Cancers in Firefighters and Fire Investigators

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    • who was an inspector appointed under subsection 2(4) of the Fire Marshals Act before that Act was repealed by the Fire Protection and Prevention Act, 1997, or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 cancers and corresponding 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.

Minimum duration of employment for prescribed cancers
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