ND High Court Stresses That Heart Attacks Only Compensable When Caused by Unusual Stress
Construing the state’s special statute limiting the compensability of heart attacks, stroke, and physical injury caused by mental stimulus, a divided Supreme Court of North Dakota reversed an ALJ’s decision that had found a deceased employee’s widow was entitled to death benefits following her husband’s fatal heart attack in spite of her failure to show that unusual stress was at least 50 percent of the cause her husband’s fatal attack [State v. Felan, 2021 ND 97, 2021 N.D. LEXIS 102 (June 3, 2021)]. The majority concluded that, contrary to the ALJ’s reading of the statute, there was no alternative means of showing the compensability of a heart attack. The statute required a showing that unusual stress was the dominant cause of the attack.
Background
Felan was injured when the truck that he was driving tipped onto its side. After he was driven to a hospital, he complained of left chest and rib pain. X-rays taken at the hospital did not reveal any fractures. Hydrocodone was prescribed for pain as well as a rib belt for comfort. During breakfast the following day, a co-employee noted that Felan was falling asleep during the mean and expressed concern that Felan should return to the hospital to get checked again. Felan declined, responded that he was fine, and informed the co-employee that he had taken five hydrocodone. When the co-employee expressed concern about the amount of hydrocodone Felan had taken, Felan responded that he was a big man, that he had taken that many before, and declined to return to the hospital.
The next day—two days after the accident—Felan was discovered dead in the hotel room where he had been staying. Workplace Safety and Insurance (WSI) reported the death, but stated it was not believed to be due to the work injury because Felan had multiple health problems including some related to his heart and diabetes. The autopsy confirmed Felan died of congestive cardiomyopathy and arteriosclerotic heart disease.
Felan’s wife filed a claim for death benefits. WSI issued its administrative order denying the claim and Felan’s wife sought an administrative hearing. An ALJ found Felan’s death compensable and WSI appealed.
The Heart Attack Statute—Unusual Stress
The majority of the appellate court noted that under N.D.C.C. § 65-01-02(11)(a)(3), compensable injuries include:
Injuries due to heart attack or other heart-related disease, stroke, and physical injury caused by mental stimulus, but only when caused by the employee’s employment with reasonable medical certainty, and only when it is determined with reasonable medical certainty that unusual stress is at least fifty percent of the cause of the injury or disease as compared with all other contributing causes combined. Unusual stress means stress greater than the highest level of stress normally experienced or anticipated in that position or line of work.
The majority said that here, the ALJ improperly applied N.D.C.C. § 65-01-02(11)(a)(3). The statute makes clear that to prove a compensable heart injury or disease, it is insufficient to look only at the event claimed to have caused the condition. Instead, the statute requires that the claimant prove at least 50 percent of the cause of the injury or disease was unusual stress through their employment.
The majority stressed that the words “only when” in N.D.C.C. § 65-01-02(11)(a)(3) required that a claim for heart-related disease or injury be proven in one manner, and one manner only. The majority indicated the ALJ had made no finding as to unusual stress as required by the statute and had instead improperly applied N.D.C.C. § 65-01-02(11)(a)(3). The ALJ’s conclusion Felan’s widow was allowed to prove Felan’s death was compensable by other means expanded the statute in a way the legislature did not intend.
Objective Medical Findings
The majority also addressed another issue that it said would likely be contested following the remand of the case. WSI had argued that the ALJ erred in the interpretation of what constitutes medical evidence supported by objective medical findings. WSI asserted the requirement specifically applies to the burden placed on the injured worker or beneficiary to prove a compensable injury.
The majority of the court said N.D.C.C. § 65-01-02(11) requires an injury “be established by medical evidence supported by objective medical findings.” The majority added that objective medical evidence may include a physician’s medical opinion based on an examination, a patient’s medical history, and the physician’s education and experience. WSI argued the ALJ erred by failing to require medical evidence supported by objective medical findings of both an injury and that the injury was caused by unusual stress.
The majority clarified the issue, noting that N.D.C.C. § 65-01-02(11) only required objective medical evidence to establish that an injury occurred. In contrast, N.D.C.C. § 65-01-02(11)(a)(3) required causation be established with reasonable medical certainty. Here, said the majority, the ALJ was provided with no objective medical evidence of the claimed injury. The widow’s medical expert testified that Felan died of a cardiac arrhythmia caused by blunt force trauma to Felan’s chest cavity. However, the doctor admitted there was no objective medical evidence that an arrhythmia occurred. Rather, the conclusion the doctor reached was a result of deductive reasoning. According to the majority, objective medical evidence may be established by a physician’s medical opinion based on an examination, a patient’s medical history, and the physician’s education and experience. However, objective medical evidence may not be established solely by deductive reasoning. On this record, the majority said the ALJ erred in concluding there was objective medical evidence of a cardiac arrhythmia.