By: Ryan Knight, Associate, Miami

It is every adjuster’s worst nightmare, a serious accident followed by the development of an even more serious medical condition. What happens when a claimant is involved in a compensable accident and then suffers a heart attack or stroke? Where is the imaginary compensability line drawn?

The first question you have to answer is whether or not the secondary injury is actually a “subsequent injury” rather than a “resulting disease, condition or manifestation.” Those may seem incredibly similar but differentiating the two will likely determine whether or not the secondary injury is compensable.

If the secondary injury is considered a “subsequent injury,” the claimant will be required to prove that the initial injury was the major contributing cause of the second injury. Fla. Stat. § 440.09(1)(b); Mangold v. Rainforest Golf Sports Center, 675 So.2d 639 (Fla. 1st DCA 1996). This is a much higher and more difficult burden to meet than if the secondary injury is considered a “resulting disease, condition, or manifestation.” In that situation, the claimant is not required to prove that the subsequent disease, condition, or manifestation arose out of the work performed. The claimant is only required to show that the original injury occurred in the course and scope of employment. Claims Management, Inc. v. Drewno, 727 So. 2d 395, 398 (Fla. 1st DCA 1999). Once they clear that hurdle, any subsequent disease, condition, or other manifestation will also be deemed compensable as long as it is directly or proximately linked to the original injury. Determining which of these two categories the claim will fall under largely turns on the medical testimony of each case.

In Mangold, the claimant was injured in the course and scope of his employment when a go-cart struck and pinned his right leg. The Employer repeatedly refused to authorize medical treatment and the claimant suffered emotional and financial stress as a result. Approximately one month after the accident the claimant suffered a fatal heart attack. The claimant had long suffered from hypertension, heart disease, high cholesterol and congestive heart failure. Intensive litigation ensued and four different cardiologists testified as to the cause of the heart attack. None of them were able to testify within a reasonable degree of medical certainty which factor was the major contributing cause of the heart attack and resulting death. The JCC and First DCA ultimately denied compensability and determined that the claimant failed to meet his burden of proving that the workplace accident was the MCC of the subsequent heart attack as opposed to his pre-existing conditions.

Compare that with the case of Petit v. Ben F. Walker Framing Co., 176 So.2d 897 (Fla. 1965). There, the claimant suffered heat stroke in the course and scope of his employment. The claimant later suffered a major heart attack and sought compensability of that injury as well. Again, this claimant had pre-existing heart disease. However, two different authorized treating physicians opined that the heat stroke either directly caused the subsequent heart attack or sufficiently aggravated the heart disease to the point where the heart attack was inevitable. The Florida Supreme Court determined that the heart attack was the direct result of the heat stroke and ruled that both injuries were compensable.

Certain types of injuries, such as psychiatric conditions, will typically fall under the “resulting disease, condition or manifestation” because psychiatric conditions aptly fall under the “manifestation” category rather than a separate and distinct injury. Drewno, 727 So.2d at 399. Injuries such as heart attacks and strokes, however, can fall under either category. When determining which category your case falls in and whether to take these types of cases to final hearing, you need to carefully consider the nature and extent of the claimant’s pre-existing conditions along with the strength of your medical testimony.