I work an extremely stressful job and I suffered a heart attack. Am I eligible for workers’ compensation benefits?

The short answer is it depends.

California does recognize heart attacks as possibly work-related injuries but don’t expect an insurance company to simply roll over and accept the claim. In most instances, the insurance will deny your claim. If you’re a police officer or firefighter, you have the presumption that a heart attack is work related. Most other professions, don’t have that benefit built into the California workers’ compensation system.

Typically, the insurance company will send you the same canned language they send many other employees injured on the job. The letter will likely say something along the lines of “there is no substantial medical evidence to establish you suffered a work related injury.” We know your job is stressful, they know your job is stressful but they’re going to make you jump through hoops.

You will likely have to go through what we refer to as the “Medical-Legal” process which consists of a Panel Qualified Medical Evaluator (PQME) or Agreed Medical Evaluator (AME). That doctor will give you an exam, run some medical tests and write a report that will tell the parties whether or not your heart attack is work related or the result of something else. The doctor will look at all of your medical history, your answers on questionnaires provided to you and any other relevant information associated with your injury.

The insurance company will likely take your deposition and ask you questions about your medical history. Be prepared to answer many sorts of questions about where you’ve lived, where you received medical treatment in the past, and what kind of medication you’ve taken in the past.

That said, if you are found to have a work-related heart attack, the costs associated with your recovery can be significant, and it will be the responsibility of the insurance company to cover the costs associated with the heart attack. Given the high cost of emergency room treatments, visits with a cardiologist, surgery and medication, exploring the possibility of filing a work compensation claim may be in your interest.

If you have suffered what you believe is in part, a work related heart attack, please do not hesitate to contact our offices so that we may guide you through the process.