Resulting from Work-Related Disability/Impairment

Policy

Workers sustaining secondary conditions that are causally linked to the work-related injury will derive benefits to compensate for the further aggravation of the work-related impairment or for new injuries.

If a worker commits suicide following a work-related injury, the WSIB must pay benefits to the worker's dependants if it is established that the suicide resulted from the work-related injury.

Purpose

The purpose of this policy is to outline when the WSIB may provide benefits to a worker who sustains a secondary physical or psychological condition due to the work-related injury/disease or treatment.

Guidelines

If a worker suffers a second accident, benefits are payable only if it is established that the work-related impairment caused the second accident.

Artificial Appliances

Damage

Artificial appliances, while being worn, are considered an extension of the body. Entitlement for damage to an artificial appliance resulting from an accident is determined using the same criteria as for other personal injury claims, see 15-02-01, Definition of Accident.

Injury resulting from malfunction

If a work-related accident or disease results in a permanent impairment requiring the worker to use an artificial appliance, any subsequent injury resulting from the malfunction of the artificial appliance being worn is deemed to be within the worker's entitlement. This interpretation includes injuries resulting from wheelchair malfunction.

No entitlement exists if an injury occurs outside the workplace, unless it results from the malfunction of an artificial appliance being worn for a work-related impairment/disability.

Examples

  • A worker wearing an artificial leg and who slips while walking, would not have entitlement for any injury sustained.
  • If a worker falls out of a wheelchair and sustains injury, there is no entitlement unless it is established that the work-related injury caused the fall.
  • If a worker continues to use crutches after active treatment is completed, e.g., because of an amputated leg, and the crutch breaks, entitlement exists for any injury sustained. However, if the crutch slipped and the worker fell, there is no entitlement.
  • Entitlement is extended for injuries resulting from accidents caused by crutches slipping, provided they were used during a period where active treatment was in progress.
  • There is no entitlement for any injury suffered by a worker as a result of malfunction of an elevating device or any other apparatus that is not actually worn by the worker. The exception is the use of a wheelchair.

Injury resulting from work-related injury

Entitlement for any secondary condition is accepted when it is established that a causal link exists between it and the work-related injury. The development of a left knee disability/impairment due to an increased dependency following a work-related injury to the right knee, is an example.

Suicide following work-related injury

Evidence

The decision-maker examines all surrounding circumstances to determine whether the suicide resulted from the work-related injury. If the evidence indicates that, as a result of the injury, the worker developed psychosocial problems that led the worker to commit suicide, the suicide may be said to have resulted from the work-related injury. Non-work-related factors are also assessed to determine whether their effect on the worker was so great that the suicide was really the result of factors unconnected to the injury.

Psychiatric reports

To determine if a suicide resulted from a work-related injury, the most useful information is usually in psychiatric reports concerning the worker's mental and emotional condition both before the occurrence of the work-related injury and during the period between the occurrence of the injury and the suicide.

Psychiatric reports unavailable

Often psychiatric reports are not available. In these cases, the decision-maker determines whether a suicide resulted from a work-related injury by relying on evidence from other sources, such as

  • the clinical history of the worker both before and following the injury
  • the work transition history of the worker (including the worker's attitude towards rehabilitation)
  • psychosocial reports about the worker's psychological state and personal life
  • the worker's employment history, and
  • reports from the worker's family members, friends and co-workers.

Application date

This policy applies to all decisions made on or after February 15, 2013, for all accidents.

Document History

This document replaces 15-05-01 dated October 12, 2004.

This document was previously published as:

03-04-02 dated May 1, 1991

References

Legislative Authority

Workplace Safety and Insurance Act, 1997, as amended
Sections 2(1), 13, 39

Workers' Compensation Act, R.S.O. 1990, as amended
Sections 1(1), 4(1), 50(3)(a)

Minute

Administrative
#9, January 28, 2013, Page 504