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."
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.
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,
unusual physical exertion for the individual and/or acute emotional stress with no significant delay in the onset of symptoms.
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.
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 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.
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.
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.
This policy applies to all decisions made on or after June 1, 1989, for all accidents.
This document replaces 03-02-09 dated August 9, 1991.
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
Board of Directors
#8(XL), June 10, 2004, Page 6622