Does Workers Compensation Cover Heart Attack?

Santa Clara, CAMany Americans, particularly those with heart conditions, have good reason to ask whether they are eligible for Worker’s Compensation if they suffer a heart attack at work. Heart attacks are normally covered by state workers’ compensation laws but there are often many factors involved and you may wonder if a heart attack or stroke qualifies for worker's comp.

According to OSHA, of the estimated 220,000 victims of sudden cardiac arrest per year in the US, about 10,000 cases occur at work. The American Heart Association states in one year alone, 350,000 Americans die from a cardiac arrest. The CDC states that every year, about 805,000 people in the US have a heart attack. Of these,

• 605,000 are a first heart attack
• 200,000 happen to people who have already had a heart attack
• About 1 in 5 heart attacks is silent—the damage is done, but the person is not aware of it.

Given these facts, combined with a rapidly aging workplace, the question—whether Worker’s Compensation covers losses stemming from heart attacks, is increasingly  more relevant. 

California Worker’s Compensation

Worker’s Compensation laws vary by state. California's workers' compensation insurance is based on a "no fault" doctrine. This means that an employee does not have to prove the injury is someone else's fault so they can receive workers' compensation benefits. Benefits are given regardless of fault if the injury is job related. The Golden State’s compensation laws state that employers should cover numerous economic losses caused by workplace injuries and illnesses on a no-fault basis, including losses stemming from heart attacks cause by employment.  For a heart attack to qualify for workers comp under California law, the worker's employment or work-related stress does not need to be the sole cause of the injury – it only has to be a “substantial contributing cause”.

A California Commission on Health and Safety and Workers’ Compensation background paper finds California’s workers’ compensation costs higher than in other states, partly because many injuries are compensable in California that are not in other states. The basic statutory requirement is that an injury must arise out of and in the course of employment to be compensable. But for an injury such as a heart attack at work, the worker’s employment or work-related stress does not need to be the sole cause of the injury. It can also be only a substantial contributing cause and all that is required is to prove a reasonable probability that it had a part in the injury. (California workers’ compensation claims attaches a body part code list which contains code 802, for heart attacks.)

But proving that work-related conditions played a role in causing a heart attack can be a challenge.

Workplace Heart Attack

Proving that your heart attack is directly caused by work -- whether caused by unusual or extraordinary physical exertion, strain, or condition during the course of regular employment and that no private contributing factors could equally be to blame – can be complicated. Some states will only allow workers’ compensation benefits for legitimate work-related injuries or illnesses.

The law stipulates that you establish that some sort of unusual or extraordinary physical exertion, strain, or condition during the course of regular employment led to the heart attack itself—and that no private contributing factors could equally be to blame. 
Many factors can be involved that lead to a heart attack, such as long hours, lack of exercise and poor diet. However, your employer can argue that you are not eligible for benefits because of your dietary habits and overall physical condition. They can state that these aggravated the condition, not the employment, and that it led to your heart attack. And of course, there is work-related stress. If you can prove that the stress of your job aggravated your condition and triggered a heart attack, you may be entitled to workers’ compensation benefits.

Say you were required to work 16 hours straight over the holidays where you were running back and forth, lifting heavy objects, and taking limited breaks. If you suffered a heart attack that would be considered work-related.

Even if you had a heart attack at work, that doesn’t necessarily mean it was work-related.

Pre-Existing Condition

According to state workers’ compensation law, when injury or disease aggravates a pre-existing condition, compensation is limited to the portion of disability reasonably attributed to work-related factors. The particular circumstances of your specific case will determine what workers’ compensation benefits are available to you. There are two types of workers’ compensation injuries: Specific injuries resulting from traumatic incidents or exposure to toxic substances over a short period of time, and cumulative injuries, which are physical or psychological disabilities caused by repetitive work-related injuries. The latter can cause “silent killers of work” such as heart disease, stroke,  hypertension and other diseases through stress in the workplace rather than physical work. Increasingly, stress-related injuries are being recognized by the courts as covered by workers’ comp insurance, which includes heart attack compensation.

Your employer’s insurance company will likely hunt for medical evidence to deny your claim but keep in mind that previous injuries may still be covered if your job made them worse. If your medical records indicate that you have a history of cardiovascular problems, high cholesterol and/or high blood pressure, you are overweight, have hypertension or high cholesterol, your claim may be denied based on you being predisposed to a stroke or heart attack. You may want to seek advice from a workers' compensation lawyer. A qualified attorney will help gather and present evidence to prove that your stroke was work-related.