Analysis of Experience in Workmen's Compensation for Heart Cases
Factors Influencing the Decision re Compensability in Heart Attacks Occurring among Industrial Workers
In this study of industrial insurance experience in cardiac cases in the State of Washington, particular attention was given to the consistency of medical opinion regarding causal relation of effort to heart attack and to the role of physicians in arriving at decisions as to such causal relationship. Four hundred thirty-one cardiac claims (53% of the total claims) submitted to the Washington State Department of Labor and Industries between 1950 and 1958 were reviewed. Twenty-one and three-tenths per cent of the claimants had documented prior heart disease. Only 6.6% had previous accepted claims for heart disease. At least 78% of all claimants whose records were studied had coronary heart disease and of the deaths, 97.8% were due to manifestations of atherosclerosis. Cardiac trauma was a rarity, occurring in 0.6% of the total and was nonfatal in all cases.
In the opinion of the authors causal relationship to the work being performed was present in 71% of the "death" cases in which compensation was allowed; conversely, it was demonstrable in only 31% of the cases of living claimants in which compensation was granted.
After the introduction of criteria for causal relationship by the Washington State Heart Association and internist panels, the following changes occurred: (1) The consistency of the assessment of causal relationship to accepted medical opinion improved, for (a) rejection of claims, where causal relationship to work existed, were fewer, and (b) the acceptance of claims where causal relationship was lacking, decreased. (2) The incidence of appeals decreased. Thus, criteria for guidance of physicians in the determination of causal relationship appear to be valuable, and determination of causal relationship and rating of disability may be better performed by a person other than the patient's attending physician.
- © 1966 American Heart Association, Inc.