Conditions for Entitlement – Cardiac Injuries and Disease Policy 21-150 | Effective Date: January 23, 2017

Purpose

The purpose of this policy is to further define the criteria used to adjudicate cases involving cardiac injuries and diseases.

Scope

This policy applies to all claims for compensation involving cardiac injuries and diseases under the Workers’ Compensation Act (WC Act).

For information on cardiac injuries and diseases of firefighters or former firefighters, please see Policy 21-116 Firefighters’ Compensation Act.

Statements

1.0 General Statements

Section 7 of the WC Act outlines the process for adjudicating claims for personal injury or death caused by accident arising out of and in the course of employment. All claims, including claims for cardiac injuries and diseases, are adjudicated using Policy 21-100 Conditions for Entitlement – General Principles.

This policy outlines WorkSafeNB’s process of weighing evidence in claims for cardiac injuries and diseases when evidence to the contrary exists.

2.0 Information Related to the Accident Arising Out of and In the Course of Employment

WorkSafeNB gathers information related to the tests of time, place and activity to determine if an accident ‘arose out of and in the course of employment’. The accident must be shown to have:

• Occurred at a time that is consistent with the worker’s hours of employment;
• Occurred on the employer’s premises; and
• Been caused by an employer sanctioned work-related activity.

For more information, see Policy 21-100 Conditions for Entitlement – General Principles and Policy 21-104 Conditions for Entitlement – Tests of Time, Place and Activity.

2.1 Medical Evidence

Medical evidence plays a key role in determining if the cause of the injury is compatible with the work-related accident. In other words, could the nature of the accident described have caused that particular cardiac injury or disease?

WorkSafeNB relies upon medical opinions, the worker’s medical history, and medical or scientific literature to determine if, in its opinion, the work-related activity or exposure was sufficient to have caused the cardiac injury or disease.

3.0 Adjudicating the Claim

For a claim to be compensable, information must show that the accident, that caused a cardiac injury or disease, arose both out of and in the course of employment. The WC Act requires WorkSafeNB to make a determination of this in one of three ways:

• When evidence is complete and supports that the accident, that caused a cardiac injury or disease arose both out of and in the course of employment;
• When evidence shows that the accident, that caused a cardiac injury or disease either arose out of the employment or in the course of employment and there is no evidence to the contrary; or
• When there is evidence to the contrary but the preponderance of evidence supports the claim being compensable.

3.1 Evidence that the Accident Arose Out Of and In the Course Of Employment

When all the evidence shows that the accident arose out of and in the course of employment and there is no evidence to the contrary, WorkSafeNB accepts the claim as being compensable.

3.2 Presumption

The WC Act also has a presumption clause, which means if an accident, that caused a cardiac injury or disease, occurred at work, WorkSafeNB presumes it was caused by work unless there is any evidence to the contrary. Similarly, if evidence shows that an accident, that caused a cardiac injury or disease, was caused by work, WorkSafeNB presumes that it occurred at work unless there is any evidence to the contrary.

3.3 Preponderance of Evidence

When gathering claim information, WorkSafeNB may find evidence that is inconsistent with the presumption that the accident may not have arisen ‘out of’ or ‘in the course of’ the employment. This is called ‘evidence to the contrary’ and may include:

• Incompatibility between the event described and the cardiac injury or disease;
• An alternate cause of the cardiac injury or disease;
• Exposure to cardiotoxic agents outside of the employment;
• Evidence that the event described did not occur in, on, or at a location which is consistent with the place of employment or the employer’s premises; and
• Evidence that the event described occurred while travelling to and from work.
• If any evidence to the contrary exists, WorkSafeNB:
• Gathers all available evidence with respect to the cause of the cardiac injury or disease, including medical or scientific literature and opinions;
• Weighs the evidence; and
• Determines the cause of the injury or disease on a preponderance of the evidence, which may include factors such as:
• Age;
• Gender;
• Family history;
• Physical inactivity;
• High blood pressure;
• High cholesterol;
• Obesity;
• Diabetes;
• High triglycerides;
• Smoking;
• Medical tests indicative of previous heart problems;
• A previous cardiac event; and
• Specific viral exposures.

When there is evidence to contradict that the accident, that caused the cardiac injury or disease, did not arise either ‘out of’ or ‘in the course of’ the employment, WorkSafeNB makes a decision by weighing the evidence on the preponderance.

The preponderance of evidence is the most persuasive and impressive evidence on one side of a case, which outweighs the evidence on the other side. A preponderance of evidence is not measured on the quantity of information, but on the significance and strength of the evidence.

When the preponderance of evidence weighs more heavily towards the accident, that caused the cardiac injury or disease, being work-related, WorkSafeNB accepts the claim.

For more information on gathering and weighing evidence, see Policy 21-113 Decision-making.