Case Law Update: Burden Of Proof In Workers’ Compensation Claims Involving Stroke Or Heart Attack

Earlier this year, the Georgia Court of Appeals issued a decision in a workers’ compensation case where the employee alleged a work-related stroke.  Save-A-Lot Food Stores v. Amos, 331 Ga. App. 517, 771 S.E.2d 192 (2015). Workers’ compensation claims typically do not require evidence of causation.  However, in cases involving heart disease, heart attack, failure or occlusion of coronary blood vessels, stroke, or thrombosis, O.C.G.A. § 34-9-1(4) requires competent and credible medical evidence that the condition was “attributable to the performance of the usual work of employment.”

In this case, while unloading pallets of meat, Amos became dizzy and flushed.  He took a short break and then continued working, but he found himself miscounting items, losing his balance, and becoming confused.  He had a severe headache, water was dripping from his right eye, and the left side of his body felt weak.  Amos was admitted to the hospital for three days.  His family doctor signed a medical narrative stating that Amos had suffered a stroke and that job-related stress was a contributing factor.  The doctor also identified Amos’ tobacco use, uncontrolled diabetes, hypoadenia, inactivity, and family history as other possible factors.

Two neurologists reviewed Amos’ magnetic resonance imaging (MRI) studies and medical records and found no objective evidence that Amos had suffered a stroke.  One of the neurologists further testified that it is not clear whether stress is even a true contributing factor for strokes.

The case went before an Administrative Law Judge (ALJ) with Amos asserting that he was completely disabled as a result of a work-related stroke.  The ALJ found that Amos had not shown he suffered a stroke, and that even if he had, the he had not shown that the stroke was caused by work stress.  The ALJ denied Amos’ request for benefits.

Amos then appealed to the State Board’s Appellate Division, alleging the ALJ unfairly held him to a heightened standard of proof.  Amos pointed to a portion of the ALJ’s order, which stated in part, “Employee is required to meet a higher standard of proof to establish that his alleged stroke is compensable.”  The Appellate Division affirmed the ALJ’s decision, finding that the preponderance of competent and credible evidence showed that Amos did not suffer a stroke.  The appellate division also ruled that to the extent the ALJ referenced a “higher standard of proof”, he erred.  That language in the ALJ’s findings of fact was stricken, but the ALJ’s decision was affirmed.

Amos appealed next to a Superior Court, which found that the ALJ’s “higher standard of proof” language was erroneous and that the appellate decision failed to correct it.  The Superior Court reversed and remanded the case to the State Board with instructions to conduct a new trial.  Save-A-Lot appealed, and the Court of Appeals reversed the Superior Court’s ruling.  The Court of Appeals held that the ALJ’s reference to a higher standard of proof was “merely a way of expressing the additional evidentiary requirement of medical evidence in such cases.”

There are a couple of lessons to be learned from this decision.

First, the Court of Appeals gives substantial deference to the State Board’s findings of fact (and expects Superior Courts to do the same).  “Because the appellate division’s decision did not apply the wrong standard of proof and because there was evidence in the record to support the appellate division’s ruling…, the superior court was required to accept the appellate division’s findings.”  Amos, 331 Ga. App. at 521. As the Court of Appels has noted in other cases, with idiopathic claims, where the condition or injury arises suddenly and the precise cause is unclear, the State Board as the fact-finding body “remain[s] the final arbiter of… whether the claimant’s disability arose out of the employment…”  See St. Josephs’ Hospital v. Ward, 300 Ga. App. 845, 686 S.E.2d 443 (2009).

Second, a thorough investigation of the claimant’s medical history is essential, particularly in cases of stroke or heart attack.  Unlike in other types of workers’ compensation claims, a history of other non-work-related risk factors can create a strong defense for the employer. Specifically, evidence of diabetes (particularly uncontrolled), smoking or tobacco use, drug use, obesity, hypertension, high cholesterol, sleep apnea, thyroid conditions, anemia, poor diet, stress, family history, gender, race, and age have all been recognized as risk factors in heart attacks and strokes.  Extreme temperature variations, physical exertion, exposure to toxic substances, and/or consumption of excessive amounts of caffeine or energy drinks may also play a role.  Investigations should include gathering medical records as well as employment applications, employment physicals or screenings, and interviewing the claimant’s supervisor(s) and co-worker(s).

Third, in stroke or heart attack claims, a strong IME opinion (supported by thorough information on the claimant’s medical history and facts surrounding the onset and progression of complaints) can make or break your defense.  In the Amos case, the ALJ and State Board found the most persuasive opinion to be that of the employer’s stroke expert, a neurologist and professor at Emory School of Medicine, who explained that medical records, MRI, and CT scan showed no evidence of a stroke.  He further testified that it was not clear whether stress was a real factor for stroke, but Amos had most of the other known significant risk factors for stroke, such as diabetes, family history, and smoking.