Claims for Heart Attack

What is a Heart Attack?

A heart attack, also called a myocardial infarction (MI) or an acute myocardial infarction (AMI), is most typically caused by disruption of the blood supply to or from the heart.  An  occlusion or blockage of a coronary artery by blood clots or the rupture of atherosclerotic plaque, which is an unstable collection of lipids (cholesterol and fatty acids)  in wall of an artery.  The resultant lack blood supply and causes damage or death (infarction) heart muscle tissue (myocardium).[i]

Heart with Muscle Damage and a Blocked Artery

heart diagram

Figure A shows a heart with dead heart muscle caused by a heart attack. Figure B is a cross-section of a coronary artery with plaque buildup and a blood clot.


Washington State : The Unusual Exertion Requirement 

Washington state is among a minority of jurisdictions that require proof of “unusual or extraordinary exertion” as a proximate cause of a workers’ cardiovascular event (heart attack) or vascular brain injury (stroke) for a compensable industrial injury.[ii]  Something more is required than “the habitual method of performance of established procedures,” or the “adherence to a pattern of behavior characterized by mechanical repetition.”[iii]  The “something more” could be:

(1)   The worker had not previously been regularly engaged in the specific occupation;

(2) Though previously regularly engaged in the specific occupation, the worker had not previously performed the particular routine task; or

(3) The worker performed the particular routine task in the specific occupation, but under conditions that entailed more physical exertion than usual.

Washington Firefighters:  A Rebuttable Presumption of Compensability

If the worker is a firefighter, a heart attack is presumed compensable if suffered within 72 hours of exposure to smoke, fumes or toxic substances, or within 24 hours of strenuous physical exertion due to firefighting activities.  Such presumption may be rebutted by a preponderance of the credible, persuasive evidence.[iv]  ; The claimant firefighter or beneficiary has the initial burden of producing evidence that the condition is contemplated by the statue, then the burden shifts to the Department or self-insured employer to rebut the presumption by a preponderance of the evidence.[v]

Oregon State:  Standard Material and Major Contributing Causes

In Oregon, heart attack claims may be caused by an industrial injury or an occupational disease.  Oregon follows the majority of jurisdictions and does not require   “unusual exertion” or some other unique or special standard for analyzing and determining the compensability of a claim for heart attack.  A specific workplace condition or event that is deemed a material contributing cause of a heart attack that occurs suddenly and unexpectedly is compensable as an industrial injury.[vi]    A workplace incident that results in a heart condition that combines with or is superimposed upon a pre-existing heart condition that cause disability or need for treatment is compensable, provided that the workplace incident is and remains the major contributing cause of the treatment or disability.[vii]

A claim for heart attack in Oregon may also be based upon an occupational disease, defined as “any disease or infection arising out of and in the course of employment caused by substances or activities to which an employee is not ordinarily subjected or exposed other than during a period of regular actual employment therein, and which requires medical conditions that develop gradually and not unexpectedly in the light of the work activity.”[viii]  A heart attack claim based upon an occupational disease theory is not compensable unless the work activities or conditions are the major contributing cause.[ix]


Workers’ Compensation claims for a heart attack can be medically and legally complex.  The unusual exertion standard in Washington or the major contributing cause requirement in Oregon demand identification of objective medical evidence and a clear understanding of the workplace circumstances the preceded and precipitated the worker’s cardiovascular event.  If you are managing a claim for heart attack, you should consider consulting with an attorney to ensure proper development of the evidence and compliance with the statutory and regulatory requirements of the relevant jurisdiction.


[i] U.S Department of Health & Human Services; National Institute of Health; National Heart Lung & Blood Institute; MayoClinic.Com; Daniel Lee Kulick, MD,

[ii] Chittenden v. Dept. of Labor and Industries, 71 Wn. 2d 899 (1967); Windust v. Dept. of Labor and Industries, 52 Wn. 2d 33 (1958) (reversing McCormick Lumber Company v. Dept. of Labor and Industries, 7 Wn. 2d 40 (1941)); Louderback v. Dept.  of Labor and Industries, 19 Wn. App. 138 (1978); In re: Harley Buchner, Dec’d., BIIA Dec. 59,239 (1982).

[iii] Buchner at 4 (referencing the holding in Louderback.)

[iv] RCW 51.32.185;  In re: Steve A. Goforth, BIIA Dec. 09 16328 (2010).

[v] In re: Edward Gorre, BIIA Dec. 09 13340 (2010).

[vi] See, Albany General Hospital v. Gasperino, 113 Or App 411 (1992).

[vii] ORS 656.005(7)(a)(B).[vii]

[viii] ORS 656.802(1)(a).

[ix] ORS 656.802(2).