Audit Reveals WSIB Denied 94% of Claims for Chronic Mental Stress this Year

An internal audit conducted by the WSIB and obtained by The Star revealed that between January and May, just 10 of the 159 claims for work-related chronic mental stress claims were approved.

While this may be welcome news to employers, worker advocates have cited the “stringent test” that workers must establish in order to obtain CMS benefits as a barrier for why claims have been denied. Under the Workplace Safety and Insurance Act and the CMS Policy, a worker must be able to demonstrate the following:

1. They have a medical condition from an “appropriate regulated health professional, such as a family physician, nurse practitioner, psychologist or psychiatrist”;
2. The worker has experienced a substantial work-related stressor, such as workplace bullying or harassment. This prong of the test requires a worker to establish that an event or accident occurred during the course of their employment and was a “substantial work-related stressor”; and
3. The substantial work-related stressor(s) was the predominant cause of the appropriately diagnosed mental stress injury.

The third prong of the test – the requirement to prove the workplace was the “predominant cause” of the illness – is higher than that for physical injuries for which workers must simply show their workplace was a “significant contributing factor”. This difference is likely contributing to some of the denials of benefits.

In addition, an employee will not be granted CMS benefits in a situation where the employer made reasonable employment-related decisions, such as a decision to change the work to be performed or imposes reasonable disciplinary action.

All of these factors play a role in whether a claim will be granted.

We will continue to monitor developments regarding chronic mental stress claims at the WSIB, including any notable decisions made by the WSIB.

To read the full Toronto Star article, click here.