Jimmy Walters worked for the Florida Department of Corrections. In December 2009, he came down with a cold, but continued to work for a week. He suffered from chills and nausea on his days off and then experienced chest pain. He went to a hospital, where he was treated for “heart symptoms” and subsequently diagnosed with myopericarditis and cardiomyopathy. He was hospitalized for several days. He filed a workers comp claim, under the Sec 112.18, the “firefighter’s presumption” which creates a rebuttable presumption of occupational causation for disabling heart disease.
For most workers, there would be no conceivable issue of compensability for flu-caused heart problems, but most workers do not work in the public safety arena and most workers are not protected by presumption laws. The facts of the case were not in dispute: there was a direct causal relationship between Walters’s stomach flu and subsequent heart problems. His initial claim was denied by the state of Florida and by a judge on appeal, who ruled that Walters had not proven that his viral gastroenteritis was an occupational disease or that the exposure was traceable to the workplace.
The District Court of Appeal overturned the ruling and awarded benefits for the treatment of heart disease. The judges noted that the presumption statute shifts the burden of proof from the claimant to the employer: “The state had the burden to prove he did not get the virus at work, and failed to carry its burden.” Some burden! The chain of causality is stark and rather crude: for public safety employees, any heart ailment caused by illness is compensable, unless the employer can trace the exposure to specific, non-work conditions. Where the cause/exposure is unknown – as in most cases – there can be no outcome other than the awarding of benefits.
By facilitating benefits to firefighters and police who may develop cancers or heart desease related to employment, law makers acknowledge the unique exposures for the people who protect us.[Back in 2008, my colleague Julie Ferguson provided the background for presumption laws.] But the generous language of these statutes may open the door to compensability far wider than any prudent legislature would intend.
The Politics of Presumption
In practice, presumption laws may create as many problems as they solve. For stressed taxpayers who ultimately foot the bills, cases of questionable compensability can be shocking: the firefighter with lung cancer who smokes two packs a day, the obese cop with heart disease, and now, the corrections officer with a flu-caused heart problem. Are these truly work related? For most people, the answer would be “no way.” For the public safety employees covered by presumption laws, compensability is a given. Their safety net is woven of much finer cloth than that which protects most people in the working world.
Posts Tagged ‘presumption’
Presumption Laws: Wide Open Door to Benefits
Monday, October 22nd, 2012Risk roundup, virtual WC event, presumption, self insurance, haboob video & more
Thursday, July 14th, 2011Risk roundup – This week’s edition of Cavalcade of Risk – edition #135 – is being hosted by The Notwithstanding Blog. In that several countries celebrate their independence in the month of July, our host has a suitably related theme that may test the breadth of your geographic trivia. Oh, and there are some good posts this week, too!
Mark September 22 on your calendar now – Better yet, head on over to Business Insurance and register for Virtual Advantage 2011 – Workers Comp Trends & Cost Control Strategies. We’re very pleased that our own Tom Lynch will be participating on a blogger panel with three other blog luminaries: Roberto Ceniceros, Joe Paduda, and Mark Walls. There will also be a keynote by NCCI’s Harry Shuford, an expert panel on pharmaceutical cost controls for worker’s comp – and more. It’s a one-day virtual conference – and best of all – there is no charge to attend.
Presumption – And speaking of Mark Walls, congrats to him on his first column in Risk & Insurance. If you don’t know Mark by name, suffice it to say he is the powerhouse behind LinkedIn’s popular Work Comp Analysis Group. In Not all claims are created equal he talks about the thorny issue of presumption and how presumption laws fiddle with a basic tenet of the workers compensation pact: that the burden to prove an injury or illness “arose out of employment” falls to the employee.
Self Insurance – If the workers comp market continues to harden, as many are predicting, many employers might be looking to alternatives to the traditional insurance options. In Risk Management Magazine, Richard C. Frese, a consulting actuary from Milliman, tackles the topic in his article Does Your Self-Insured Program Need a Tune-Up?. It’s a good overview of what you need to know if you are considering the move.
Employment law – Attorney Phillip Miles posts a handy SCOTUS Employment Law Year in Review 2011 – a summary of cases with links for more information.
New blog discovery – check out Texas Mutual’s Blog. We particularly liked the recent post on The ABCs of new employee safety. This is an important issue – in their own claim analysis, they found that roughly 27% of job-related fatalities involve employees who have been on a new job for less than 90 days. They also cite the OSHA stat that 40% of all injured employees have been on the job for less than a year. They also note that “new employee” may not just be a new hire: “New employees include people who transfer to a new position, return to work after an extended absence, operate a new piece of equipment or implement a new procedure.” Check out the post for tips on this topic.
Wow of the week – a little off topic, but check out this amazing video of the massive haboob (dust storm) that hit Phoenix on July 5.
Briefs
* Opioids, deaths, and workers comp
* LAPD prescription drug abuse tied to disabilities
* Consumer Reports: Can you read this drug label?
* The 10 worst states for P&C insurers
* Safety tip sheet: Livestock handling
* Safety on the loading dock