COURT REVIEWS COMPENSABILITY STANDARD FOR HEART ATTACK UNDER WORKER’S COMPENSATION

November 12, 2013

Recently, the Court of Appeals for the First District reviewed a trial court’s order granting summary judgment in favor of an insurer after finding that the worker’s compensation claim failed to meet the statutory standard to recover for a heart attack.  In Poplin v. Amerisure Mutual Insurance Company, No. 01-13-00102-CV (Tex.App.- Houston [1st Dist.] Oct. 31, 2013), the insured had a heart attack while on the job.  He was initially diagnosed by paramedics as suffering from heat exhaustion but the hospital determined he was having a heart attack and shortly after, the insured passed away.  The insurer denied the claim and the administrative process supported their decision.  After suit was filed, the insurer filed a traditional and no evidence motion for summary judgment which was granted by the trial court.  This appeal followed.

On appeal, the court reviewed Texas Labor Code § 408.008 stipulating in part that a heart attack is a compensable injury only if the attack can be identified as occurring at a definite time and place and caused by a specific event in the course and scope of employment.  The statute also requires that “the preponderance of the medical evidence regarding the attack indicates the employee’s work rather than the natural progression of a preexisting heart condition or disease was a substantial contributing factor of the attack.”  The court reviewed the evidence and found that the worker’s estate failed to proffer evidence that “work rather than the natural progression of a pre-existing heart condition or disease was a substantial contributing factor” to the heart attack.  Accordingly, summary judgment in favor of the insurer was affirmed.