A workplace accident resulting in injury is usually covered by workers’ compensation insurance, with very few exceptions. Unless the injuries were self-inflicted, or the employee was under the influence of alcohol or drugs at the time of the injury, the employer’s workers’ compensation insurance should provide medical care and compensation for lost wages to the injured employee, along with other possible benefits.
However, with work-related illnesses such as heart attacks, the situation is not quite so cut-and-dried.
Work-Related Illnesses and Workers’ Comp
According to the California Division of Occupational Safety and Health (Cal/OSHA), an injury or illness is considered work-related if exposure or an event in the work environment caused a condition or contributed to it, or aggravated a pre-existing condition significantly. Cal/OSHA classifies qualifying illnesses as:
- Skin diseases or disorders
- Respiratory conditions
- Hearing loss
- All other occupational illnesses
A California Commission on Health and Safety and Workers’ Compensation background paper states that California’s workers’ compensation costs are higher than in other states in part 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.
However, for an injury such as a heart attack, the worker’s employment or work-related stress does not need to be the sole cause of the injury – only a substantial contributing cause — and all that is needed is proof of a reasonable probability that it has been.The document cover sheet for California workers’ comp claims attaches a body part code list which contains a code, number 802, for heart attacks.
Under 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.
Cumulative Workers’ Comp Injuries
There are two types of workers’ compensation injuries.
- First, specific injuries resulting from traumatic incidents or exposure to toxic substances over a short period of time, such as construction accidents.
- Secondly, cumulative injuries, which are physical or psychological disabilities caused by repetitive work-related injuries.
A certain type of cumulative injury can cause heart disease, stroke, digestive problems, hypertension, and other diseases through emotional stress and tension in the workplace, as opposed to physical work. Although American medicine has been slow to acknowledge the effects of the mind on the body, these types of stress-related injuries are now being recognized by the courts as covered by workers’ comp insurance.
An employee who has a heart attack and can show that the cause was work-related may be eligible for workers’ compensation benefits, which may include:
- All necessary and reasonable medical care
- Temporary disability benefits, generally calculated at 2/3 the employee’s gross wages
- Permanent disability benefits, if the employee is unable to return to work
- Vocational rehabilitation training
- Death benefits for dependents if the employee did not survive the heart attack
The purpose of workers’ compensation insurance is to provide immediate relief to injured workers without the necessity of filing a personal injury claim against the employer. Workers who have suffered heart attacks may be eligible for that relief if it can be shown that the injury was caused by work-related factors.