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Strokes, Heart Attacks, and Workers’ Compensation – Part One

Many jobs involve heavy manual labor. Many jobs involve a great amount of stress. These jobs can cause an employee to suffer a stroke. Workers who are overweight, have heart disease, high blood pressure, or have diabetes are especially prone to suffering work-related strokes. If you are an employee and you suffer a stroke or heart attack at work, depending on the circumstances, you or your dependents may have a valid claim for workers’ compensation. With prompt treatment, many stroke victims can recover most of their bodily functions. When treatment is delayed, workers may suffer paralysis, cognitive disabilities, and many other injuries. As we unfortunately know, some strokes and heart attacks are fatal.

What causes strokes or heart attacks in the workplace?

Some of the causes of strokes at work include stress, long hours, working outdoors in extremely hot or cold conditions, demanding tasks, and poor management. Poor diet, a lack of physical activity, excess with, and alcohol may also contribute to a stroke while working.

The difference between a heart attack and stroke? A stroke involves blockage of blood flow to the brain. A heart attack involves blockage of blood flow to the heart.

Unfortunately, particularly in Virginia, unless you are a first responder such as a Firefighter, Police Officer, ABC Officer, Conservation Officer, Airport Authority Police Officer, Virginia Port Authority Police Officer, Campus Police Officer at a public College, or voluntary EMT, you (or your dependents if you do not survive) will likely have an uphill climb to prove that your stroke or heart attack came from work conditions.

This is because those occupations are subject to a special statute, namely VA Code 65.2-402, which provides a presumption that anyone who has hypertension or heart disease which causes either death or disability of those persons is presumed to have an occupational disease, suffered in the line of duty.

For everyone else not in those occupations, in Virginia, you must first prove two things to show an injury by accident:

  • The first is that the injury occurred during the course of employment. That means that the heart attack or stroke occurred while you were performing your job.
  • But the second part of that is that the injury arose out of employment. This is different. It means that the specific conditions that caused the heart attack or stroke were due to the conditions under which you were required to work.

For instance, if you are simply sitting at your desk at your place of employment and suffer a heart attack or stroke, that is not going to be a compensable injury.

On the other hand, if you are engaged in some kind of strenuous activity specific to your job during an identifiable period of short time, such as lifting heavy objects, and you suffer a heart and your doctor states that your heart attack occurred due to the extreme exertion required by your job, that would be compensable.

But if you are not a first responder, and your heart attack or stroke is found to be caused by the cumulative effect of stress or exertion over a long period of time such as weeks, months or years, that is not compensable. This is the same as with all other cumulative injuries in workers compensation, with the exemption of carpal tunnel syndrome: they are not compensable.

Of course, fault of the employer is not a requirement of a workers’ compensation claim in either North Carolina or Virginia.

What are the different types of strokes?

The National Institutes of Health (NIH) defines a stroke as the stoppage or reduction of blood flow to the brain or sudden bleeding in the brain. Strokes are classified as:

  • Ischemic strokes. With this type of stroke, the flow of blood to the brain is blocked. This means that brain cells cannot get the oxygen and nutrients they need which can cause the brain cells to die within minutes.
  • Hemorrhagic strokes. With this type of stroke, sudden bleeding in the brain causes pressure and damage to the brain cells.

Another type of stroke is a transient ischemic attack (TIA), also known as a mini-stroke which happens when the flow of blood to the brain is stopped for a short time. The symptoms of a stroke and a TIA are virtually identical. Many workers who have a TIA have a full stroke within a year – if they don’t get treatment.

Nearly 90 percent of strokes are ischemic strokes. Strokes are also classified based on where the blockage or bleeding happens.

Strokes are medical emergencies. Employees who have a stroke need immediate medical care. If there isn’t a doctor on site, the worker should be transported to the nearest hospital emergency room by an ambulance service that can provide life-saving care.

Note that we did not include Heat Stroke in this discussion. That is an entirely different phenomenon, but it may be compensable.

Heart Attacks

Heart attacks may be harder to discover than strokes, because a heart attack may involve chest pain, which can be caused by a variety of sources, whereas a stroke typically results in immediately recognizable neurological symptoms.

There are three main kinds of heart attacks:

  • ST segment elevation myocardial infarction (STEMI)- A STEMI occurs when a coronary artery becomes completely blocked and a large portion of the muscle stops receiving blood. It’s a serious heart attack that can cause significant damage.
  • non-ST segment elevation myocardial infarction (NSTEMI)-this is where the artery is only partially blocked. Unlike STEMI, it may not show up on EKG. While there may be less heart damage, an NSTEMI is still a serious condition.
  • coronary spasm, or unstable angina-According to Healthline, “The symptoms, which can be the same as a STEMI heart attack, may be mistaken for muscle pain, indigestion, and more. It occurs when one of the heart’s arteries tightens so much that blood flow stops or becomes drastically reduced. Only imaging and blood test results can tell your doctor if you’ve had a silent heart attack.”

There is no permanent damage during a coronary artery spasm. While silent heart attacks aren’t as serious, they do increase your risk of another heart attack or one that may be more serious.

The signs and symptoms of strokes include sudden confusion, difficulty speaking and understanding speech, numbness of the face or limbs (often just one side of the body is affected), a severe headache, vision difficulties, dizziness, loss of balance, and difficulty walking.

Medical professionals often use a “FAST” test to help quickly identify stroke symptoms. The FACE tests are:

  • F — Face: Ask the person to smile. Does one side of the face droop?
  • A — Arms: Ask the person to raise both arms. Does one arm drift downward?
  • S — Speech: Ask the person to repeat a simple phrase. Is their speech slurred or strange?
  • T — Time: If you observe any of these signs, call 9-1-1 right away. Early treatment is essential.

Stroke complications include the following especially if there is a great amount of brain damage:

  • Dangerous blood clots may form.  Stroke victims may have mobility problems which can increase the chances of developing blood clots in the deep veins of the logs. If a blood clot breaks loose and travels to the lungs, the worker could die. Medications and other medical remedies may help.
  • Loss of bladder or bowel control. Some strokes may affect the muscles needed to urinate and have bowel movements. Victims may need to use catheters which can lead to urinary tract infections. Lack of bowel control may also lead to constipation.
  • Loss of bone strength and density including the possibility of osteoporosis.
  • Muscle difficulties. These can include weakness, stiffness, and spasms. Employees who have suffered strokes may have difficulty walking.
  • Problems with language, memory, and thinking. A stroke may affect your ability to focus. A stroke could also increase the risk of dementia.
  • Seizures. Seizures may occur especially in the immediate weeks after a stroke occurs.
  • Swelling in the brain. “After a stroke, fluid may build up between the brain and the skull or in the cavities of the brain, causing swelling.” Physicians may ‘drain fluid from the brain or cut away part of the skull to relieve the pressure the fluid puts on your brain.”
  • The senses may be affected. Employees who have strokes may have difficulty with sight, sound, and touch which can affect the ability to read, change clothes, and other daily tasks.

Other complications may include pneumonia, difficulty swallowing, and difficulty speaking.

How do doctors determine if you had a stroke?

It’s critical to get to an emergency room as soon as possible after a stroke at work. The ER doctors will normally have a stroke team ready because immediate care is critical. The doctors will seek to determine (immediately and after the initial treatments) what type of stroke you had, the cause of the stroke, the part of the brain that was affected, and whether your brain is bleeding. They will work to determine if you had a full stroke or TIA.

Some of the tests that will be taken to help diagnose your health are:

  • Computed tomography (CT). This imaging test uses X-rays to take images of the brain. A brain CT can show whether your brain is bleeding and the extent of any damage to brain cells due to the stroke.
  • Magnetic resonance imaging (MRI). This test uses magnets and radio waves to create images of the brain. “An MRI may be used instead of — or in addition to — a CT scan to diagnose a stroke.” An MRI can identify brain tissue changes and damage to brain cells.

Other imaging tests may include “digital subtraction angiography (DSA) and positron emission tomography (PET) to look for narrowed blood vessels in the neck, an aneurysm, or an arteriovenous malformation (AVM, or tangled blood vessels) in the brain.”

Non-imaging tests may include blood tests, an electrocardiogram (EKG), and a lumbar puncture (spinal tap).

The ER team will also ask you or your family members about your risk factors. They’ll also conduct an oral exam and a physical exam. The doctors will examine your heart health to see if you have any heart diseases and the scope of your heart disease.

What Benefits would you or your Dependents be Entitled to in the Event you Suffered a Compensable Stroke or Heart Attack at Work?

If you survive the stroke or heart attack and can prove it is compensable In North Carolina and Virginia, workers are generally entitled to the following workers’ compensation benefits:

  • Payment of medical bills. Workers’ compensation should pay for all your ER care, hospitalizations, surgeries, doctor visits, rehabilitative therapy, medications, and other medical care related to your work injury.
  • Temporary disability benefits. Employees who are injured on the job should receive 2/3rds of their average weekly wages (some caps and limitations may apply) for up to 500 weeks while held out of work by his or her doctor, until the worker is released to his or her pre-injury work.

Death Benefits. If you do not survive the heart attack or stroke, your dependents may still be entitled to death benefits.

NC. Generally, death benefits in North Carolina are paid in the following amounts to the eligible beneficiaries (the spouse, minor children, and people who qualify as dependents of the worker).

  • Funeral and burial expenses up to $10,000
  • 2/3rds of the decedent’s average weekly wages (subject to certain limits) for a minimum of 500 weeks. Minor children receive their share of the benefits up to the time they turn 18. It may be necessary for someone to be appointed the guardian ad litem of the child(ren) if the other parent is deceased or is otherwise unqualified.
  • The widow/widower receives 2/3rds of the decedent’s average weekly wages until they die or remarry.

VA. In Virginia, the death benefits are comparable to North Carolina. The funeral and burial expenses should be paid up to $10,000. The spouse, children, and dependents receive 2/3rds of the decedent’s average weekly wages for up to 500 weeks. The children receive benefits until they reach 18, unless they can show they are enrolled in school.

At Joe Miller Law Ltd., our North Carolina and Virginia workers’ compensation lawyers understand the unique challenges in showing that your stroke is work-related. We work with cardiologists, ER doctors, and other physicians to show whether you can return to work with proper treatment and the type of treatment and rehabilitation you will need. We seek full compensation for your medical bills, temporary disability benefits, and, if necessary, permanent disability benefits. Call attorney Joe Miller, Esq., at 888-667-8295 or complete my online contact form to schedule a free consultation.

Our law firm does have a way for you to provide your details of your accident and injuries if you simply want to do that electronically from the comfort and safety of your home at any time of day or night. To utilize this service, simply click here: New Electronic Case Review.

We’ll get back to you, typically within 24 hours to provide our response as to whether your situation is one where we can provide you with legal representation. If we require more information, we’ll contact you and ask for that information in order to make that determination as to whether we are the best folks to assist you. If we ultimately determine that we cannot represent or assist you, we will not leave you high and dry. We’ll do our best to provide you with other resources to assist you.

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If you are looking at this site, you or a loved one has probably been hurt. If that's true, you've come to the right place. Helping people who have been hurt is what we do. In fact, it is all we do. Joe Miller Law is a law firm concentrating exclusively on representing people who are injured by the carelessness of others or those hurt on the job. We provide the highest quality legal services to people who have been seriously injured. We practice Personal Injury law and Workmens' Compensation law in both Virginia and North Carolina.