MENTAL HEALTH CLAIMS

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 WSIB Ontario policies as of 2025. WSIB does not have one simple master list of “approved mental illnesses,” but instead adjudicates mental health claims based on specific policies, conditions, and circumstances.

Under WSIB policy, mental illness claims typically fall under two main coverage categories:

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Traumatic Mental Stress (TMS) — Policy 15-03-02

WSIB may cover mental illnesses caused by a sudden and unexpected traumatic event at work.

Covered conditions may include (examples):

• Post-Traumatic Stress Disorder (PTSD)

• Acute Stress Disorder

• Adjustment Disorders (related to the trauma)

• Major Depressive Disorder (if related to the traumatic event)

• Anxiety Disorders (directly resulting from the trauma)

• Panic Disorders (linked to the traumatic incident)

• Sleep Disorders secondary to traumatic mental stress

Key requirement:

The event must be clearly traumatic, sudden, and directly work-related (e.g. serious accident, workplace violence, witnessing death or severe injury, robbery, assault, etc.)

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Chronic Mental Stress (CMS) — Policy 15-03-14

WSIB may cover mental illnesses caused by ongoing, significant workplace stressors — provided they are:

• Substantial

• Work-related

• Not typical work pressures

• Not caused by interpersonal conflicts unless severe (e.g. bullying, harassment)

Covered conditions may include (examples):

• Generalized Anxiety Disorder (work-related)

• Major Depressive Disorder (linked to chronic stressors)

• Panic Disorder (related to chronic harassment or workload)

• Adjustment Disorder (prolonged work stress)

• Work-related burnout (if medically diagnosed and meets criteria)

• Somatic Symptom Disorders (if related to the chronic workplace stressor)

• PTSD (from prolonged severe harassment or psychological abuse)

Key requirement:

The workplace stressor must be severe, ongoing, and predominantly work-related — personal issues or normal job stress are generally excluded.

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* Post-Traumatic Stress Disorder (PTSD) for First Responders — Policy 15-03-13

Ontario law provides presumptive entitlement for certain workers:

• Firefighters

• Paramedics

• Police officers

• Correctional officers

• Nurses (in some roles)

• Emergency dispatchers

In these cases, if diagnosed with PTSD, WSIB generally presumes the condition is work-related unless proven otherwise.

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Secondary Mental Illness Claims

Even when mental illness is not the primary claim, WSIB may also cover mental illness as a secondary condition linked to physical injuries:

Examples include:

• Depression following chronic pain or permanent impairment

• Anxiety from long-term disability or fear of re-injury

• Adjustment disorders from loss of career or functional ability

• Insomnia caused by pain, medication, or mental stress

• Somatic symptom disorders resulting from work injury experience

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Conditions Generally NOT Covered:

WSIB usually denies claims for:

• Normal job stress (deadlines, performance pressures)

• Conflicts with management (unless severe harassment exists)

• Disciplinary actions

• Termination of employment (except in cases of harassment/violence)

• Personal relationship issues at work

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How WorkAid.ca Can Help

Mental illness claims are often complicated, heavily evidence-driven, and misunderstood by WSIB case managers. At WorkAid.ca, we:

• Help collect proper psychiatric & psychological evaluations

• Prepare functional ability assessments

• Present medical-legal opinions

• Build the link between the diagnosis and the work-related stressor or injury

• Guide you through WSIB appeals and WSIAT hearings
 
 

If you have been injured and need legal assistance, don't hesitate to contact us. We are available 24/7 to help you with your case.