Office employees and other sedentary workers typically have lower frequency and severity of workers' compensation claims than their more active or labor-intensive coworkers. However, new medical evidence suggests a link between sedentary employment and significant health issues which could potentially raise both the frequency and severity of workers' compensation claims for these workers in the future.
Recent medical studies have shown a link between sitting and other sedentary behavior and an increased risk of events associated with cardiovascular disease such as chest pain or heart attack, as well as other diseases such as cancer, diabetes or metabolic syndrome. Consider:
- An Australian study of more than 200,000 individuals revealed that people who sat for 11 hours per day or more were 40% more likely to die from any cause, and those who sat between 8 and 11 hours per day had a 15% greater risk of death compared to individuals who sat less than four hours per day
- A Women's Health Initiative Observational Study found that women who sat more than 10 hours per day had significantly greater risk for heart disease, heart attack and stroke compared to women sitting five hours per day or less
Although these studies did not specifically deal with employment, the results can easily be applied to sedentary work activities. It is important to note these studies looked at adults age 45 or older. Also, studies differed on the relationship of other factors to the findings.
The American Medical Association (AMA), at its 2013 annual meeting, adopted policy recognizing potential risks of prolonged sitting. "Prolonged sitting, particularly in work settings, can cause health problems and encouraging workplaces to offer employees alternatives to sitting all day will help to create a healthier workforce," said AMA board member Patrice Harris, M.D.
What does all of this mean for your workers' compensation risk of heart-related claims?
Generally, a workers' compensation claimant would need to establish both medical and legal causation in order to prove a heart attack compensable. For medical causation, in general, the heart attack must be caused by the work environment rather than the natural progression of cardiovascular disease. A workers' compensation claimant is required to provide medical evidence from an expert witness that connects the heart attack to the employment. The standard for that connection varies from jurisdiction to jurisdiction. In some states, the employment needs only to contribute to the heart attack. Other states require more than just contribution and the employment must be a substantial or material cause of the heart attack.
Regardless of which standard a jurisdiction uses for medical causation, an expert witness can theoretically use the above-mentioned medical studies to try to prove medical causation. In a contribution state, an expert medical witness could opine that 1/3 of a claimant's day spent in a sitting position at work certainly contributed to the heart event. In a substantial or material cause state, an expert medical witness could draw the conclusion that eight hours of sedentary work every day was the substantial or material cause of the claimant's heart-related problems.
In addition to medical causation, a workers' compensation claimant must also prove legal causation of the heart attack. A majority of states have adopted the usual exertion rule for legal causation. The above studies could support legal causation in these states by showing the sedentary work activities were a substantial contributing cause of the heart attack.
Some states require only that the usual exertion of the work activities be greater than the claimant's exertion outside of work. But in a minority of states, an employee would need to show an unusual work exertion above and beyond their normal employment activities caused their heart attack and the above medical studies would be less relevant. However, if the results of these medical studies become accepted medical doctrine, one can foresee these states moving toward the primary usual exertion legal causation standard for heart attacks over time.
Clearly the trend in current medical studies is that sitting and sedentary activities for many hours each day can contribute to an increased risk of significant medical conditions including cardiovascular disease and heart attacks. Here are eight steps employers can take now to help minimize future risk and promote healthy lifestyles for their employees:
- Encourage employees to participate in a heart screening to determine heart health
- Make available alternatives to sitting, as encouraged by the AMA, such as standing work stations
- Allow the use of wireless or Bluetooth headsets so employees can stand or walk around while on the telephone
- Encourage employees to not eat lunch at their desks, but to visit the lunchrooms to eat, walk outside or exercise at lunch
- Build periodic movement into the regular work routine of employees
- Encourage less e-mail and more face-to-face discussion which would require employees to get up from their desks to visit co-workers (this option has the added benefit of promoting better relationships in the workplace)
- Provide an on-site exercise room where feasible and promote its use
- Build financial incentives into employee health plans to get regular physicals, join fitness centers, lose weight, stop smoking and generally have healthier lifestyles
In summary, there are significant new medical studies which show a link between sitting and sedentary activity and an increased risk of various diseases, including heart attacks and cardiovascular disease. In theory, these studies could substantially change the landscape of compensability of workers' compensation claims from sedentary employees for heart attacks. In practice, it remains to be seen how and to what extent the landscape changes. In the interim, anything an employer can do to encourage more movement and less sitting during the work day could mitigate future heart attack claim risk.
Do you have suggestions or examples of how your organization is working to prevent this growing trend?
Joe Daly, Director Technical Performance