WCBs typically look for causal relationship to the job and extraordinary circumstances
On a cool fall day a few years ago, a semi-retired 61-year-old Ontario truck driver carrying a 90-tonne load of steel had a heart attack and died shortly after using a hand crank to lower the dolleys on his trailer.
His wife applied for benefits under the province's Workplace Insurance and Safety Board (WSIB) Disease and Survivor Benefits Program. Her request was denied on the grounds the truck driver was simply carrying out his normal daily duties that October morning.
The decision was overturned on appeal. Two much younger employees testified the dolleys were especially difficult to crank in cold weather and had to be turned at least 20 times to raise the trailer to the right height. The truck driver had also been working long hours. The tribunal ruled his job played a significant contributing factor in his heart attack.
"The fact of having a heart attack at work won't automatically get you benefits," said employment law expert Madeleine Loewenberg, a senior associate with Ogilvy Renault in Toronto. "There are two thresholds employees must cross for it to be considered a workplace incident."
Cause of heart attack
While the wording varies by province, most follow policies similar to Ontario. For a worker or the employee's survivor to be entitled to benefits, one of two requirements must be met. The first is that the heart attack must "have arisen out of and in the course of employment."
"It has to be a result of the work," said Loewenberg. "There must be a causal relationship."
For example, if an employee is asked to lift something extremely heavy that is not considered part of his normal job duties.
There are three other cardiac conditions related to workplace heart attacks. The first is traumatic injury to the chest wall — an object hits an employee in the chest, triggering a heart attack. The second is electrocution or shock producing an irregular cardiac rhythm. The third involves the inhalation of smoke, noxious gases or fumes, and is most often related to firefighters.
What if the work involves mental, not physical, stress? In Ontario, the other threshold for heart attacks to be considered workplace incidents is whether the employee experienced "unusual physical exertion or acute emotional stress with no significant delay in the onset of symptoms."
In this case, said Loewenberg, the heart attack must be the result of circumstances that are out of the ordinary. Some workers in Ontario have successfully argued their occupational job stress contributed to the development of coronary artery disease. Loewenberg said those cases must be "extreme."
"The (WSIB) takes an individualized approach," she said. "A build up of events over time may enable a claim under acute emotional stress. However, the board has not been quick to rule in situations of workplace bullying or harassment."
Suzanne Dajczak, a WSIB lawyer in Windsor, Ont., noted the board "tends toward the physical" aspects of a job.
"In some circumstances, it needs to be more flexible," she said. "Sometimes you have bad people working together with increased job stress and that can be a factor."
That is starting to happen, according to workplace mental health expert Martin Shain. In his report Tracking the Perfect Legal Storm, he notes there is an increasing trend in favour of heart attack victims – usually on appeal – who have suffered mental injury as a result of acute or chronic stress.
Shain highlights a case involving another Ontario truck driver, this time working in hot, humid, cramped working conditions. The man was angry and frustrated with his employers for sending him to a place where he would be too late to deliver and have to spend the weekend in his truck.
The driver was diabetic and had pre-existing hypertension, kidney and gallbladder problems. Shortly after the delivery, he had a heart attack at another location and died.
Although he "almost certainly had pre-existing cardiovascular disease," the appeal tribunal found the truck driver's anger and anxiety was a precipitating factor.
Site of the heart attack
Where the heart attack occurs can also play a role in deciding whether or not a heart attack is considered to be work related. Loewenberg said there are too many variables to be able to make a causal connection between a heart attack at home, and stress or exertion in the workplace. However, she notes workers compensation boards tend to look at each case individually.
It should also be noted that an employee who survives a heart attack on the job but has complications later on, or dies, may not be entitled to benefits.
"If it's outside the acute phase, it may not be accepted," said Peter Sholdas, a paralegal and certified WSIB specialist in Toronto. "However, the acute phase is not defined. It could be anytime after a work-related accident." (Some provincial policies consider the 30-day period post-heart attack to be the "acute" phase.)
Pre-existing conditions
Whether or not the employee had pre-existing conditions — obesity, smoking, high blood pressure, family history — may or may not be a factor, according to Loewenberg.
Generally speaking, if the heart attack arises out of the job or because of unusual physical exertion or acute mental stress, even the unhealthiest worker is entitled to benefits.
However, Loewenberg said the employer may be "relieved of some of the compensation burden" in the presence of those conditions.
Ultimately, she notes, most cases are decided based on individual circumstances, which is why it is crucial for employers to know what the functions of a job are and to assess hazards as they relate to the potential for heart attacks.
Danielle Harder is a Brooklin, Ont.-based freelance writer.
HEART ATTACKS IN THE WORKPLACE
Memo to employers: Get involved in your employees’ health
A loss is a loss, according to Eric Stein, an Edmonton-based occupational health consultant, and employers particularly need to keep that in mind when it comes to heart attacks.
While the law draws a distinction between a job-related heart attack and those that happen outside the workplace, Stein is frustrated that some employers seem to draw the same distinction when it comes to their employees' heart health.
"Whether you did fall from a forklift and break your arm, or whether you had a heart attack at home doesn't matter," he said. "You're still off work. In many of the Scandinavian countries they don't have workers' compensation. An illness is an illness, and it's still time away from work."
Stein said unlike accidents, which are seen as preventable, heart attacks are seen as health conditions. But both can cost an employer the same in time and money.
"With a heart attack, you will lose the worker for six months, or he'll die," he said. "Well, how many years of training have you invested? How many benefits did you pay over time?"
Stein said it's important for companies to consider how heart attacks can be prevented, in much the same way as industrial accidents. For example, people who work in sedentary jobs – truck drivers, bus drivers or office workers – should be considered high-risk and offered heart health education and incentives. Likewise, companies can introduce walking groups or fitness plans.
He said human resource departments are often reluctant to discuss heart health promotion because it can be seen as a personal responsibility.
"Where do you draw the line between what an employee is doing at home – and what he's doing at work? It's a bit like drug testing," he said. "Plus, it's not like you can bring in equipment, for example, and sell the company on the cost savings."
Stein said complicating the matter is the volume of contract workers today. They're often under intense stress, but they don't qualify for in-house health promotion.
"The challenge for us, in terms of delivery, is that we don't have the traditional style employee anymore," he said. "Even within companies, health and safety is the first thing that gets cut in tough times."
Stein said small and medium-sized businesses are more likely to get the message. They represent a good proportion of his clients. He said it's likely because people know each other better in smaller firms, and feel more responsibility for each other's health.
His wife applied for benefits under the province's Workplace Insurance and Safety Board (WSIB) Disease and Survivor Benefits Program. Her request was denied on the grounds the truck driver was simply carrying out his normal daily duties that October morning.
The decision was overturned on appeal. Two much younger employees testified the dolleys were especially difficult to crank in cold weather and had to be turned at least 20 times to raise the trailer to the right height. The truck driver had also been working long hours. The tribunal ruled his job played a significant contributing factor in his heart attack.
"The fact of having a heart attack at work won't automatically get you benefits," said employment law expert Madeleine Loewenberg, a senior associate with Ogilvy Renault in Toronto. "There are two thresholds employees must cross for it to be considered a workplace incident."
Cause of heart attack
While the wording varies by province, most follow policies similar to Ontario. For a worker or the employee's survivor to be entitled to benefits, one of two requirements must be met. The first is that the heart attack must "have arisen out of and in the course of employment."
"It has to be a result of the work," said Loewenberg. "There must be a causal relationship."
For example, if an employee is asked to lift something extremely heavy that is not considered part of his normal job duties.
There are three other cardiac conditions related to workplace heart attacks. The first is traumatic injury to the chest wall — an object hits an employee in the chest, triggering a heart attack. The second is electrocution or shock producing an irregular cardiac rhythm. The third involves the inhalation of smoke, noxious gases or fumes, and is most often related to firefighters.
What if the work involves mental, not physical, stress? In Ontario, the other threshold for heart attacks to be considered workplace incidents is whether the employee experienced "unusual physical exertion or acute emotional stress with no significant delay in the onset of symptoms."
In this case, said Loewenberg, the heart attack must be the result of circumstances that are out of the ordinary. Some workers in Ontario have successfully argued their occupational job stress contributed to the development of coronary artery disease. Loewenberg said those cases must be "extreme."
"The (WSIB) takes an individualized approach," she said. "A build up of events over time may enable a claim under acute emotional stress. However, the board has not been quick to rule in situations of workplace bullying or harassment."
Suzanne Dajczak, a WSIB lawyer in Windsor, Ont., noted the board "tends toward the physical" aspects of a job.
"In some circumstances, it needs to be more flexible," she said. "Sometimes you have bad people working together with increased job stress and that can be a factor."
That is starting to happen, according to workplace mental health expert Martin Shain. In his report Tracking the Perfect Legal Storm, he notes there is an increasing trend in favour of heart attack victims – usually on appeal – who have suffered mental injury as a result of acute or chronic stress.
Shain highlights a case involving another Ontario truck driver, this time working in hot, humid, cramped working conditions. The man was angry and frustrated with his employers for sending him to a place where he would be too late to deliver and have to spend the weekend in his truck.
The driver was diabetic and had pre-existing hypertension, kidney and gallbladder problems. Shortly after the delivery, he had a heart attack at another location and died.
Although he "almost certainly had pre-existing cardiovascular disease," the appeal tribunal found the truck driver's anger and anxiety was a precipitating factor.
Site of the heart attack
Where the heart attack occurs can also play a role in deciding whether or not a heart attack is considered to be work related. Loewenberg said there are too many variables to be able to make a causal connection between a heart attack at home, and stress or exertion in the workplace. However, she notes workers compensation boards tend to look at each case individually.
It should also be noted that an employee who survives a heart attack on the job but has complications later on, or dies, may not be entitled to benefits.
"If it's outside the acute phase, it may not be accepted," said Peter Sholdas, a paralegal and certified WSIB specialist in Toronto. "However, the acute phase is not defined. It could be anytime after a work-related accident." (Some provincial policies consider the 30-day period post-heart attack to be the "acute" phase.)
Pre-existing conditions
Whether or not the employee had pre-existing conditions — obesity, smoking, high blood pressure, family history — may or may not be a factor, according to Loewenberg.
Generally speaking, if the heart attack arises out of the job or because of unusual physical exertion or acute mental stress, even the unhealthiest worker is entitled to benefits.
However, Loewenberg said the employer may be "relieved of some of the compensation burden" in the presence of those conditions.
Ultimately, she notes, most cases are decided based on individual circumstances, which is why it is crucial for employers to know what the functions of a job are and to assess hazards as they relate to the potential for heart attacks.
Danielle Harder is a Brooklin, Ont.-based freelance writer.
HEART ATTACKS IN THE WORKPLACE
Memo to employers: Get involved in your employees’ health
A loss is a loss, according to Eric Stein, an Edmonton-based occupational health consultant, and employers particularly need to keep that in mind when it comes to heart attacks.
While the law draws a distinction between a job-related heart attack and those that happen outside the workplace, Stein is frustrated that some employers seem to draw the same distinction when it comes to their employees' heart health.
"Whether you did fall from a forklift and break your arm, or whether you had a heart attack at home doesn't matter," he said. "You're still off work. In many of the Scandinavian countries they don't have workers' compensation. An illness is an illness, and it's still time away from work."
Stein said unlike accidents, which are seen as preventable, heart attacks are seen as health conditions. But both can cost an employer the same in time and money.
"With a heart attack, you will lose the worker for six months, or he'll die," he said. "Well, how many years of training have you invested? How many benefits did you pay over time?"
Stein said it's important for companies to consider how heart attacks can be prevented, in much the same way as industrial accidents. For example, people who work in sedentary jobs – truck drivers, bus drivers or office workers – should be considered high-risk and offered heart health education and incentives. Likewise, companies can introduce walking groups or fitness plans.
He said human resource departments are often reluctant to discuss heart health promotion because it can be seen as a personal responsibility.
"Where do you draw the line between what an employee is doing at home – and what he's doing at work? It's a bit like drug testing," he said. "Plus, it's not like you can bring in equipment, for example, and sell the company on the cost savings."
Stein said complicating the matter is the volume of contract workers today. They're often under intense stress, but they don't qualify for in-house health promotion.
"The challenge for us, in terms of delivery, is that we don't have the traditional style employee anymore," he said. "Even within companies, health and safety is the first thing that gets cut in tough times."
Stein said small and medium-sized businesses are more likely to get the message. They represent a good proportion of his clients. He said it's likely because people know each other better in smaller firms, and feel more responsibility for each other's health.
