An Ontario arbitrator has ruled the City of Greater Sudbury must compensate a firefighter’s estate after ruling the employer breached its collective agreement by purchasing an accidental death and dismemberment insurance policy that excluded coverage for a workplace-related suicide.
According to the parties, the case is the first in the fire sector to address whether AD&D benefits must cover death by suicide when linked to work-related post-traumatic stress disorder. The arbitrator found the policy’s suicide exclusion and one-year time limit between accident and death were inconsistent with the employer’s obligation to provide coverage for accidental deaths in a firefighter workplace.
The ruling has implications for employers in high-risk occupations who purchase group insurance policies with standard exclusions that may not align with collective agreement obligations or the nature of workplace hazards their employees face.
Background of the case
The firefighter began working for Greater Sudbury in April 2011. In September 2019, he went on Workplace Safety and Insurance Act leave for work-related PTSD. He died by suicide at home in May 2022 at age 40, following an unsuccessful attempt to return to work.
The WSIB concluded the death was related to his PTSD and provided his estate with compensation for burial costs and bereavement counselling. The city successfully claimed the firefighter’s life insurance benefit but did not initially submit an AD&D claim.
When the Sudbury Professional Firefighters’ Association grieved, the city filed an AD&D claim with SSQ Financial Group (now Beneva) on the firefighter’s behalf. The insurer denied the claim, stating the death was not accidental under the policy terms.
The collective agreement required the city to pay premiums for group life insurance providing two times basic annual salary “with double indemnity in case of accidental death.”
Policy exclusions at issue
The AD&D policy in effect when the firefighter died excluded coverage for “self-inflicted injuries, suicide or attempted suicide, regardless of the state of mind of the insured person.” It also imposed a one-year time limit between the date of the accident and death.
The city argued its obligation was limited to paying premiums for a standard AD&D benefit. It said the suicide exclusion was longstanding, appeared in multiple predecessor policies from different insurers, and was identified in employee handbooks distributed over the years.
The association argued the firefighter’s death was an accidental death under the collective agreement. PTSD was the workplace accident, it said, and suicide was the consequence of that accident.
Arbitrator’s jurisdiction to decide
The arbitrator first addressed whether he had authority to hear the grievance. The city argued that because it paid premiums for an AD&D plan, any dispute over eligibility belonged between the insurer and the estate.
The arbitrator rejected this position. “The essence of the dispute is not whether the grievor meets the eligibility requirements of the policy,” the arbitrator wrote. “It is rather whether the policy purchased by the City meets the requirements of the Collective Agreement.”
The arbitrator found the question of whether a plan with the suicide exclusion and time limit met the collective agreement’s requirements for coverage “in case of accidental death” required examination of the broader workplace and collective bargaining context.
Employee handbook insufficient notice
The city argued the association was aware of the policy restrictions through employee handbooks distributed to all staff, including firefighters. The handbooks addressed AD&D benefit limitations over multiple versions from 2003 to 2020.
The arbitrator found no evidence the association received copies of the actual AD&D policies or that the exclusionary language was brought to its attention. Nothing in materials related to previous grievances about policy disclosure mentioned the AD&D policy.
The handbooks stated unionized employees should consult their collective agreements, which would prevail over conflicting handbook provisions. Under the “Accidental Death and Dismemberment Insurance” heading, the handbooks said the plan offered “twenty-four (24)-hour protection against accidents, on or off the job.”
The suicide exclusion appeared several pages later under a “Limits and Exclusions” subheading, following descriptions of multiple other benefits. “A firefighter, having read that the Collective Agreement governs and that the benefit is intended to provide 24-hour protection against accidents on the job, could reasonably conclude that these restrictions would not apply in circumstances of workplace accidents causing death,” the arbitrator wrote.
The arbitrator found distributing an employee handbook explicitly superseded by the collective agreement, which addressed limitations in an “oblique and inconsistent manner,” fell short of establishing the association agreed to the policy restrictions.
Definition of accidental death in fire sector
The arbitrator found the firefighter’s death was an accidental death within the collective agreement’s meaning, requiring the city to have obtained coverage for these circumstances.
“It is now well established that in the fire sector, the term ‘accidental death’ generally includes death from occupational illnesses, and particularly those that are presumptively recognized under the WSIA and that fall within the common law definition of an accidental death,” the arbitrator wrote.
The arbitrator cited two key contextual factors. First, the parties bargained in a firefighter collective agreement context, where an AD&D benefit is reasonably understood to cover deaths from occupational illnesses caused by workplace exposures.
Second, an arbitral consensus has emerged that firefighter collective agreements referring to accidental death benefits include coverage for death from occupational illness, absent contrary indication.
Application of expectations test
The city argued suicide should be excluded because it involves an intentional act. It described the firefighter’s death as “pre-meditated and self-inflicted.”
The arbitrator rejected this position, drawing on court decisions establishing an expectations test for determining whether a death is accidental. The correct question was not whether the firefighter expected to die when he took steps to end his life, but whether he expected to develop the occupational illness through workplace exposures that caused him to take those steps.
“Firefighters no more expect to develop PTSD from those exposures than they do cancer,” the arbitrator wrote.
The arbitrator found the firefighter’s death was “triggered by the external events of repeated traumatic exposure while working as a firefighter.”
The city also argued it would be impossible to distinguish accidental from intentional suicide. The arbitrator disagreed, noting the proper distinction was between death by suicide caused by an accident and death by suicide that was not.
Weight of WSIB determination
The arbitrator gave significant weight to the WSIB’s finding that the firefighter’s death was related to his work-related PTSD.
Under the WSIA, firefighters diagnosed with PTSD are presumed to have acquired it through their occupation. WSIB operational policy states that if a worker dies by suicide following a work-related injury, the board must pay benefits if the suicide resulted from the work-related injury.
The WSIB had evidence of the firefighter’s exposure to traumatic workplace circumstances. It accepted the PTSD claim and determined his death was related to this condition.
The arbitrator noted the WSIB’s approach was consistent with common law and supported the association’s interpretation of accidental death under the collective agreement.
Implications for employers
The arbitrator found the city breached the collective agreement by failing to pay premiums for a group life insurance plan with double indemnity in case of accidental death. The grievance was allowed, with calculation of the amount owing to the estate remitted to the parties.
The agreed facts indicated this was the first AD&D claim between the parties, along with a separate claim filed around the same time for another firefighter.
The case establishes that employers cannot satisfy collective agreement obligations by purchasing insurance policies with exclusions that conflict with the intended scope of coverage, particularly in workplaces with known occupational hazards.
For employers in sectors with recognized occupational health risks, including mental health conditions like PTSD, the ruling suggests standard insurance policy exclusions may be insufficient to meet contractual obligations for accidental death coverage.
The decision also reinforces that employee handbooks cannot override collective agreement terms, and that distributing handbooks to individual employees does not constitute notice to the union as the bargaining agent.
