years |
| Primary-site prostate cancer | 15 years |
| Primary-site lung cancer | 15 years |
| Primary-site skin cancer | 15 years |
| Primary-site ovarian cancer | 10 years |
| Primary-site cervical cancer | 10 years |
| Primary-site penile cancer | 15 years |
| Primary-site pancreatic cancer | 10 years |
| Primary-site thyroid cancer | 10 years |
Additional criteria
In addition to the above criteria, for:
- primary-site colorectal cancer, a diagnosis must be obtained prior to the age of 61 years, and
- primary-site lung cancer, the worker must not have smoked a tobacco product in the 10 years prior to diagnosis.
Date of accident/injury
For the purpose of this policy, the date of diagnosis is used to determine whether the worker meets the requirements of the presumption (e.g., calculation of duration of employment). Once entitlement is established in a claim, benefits and services generally flow from the date of accident/injury, which may be an earlier date. For more information, see 11-01-04, Determining the Date of Injury.
Rebutting the presumption
If a worker qualifies for the presumption, the worker’s cancer is presumed to be an occupational disease that occurs due to the nature of the worker’s employment as a firefighter or fire investigator, unless the contrary is shown. If the contrary is shown, the presumption of work-relatedness is rebutted.
The presumption is only rebutted if the evidence establishes on a balance of probabilities that:
- the worker either had negligible exposure or was never exposed to the hazards of a fire scene or to another known occupational risk factor for their cancer during their employment as a firefighter or fire investigator, or
- the worker’s non-occupational risk factors were of such importance that they overwhelmed any occupational exposure the worker had as a firefighter or fire investigator, rendering it insignificant in the development of the worker’s cancer.
Examining whether the presumption is rebutted
It is not necessary to examine whether the presumption is rebutted in every case. Generally, if a worker qualifies for the presumption, an examination into rebuttal is only necessary if the existing evidence in the claim raises a question about whether the worker’s cancer is due to the nature of their employment as a firefighter or fire investigator. For instance, there may be a question about work-relatedness when the nature of the worker’s job does not involve regular exposure to the hazards of a fire scene.
Case-by-case
If the presumption is rebutted, the worker’s cancer may still be work-related if the worker’s job history includes other types of employment. In these cases, the worker’s job history, outside of their employment as a firefighter or fire investigator, should be examined to determine if there is a work-related cause.
Time Limits
Workers or their survivors may refile previously denied claims, or present new claims, with no time restrictions other than a requirement that the date of diagnosis is on or after January 1, 1960.
NOTE
The six-month time limit for filing a claim applies to claims in cases where the worker does not qualify for the presumption or where the presumption has been rebutted, see 15-01-03, Workers' Requirement to Claim and Consent.
Application date
This policy applies to decisions made on or after July 20, 2023.
NOTE
During the period beginning on June 29, 2023 and ending on July 19, 2023, decisions related to claims for primary-site pancreatic cancer and primary-site thyroid cancer were made in accordance with Ontario Regulation 253/07, as amended by Ontario Regulation 177/23.
Document History
This document replaces 23-02-01 dated June 1, 2023.
This document was previously published as:
23-02-01 dated July 4, 2018
23-02-01 dated January 1, 2017
23-02-01 dated January 4, 2016
23-02-01 dated April 27, 2015
23-02-01 dated January 2, 2015
23-02-01 dated July 7, 2014
23-02-01 dated February 23, 2010
23-02-01 dated February 11, 2008
23-02-01 dated October 12, 2004
16-02-02 dated June 15, 1999.
References
Legislative Authority
Workplace Safety and Insurance Act, 1997, as amended
Sections 2(1), 15, 15.1(4)-(7), 15.2, 94
Ontario Regulation 253/07, as amended
Minute
Administrative
#1, July 17, 2023, page 619