You Be the Judge

Is ‘Hypertensive Crisis’ Compensable?

When doctors' views are mixed on whether man's injury was work related, the ball is left in the judge's court.
By: | August 17, 2015

A correctional officer for the Missouri Department of Corrections was involved in a “take down” of an uncooperative inmate. The officer felt nothing unusual at the time, other than “an adrenaline rush.” The officer and a coworker escorted the inmate to another location within the prison.


While doing so, the officer began to experience shortness of breath. He went to get a drink of water, and he began to spit up blood. He was transported by ambulance to the hospital where he lost consciousness.

Chest X-rays revealed the presence of a pulmonary edema. The officer had preexisting hypertension and was taking medications. He was transported to another hospital where he remained unconscious for a week.

A pulmonary specialist said it did not appear that his “disease process” was related to trauma. Another doctor said it was unclear whether his condition was related to a cardiac contusion tipping him into congestive heart failure or whether he had a pulmonary contusion that worsened his respiratory and cardiac status or was secondary to the stress of the altercation. A cardiologist said the officer suffered from a “hypertensive crisis.” An independent medical examiner said that the work incident in which the officer experienced extreme exertion was the direct, proximate, and prevailing factor precipitating the hypertensive crisis.

The officer recovered with no permanent disability, and he returned to work. He sought workers’ compensation reimbursement for the medical expenses associated with his hospitalization. The administrative law judge denied the claim. The Labor and Industrial Relations Commission affirmed the denial of benefits, finding that although the officer suffered a work-related accident, he did not prove that the accident was the prevailing factor for causing his injuries.

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How the Court Ruled

The court explained that the officer was required to establish that his accident was the prevailing factor in causing his hypertensive crisis. Although the officer claimed that certain evidence was ignored, the court pointed out that hypertensive crisis is a “sophisticated injury that could be caused by various factors.”

A is incorrect. The court found that the officer did not establish that his accident was the prevailing factor in causing his hypertensive crisis.

C is incorrect. The court noted that the commission was unable to determine whether the independent medical examiner asserted that the work accident was a prevailing factor in causing the resulting treatment or that the work accident was merely the main precipitating factor of his injury.


The court also pointed out that the examiner’s conclusions stemmed from an incorrect understanding of the facts. While the examiner’s report suggested that the officer experienced extreme exertion in taking down the inmate, the officer said that the event required only minimal exertion.

B is correct. In Malam v. State of Missouri Department of Corrections, No. SD33620 (Mo. Ct. App. 06/24/15), the Missouri Court of Appeals held that the officer’s medical treatment for his “hypertensive crisis” was not compensable.

Editor’s note: This feature is not intended as instructional material or to replace legal advice.

Christina Lumbreras is a Legal Editor for Workers' Compensation Report, a publication of our parent company, LRP Publications. She can be reached at [email protected]

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The R&I Editorial Team can be reached at [email protected]