Can my congenital heart condition be covered by the Heart Lung Bill F.S. 112.18?
Well, like most answers from attorneys: it depends. In certain circumstances the answer is yes and sometimes the answer is no. There are a number of abnormalities in the heart that can exist at birth but the ones that come up most often in Heart Lung Bill cases are: atrial septal defect, bicuspid aortic valve, and Wolf-Parkinson-White Syndrome.
- An atrial septal defect (ASD) is a hole in the heart wall between the two upper chambers of your heart. The hole increases the amount of blood that flows through the lungs. A large, long-standing atrial septal defect can damage your heart and lungs. Surgery or device closure might be necessary to repair atrial septal defects to prevent complications. The typical symptom of this condition is arrhythmia or skipped heart beats.
- A bicuspid aortic valve is when the valve has only two cusps instead of three. This valve is the main valve in the heart the supplies blood to the rest of the body through the aorta. When a bicuspid valve is present, it can cause stenosis (narrowing of the valve), which prevents the valve from functioning the way it is supposed to, leading to the need for surgical replacement. It can also cause blood to back flow into the aorta and cause an aneurysm.
- Wolff-Parkinson-White syndrome, an extra electrical pathway between your heart's upper and lower chambers causes a rapid heartbeat. This usually manifests itself as some sort of arrhythmia. It can also be referred to as a slow accessory pathway.
Now, seeing as these conditions are congenital, meaning you were born with them, they were obviously present at the time of your pre-employment physical and your worker’s comp carrier will try to deny claims for these conditions as being pre-existing or assert you do not meet the criteria for F.S. 112.18. However, these conditions could still fall under the coverage of the Heart Lung Bill if there is some sort of work-related trigger of your disabling event OR worker’s comp cannot prove that the trigger wasn’t work related. Trigger in this context meaning “made symptomatic”. Whether the carrier is responsible requires a two-step analysis that isn’t always black and white.
This concept first came about in Mitchell v. Miami Dade County, 186 So. 3d 65, 66 (Fla. 1st DCA 2016).
Ms. Mitchell was a police officer for the agency. Her disabling event occurred when she was hospitalized for super ventricular tachycardia and while receiving treatment it was discovered that she was born with a slow abnormal pathway. A slow accessory pathway is an additional electrical connection between two parts of the heart. While the underlying electrical abnormality of her heart was congenital, the trigger, could not be proven to be non-occupational and Ms. Mitchell’s claim was found to be compensable.
In Brent v. City of North Bay Village, OJCC Case No.: 09-030816CMH,
The claimant was a police officer that suffered a stroke and filed a claim under FS 112.18. The carrier denied the claim on the basis that the claimant’s congenital atrial septal was the cause of the stroke and arrhythmia. The court ultimately accepted the opinion of the carrier’s expert which was that the atrial septal defect caused a narrow passageway that allowed a blood clot to travel from the left side of the heart to the right, causing the stroke. There the carrier proved a non-work-related trigger of the event and the claim was denied.
In Brown v. Palm Beach County BOCC, OJCC Case No: 14-022337MAD
The Claimant had a 2005 compensable claim for an arrhythmia and had been receiving cardiology care for that condition as well as an aortic aneurysm condition discovered by the authorized cardiologist 1 year after the date of accident. The Claimant was found to have a congenital bicuspid valve on echocardiogram and the carrier paid for treatment for nearly 10 years. In August of 2014, the Claimant’s aortic aneurysm had grown to a large enough size which required surgical intervention and a new claim was filed for that date of accident. The E/C then denied both the 2005 and 2014 claims asserting an argument based on the prior congenital findings. The court found that the carrier waived any right to deny compensability for the 2005 claim and the 2014 aneurysm met the criteria of FS 112.18.
Taking these cases into account, it is very clear that the facts of a 112.18 case are very different and unique. Each case requires extensive review of the medical circumstances surrounding the claim and the right expert testimony.
If you’re a first responder with questions about filing a compensation claim or would like us to review the facts of your case and determine the best course of action, contact a workers’ compensation attorney at Bichler & Longo for a free evaluation
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