NTUC Income Insurance Co-operative Ltd and Another v Next of kin of Narayasamy s/o Ramasamy, deceased

• Judge: Sundaresh Menon JC
• Judgment Date: 13 September 2006
• Neutral Citation: [2006] SGHC 162
• Defendant Counsel: Lim Seng Siew (instructed) with S K Kumar (S K Kumar & Associates)
• Year: 2006
• Published date: 15 September 2006
• Plaintiff Counsel: Anparasan s/o Kamachi and Amy Lim (KhattarWong)
• Subject Matter: Whether heart attack amounting to accident arising in course of work and causing injury,Workman dying from heart attack,Workman shown to have pre-existing heart condition,Claim for compensation under s 3(1) of Workmen's Compensation Act,Workman engaged in strenuous work immediately prior to suffering heart attack,Employment Law,Section 3(1) Workmen's Compensation Act (Cap 354, 1998 Rev Ed),Work part of workman's work scope
• Citation: [2006] SGHC 162
• Court: High Court (Singapore)

13 September 2006

Sundaresh Menon JC:

Background

1 The Workmen’s Compensation Act (Cap 354, 1998 Rev Ed) (“the Act”) provides that an employer shall be liable to his workman who suffers personal injury by an accident arising out of his employment. No difficulty arises where the workman has been in an accident as that term is commonly understood. However, difficulties can arise where an injury is sustained that is closely related to the workman’s pre-existing medical condition. In such cases, the line between wear and tear on the one hand and an accident in the course of employment on the other can seem very thin. This is such a case.

2 Narayasamy s/o Ramasamy (“the deceased”) was a 58-year-old male working as a coach driver for Asia Coach Services Pte Ltd, the second applicant. He had been so employed for some years. It was within his work scope to ferry specified airline crew between the airport and the hotels at which they were staying and in this context to help with the carriage, loading and stowage of the luggage of an entire crew from the kerbside onto the luggage compartment of his coach at the start of each journey and to do the converse when he reached his destination.

3 On 4 March 2004, the deceased started work at about midnight. He made a number of trips ferrying crew and luggage between hotels in the city and the airport. An eyewitness testified that the deceased had been loading bags at the airport on one of these trips and had felt uncomfortable then. The witness in question had assisted him with some bags at that time.

4 The same witness testified that a couple of hours later, he saw the deceased for the second time that morning. He was carrying a piece of luggage to the luggage compartment of the coach. He then felt breathless and was unable to continue with his work. An ambulance was called and he was brought to a nearby hospital where he was pronounced dead at about 4.30am.

5 It cannot be disputed that the deceased had been engaged in heavy work for some hours prior to his death. There was evidence before the learned Deputy Commissioner of Labour (“the Commissioner”) who heard the matter at first instance that the deceased would typically have ferried a crew of between 15 and 20 members, with at least two bags each. These bags tended to weigh between 10kg and 30kg or more each. The evidence was that the deceased typically had to load and unload all that luggage on each trip with little, if any, assistance. He had been doing such work on the morning in question just hours prior to his death.

6 An autopsy was duly performed. The cause of death was identified as a recurrent myocardial infarction. In short, he had sustained a heart attack but the effects of this were superimposed on one he had suffered previously. It was also learnt that some major coronary blood vessels of the deceased were already severely narrowed prior to his death. He was therefore not in good health to begin with.

The proceedings before the Commissioner

7 The deceased by his next of kin (“the respondent”) brought a claim for compensation but this was assessed at “nil” by the Ministry of Manpower on the basis that the injury was not work-related. The respondent challenged this and it then went before the learned Commissioner. The central issue before the Commissioner was whether the heart attack had been sustained in the course of the employment of the deceased as required by s 3(1) of the Act. NTUC Income Insurance Co-operative Ltd, the first applicant, was the insurer. It did not dispute that the heart attack was an accident. However, it did dispute that the heart attack had arisen in the course of his employment. In the first applicant’s view, he had died of causes unrelated to his employment, it being purely coincidental that he had suffered the heart attack while working.

8 Much of the facts were not ultimately controversial. The real issue on the facts turned on the medical evidence that went to the immediate cause of the death; specifically, was the heart attack caused or contributed to by the work that the respondent had been doing during and just prior to his untimely demise?

9 The only medical evidence led was that of Dr Wee Keng Poh (“Dr Wee”), a principal forensic consultant with the Centre for Forensic Medicine of the Health Sciences Authority and one of two doctors who conducted the autopsy. Dr Wee was called on behalf of the respondent and was cross-examined by the applicants’ counsel. The applicants did not call any medical evidence.

10 I propose to set out the essence of Dr Wee’s evidence in a little detail. When the autopsy report was submitted to the first applicant, it had taken issue with the claim on the basis that the death appeared to have been brought about by natural causes. Dr Wee was therefore asked by the respondent’s counsel to clarify if the deceased’s heart attack could have been caused by strenuous work. Dr Wee responded that it most certainly could have been. However, he added that for him to conclude that the deceased had in fact sustained the heart attack because of the strenuous work he was said to be doing that morning, it would be helpful to show that he had been exerting himself “over and above what he was used to”. It should be noted that this was a comment made months before the hearing; and it was made at a time when Dr Wee was not clear from the materials he was presented with just what the deceased had been doing prior to and at the time he sustained the heart attack.

11 Before the Commissioner, Dr Wee specifically testified to the effect that:

(a) exertion could have triggered the heart attack;

(b) had the deceased, shortly before the injury, been carrying ten to 15 bags weighing between 15 and 25 kilograms each, that “would have contributed to … the heart attack”; and

(c) the degree of strain that a person could endure without sustaining a heart attack would depend on the state of health of that person’s heart.

12 Under cross-examination, he added that what would be strenuous would be subjective and would depend on the age and fitness of the particular patient at the time of the incident. He also said that given the state of the deceased’s heart, the attack could have occurred with or without exertion. Indeed, it could even have happened while the deceased was sleeping. He was then asked if the exertions of the deceased had to be over and above what he was used to in order for it to be identified as a cause. He responded that if it was, “there would certainly be exertion that contributed significantly to his heart attack”. When asked to clarify this by the learned Commissioner, he said:

If it can be proven that he was exerting over and above what he was used to, then I have no hesitation to say that physical exertion was a contributory cause.

If it cannot be proven, then [it is] difficult for me to say with certainty though … heart disease is not static, it can deteriorate [to such a point that] what he was used to can be strenuous.

[emphasis added]

13 The Commissioner quite rightly in my view regarded the evidence on this issue as unclear. He therefore directed the parties to seek certain written clarifications. This was done and Dr Wee duly clarified that, in his opinion, having regard to the actual medical condition of...