Administrative problems affecting cardiac patients.

The words “Accident, Notice and Causal Relation” under the New York State Workmen’s Compensation Law are words of “art” that embrace only “those accidents or occupational diseases” that “arise out of and in the course of employment.”1 The Court of Appeals of this state, in a recent decision, advised “whether a particular event was an industrial accident is to be determined, not by a legal definition, but by the common sense viewpoint of the average man.”2 The effect of overexertion or strain as an accidental insult to the heart has long held the attention of physicians, the Workmen’s Compensation Board and Courts. The damage to the heart brought on by overexertion or strain in the course of daily work, has been held to be a compensable claim, though a pre-existing pathology may have been a contributing factor.3 The most important factor in each case is the medical record. Peculiarly enough the medical record does not begin with the physician. The medical record begins with the claimant. As early as possible, the claimant should be questioned in detail, about his work during his employment, where and when he first noticed symptoms; the extent of pre-existing heart disease or other non-cardiac complications, if any, and periods of hospitalization. The medical reports filed by the attending physician should fully reflect such history and render an opinion as to whether the accident was a competent producing cause of the injury sustained, aggravating or activating a previously existing condition, resulting in the present disability. The obligation of the employer or carrier to provide medical care and pay compensation commences with knowledge of a claim and disablement, except in controverted cases.4 The relationship between the physician and his patient is more defined, once there is a claim that the disablement is work-connected.5 It is then of the utmost importance for the attending physician to understand that where the claimant is disabled and has a reduced or no actual earning capacity, the Board must have due notice of the nature of his injury and physical impairment, so that it can fix the degree of disability of the claimant and establish his rate of compensation within the maximum and minimum provided by law.6 Since the right to receive compensation is dependent upon the submission by the claimant of medical proof of disability and the relationship of such disability to the accident, the importance of the prompt filing of adequate medical reports in adjudication of compensability of the claim and the right of the claimant to receive medical care and payment of cornpensation, cannot be overemphasized. It is interesting to note that in a tabulation of the closed cases covering the period from January, 1952 to June, 1952, in 66.5 per cent of the cases,