New Blood Pressure Guidelines May Mean More Workers’ Compensation Claims

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By: Michael Arington, Associate, Jacksonville

Employers and defense attorneys can expect more claims for high blood pressure because of new blood pressure guidelines from two leading medical associations. The new requirements mean more people will qualify for diagnoses of hypertension, resulting in more claims from first responders, claimants needing cardiac clearance for surgery, and claimant attorneys arguing hindrance to recovery claims.

The new guidelines were recently published by the American Heart Association and the America College of Cardiology, and subsequently endorsed by every major physicians’ association. After reviewing decades of hypertension cases, the new guidelines concluded hypertension was a serious health problem calling for earlier diagnosis and treatment.

For decades, a diagnosis of hypertension required a blood pressure reading that exceeded 140/90. The new guides lower that threshold. A doctor can assign a diagnosis of hypertension and start treating it when blood pressure exceeds 130/80.

The Center for Disease Control estimates that 75 million adults – one in three – have hypertension. The new guidelines estimate an additional 1.5 million more adults will automatically qualify for diagnoses of hypertension, making them eligible for medications and frequent testing under insurance coverage, including workers’ compensation. The new guides will result in more workers’ compensation claims from at least three groups of employees – first responders (fire, police, and corrections), claimants needing cardiac clearance for surgery, and claimants saying hypertension hinders treatment of their compensable injury.

Claimant attorneys in first responder claims are already arguing the new guidelines as evidence of hypertension to obtain workers’ compensation benefits under the statutory presumption of compensability for heart claim. For the past ten years claimant attorneys filed claims when a first responder went to a doctor and was diagnosed with hypertension, demanding medical treatment and impairment benefits equal to at least 32 weeks at the maximum comp rate. The new guides would lower the threshold for claims by first responders.

The new guides may also lead to more claims for cardiac clearance for surgery. Many doctors send older and sicker claimants to a cardiologist for clearance before performing surgeries with long and difficult procedures or with long recovery times. Under the new guidelines, more doctors will send more claimants more often for cardiac clearance because more patients will have blood pressure readings that qualify as hypertensive.

Claimants who do not get cardiac clearance for surgery can be expected to file claims under Florida’s hindrance to recovery doctrine to make employers treat hypertension until it no longer interferes with effective treatment of the compensable injury. Hindrance to recovery benefits can last for years. Even claimants with hypertension, but not facing surgery, can file claims for treatment of hypertension under the hindrance to recovery doctrine. As long as a physician says hypertension hinders treatment of the compensable injury, or recovery from it, an employer may have to pay for hypertension.

The new guidelines can be found online at the American Heart Association or American College of Cardiologists websites.

Please contact us with any presumption claim questions you may have.