Causation in Heart-Related Disease, Perivascular Disease, and Strokes in Louisiana Workers Compensation

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Heart-Related Disease, Perivascular Disease, and Strokes

The area of heart disease and strokes in Louisiana workers compensation can be one of the more confusing and difficult areas in Louisiana workers compensation.  

This area of law includes heart disease, heart attacks, strokes, blood vessel conditions, and or perivascular disease. 

To begin with, the Louisiana Workers Compensation Act, contrary to common sense, specifically exclude heart-related or perivascular disease from the classification of an occupational disease.  

And second, the Louisiana Workers Compensation Act specifically includes heart-related or perivascular disease as a "personal injury by accident." So basically, almost unbelievably, this means that under Louisiana workers compensation, heart disease and perivascular disease are not actually diseases, but instead injuries that happen in a single event. 

Most importantly, the Louisiana Workers Compensation Act specifically holds that heart-related and perivascular injuries are only compensable (meaning the employee will receive benefits) when it is shown by clear and convincing evidence that:

  1. The physical work stress was extraordinary and unusual in comparison to the stress or exertion experienced by the average employee in that occupation; and
  2. The physical work stress or exertion, and not some other source of stress or preexisting condition, was the predominant and major cause of the heart-related or perivascular injury, illness, or death.

Like a heart attack, a stroke constitutes “perivascular injury” under Louisiana "heart-related and perivascular injuries" workers compensation statute.

Also, in this "heart-related and perivascular injuries" workers compensation statute, the term “extraordinary” is defined as going beyond what is usual, regular or customary, and the term “unusual” is defined as not usual, uncommon and not in accordance with usage, custom or habit.  

However, if an employee's work requires physical effort and exertion and an employee's heart or other organ fails or suffers functional impairment while employee is engaged in performance of his or her usual and customary duties, it is an “accident” within Workmen's Compensation Act, and it is not necessary for employee to show that the disabling injury was the result of unusual physical effort.

Burden of Proof for A Heart-Related Injury or Stroke

One purpose of this "heart-related and perivascular injuries" workers compensation statute was to make the burden of proof regarding perivascular injuries high enough so as to exclude from coverage employees who just happen to suffer perivascular injuries at work.  

This is because heart attacks and strokes are ordinarily the result of natural causes, instead of the result of trauma injury or particular effort.  

Thus, since an employee typically has at least some minor amount of heart attack or stroke risk, the employment must be clearly shown to have increased the risk of heart attack or stroke in order for the employee to be covered. 

So in particular, the purpose of the heightened burden of proof - namely clear and convincing evidence rather than preponderance of the evidence - for an employe to recover workers compensation benefits for heart-related or perivascular injuries is to prevent the employer for having to pay for employees who just happen to suffer heart attack or stroke at work.  

This clear and convincing evidence standard is a heavier burden of proof than the usual civil case preponderance of the evidence (more likely than not) standard, but is less burdensome than the beyond a reasonable doubt standard of a criminal case.  

Basically, to prove a matter by clear and convincing evidence means to show that a disputed fact is "highly probable" and "much more probable than not."

Did the Employment Cause A Heart-Related Injury or Stroke?

Under Louisiana workers compensation, the employment must be clearly shown to have increased the risk of injury before employee can be compensated for heart-related or perivascular injuries or stroke.  

Also, the mere occurrence of a heart attack at work does not entitle an employee to compensation;  it must be shown that the heart attack is causally related to the disability, i.e., that it caused, contributed to or accelerated the heart disease.

The test as to whether there was a causal link between employee's work and heart attack (or whether the employment caused the heart attack of perivascular disease or stroke) is an objective one.  That means that the  comparison is not between physical stress required of job and physical work stress encountered in non-employment activities of average person, nor is the comparison with an employee's own unemployment life activities. Instead, it simply means the comparison of the exertion of a worker to that experienced by the average employee in that occupation. 

Additionally, a workers' compensation claim based on a heart attack does not fail simply because the medical expert cannot definitively state the heart attack's primary cause. 

Pre-existing Heart Disease or Perivascular Disease

The existence of a pre-existing heart condition or risk factor alone will not prevent recovery of workers' compensation benefits for a work-related heart attack.

In fact, workers compensation benefits are due in compensation cases involving heart conditions resulting in disability or death, whether or not the condition is pre-existing, when caused, precipitated, or accelerated by even usual and customary activities, exertions, and other factors directly connected with employment.

For example, the fact that an employee has a previously unknown but pre-existing high blood pressure condition will not prevent that employee from receiving workers compensation benefits if the employee has a stroke, so long as the employee's physical work stress or exertion (and not the pre-existing condition) was a major cause of his stroke. 

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