Policy
The WSIB accepts claims as work related when:
- a causal relationship is shown between the cardiac condition and an accident at work, or
- the cardiac condition is established as a disablement "arising out of and in the course of employment."
Guidelines
The WSIB accepts entitlement for cardiac conditions under any of the following circumstances:
- traumatic injury, either penetrating or non-penetrating injuries to the chest wall
- electric shock producing irregular cardiac rhythm
- inhalation of smoke and various noxious gases and fumes, e.g., fire fighters, and
- complication of treatment for a work-related injury, e.g., anaesthesia with an interval of hypotension, hypoxia or cardiac arrest.
NOTE
When entitlement is established under the above points for a cardiac condition, there will be no limitation of ongoing entitlement as long as the subsequent condition is related to the work-related cardiac condition,
or
-
unusual physical exertion for the individual and/or acute emotional stress with no significant delay in the onset of symptoms.
NOTE
This instance is allowed on the basis of aggravation of a pre-existing non-work-related condition. When entitlement is established, the condition has stabilized, and a permanent disability/impairment evaluation has been conducted, further entitlement will not be granted for a subsequent cardiac condition unless there is a new work-related occurrence, which merits allowance under a new claim.
Temporary disability/impairment
In most instances, claims for cardiac conditions are considered on the basis of aggravation of a pre-existing condition, usually arteriosclerotic heart disease.
When a claim is accepted under this category for a heart condition, entitlement includes full benefits for wage loss and health care.
Permanent disability/impairment
Permanent disability/impairment awards are granted in cardiac claims when permanent disability/impairment results from the injury.
The decision-maker obtains a WSIB medical consultant's opinion on the suitability of permanent disability/impairment evaluation, based on the work-related condition. The consultant may then arrange an assessment, including stress testing, for details on the worker's limitations, with an outside cardiologist.
When the test results are received, a further opinion is obtained from the WSIB medical consultant. If the condition is then considered suitable for a permanent disability/impairment assessment, an examination is conducted. The American Medical Association Classification of Cardiovascular Impairment may be used as a guide.
The decision-maker makes a determination using the assessment results, interviews the worker, processes the award where applicable, and confirms the details by letter.
Indisputable rating
Where the worker is 100% permanently totally disabled/impaired and unfit for evaluation, an "Indisputable Rating" may be required based on review of all health care information.
Traumatic cardiac conditions
In the case of traumatic cardiac conditions, e.g.,
- cardiac tamponade, defined as compression of the heart by pericardial fluid
- cardiac contusion
- valvular damage, or
- effects of the passage of an electrical current,
the appropriate award for permanent disability/impairment, determined by the decision-maker, is granted to the worker. There is no limitation of ongoing entitlement in the claim, relative to the compensable cardiac condition.
Aggravation of pre-existing conditions
Certain limitations apply when determining the permanent disability/impairment award in claims where allowance has been made on the basis of aggravation of a pre-existing non-work-related condition (see 14-05-03, Second Injury and Enhancement Fund).
Where a pre-existing disability is considered "major" or "moderate", the amount of the permanent disability/impairment award may be reduced.
Subsequent to a permanent disability/impairment assessment, ongoing health care treatment is not within entitlement if the need for treatment arises from an underlying vascular disease, which pre-existed the accident. Exceptions are those cases where various surgical procedures, e.g., coronary artery bypass, may be implemented in the acute phase of the disability/impairment. Ongoing entitlement may be extended on the advice of the WSIB's medical consultant.
Fatal claims
If death occurs immediately, e.g.,
- as the result of the compensable cardiac condition, shortly after the initial onset, or
- while the condition is still in the acute phase,
the fatal claim may be accepted and full death benefits may be paid.
If death occurs as the result of a new or progressive cardiac condition, the fatal claim is not accepted unless there is a new occurrence, at work, which merits allowance under a new claim.
Application date
This policy applies to all decisions made on or after June 1, 1989, for all accidents.
Document History
This document replaces 03-02-09 dated August 9, 1991.
References
Legislative Authority
Workplace Safety and Insurance Act, 1997, as amended
Sections 2(1), 13(1), 48
Workers' Compensation Act, R.S.O. 1990, as amended
Sections 1(1), 4(1), 35
Minute
Board of Directors
#8(XL), June 10, 2004, Page 6622