By: Ryan Lawson, Associate, Atlanta

Over the last few months, I have had the pleasure of handling a few unique cases involving cardiac pathology, including one heart attack case victory in December, and another rather complicated claim involving a cardiac-related death which is still in the discovery phase of litigation. In handling these cases – especially preparing for trial in the former – I have had the opportunity to revisit some of the interesting distinctions and caveats that arise when handling a cardiac-related case in Georgia.  While cardiac cases are very factually sensitive and need to be approached on an individual basis, this article is designed to provide a brief overview of how Georgia looks at injuries involving cardiac pathology, and what to look for when making a decision on compensability.

To begin, for any case to be compensable in Georgia, the claimant must prove by a preponderance of the competent and credible evidence, that he or she sustained an accident or injury arising out of and in the course of the claimant’s employment. However, when the accident or injury involves cardiac pathology, this burden is considerably heightened by way of O.C.G.A. § 34-9-1(4), holding, in part:

… nor shall injury and personal injury include heart disease, heart attack, the failure or occlusion of any of the coronary blood vessels, stroke, or thrombosis, unless it is shown by a preponderance of the competent and credible evidence, which shall include medical evidence (emphasis added), that any such conditions were attributable to the performance of the usual work of employment. Id.

Effectively, the statute excludes heart related conditions from the scope of the Georgia Workers’ Compensation Act unless there is medical evidence relating the claimant’s work with the alleged cardiac injury. However, it is important to note that a claimant cannot meet this heightened burden of proof by simply putting on medical evidence suggesting that his or her job duties contributed to the heart-condition. Rather, Georgia Law requires that the claimant present medical evidence directly linking the claimant’s work duties to the resulting cardiac condition.  This requirement is made very clear in the case of Aflac Inc. v. Hardy, 250 Ga. App. 570, (July 13, 2001), which is briefly presented below:

Hardy worked for AFLAC as an invoice specialist. At trial, Hardy testified that she had difficulty with her job because “you were continually pushed to get things done quickly but accurately and there was no way you could do it quickly and accurately.” On April 27, 1998, Hardy reported to work.  Approximately two hours later, she began feeling nauseous and dizzy, and she experienced chest pain. Hardy was taken to a local hospital, where doctors discovered that she had suffered a heart attack. After being released from the hospital, Hardy was seen by Dr. Schwindt, who concluded that Hardy had “premature coronary artery disease.” Hardy filed a notice of claim with the State Board, asserting that she was entitled to income and medical benefits as a result of her heart attack. At trial, the Employer tendered the report of Dr. Charles Wickliffe, who concluded that Hardy’s coronary disease had caused her heart attack, but that “there is no evidence to support a conclusion that Hardy’s coronary artery disease was in any way related to her employment at AFLAC.” Hardy, on the other hand, tendered a report from Dr. Patricia Gruczak, who wrote that Hardy’s “stressful work environment cannot be clearly implicated; although, I must say it can play a role in exacerbating symptoms.”

The Court in Hardy held:

In order to prevail, Hardy must provide some medical evidence that her work contributed either to her underlying coronary artery disease or to her April 1997 heart attack. Here, Dr. Gruczak’s report clearly states that a stressful job such as Hardy’s “can play a role in exacerbating symptoms.” Such evidence does not meet Hardy’s burden of proof. Dr. Gruczak does not state in her report that Hardy’s job did exacerbate her symptoms, but merely that work stress “can” do so. Such an equivocal statement merely raises the possibility that stress was a factor, which generally is insufficient to sustain a party’s burden of proof…As the record is devoid of any medical evidence that Hardy’s job contributed to her underlying heart disease or to her heart attack, Hardy failed to carry her burden of proving entitlement to workers’ compensation benefits. (Emphasis added).

The Hardy case presents an excellent example of the heightened burden of proof faced by a claimant when attempting to obtain benefits related to a coronary event, as well as a good reminder that medical evidence alone does not carry the claimant’s burden if the evidence does not speak to the specific requirements of Georgia Law.  Putting this into practice, when making a compensability decision in relation to a cardiac claim, remember two things: First, the claimant must meet a very challenging burden of proof in order to successfully obtain benefits under the Law; and Second, medical evidence will be the most important factor in the court’s determination of compensability.  Therefore, it is very important to establish, from the beginning of the case, a litigation strategy and plan that focuses on winning the battle of medical opinions and experts, and ensuring that your expert opinion(s) speak directly to the very specific causation element required by Georgia Law.

Making the right decisions at the beginning of a case can have a tremendous impact on reducing overall claim exposure and obtaining the best possible result for the employer and insurer. To this regard, if you have any questions regarding how to handle a cardiac-related claim, or would like more information on how to navigate the challenges of a cardiac case, please feel free to contact me with the specifics of your claim.