GUIDE TO THE APPLICATION OF G.L. c. 32, s. 94
THE HEART LAW

Added to the retirement law in 1950, G.L. c. 32, s. 94 establishes a rebuttable presumption that, in the case of certain eligible public employees, any condition or impairment of health caused by heart disease or hypertension is service connected unless the contrary is shown by competent medical evidence.

IN YOUR ANALYSIS OF THIS CASE PLEASE CONSIDER:

Is there evidence that the heart disease or hypertension is not service connected?
Questions on the Certificate for Accidental Disability (HEART) deal with this important issue.
The Heart Law Presumption attributes heart disease or hypertension to the individual’s employment unless the contrary is shown by competent evidence.

As indicated on the form, these non-service connected factors may be uniquely predominant influences on the mental or physical health, or may be accidents or hazards undergone which are not job-related.

Is there evidence that, although not irrebuttable, so predominates as to obligate a fact
finder to come to the conclusion that for this particular applicant the heart disease or
hypertension is caused by non-job related factors that are the basis for your answers to
the Questions on the Certificate?

In dealing with this question, you must focus on three areas
• The condition of the applicant
• Other factors which could have caused the disability
• The presumption

It is the responsibility of the medical panel to define, characterize and when possible quantify (e.g., compare to the average risk or provide a relative risk) influences that are uniquely predominant in their impact on the development of this condition. In other words, the medical panel when possible should provide scientific evidence that substantiates their rationale regarding how strong an impact the non- service connected influences have had on the development of the conditions in question. Keep in mind that the mere existence of evidence that heart disease or hypertension is not service connected does not alone cause the presumption to disappear completely.

Sufficient evidence to overcome the presumption might include:
• A congenital problem
• Non-work related pathology via infection, e.g., infectious endocarditis from
abuse of intravenous drugs.
• Clear exposure to a condition outside of work, e.g., cocaine or alcohol
induced cardiomyopathy.

If you find that, for this particular applicant, there is evidence that, although not irrebuttable, so
predominates as to obligate a fact finder to come to the conclusion that the applicant’s condition is caused by factors unrelated to his or her employment, then the presumption is overcome. If you make that determination, then your answer to Question 3 on the Certificate for Accidental Disability (HEART) is NO. Otherwise, the answer to Question 3 on the Certificate for Accidental Disability (HEART) is YES.

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