HEART ATTACK CASE CAUSES HEADACHE UNDER WORKERS' COMP LAW

June 11, 2004

Steven P. Garmisa
Hoey & Farina Attorney
garmisa@hoeyfarina.com
1-888-425-1212

An Illinois Supreme Court ruling designed to clear up confusion with "preexisting conditions" in workers' compensation claims caused a lingering headache in a heart attack case.

With one justice dissenting, the Appellate Court ruled that Howard Haulk wasn't entitled to workers' compensation for a heart attack because his physician admitted, during cross-examination, that Haulk was a "heart attack waiting to happen." Twice Over Clean Inc. v. Industrial Commission, 2004 Westlaw 1048935 (Industrial Com'n. Div.) (May 6).

The dissenting justice concluded there was sufficient evidence that heavy work, under harsh conditions, triggered Haulk's heart attack, even though his coronary arteries were 90 percent occluded.

The Appellate Court previously ruled that Haulk wasn't entitled to compensation (reversing the arbitrator, commission and circuit court). But the Illinois Supreme Court instructed the intermediary court to reexamine its ruling against Haulk in light of Sisbro Inc. v. Industrial Commission, 207 Ill.2d 193 (2003), referred to as "Sisbro II," which overturned the Appellate Court's decision in "Sisbro I."

Here are some highlights of Justice Jack O'Malley's majority opinion (with various omissions not noted in the quoted text):

"In our prior decision we did not address whether claimant's work activities contributed to his infarction. We held that claimant was not entitled to compensation irrespective of causation because, as his own physician admitted, his condition was so deteriorated that any activity, work-related or not, might be sufficient to cause an infarction.

"We relied on our statement in Sisbro I that 'a claimant is not entitled to compensation, regardless of whether his condition was caused by work-related aggravation of a preexisting condition, if his physical condition has so deteriorated that his condition of ill-being could have been produced by normal daily activity.'

"We derived the rule in Sisbro I from the following statement by the Supreme Court in County of Cook v. Industrial Commission, 69 Ill.2d 10, 17- 18 (1977):

" 'The mere fact that an employee might have suffered a fatal heart attack, even if not working, is immaterial, for the question before the commission is whether the work that was performed constituted a causal factor. The sole limitation to the above general rule is that where it is shown the employee's health has so deteriorated that any normal daily activity is an overexertion, or where it is shown that the activity engaged in presented risks no greater than those to which the general public is exposed, compensation will be denied.'

"We noted that subsequent cases had taken this language as establishing two exceptions to the general rule that compensation is due where a work-related activity causes the aggravation of a preexisting condition. See Sisbro I, 327 Ill.App.3d at 872.

"In Sisbro II, our Supreme Court held that we erred in characterizing the normal daily activity and no greater risk factors as exceptions that bar recovery despite the existence of a causal connection between the claimant's employment and his injury. After reviewing the cases upon which County of Cook relied in describing the no greater risk and normal daily activity factors as 'limitations' on recovery, the Supreme Court rejected the two-step process we applied in Sisbro I:

" '[These cases] do not stand for the proposition that where a causal connection between work and injury has been established, it can be negated simply because the injury might also have occurred as a result of some "normal daily activity." Rather, these cases demonstrate that where "any normal daily activity is an overexertion" or whether "the activity engaged in presented risk no greater than those to which the general public is exposed" are matters to be considered when deciding whether a sufficient causal connection between the injury and the employment has been established in the first instance. We have never found a causal connection to exist between work and injury and then, in a further analytical step, denied recovery based on a "normal daily activity exception" or a "greater risk exception." ' Sisbro II, 207 Ill.2d at 211-12.

"According to the Supreme Court, a claimant's vulnerability to injury during normal daily activities is not an 'exception' that applies to bar recovery despite the existence of a 'sufficient causal connection' between work and injury, but instead is a 'limitation' on when a 'sufficient causal connection' may be found in the first instance. The Supreme Court denied that it has ever found an injury noncompensable where there existed a 'sufficient causal connection' between work and injury, because there is no analytical step beyond the causation inquiry.

"Before we apply it to the facts of this case," O'Malley continued, "we explain our understanding of this rule. Although the Supreme Court implies in Sisbro II that the concept of 'sufficient causal connection' is no innovation, our research discloses that the phrase appears only in one majority opinion and one dissent before Sisbro II.

"What makes a cause 'sufficient'?," O'Malley asked. "If a 'sufficient cause' is a cause distinguished by some degree of dominance, then the concept indeed is a novelty in workers' compensation cases because the Supreme Court has always refused to distinguish among degrees of causation:

" 'To come within the statute the employee must prove that some act or phase of the employment was a causative factor in the ensuing injury. He need not prove it was the sole causative factor, nor even that it was the [principal] causative factor, but only that it was a causative factor in the resulting injury.' Sershon v. Industrial Commission, 63 Ill.2d 395, 399 (1976).

"Sisbro II supplies a specialized definition of 'sufficient causal connection' for aggravation cases, partially relieving us of the problems we see in attempting to define the concept in light of established Supreme Court precedent. According to Sisbro II, a work activity is a 'sufficient cause' of the aggravation of a preexisting condition if none of the limitations articulated in County of Cook apply, that is, if the work activity presented risks greater than to which the general public is exposed and the claimant's condition was not so deteriorated that his injury could have occurred through normal daily activity. In rejecting the approach we followed in Sisbro I, the Supreme Court held that the factors are 'limitations' applied in the course of the causation analysis, not 'exceptions' applied after that analysis."

O'Malley painstakingly analyzed the cases cited in Sisbro II, plus a series of other Supreme Court rulings. These rulings persuaded O'Malley "of the continued vitality of County of Cook's declaration that an injury suffered at work is not compensable 'where it is shown the employee's health has so deteriorated that any normal daily activity is an overexertion or where it is shown that the activity engaged in presented risks no greater than those to which the general public is exposed.'

"Turning to the facts of this case, we hold that the normal daily activity limitation bars compensation. Dr. Cohen, claimant's family physician, opined that claimant's coronary arteries were so occluded that 'any activity or no activity could put sufficient stress on the heart to result in a myocardial infarction.'

"Dr. Cohen further testified that claimant was a 'heart attack waiting to happen.' We cannot imagine a more compelling case for applying the normal daily activity limitation. Dr. Cohen's testimony as to the likelihood of claimant suffering a heart attack regardless of his employment was entirely undisputed. Hence these facts present a far stronger case for the limitation than Sisbro I and II, where only one of the medical experts to testify opined that the claimant would have developed his condition of ill-being eventually through normal daily activity, even though both experts recognized that even minor, ordinary activity could cause the claimant's condition of ill-being.

"Of course," O'Malley cautioned, "we are careful to present our conclusion in the analytical framework set forth in Sisbro II. We do not hold that claimant proved a causal connection between his employment and his injury and yet deny him compensation because his condition of ill-being would have occurred regardless of his employment. Rather, we hold that, in light of his susceptibility to a heart attack outside of work, he failed in the first instance to prove a 'sufficient causal connection' between his work and his injury."

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