Compensable or Not? Heart Attacks, Strokes and Similar Work Injury Claims in Alabama
By: Trey Dowdey
Heart attacks, strokes or seizures in the workplace can be tricky compensability issues to assess when handling claims. At first blush, these types of injuries might appear purely personal and unrelated to an employee’s job, but claims practitioners should be aware these types of injuries are nuanced and can result in compensable work injuries under the Alabama Workers’ Compensation Act (the Act).
Accidents are defined under the Act as “’personal injuries due to accident’ or ‘injuries or death caused by accident’“ . . . construed to mean an unexpected or unforeseen event, happening suddenly and violently, with or without human fault, and producing at the time injury to the physical structure of the body . . . . ” Ala. Code §25-5-1(7).
Ala. Code §25-5-1(8) goes on to provide that for compensation (money benefits) to be awarded to an employee, an injury by accident must arise out of and in the course of the employment.
However, Ala. Code §25-5-1(9) then takes a broader approach as to what are compensable work injuries including: (1) acute and sudden “accidents;” (2) “occupational diseases;” (3) diseases that result “naturally and unavoidably from” accidents; and (4) cumulative trauma injuries. Specifically, the Act states “’[i]njury and personal injury’ shall mean only injury by accident arising out of and in the course of the employment, and shall not include a disease in any form, except for an occupational disease or where it results naturally and unavoidably from the accident . . . [and] [i]njury shall include physical injury caused either by carpal tunnel syndrome disorder or by other cumulative trauma disorder if either disorder arises out of and in the course of the employment . . . . ”
Practically speaking, with any of these four types of injuries, an injury arises in the course of employment when it occurs within the period of employment, at a place where the worker may reasonably be and while reasonably fulfilling the duties of employment. Moreover, whether an injury 'arises out of' the employment is a question of whether there is a causal relationship between the employee’s performance of duties and the complained-of injury. Ex parte Trinity Indus., Inc., 680 So.2d 262 (Ala. 1996).
Generally, whether a workers’ claimed injury arises out of and in the course of employment depends upon the facts and circumstances of each particular case. Further, to determine whether an employee's injury arose out of his employment, the court "must determine whether the employee's injury arose from any risk or danger incidental to the character of his employment." Young v. Mut. Sav. Life Ins. Co., 541 So.2d 24 (Ala.Civ.App. 1989). (emphasis added).
The employment should be considered the legal cause of the injury for workers' compensation purposes only when the injury results from an occupational risk. Mercy Logging, LLC v. Odom, 104 So.3d 908 (Ala.Civ.App. 2012). Moreover, the job must be “source and cause” of the accident. Wooten v. Roden, 71 So.2d 802 (Ala. 1954). To satisfy the “source and cause” requirement, “the rational mind must be able to trace the resultant injury to a proximate cause set in motion by the employment and not otherwise . . . . ” Id. at 805.
Alabama courts have specifically rejected a “but-for” causation test for unexpected fall cases, where all an injured worker would need to prove under such a “but-for” test is an accident while working at the job location. Slimfold Mfg. Co. v. Martin, 417 So.2d 199 (Ala.Civ.App. 1981). Such a “but-for” causation test is not much of a causation test at all, as employers could be liable for any number of personal health conditions completely unrelated to work. As such, Alabama requires that an injured worker must carry the burden to establish a definite causal connection between the work and the injury. Id. at 201-02. “Accidental” injuries include, by statutory definition, the contraction of occupational diseases, per Ala. Code §25-5-111, and acute, sudden and unforeseen injuries, and these “accidental” injuries require the injured worker to prove a work injury by a preponderance of the evidence. Ala. Code §25-5-81(c). See also Drummond Co., Inc. v. Moore, 730 So.2d 222 (Ala.Civ.App.1998). Meanwhile, cumulative stress injuries require proof by clear and convincing evidence. Ala. Code §25-5-81(c) (Heart attacks, strokes, seizures or the like can conceivably be caused at work from acute, accidental, sudden and unexpected events or from cumulative stress or trauma over time).
Cardiovascular problems may be compensable acute or cumulative stress injuries under Act, and benefits have been awarded for heart failures, strokes, aneurysms, seizures, blood clots and other cardiovascular problems (these types of injuries have been styled “nonaccidental injuries.” Ex parte Trinity Indus., Inc., 680 So.2d 262 (Ala. 1996)).
To establish causation with such so-called “nonaccidental injuries,” a claimant must satisfy a two-prong causation test by producing substantial evidence, establishing both (a) legal causation and (b) medical causation. Merely showing a “but-for” or close spatial or temporal relationship between the injury and the place or time of the claimant's performance of the job is not, in itself, always sufficient to satisfy either of the two causation prongs for nonaccidental injuries. Id.
More specifically, according to The Supreme Court of Alabama, in Ex parte Trinity Indus., Inc., there is a two-prong requirement for nonaccidental injuries.
(1) The claimant must establish legal causation for “nonaccidental” injuries and prove that the performance of his or her duties as an employee exposed him or her to a danger or risk materially in excess of that to which people are normally exposed in their everyday lives; and
(2) The claimant must establish medical causation for such “nonaccidental” injuries, by producing evidence tending to show that the particular exposure to risk proven in regard to prong one (legal causation) “was in fact [a] contributing cause of the [complained-of] injury.” Ex parte Trinity Indus., citing City of Tuscaloosa v. Howard, 318 So.2d 729 (Ala.Civ.App. 1975).
Ex parte Trinity Indus., Inc. at 266-67.
A claimant must prove prongs 1 and 2 above by “substantial evidence,” which has been defined as “evidence of such weight and quality that fair-minded persons in the exercise of impartial judgment can reasonably infer the existence of the fact sought to be proved.” West v. Founders Life Assurance Co., 547 So.2d 870, 871 (Ala.1989).
For example, a local police officer alleges a “nonaccidental injury” heart attack from stress induced by his job. The officer had a heart attack five minutes after being involved in a shootout while working. The officer is also known to smoke and drink heavily. Testimony by the authorized treating physician indicates that such a heart attack could have been caused by the shootout, by a preponderance of the evidence, and benefits may be owed under the Act. What about a police officer who alleges 25 years of cumulative stress from dangerous duties ultimately caused a heart attack? Possibly – medical expert opinion evidence will be key.
Along the same lines, heart attacks, strokes and seizures can also create tricky situations, potentially causing unexplained or idiopathic falls and injuries with employees at work. “Idiopathic, in the work injury context, means ‘peculiar to the individual’ and not ‘arising from an unknown cause.’” Ex parte Patterson, 561 So.2d 236 (Ala.1990). Idiopathic refers to a “pre-existing physical weakness or disease.” Id. at 238 n. 2.
Did the heart attack or stroke cause such a fall? Did the job requirements or duties cause the heart attack or stroke? Did an idiopathic seizure (not caused by the job) cause a fall, whereby the job requirements made the injuries from the fall worse than the fall would have been if not at work (for example, an epileptic employee who is required to work from a three-foot platform, had an idiopathic seizure (not work-related), but then fell off the three-foot platform and suffered injuries worse than just falling on a normal floor)? See Irby v. Republic Creosoting Company, 228 F.2d 195 (1955).
With such “idiopathic falls,” the general rule, again, remains that “the employment must be the source and cause of the accident” to be a compensable work injury. Slimfold Mfg. Co. v. Martin, 417 So.2d 199 (Ala.Civ.App. 1981). These situations become tricky when falls are due to personal health reasons with no connection to the job. Further, injuries attributable solely to “idiopathic factors” are not compensable.
The Alabama Supreme Court has noted “[t]he principal ‘fault line’ that has been revealed by the application of the ‘arising out of’ requirement by Alabama courts is the distinction between accidents that are at least partially attributable to an affirmative employment contribution and those that are attributable solely to what are called 'idiopathic' factors . . . .” Ex parte Patton, 77 So.3d 591 (Ala.2011).
In summary, when confronting claims with potentially idiopathic heart attacks, strokes, seizures or other similar personal health conditions that coincide with work and that could be connected to an employee’s work, an early investigation into all facts and conditions surrounding the claimed work injury, the timeline of events, witnesses, the claimant’s medical history and an analysis of the job duties and requirements will be crucial, as these cases often turn on subtle and precise facts.
Attorney Contact Info
Trey Dowdey
trey.dowdey@swiftcurrie.com
205.314.2409