Hydro One Networks Inc. 483 Bay Street, Toronto, Ontario M5G 2P5. July 7, Attention: Consultation Secretariat

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1 Hydro One Networks Inc. 483 Bay Street, Toronto, Ontario M5G 2P5 July 7, 2017 Attention: Consultation Secretariat Workplace Safety & Insurance Board Consultation Secretariat 200 Front Street West, 17 th floor Toronto, Ontario M5V 3J1 Attention: Re: Traumatic or Chronic Mental Stress Operational Policy Please receive Hydro One s submission regarding the WSIB s revised Operational Policy Traumatic or Chronic Mental Stress (Accident on or After January 1, 2018). We appreciate the opportunity to participate in this consultation and we look forward to reviewing the final report to stakeholders. Hydro One has a dedicated team of professionals specifically accountable for providing guidance, advice and support for all matters related to Disability Management. Initially dedicated to WSIB Management and Early & Safe Return to Work, the work has further evolved to provide support and guidance for managing Sick Leave absences and Long Term Disability. The feedback included below addresses items within the proposed policy which Hydro One believes could have the most significant impact to stakeholders, entitlement decisions, claims costs, and the insurance system as a whole: Change in Diagnostic Requirements, Proposed WSIB Service Delivery Model Language changes and definitions Diagnostic Requirements The suggestion that the WSIB is proposing that a Family Physician s DSM diagnosis will be considered sufficient is concerning to stakeholders. Proposed Policy: The WSIB will accept the claim for adjudication if an appropriate regulated health care professional provides the DSM Diagnosis. Background Information: an appropriate regulated health professional, such as a family physician WSIB Traumatic or Chronic Mental Stress Consultation Submission July 7,

2 The identification of a DSM diagnosis in itself is not indicative of a thorough clinical assessment by the treating practitioner. Nor is the identification by a Family Physician of a DSM diagnosis an indication that the diagnosis is the most accurate diagnosis. The Diagnostic and Statistical Manual was developed by the American Psychiatric Association (APA) and is truly intended for use by psychiatrists and other trained clinicians and mental health care providers. The APA itself recommends that a mental health care provider is best equipped to provide an accurate diagnosis and treatment. An accurate diagnosis supported by objective findings and assessment is important noting the implications following a determination of initial entitlement. Furthermore, the acceptance of an incorrect diagnosis could significantly impact a worker s recovery and well-being; in the event inappropriate treatment measures are implemented. The proposed policy and background information indicates that if recovery and return-to-work measures are unsuccessful, then at that time consideration a further assessment may be arranged. Diagnosis by a family physician/general practitioner is insufficient for establishing entitlement for compensable Traumatic or Chronic Mental Stress. If the claimant is not yet under the care of a psychiatrist or psychologist when the claim is established, a decision on entitlement should be reserved until a referral to a suitable mental health care provider is arranged. Hydro One believes that a claim can be accepted for adjudication if a regulated HCP provides the diagnosis. However, it is our belief that a determination on entitlement should not be rendered until a referral and assessment by a trained clinician (i.e. psychiatrist or psychologist) has taken place to confirm the DSM diagnosis, which indicates the primary diagnosis meets the appropriate defined diagnostic requirements. The appropriate DSM assessment in combination with the other policy guidelines, standard of proof and causation would be most appropriate in addressing compensable vs. non-compensable illnesses. Additionally, with many instances of Mental Health illness, there are multiple issues/conditions atplay. Although stress arising out of and in the course of employment can be a contributing factor, consideration should be given to whether the primary diagnosis is related to the workplace event(s), or whether it is a lower-level diagnosis/factor under DSM guidelines. Proposed Service Delivery Model Currently, the WSIB manages Traumatic Mental Stress claims under the Occupational Disease & Survivor Benefits (OSDB) branch of the WSIB. The Background Information document proposes that the WSIB will establish a new dedicated claims intake process to expedite decision-making. Hydro One suggests that a dedicated team is required to address the unique nature of Traumatic and Chronic stress and suggests the WSIB establish a specific Mental Health team/department to address all Traumatic and Chronic Stress claims. The complex nature of mental health conditions warrant a specialized team with familiarity in managing mental health conditions, treatment programs, and handling of the unique circumstances y and return-to-work outcomes. The Background Information in the proposed policy appears to indicate the intent of establishing a new dedicated team would be to expedite decision making. However caution should be undertaken, as noted in our concerns raised above under the heading of Diagnostic Requirements. While timely decisions are understandable, it is imperative to ensure the decisions are accurate based on sufficient objective medical evidence and have had adequate information gathering prior entitlement determinations. WSIB Traumatic or Chronic Mental Stress Consultation Submission July 7,

3 Additionally, consideration should be given to establishing Traumatic and Chronic Mental Stress investigators. Issues such as Harassment, Bullying, and Interpersonal Conflict should be met with the appropriate degree of sensitivity. There should be recognition that in some instances accusations and allegations may be unfounded, and the WSIB as a neutral third party could appropriately gather information from all involved parties through thorough investigations. In instances where collective agreement grievances are already underway or Human Rights complaints are established prior to a WSIB claim, the WSIB may defer to other third party investigators, where appropriate. Large companies may already have processes and procedures in place to investigate internally and/or with the assistance of independent third parties. The WSIB must recognize that Bill 168 (2009) and the circumstances of specific bullying, violence, or harassment may be multijurisdictional. Employers and workers have specific roles and responsibilities under the Occupational Health & Safety Act (OHSA), which may result in Ministry of Labour involvement. Additionally, acts of violence as defined by the OHSA may involve matters that fall under Canada s Criminal Code and the requirement to involve police/law enforcement. Matters of harassment may require action under the Ontario s Human Rights Code. Lastly, there may be internal involvement by an Employer s security department, and possible involvement with union Grievances and Arbitrations in unionized environments. Consider the following: How does the WSIB intend to address jurisdictional findings of fact? Will the WSIB defer determination of an entitlement decision until conclusion of the investigations being conducted by other parties/jurisdictions? The legal principle of estoppel will need to be considered in instances where the same issue is being brought forth to multiple jurisdictions (OHSA/MOL, Ontario Human Rights, Criminal Code, or Union Grievances). The expectation for stakeholders would be that the WSIB would be bound by the findings of fact if previously established by other jurisdictions and/or entities. Language Changes and Specific Definitions We have identified a number of language and specific references below and where applicable, offered suggested changes or improvements. Acute Reaction: The most notable change between the current Traumatic Mental Stress, and the proposed Traumatic or Chronic Mental Stress policies is the differentiation and definitions of Acute Reaction and Cumulative Effect. By removing the statement that the event(s) must result in a psychiatric/psychological response, this further broadens the opportunity for entitlement when a diagnosis is offered by an appropriate regulated health care professional such as a family physician. The change implies that there is no longer a need for demonstrable symptoms and presentation by the injured/ill worker which aligns with the DSM diagnosis to support an objective significant or severe reaction. In the absence of clear information supporting the psychiatric/psychological response (i.e. chart notes, emergency room records, etc.), the policy implies that all that is required is the diagnosis by itself. Hydro One believes the previous language from relating to delayed responses (page 2, paragraph 3 under Acute Reaction ) for traumatic mental stress should remain in the new proposed policy. The language offers clear information to decision makers and stakeholders on what is required to establish compatibility and proof of accident when there has been a distinct delay in onset. WSIB Traumatic or Chronic Mental Stress Consultation Submission July 7,

4 Substantial Work-Related Stressor The definition of what is considered substantial in the proposed policy is insufficient. Excessive in intensity and/or duration offers no further clarification than the term substantial. Hydro One suggests that the WSIB clearly establish defined thresholds for what would be considered excessive intensity and duration and/or provide specific examples similar to the list provided for traumatic events for Traumatic Mental Stress. A list may not be entirely inclusive but will provide more clearly defined circumstances for all parties involved. Routine stress Hydro One believes that routine stress is considered a normal and expected part of many occupations. It is our belief that the proposed Operational Policy goes beyond the intentions of the clearly outlined legislative amendments. High-Level routine stress directly related to the intended nature of the occupation or job category falls within the category of employer s decisions or actions relating to employment. The direction of the policy is contradictory in nature, as it clearly outlines that decisions and/or actions that are related to the job function (such as; assigned workload, changes in working hours, changes in productivity expectations, deadlines and accuracy) would not qualify for entitlement for traumatic or chronic mental stress. The WSIB acknowledges there are a number of occupations or job categories that are expected to have a high-degree of routine stress levels, but then implies that entitlement would be granted in those instances. Hydro One proposes that the only instances where chronic stress related to employer s decisions or actions should be considered for entitlement are instances where the resulting stress is due to unreasonable and/or unfair expectations of productivity, efficiency, and/or accuracy. When there is a combination of chronic stress related to both employer s decisions/actions and substantial work-related stressors : How does the WSIB propose to weigh the significance of the two contributing factors, and determine what is considered a significant contributing cause? Does the work-related stressor have to be considered excessive in intensity and/or duration on its own? Is there a reduction in the threshold when there is a work-related stressor in combination with decisions/actions that are deemed stressful? If the work-related stressor must be excessive in and of itself, then this section in the proposed policy should be rephrased to address any confusion or misinterpretation that may arise. Workplace Harassment Hydro One proposes changing in a workplace to the more appropriate in the course of employment under the paragraph on page 4 of 6. Workplace harassment occurs when a person or persons engage in a course of vexatious comment or conduct against a worker, in the course of employment, that is known or ought.. Interpersonal Conflicts: Broaden the language in the paragraph under Interpersonal Conflicts to clarify that the comment, conduct, or behaviours needs only to be perceived as vexatious/inappropriate by the worker. What one worker feels is inappropriate may differ from another s perspective. WSIB Traumatic or Chronic Mental Stress Consultation Submission July 7,

5 Pre-existing, non-work-related psychological condition Hydro One suggests that references to the following two Operational Policies be included within the proposed policy, in addition to the reference to Pre-existing Conditions: Aggravation Basis Second Injury Enhancement Fund The two above-noted policies are already noted in , and should remain tied noting the benefit, cost, and entitlement implications related to all the policies. Conclusion We appreciate the opportunity to participate and provide feedback on this WSIB consultation on the proposed Traumatic or Chronic Mental Stress operational policy. We look forward to receiving further feedback on the submissions of all stakeholders and reviewing the final Operational Policy prior to implementation. Yours Sincerely, Jim Harding Manager, Health Services and Rehabilitation Health, Safety and Environment Hydro One Networks Inc. hardingj@hydroone.com WSIB Traumatic or Chronic Mental Stress Consultation Submission July 7,