Injury-specific initial entitlement decision

A dental injury can occur on its own, as a result of another physical work-related injury or as damage directly caused by the treatment of a work-related injury.

Review available documents to confirm the dental injury. This can include:

• A report of the dental damage
• A detailed dental history
• A report outlining the proposed treatment
• X-rays or photos

If there are work-related TMJ concerns, obtain related medication history and assist the worker in determining their oral hygiene requirements, such as a special appliance or aid.

A request for an opinion from a dental consultant may be required to determine the relationship between the dental damage and the work-related accident, or if there is anticipated severe or long-term damage as a result of the injury.

Review the worker’s medical and x-ray reports on file to help confirm the details of the fracture.

Workers can be compensated for noise-induced hearing loss that occurs within Alberta and Saskatchewan, or if they were employed with the Government of Canada in Nunavut, Yukon or Northwest Territories.

Review the available documentation and communicate with the worker and employer to gather:

• A history of the worker’s hearing loss and a medical history. Discuss symptoms and concerns with the worker.
• Records of the worker’s employment history and exposure to noise.
• An audiogram completed within the last year by a registered hearing aid practitioner (RHAP) or audiologist.
• Any additional audiogram readings or ENT (ear, nose and throat) reports.

If appropriate, send the hearing loss factsheet to the worker for more information

Review the reports to determine whether the pattern of hearing loss shown on the audiogram(s) is consistent with occupational noise-induced hearing loss.

If required, obtain a medical opinion from a medical consultant to establish:

• The level of hearing loss
• The relationship between the hearing loss and occupational noise exposure
• The level of entitlement for tinnitus
• An indication of a permanent clinical impairment and recommendation for compensation.

In some cases, the medical consultant may request further testing such as an auditory brain stem response test or an MRI.

In order for a claim for occupational noise induced hearing loss to be accepted, the following criteria must be met:

• The worker’s audiogram(s) demonstrate the pattern shown in the noise-induced hearing loss chart below:
  
• The worker has been exposed to at least two years of noise levels equal to or greater than 85 decibels averaged over an eight-hour workday (the Alberta occupational exposure limit).

Occupational disease may progress over time, and may involve multiple employers. A worker may experience symptoms immediately following exposure to a workplace hazard or many years later.

Occupational injury or disease claims may require further information gathering to determine when the illness began and if it was a result of the worker’s workplace conditions.

Obtain the worker’s health and employment history. Gather their previous health and/or dental records and any related diagnostic reports such as x-rays.

The following information can also help guide the entitlement decision for an occupational injury or disease:

• The timeframe between the exposure and the onset of symptoms.
• Details on how the worker was exposed.
• The job description and if required, the brand name of the safety equipment used.
• Biochemical testing reports.
• Information detailed on workplace Materials Safety Data Sheets (MSDS).
• Air quality reports/industrial hygiene reports, Occupational Health and Safety reports and any other reports documenting substances within the work environment.

If required, request a medical opinion to gain additional information or guidance on the relationship between the symptoms and work exposure, diagnosis, work restrictions, and whether a permanent impairment is anticipated.

Psychological or psychiatric injuries at work can happen suddenly, due to a traumatic situation, or can develop over time. They can also develop in response to being injured at work or undergoing treatment for a work-related injury. To accept a claim for a psychiatric or psychological injury, there must be a confirmed psychological or psychiatric diagnosis as defined in the most current version of the Diagnostic and Statistical Manual of Mental Disorders (DSM).

WCB will presume that a confirmed psychological or psychiatric injury arose out of and occurred in the course of employment in the following circumstances, unless there is evidence to the contrary:

• A first responder (as defined in section 24.2 of the Workers' Compensation Act) has been diagnosed with post-traumatic stress disorder (PTSD) or a worsening of an existing case of PTSD (for accidents/incidents that occur on or after December 10, 2012). First responders include firefighters, police officers, peace officers (sheriffs only), and paramedics (including emergency medical responders (EMRs), primary care paramedics and advanced care paramedics).
  
  For accidents/incidents that occur on or after April 1, 2018, correctional officers and emergency dispatchers are also covered.
  
  Effective April 1, 2018, this presumptive coverage also includes other psychological/psychiatric conditions that develop after a confirmed exposure to a traumatic event at work.
• A worker has been diagnosed with a psychological/psychiatric condition and had a confirmed exposure to a traumatic event at work (for accidents/incidents that occurred between April 1, 2018 and December 31, 2020).

For any circumstances and time frames not specified above, WCB will accept a confirmed psychological/psychiatric injury when there is a link between the psychological/psychiatric diagnosis and the work accident/incident(s) or the injury/subsequent treatment. This includes:

• A traumatic event at work; it must be confirmed that the psychological/psychiatric injury was caused, at least in part, by the traumatic event/situation at work.
• An accumulation of work stressors over time or a stressor that exists over time; it must be confirmed that the stressor(s) is the predominant cause of the psychiatric/psychological injury.
• A psychological response to being injured and/or undergoing treatment for that injury; it must be confirmed that the psychological/psychiatric injury was caused, at least in part, by the injury or treatment.

An event/incident(s) at work is considered to be traumatic when it involves direct personal experience of an event or directly witnessing an event that is sudden, frightening, shocking, specific and involves actual or threatened death or serious injury to oneself or others or threat to one’s physical integrity.

For the period of April 1, 2018 to December 31, 2020, a traumatic event can also include workload or work-related interpersonal incidents that are excessive and unusual in comparison to the pressures and tensions experienced in normal employment.

Effective January 1, 2021, interpersonal relations between a worker and coworkers, management, or customers may be traumatic when they result in behaviours that are aggressive, threatening or abusive. Excessive workload alone would not be considered traumatic but may be considered as a chronic stressor.

Review the information on file to determine if there is evidence that the worker experienced a traumatic incident at work or an accumulation of stressors over time.

Also review whether there is a confirmed psychiatric or psychological diagnosis made by a physician (including psychiatrists) or psychologist using the criteria in the most current edition of the DSM.

Contact the worker and the employer to obtain information about the traumatic incident or workplace stressors. Ask questions to get an understanding of the worker’s injuries, how they’re coping and progressing and any initial or ongoing medical treatment they’ve received.

If a decision to accept the claim or injury cannot be made immediately and the worker advises they are not yet receiving any treatment, offer up to five sessions of psychological counselling so they can receive support until the review is complete.

If the information is unclear or there is no confirmed DSM diagnosis, contact the worker’s physician or psychologist using the appropriate letter to obtain additional information or clarification.

If appropriate, send the related psychological injury fact sheets to the worker and/or employer for more information:

When additional information is required to make a decision on acceptance or the injury, obtain an opinion from a medical consultant or psychological consultant or consider referrals for additional investigation(s) such as a Traumatic Psychological Injury (TPI) assessment, a Comprehensive Psychological Assessment (CPA) or an Independent Medical Examination (IME – psychiatric). A CPA may be helpful in establishing if the work stressors are the predominant cause of the psychological injury diagnosed. See the medical testing and exam referrals procedure for more information on making a referral.

Additional information may be needed to make the entitlement decision, such as interviews with other stakeholders, witness statements or investigation by the Special Investigations Unit.

Contact the worker and employer and discuss whether there was a specific task that lead to the injury. Ask additional questions related to the worker’s job duties:

• Describe the typical tasks you perform each day.
• How long does it take to complete each task? How many times per day do you perform them?
• What are the typical movements required to complete those tasks (such as twisting, lifting or reaching)?
• How long has this been your typical work day?
• Have there been any recent changes to your job?
• Do you rest between tasks?
• When are your scheduled breaks? Do you take them?
• When did you first notice symptom(s) and have they become worse? What were you doing at the time?
• Are there any other factors that may have contributed to your injury?

Also consider:

• Whether the worker has previous injuries or pre-existing conditions.
• Knowledge of the worker’s job and industry.
• The medical provider’s opinion.