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Did strenuous work cause employee’s at-work, fatal heart attack?

Heart attacks can be covered by workers’ compensation insurance depending on the circumstances. Witness and expert medical testimony swayed the court in this case. 

Martan Kelly Jr. was a technician for Card Heating & Air Conditioning in Pennsylvania. One morning, he reported to work at a funeral home where the company was installing heating and air conditioning equipment. He told his foreman that he felt weak, tired and had a kink in his neck from sleeping poorly the night before. Kelly declined an offer to go home and was given a light-duty assignment of running thermostat wire.

Feeling better around noon, Kelly decided to run wire in the attic of the one-story building by climbing a 12-15 foot ladder. A short time later, employees heard moaning coming from the attic and found Kelly lying incoherent on the floor, bleeding from his head, face and leg.

Kelly was pronounced dead at a local hospital a short time later.

An autopsy revealed coronary artery and heart disease, three heart arteries significantly blocked (60-90%), and 90% stenosis of the left main descending coronary artery. The cause of death was a heart attack.

Kelly’s widow filed a workers’ compensation claim for survivors’ benefits, claiming his heart attack occurred as a result of his employment. Card denied the claim, and the case went before a workers’ comp judge (WCJ).

Kelly’s widow testified he didn’t have any health problems, didn’t complain about chest pain, never saw a heart doctor and wasn’t on any medications. She acknowledged her husband smoked a pack of cigarettes a day for the last 30 years.

Card’s foreman also testified about how Kelly said he felt when he arrived for work the day he died. The foreman said he would not consider running wire to be physical labor, rather it was light duty work. A Card supervisor agreed running wire was a “pretty low strenuous job.”

A board-certified cardiologist testified for Kelly’s widow that Kelly’s heart attack occurred because he exerted himself by climbing the ladder that could have led to a plaque rupture and his heart attack. The doctor also said it was likely Kelly fell because of his bleeding when found by co-workers. A fall also could have caused a plaque rupture. The doctor acknowledged he couldn’t be certain when the plaque ruptured and that Kelly had other risk factors, including smoking, a family history of coronary artery disease (his mother died of it at age 59) and untreated high cholesterol.

When he was cross-examined, the doctor said his statement that Kelly “likely fell and hit his head” “should probably be changed to ‘potentially.'”

Card also had a doctor board certified in cardiovascular disease testify. The company’s doctor didn’t believe Kelly’s heart attack was work-related. The company’s doctor said Kelly’s pre-existing coronary artery disease put him at a high risk for a sudden cardiac death. Since three of his arteries were so severely blocked, he was an imminent risk for a heart attack whether he was working or not.

The company doctor also said Kelly had been suffering from insufficient blood flow to the heart for 8 to 12 hours before coming to work. The doctor noted Kelly slept in a recliner chair the previous night because he wasn’t able to lie flat in bed due to his cardiac symptoms. The doctor also said Kelly’s duties the day he died were insufficient to cause the heart attack. Climbing the ladder wouldn’t have elevated Kelly’s heart rate enough to cause a cardiac event unless he had done it quickly or repeatedly and for more than nine minutes.

The WCJ ruled in favor of the company. The judge found the company doctor’s testimony to be more credible and agreed with the foreman that the work Kelly was doing wasn’t strenuous. The judge also noted Kelly’s pre-existing blockages that put him at risk of an imminent heart attack with or without physical exertion.

Kelly’s widow appealed, and the Pennsylvania Workers’ Compensation Appeal Board affirmed the WCJ’s ruling. She took her case to a state court

Not enough proof it was work-related

The burden is on the claimant (in this case Kelly’s widow) to show that a fatal heart attack is work-related. Specifically the claimant must show the heart attack:

  • arose in the course of employment, and
  • was related to employment.

Kelly’s heart attack happened at work, so there’s no question it arose in the course of employment. The question is whether it was related to employment.

If a worker’s sudden cardiac death isn’t obviously caused by work, a connection must be established by “unequivocal medical testimony.”

Kelly’s widow argued the Board erred because there wasn’t proof he was having symptoms 8 to 12 hours before the heart attack as the company doctor said.

But the court said that didn’t matter. “Even if we accept Claimant’s (Kelly’s widow’s) position, which we do not, Claimant would still not have sustained her burden of showing that the heart attack was work-related,” the court wrote.

The court found no fault of the Board for deciding that laying wire and climbing a ladder wasn’t strenuous work. “Taken together with how the cardiac event unfolded, [the company doctor’s] conclusion that the cardiac event began the previous night was a permissible inference,” the court said.

Kelly’s widow would not receive workers’ comp survivor benefits for her husband’s at-work heart attack.

(Lisa Kelly v. Card Heating & Air Conditioning, Commonwealth Court of PA, No. 355 C.D. 2017, 8/16/17)

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