UNDERSTANDING THE “HEART” PRESUMPTION
Public safety officers are entitled to the ‘Heart Trouble’ presumption. If an officer develops or manifests ‘heart trouble’ during their employment, the ‘heart trouble’ is presumed to have been caused by work. The presumption also extends for up to five years after the last day worked. This presumption has not stopped employers from denying claims and litigating the issue of whether or not it is work related. The two most common attacks on the heart presumption is whether the officer has actual “heart trouble” and whether the ‘heart trouble’ was caused by non-industrial factors congenital heart defect.
The heart presumption is set forth in Labor Code section 3212. Section 3212 creates a rebuttable presumption of industrial causation in favor officers. This provision states that an injury to the heart that develops or manifests itself during employment is presumed to be industrial, unless controverted by other evidence. The terms “develop” and “manifesting” under the presumption has been interpreted to mean that the condition progressed or first presented (“diagnosis by physician”) during employment. Thus, as long as the employee has some form ‘heart trouble’ that developed or manifested during employment, the employee has met his or her burden and the employer must rebut the presumption.
However, such rebuttal cannot be “attributed to any disease existing prior to such development or manifestation.” Section 3212 further states: “The ‘heart trouble’ so developing or manifesting itself in such cases shall in no case be attributed to any disease existing prior to such development or manifestation.”
In Muznik v. WCAB (1975), the court broadly construed the meaning of the term “heart trouble” to encompass “any affliction to, or additional exertion of, the heart caused directly to that organ or the system to which it belongs, or to it through interaction with other afflicted areas of the body.” Hypertension, as a stand-alone issue does not qualify as ‘heart trouble’. However, in the vast majority of cases, an officer on medications for hypertension will have some form of legal ‘heart trouble’ and would fall under the presumption
To rebut the presumption of industrial causation, the employer must show through substantial medical evidence that some contemporaneous non-work-related event was the “sole cause” of the heart trouble. If they cannot show that, the appeals board is bound to find in accordance with the presumption.
Demonstrating how complex the litigation can become regarding ‘heart trouble’, the WCAB reversed a trial court’s denial of benefits in the case of Kennedy v. City of Oakland (2012). In the Kennedy case, the injured officer was a fire fighter who sustained an injury to his heart, circulatory system and cerebrovascular system caused by a stroke. The stroke was caused by a congenital heart anomaly. Importantly, the officer had no prior history of heart disease. The evaluating physician determined the heart condition and resulting stroke was caused by a congenital heart defect and thus the heart presumption was rebutted. The trial court agreed and found against the injured officer stating the heart presumption was rebutted due to the congenital heart defect. On appeal, the WCAB reversed and stated while the evidence establishes that the sole cause of the injury was the pre-existing congenital condition, the anti-attribution clause of Labor Code section 3212 prevents the Appeals Board from considering whether that condition rebuts the industrial presumption. The WCAB concluded when the anti-attribution clause applies, the ‘heart trouble’ shall not be attributed to any pre-existing disease. In the absence of evidence that some other “contemporaneous non-industrial event” was the cause of his injury, the injured officer is entitled to the presumption of industrial causation.
The heart presumption is continuously under attack by counties and cities. The employers will seek any angle to deny an officer or a dependent the heart presumption. It is imperative that a member seek out professional advice prior to entering the litigation that comes with filing a heart claim.