January 18, 2012
Handicap Reimbursement Program

by Justice Paul E. Pfeifer

Should hypertension be considered a “handicap” that is eligible for workers’ compensation reimbursement to employers? That’s the question that was at the heart of a case that came before us here, at the Ohio Supreme Court.

The case originated with Fairfield City Schools and one of its employees, Edward Carpenter Jr. In 2002, Carpenter injured his back at work. The injury resulted in a considerable amount of disability compensation – first temporary total, and now permanent total compensation.

In 2008, Fairfield requested handicap reimbursement from the Ohio Bureau of Workers’ Compensation for at least part of the disability payments made to Carpenter. Fairfield alleged that Carpenter’s preexisting hypertension – which he’s had since at least 1995 – is a cardiac disease that delayed his recovery from back surgery, and thus contributed to prolonged disability payments.

In making this claim, Fairfield was referring to the handicap reimbursement program. Created in 1955, the program encourages employers to hire persons with certain mental or physical conditions that could hinder employment. The program does this by charging the state surplus fund all or part of the cost of a long list of diseases or conditions. If one of those diseases or conditions either caused or aggravated the industrial injury leading to death or disability, the surplus pays some or all of the compensation.

Hypertension is not on the list, but “cardiac disease” is. To support its claim, Fairfield submitted the report of a doctor who had reviewed Carpenter’s medical records. The report stated that Carpenter had hypertension, which was managed with medication.

The report also said that the hypertension would reasonably contribute to a “handicap assessment” with respect to Carpenter’s back surgery. “Chronic hypertension plays a role in delaying healing from these surgeries, exacerbated by his chronic smoking. Hypertension results in stiffer arteries, which limits healing, particularly involving the fusion surgeries.”

But the Bureau rejected the doctor’s report as “insufficient to establish cardiac disease as a pre-existing condition that delayed recovery.” The bureau described the report as “speculative and tenuous” and stated that it didn’t show that Carpenter’s injury was affected by hypertension but instead merely explained that in general, injuries are affected by hypertension.

The Bureau denied reimbursement. After that, Fairfield appealed to the Industrial Commission of Ohio, which handles such matters.

A staff hearing officer for the Commission denied reimbursement for three reasons. First, because hypertension isn’t one of the enumerated diseases listed in the statute. Second, because Fairfield did not establish that Carpenter’s hypertension constituted a cardiac disease. And third, because there was insufficient evidence to establish that Carpenter’s high blood pressure contributed to the cost of his workers’ compensation claim.

The next stop was the court of appeals, where Fairfield challenged the denial of reimbursement. Fairfield relied heavily on a newly submitted piece of evidence – a one-page Bureau of Workers’ Compensation document entitled “Handicap Reimbursement Guidelines.”

The document stated that “evidence of high blood pressure/hypertension, without more explanation, does not constitute evidence of cardiac disease.” Fairfield argued that it had satisfied the guidelines by submitting the doctor’s reports that explained why Carpenter’s hypertension should be considered a cardiac disease.

But the court of appeals stressed that the guidelines on which Fairfield relied weren’t from the Industrial Commission, but rather from the Bureau of Workers’ Compensation. Describing them as internal guidelines, the court of appeals noted that Fairfield had cited no authority that bound one state agency to the internal guidelines of another.

The court also held that the Industrial Commission’s exclusive authority to weigh the evidence permitted it to conclude that the doctor’s reports were insufficient. Emphasizing the Commission’s substantial expertise in the area of handicap reimbursement, the court of appeals concluded that the Commission did not abuse its discretion in finding that hypertension was not a cardiac disease for handicap reimbursement purposes.

After the court of appeals issued its finding, the case came before us for a final review.

Fairfield argued that because the handicap reimbursement statute does not define “cardiac disease,” it must be “accorded its plain, everyday meaning.” In making this assertion that Carpenter’s high blood pressure should be classified as a cardiac disease, Fairfield relied on a bit of extrapolation: because the term “cardiac” means relating to the heart and hypertension affects the blood vessels that supply the heart, hypertension is a cardiac disease. We rejected that proposition.

If the mere fact of blood circulation were sufficient to transform a chronic condition into a cardiac disease, then leukemia and anemia would also be cardiac diseases because they, too, affect the blood. Fairfield’s reasoning could permit employer reimbursement for many conditions never anticipated by the legislature.

Fairfield’s logic would also permit handicap reimbursement in situations where a person’s hypertension has never manifested itself with the symptoms of a cardiac disease. High blood pressure can certainly lead to serious heart problems, but many people – including Carpenter – control it and suffer no heart-related effects. The doctor reported that Carpenter’s hypertension was managed with medication, with no cardiac implications.

The stated purpose of the handicap reimbursement law is to encourage employers to hire and retain handicapped employees with the conditions that are listed – such as cerebral palsy, Parkinson’s disease, or muscular dystrophies. To an employer, any of the conditions may raise concerns about an employee’s productivity or the employer’s ability to respond in the event of an emergency. Without an incentive to hire people suffering from these conditions, an employer might be less inclined to employ them.

But according to the American Heart Association, one in three adults has hypertension, so no incentive is needed to hire someone with high blood pressure. In addition, high blood pressure, unlike many of the conditions listed in the law, can be controlled, so it’s far less likely to disrupt workplace productivity or safety. Simply put, hypertension isn’t the impediment to employment that the other conditions might be.

Therefore – by a seven-to-zero vote – we affirmed the court of appeals’ judgment. The Commission did not abuse its discretion in denying Fairfield’s application for handicap reimbursement.

EDITOR'S NOTE: The case referred to is State ex rel. Fairfield City Schools v. Indus. Comm., 129 Ohio St.3d 312, 2011-Ohio-2378. Case No. 2010-0674. Decided May 24, 2011. Opinion Per Curiam.