Ⅴ. Death from Overwork (Heart Attack: Myocardial Infarction Acute myocardial infarction is an incident where the heart muscle dies from a lack of blood by a sudden blockage of the coronary arteries which provide blood to the heart.
) and Verifications: Plant Manager From June to August 2011, Jihye Byun and Bongsoo Jung represented the widow in this case against the Employee Welfare Corporation.


A. Introduction

On May 4, 2011, the plant manager (hereinafter referred to as “the Employee”) of a milk-carton printing company (hereinafter referred to as “the Company”) in Gyeonggi province died from a heart attack (acute myocardial infarction) while at his office desk. His spouse applied to the Employee Welfare Corporation for a survivor’s pension claiming this was an occupational accident, that the Employee had died from overwork and stress related to work.
Generally, an injury occurring at work is easily admitted as an occupational accident. However, it is possible to have an illness occurring from overwork and stress declared an occupational accident when the survivor can satisfy the strict criteria presented by the Minister of Employment and Labor for recognition of a considerable relationship between work and death. Accordingly, it is not possible to declare an incident like this an occupational accident when the survivor applying for industrial accident compensation cannot confirm a cause-and-effect relationship between work and death.
The Employee Welfare Corporation, after this widow’s application for the survivor’s pension, declared in August 2011 that the employee’s death was caused by overwork and stress related to work. In reality, it is difficult to prove overwork and stress are the cause of death at work, but it was estimated that there was sufficient evidence to verify this case as related to overwork. In this article, I will explain the details of overwork and stress that caused illness in this employee’s case. After reviewing the criteria for determination as an occupational accident concerning the acute myocardial infarction (heart attack) according to the Industrial Accident Compensation Insurance Act, I will lay out the considerable cause and effect relationship between the Employee’s work situation and his death.

B. Details of Overwork

1. Summary
The Company, with a head office in the US, an administrative office in Seoul, and a factory in Gyeonggi province, has been engaged in printing milk cartons, etc. with about 100 employees. Since the Employee was hired by the company in 1984, he had been given many different positions until he became plant manager in 2004. In February and March 2011, foot-and-mouth disease was spreading around the country, causing a reduction in Company sales and increasing labor costs. Then, the head office in the US ordered him to implement redundancies, which created stress for the Employee as he had to lay off many of the colleagues who had worked together well for more than 10 years. In the meantime, a huge earthquake and tsunami occurred in Japan, resulting in the Company receiving a great number of production orders in April 2011. Production was extended from two shifts to three to meet the sudden increase in orders. Because of the strict quality demands from the Japanese milk carton production company, the Company had to scrap many defective products, which increased labor costs even more. In the middle of this, just one day before the Employee’s death, the Employee entertained directors from the head office who had just arrived in Korea to visit the factory. He returned home very late, and went to bed even later after putting together a presentation on the Company’s business situation. The following morning, the Employee went to the office at 7 o’clock, and while preparing for the presentation, had a heart attack (acute myocardial infarction) and died around 8:30 am, while sitting at his desk.
2. Details
(1) The Employee’s health
In reviewing the Company’s medical checkup reports for the previous three years (from 2008 to 2010), no evidence was found that the Employee had died from natural deterioration of a pre-existing condition. Some doctors had noted that the Employee had to be careful with his blood pressure and high cholesterol, but his figures were within the normal range.
In reviewing details of his use of the National Health Insurance over the five years leading up to his death, it was discovered that the Employee had visited the hospital once every two months since 2006 to check his blood pressure, and had taken prescription medication for hypertension every morning. He did not have any disease or other condition.

(2) Details of the Employee’s heavy workload
1) Twenty-four hours before the heart attack
The day before his heart attack, the Employee arrived at his office one hour earlier and started working. Then in the evening, he entertained in Incheon some directors from the head office until 9:40 pm and arrived home at about 12 pm. He then stayed up one more hour working on the presentation for the directors from the head office before going to bed. The morning of the heart attack, the Employee arrived at the office one hour early, at 7am, to work some more on the presentation.
2) One week before the heart attack
The Employee came to work every day of the entire week before the heart attack, including Saturday, April 30, Sunday, May 1, and the Company Foundation Day, May 2. Due to the combination of increased orders from Japan and peak-season production, the factory was in full-scale production, with employees working overtime and on holidays and weekends from the middle of April to the early part of May. These situations, as well as his preparations for the visit by company directors created physical and emotional hardship for the Employee that was too great for his body to bear.
3) Three months before the heart attack
- In early February, foot-and-mouth disease was spreading around the country, which increased costs due to reduced production. Because of this situation, the Employee was ordered by the head office in the US to reduce the number of employees.
- Because of all the production orders from the Japanese company, the Employee had to deal directly with all disputes with the buyer over quality issues in April 2011. As he was the only one in the company who could speak Japanese, he also had to entertain the Japanese engineers with dinner several times.
- In April and May, the Company began emergency production, changing the work schedule from two shifts to three, to meet the orders from Japan and peak-season production. The Employee worked at the office almost every day of April (including weekends & holidays) because of his responsibilities as the plant manager.

(3) Major details of stress
The Employee also experienced significant mental stress as well as the physical fatigue mentioned in the above paragraphs. He was ordered to implement a redundancy plan because the production costs in the Korean plant were higher than in the Taiwanese or Chinese plants, and also due to the impact foot-and-mouth disease had on the industry. He had already reduced the number of employees by 30 percent from 2007 to 2009 through individual interviews, letting go of people who had worked with him for more ten years. This created greater stress, partly because he had never thought there would be more lay-offs so soon. Having this latest redundancy plan confirmed while entertaining the directors from the head office added to the burden.

C. Related Legal Regulations: Criteria for Determining Heart Attack or Brain Vessel Disease as Occupational Accidents

That an employee’s illness or disease was caused by his/her job-related duties must be verified before determination of that illness or disease as an occupational illness. The criteria for recognition of “illness or death caused by an occupational reason” are as follows. (Implementation Decree ([Article 34] and its attachment #3).
1. When an employee at work experiences such things as an intra-cerebral hemorrhage, subarachnoid hemorrhage, cerebral infarction, myocardial infarction, or aortic dissection, or dies from one or more of these incidents (for at least one of the following reasons), this can be considered a work-related accident (however, in cases where the incident was caused by natural deterioration, it will not be regarded as a work-related accident):
1) Sudden and unexpected tension, excitement, horror, surprise or changes in the work environment cause remarkable physiological changes to the employee;
2) The work burden increases for a short period of time just before occurrence of the accident due to volume of work, time, intensity, responsibilities, or changes to the work environment, and causes physical and mental fatigue that can noticeably affect the normal operation of blood vessels in the brain or heart;
3) The chronic work burden due to volume of work, time, intensity, responsibilities, or changes to the work environment causes physical and mental fatigue that can noticeably affect the normal operation of blood vessels in the brain or heart.
2. For incidents of brain vessel or heart disease not described in paragraph A above, if the occurrence or deterioration of the disease can be verified as happening during the time periods mentioned above and medically verified as remarkably related to work, it can be regarded as a work-related illness.
3. Ministry of Employment and Labor Notification 2008-43

1. Brain Vessel Disease or Heart Disease
A. “Sudden and unexpected tension, excitement, horror, surprise or changes in the work environment cause remarkable physiological changes to the employee” means that, within the 24 hours before occurrence of the incident, the condition of the brain vessel or heart disease deteriorated rapidly and noticeably more than naturally, due to the occurrence of sudden and unexpected incidents or rapid changes in the work environment.
B. “The work burden increases for a short period of time just before occurrence of the accident due to volume of work, time, intensity, responsibilities, or changes to the work environment, and causes physical and mental fatigue that can noticeably affect the normal operation of blood vessels in the brain or heart” means that, within the one week before occurrence of the incident, the volume of work or working hours increased by at least 30%, and the intensity, responsibilities or work environment changed so greatly that a normal person would not be able to adjust.
C. “The chronic work burden due to volume of work, time, intensity, responsibilities, or changes to the work environment causes physical and mental fatigue that can noticeably affect the normal operation of blood vessels in the brain or heart” means that it was objectively confirmed that the physical and mental stress continuously occurred more often than during general work duties for at least three months before occurrence of the incident.
D. When evaluating “work burden for a short period of time” and “chronic work burden” according to “B” and “C” above, the following items shall be considered collectively:
1) Working hours and intensity at normal times;
2) Special cases such as fixed night-work, shift work, driving for long periods of time, etc.;
and
3) Whether the employee can adjust to the volume of work, choose the adjustment period, and get enough sleep.



D. Opinion (Verifying the cause-and-effect relationship between work and death)

A review of this case reveals that the related facts almost completely satisfy the Criteria for Evaluation as an Occupational Accident. The foot-and-mouth disease that affected the nation earlier that year had also seriously and negatively impacted the milk carton company the Employee worked for in terms of lost business and increased costs. Receiving the redundancy plan only made matters worse. Then suddenly orders from Japan greatly increased in April 2011 after the earthquake and tsunami. The factory had to work three shifts instead of two, working overtime and on holidays and weekends, days which the Employee also worked. There were disputes over quality issues with the related Japanese managers, which, as mentioned, the Employee had to directly resolve. On top of the accumulated physical fatigue from the aforementioned work load, his emotional stress greatly increased as the plant manager in charge of implementing the redundancy plan given by company headquarters. Accordingly, as it could be deemed that the Employee’s death could be considered a case where “the work burden increases for a short period of time just before occurrence of the accident due to volume of work, time, intensity, responsibilities, or changes to the work environment, and causes physical and mental fatigue that can noticeably affect the normal operation of blood vessels in the brain or heart,” this case was determined to be a work-related-accident.