I have been employed as a police officer for 20 years. Approx. (6-7) years ago, I suffered from high blood pressure on duty and had to be driven to the hospital for treatment. About (6) months later, I had severe chest pains on duty. Again I was taken to the hospital Each time I went to the hospital, I was given an EKG and I appeared fine. I was diagnosed with hypertension, high colesteral, and diabetes. I have been taking medication for these health issues. I was diagnosed a couple of years prior to problems at work. Claims were filed with workmans comp. These temporarily paid for my medication while they viewed my health records. 6 months lately they denied the heart and lung bill, and claims discontinued paying for my medications. Am I elgible for the heart and lung bill, and is it to late to appeal the denial through a lawyer?
Having trouble responding on WordPress to e-mail, but I can still post. So I am reprinting the question and my response.
There are 2 questions here. The first has to do with the compensability of the hypertension. The heart/lung bill simply requires you pass a pre-employment physical. If you had signs of hypertension on the pre-employment physical the case would be difficult to win.
If you passed a pre-employment physical without signs of hypertension, but back in your medical records there lurks prior treatment for hypertension, these records can be used to rebut the presumption.
So if you passed a pre-employment physical and developed hypertension, it is presumed in-line of duty by statute. The burden then shifts to the employer to show by clear and convincing evidence some other cause for the hypertension, which can include prior (pre-employment), medical records. It can also be as simple as testimony from a cardiac specialist that you are overweight and have high cholesterol. The judge weighs what constitutes “clear and convincing evidence” but it is a much higher standard than preponderance of the evidence.
The second issue from our police officer involves the statute of limitations. A claim for workers’ compensation can be brought within 2 years of your date of accident or within 1 year of your last medical treatment with your authorized workers’ compensation physician who treats you for the hypertension. In addition, there is a 120 day “pay and investigate” rule. If you have been getting medication for hypertension for more than 120 days while they sifted through your medical records, you can argue they are barred from denying your claim.