It is no secret that heart attacks occur frequently in our society. National statistics indicate approximately 10,000 heart attacks occur while at work, however very specific criteria must be met before being considered as a compensable injury. The first issue to address would begin with the section of the statute concerning the compensability of heart attacks (Section 408.008). There are three basic criteria that must be met. First, the heart attack must occur at a definite time and place caused by a specific event occurring in the course and scope of the employee’s employment. Second, the preponderance of the medical evidence regarding this event indicates that the work rather than a natural progression of pre-existing heart conditions was a substantial contributing factor to the noted cardiac injury. Lastly, the heart attack was not triggered by emotional or mental stress fractures unless precipitated by a sudden stimulus.

The first criterion is relatively easy to establish. The overwhelming frequency of individuals who sustained such a heart attack knows exactly when this event occurred. The specific activities precipitating the cardiac event must be tied to the employee’s occupational endeavors. The question then becomes, do these endeavors germane to the course and scope of employment? The next issue is, is this clinical situation simply a progression of pre-existing unrelated medical maladies? Statistically, more than 31% of all Americans are obese (and 71.6% could be considered overweight). It is also noted, 30% of all Americans suffer from hypertension. An overwhelming 54% of Americans have elevated cholesterol or hyperlipidemia. Each of these contributes to causing occlusion of the coronary arteries, resulting in a lack of blood to the muscle of the heart causing a myocardial infarction (death of that tissue a.k.a. heart attack). Therefore, medical history be obtained from as many sources as possible to establish that the noted heart attack was not a function of other unrelated causes. Lastly, a heart attack cannot be tied to emotional or mental health stressors unless specifically a function of employment. Therefore, the issue to be resolved would be, was this individual under unusual strain, exceptional exertion, or other violence causing this particular event?

As you can see, establishing that a heart attack is a function of employment is a rather difficult standard to meet. This is not to say it does not happen, only that all pre-existing factors must be excluded before accepting this as a compensable event. There are many Appeals Panel decisions addressing heart attacks. The majority of these decisions date back to the early 1990s. One key decision note is, it takes more than a doctor’s opinion that work precipitated a heart attack. The specifics of how the work caused the heart attack and that the work was a “greater factor” is noted (AP# 100566). Having a comprehensive clinical assessment by an independent provider reviewing all facts relative to the noted myocardial infarction is crucial in this determination process.