Pursuant to Workers’ Compensation Law (WCL) § 21, injuries that occur at a claimant’s place of employment are presumed to be compensable work-related injuries for the purposes of awarding indemnity and medical benefits unless substantial evidence to the contrary is produced. In essence what this means is that if an employee suffers an injury during work hours and/or on the premises of his or her place of employment, the claimant will be entitled to indemnity benefits for any causally related lost time from their employment as long as they are able to produce medical reports evidencing a disability resulting from the injury.
However, according to WCL § 10, New York law dictates that for a workers’ compensation claim to be compensable the associated accident must have arose out of and in the course of employment, meaning there must be a causal nexus between the injury and the claimant’s employment. Idiopathic injuries, or personal injuries, may create a defense to a Workers’ Compensation claim if the employer can rebut the presumption that accidents arising in the course of employment arise out of the employment with “substantial evidence to the contrary.” See WCL §21.
Idiopathic injuries can be understood as injuries that spawn from something personal to the employee such as a spontaneous fainting spell or when an employee claims that their leg simply “gave out” and they fell without tripping on anything. Although difficult to prove, the employer can raise a defense to such claims by attempting to prove that the accident did not “arise out of or in the course or the employment.” Another such example that is a little more difficult to characterize as either idiopathic or work-related, are heart attacks that are suffered during employment.
Many factors may lead to the onset of a heart attack. Some of those factors may be personal to the claimant, such as a person’s body weight, family history of heart disease, pre-existing conditions such as diabetes and high blood pressure, or habits such as smoking or frequently consuming alcohol. Other factors may be related to a person’s employment such as strenuous exercise or extreme emotional stress. Since the cause and external triggers for heart attacks are difficult to discern, adjudicating New York State Workers’ Compensation heart attack claims can be difficult to defend.
The recent case, Hartigan, Christopher v. Albany County Sheriff’s Department, el al. focused on the situation where a claimant suffered a heart attack at work and the self-insured employer denied the claim arguing that the claimant’s injury was not related to his employment but was idiopathic or personal in nature.
In this case, the Albany County Sheriff’s Department appealed from a New York State Workers’ Compensation Board’s decision that determined that the claimant’s heart attack was causally related to his employment and established the claim as a compensable work related injury that entitled the claimant to indemnity and medical benefits. The claimant in this matter was a correction officer who allegedly experienced chest pain, which was later determined to be symptoms of a heart attack, upon delivering two heavy food carts to prisoners on certain cell tiers while on duty.
Following a Workers’ Compensation hearing a law judge determined that the claimant had suffered a work related injury and awarded the claimant indemnity benefits. The employer filed an application for review to the Workers’ Compensation Board which upheld the decision of the law judge finding that the claimant’s heart attack was a compensable, work related injury. The employer then appealed to the Supreme Court of New York, Appellate Division.
The Appellate Court reversed the prior decisions of the Workers’ Compensation Board determining that the Board’s decisions to find the claimant’s injury causally related to his employment was based upon the medical evidence submitted to the record. According to the Appellate Court, where medical proof is relied upon to demonstrate a causal relationship between a work injury and employment, it must signify a probability of the underlying cause that is supported by a rational basis and not be based upon a general expression of possibility. See Matter of Lichten v. New York City Tr. Auth., 132 AD3d 1219, 1219-1220 (2015).
In this case, because the testimony of the claimant’s treating cardiologist expressed merely the possibility that the physical activities in which the claimant engaged could have caused his heart attack, such testimony fell short of the required degree of medical proof and therefore the Board’s prior decisions lacked a rational basis and was not supported by substantial evidence.
Join In the Learning!
The New York Handbook
Our webinar series was designed as a complement to our New York Workers’ Compensation Handbook. The Handbook is written in “plain English” and provides a resource for risk managers and claims professionals who need a complete and easy-to-use reference guide for handling New York claims.
Digital editions of our book on New York workers’ compensation defense are available for download (FREE) here:
New York PDF link: bit.ly/nywcpdf
New York ePUB link: bit.ly/nywcepub
New York Kindle link bit.ly/nywckindle