Claims Adjudication Tune-Up (CAT-U)
February 2025 Edition
Welcome to Self-Insurance’s (SI) Claims Adjudication Tune-Up (CAT-U) newsletter. This is where the Washington State Department of Labor & Industries (L&I) shares best practices and information, as well as highlight opportunities for improvement. The focus of this month’s CAT-U is heart claims.
Legal Corner
Case Law – Windust v. Dept. L&I (1958)
Background: Mr. Windust collapsed and died as he stepped up about two feet to look into the drum of his concrete truck to determine the amount of the remaining concrete, as part of his normal job duties. His death was due to a myocardial infarction (heart attack). Windust’s widow filed a claim for survivor benefits, which was rejected by the department because there was no injury within the statutory definition (RCW 51.08.100).
With this case, the court held that the routine job duties at work could not cause a heart attack that would be an industrial injury.
Claim impact: A claim can only be allowed when the heart attack resulted from unusual physical exertion not ordinarily required of the worker in the performance of his or her job duties. The exertion must be unusually strenuous in contrast to normal work activity.
Note: Injury heart claims has since been added for emotional stress, strain or exertion and presumption for certain occupations including firefighters, emergency medical technicians, fire investigators and law enforcement officers.
Revised Code of Washington (RCW) 51.32.185(1)(a) and (1)(c)
...there exist[s] a prima facie presumption that... any heart problems, experienced
within seventy-two hours of exposure to smoke, fumes, or toxic substances, or
experienced within twenty-four hours of strenuous physical exertion due to
firefighting activities... (for firefighters) or ...in the line of duty... (for law enforcement
officers) ...are occupational diseases...
Take away: Heart problems are allowable for occupational diseases for firefighters, law enforcement officers, EMTs and fire investigators. State law defines these covered occupations and criteria under the presumption in more detail.
News You Can Use
Symptoms and testing for heart attacks:
Symptoms can vary between men and women. Most common symptom experienced is chest pain or discomfort. Other symptoms such as nausea, vomiting, shortness of breath, pain/discomfort in the arm can vary by person and in severity.
Diagnostic imaging and blood tests can help providers with diagnosing heart attacks. Electrical testing such as an Echocardiogram (EKG or ECG) can diagnose a heart attack, but only while it's happening. Abnormalities in the electrical activity can identify the areas of heart muscle that are deprived of oxygen and/or areas of muscle that have died.
Blood testing for markers caused by the cardiac event (troponins) can find evidence of a heart attack for as long as two weeks after the event happened.
Other diagnostic and blood tests may include but are not limited to myoglobin test, CK-MB test, cardiac catheterization and coronary angiography.
Trainer's Trivia
February
How many heart attacks occur in the U.S. every year?
(See next month's edition for the answer, and a little science!)
January
Question: What year did the Self-Insurance program get started?
Answer: Washington employers were allowed to self-insure in 1971. That was the same year that Intel released the first microprocessor, the 26th Amendment lowered the voting age from 21 to 18, and Starbucks was founded.
More Reading and Resources
RCW 41.26.030(17)(a)(b)(c)(h) and (19)(b)(c)(e) "Definitions" for firefighters and law enforcement officers
Self-Insurance Claim Adjudication Guidelines, Validity Chapter covers cardiovascular injuries and heart problems as occupational diseases in Firefighters, EMTs, Fire Investigators and Law Enforcement Officers.
Reminders/tips from the SI teams
Cardiovascular injuries may cause workers to feel that they are having to confront their mortality and adds an additional layer of stress and worry. Behavioral Health Intervention (BHI) can be a key to helping a worker's early stages of recovery. It may be necessary to authorize a mental health evaluation if treatment is needed beyond BHI.
For more information, email: SITrainerQuestions@Lni.wa.gov
|
