Does WorkCover cover heart attack?

If a worker suffers a heart attack – whether during work hours or outside work hours –  it may be possible that they will be entitled to WorkCover benefits, just as a person would be entitled to WorkCover benefits for a physical injury sustained during work.

The rest of this page will explore the topic further.

Heart attack and employment

In order to be entitled to claim WorkCover benefits, a person must have a work related injury or condition.

When it comes to heart attack and WorkCover benefits, employment must be a significant contributing factor to the heart attack.

This is the applicable test regardless as to whether the heart attack occurred during work hours or outside work hours.

When determining whether work is a significant contributing factor to a heart attack, there are a number of factors that are taken into account.

These are:

• How long a person has been with an employer. Have they been with an employer for two months performing heavy work, or ten years?
• The nature of the work performed
• Is the work heavy and repetitive in nature, or the opposite?
• Would the heart attack have occurred but for employment?
• Are there any hereditary risks? Does heart disease run in the family?
• The lifestyle of the worker and their activities outside of work. Are they a smoker? Do they exercise? Are they generally healthy?

When a claim is lodged for a heart attack relating to employment, the WorkCover insurer will usually organise for that person to be assessed by a doctor, usually a cardiologist.

The cardiologist will need to assess the persons heart attack in light of the above factors.

They’ll want to know about the history relevant to the heart attack, subsequent worker history, current complaints and treatment, your medical and occupational history, and your personal and social history.

They’ll then send a medical report to the insurer and once this report has been provided to the insurer, they (the insurer) will then issue a notice confirming that they have either accepted or rejected your claim.

Heart attack at work or outside work hours?

Under the WorkCover system in Victoria, a person can be entitled to benefits if their heart attack happened while they were working and while at home.

So the heart attack could occur while someone is working, or it could occur outside of work hours.

Either situation is acceptable in terms of claiming WorkCover benefits.

If a claim is accepted for the heart attack

If a claim for a heart attack injury is accepted by the WorkCover insurer, then a person will have an entitlement to the payment of medical and like expenses.

Typical expenses claimable may include GP attendances, attendances upon a cardiologist, medication and potentially surgery.

If a your ability to work has been impacted as a result of the heart attack, then you may also have an entitlement to the payment of weekly payments.

Lump sum compensation may also be open to a person to pursue who has had a heart attack related to their employment in the form of an impairment benefit, and in limited instances, a common law claim.

If the claim is rejected for the heart attack

Then, just like any other rejected WorkCover claim, if that claim is rejected and if you wish to contest the rejection, you can proceed to Conciliation.

Conclusion

If a person suffers a heart attack, they may be entitled to WorkCover benefits if the heart attack is related to employment. The insurer will likely organise for you to be medically assessed by a cardiologist.

If the WorkCover claim is accepted, you’ll be entitled to be paid medical and like expenses related to the treatment of the heart attack. If your ability to work has been impacted, you may have an entitlement to weekly payments. You may also have an entitlement to lump sum compensation.