A Stroke or Heart Attack at Work: Is It a Work Injury?

Published: 2026-09-24

Usually not — unless a specific event or exertion at work can be shown, medically, to have triggered, contributed to or accelerated the stroke or heart attack. Section 5(1) of the Employees' Compensation Ordinance (Cap. 282) speaks of "personal injury by accident": the Court of Final Appeal has held that the accident and the injury must be two different things, so a stroke or heart attack cannot be its own accident. All six stroke and heart-attack claims discussed below (one in the Court of Appeal, five in the District Court) failed, as did a Court of Final Appeal claim over a workplace death of unknown cause; the two routes that remain are proving a particular work trigger, or an occupational disease listed in the Second Schedule — and neither stroke nor heart disease is listed.

At a glance

Question	What the law says	Source
I had a stroke at work — is that the "accident"?	No. Accident is cause, injury is effect; they must be distinct.	[2013] HKCFA 32 ¶17, ¶21
Does the s.5(4)(a) presumption help?	No. It goes only to whether an accident arose "out of" the employment, not to whether there was an accident at all.	[2013] HKCFA 32 ¶5
What has to be proved?	That "some particular act at work" triggered, contributed to or accelerated the event; "stress" without evidence of a real change in workload is not enough.	[2023] HKCA 75 ¶55, ¶64
Can an ordinary exertion count?	Possibly. The Court of Appeal said this route "clearly requires evidence both medical and factual" that the exertion was excessive for this employee; it was not open on that appeal because it had not been run at trial, and the evidence was lacking.	[2023] HKCA 75 ¶26
Depression after being shouted at by a boss?	An ordinary meeting or argument is not an accident; [2018] HKDC 766, drawing on UK decisions, looked for words that were "outrageous and untoward" and an "unexpected mishap" (Judiciary's English translation), and found nothing "unexpected and untoward" in an ordinary meeting. Psychiatric injury after a physical accident is a different matter.	[2018] HKDC 766 ¶45, ¶91–95; [2021] HKDC 1456 ¶55
The occupational-disease route?	Only for diseases listed in the Second Schedule; causation is presumed only for employment in the trades listed against them within the prescribed period. Stroke and heart disease are not listed.	ss.32, 34; Second Schedule
A fatal collapse — what matters first?	Cause-of-death evidence (the CFA case failed for want of an autopsy); the application within 24 months of the date of death or before any determination by the Commissioner under s.6B(1)(a), whichever is earlier; the Court may accept a late application if there was a reasonable excuse.	[2013] HKCFA 32 ¶17; ss.14(1), 14(4)

What the Ordinance says: the accident and the injury must be distinct

Section 5(1) makes the employer liable "if in any employment, personal injury by accident arising out of and in the course of the employment is caused to an employee": accident is cause, injury is effect. In [2013] HKCFA 32 an employee spent an ordinary working day at his employer's mainland factory, went to the toilet and was found slumped on the floor; he had no breathing or heartbeat on arrival at hospital and could not be resuscitated, no autopsy was performed and the cause of death could not be determined. The family argued that the death itself was the accident. The Court of Final Appeal held at ¶21:

"It is undoubtedly the law that the accident must be distinct from the injury, with the accident being at least a contributory cause and the injury being the effect."

The s.5(4)(a) presumption does not rescue this step. It provides that "an accident arising in the course of an employee's employment shall be deemed, in the absence of evidence to the contrary, also to have arisen out of that employment". The Court said at ¶5 that whether the injury was by accident "is distinct from, and logically anterior to, any question of whether what has happened arose out of or in the course of the employment. So this presumption does not go to the distinct and anterior question of whether the injury was by accident." The presumption operates at the second step; stroke claims usually fail at the first.

The Court of Appeal's modern statement: "some particular act at work"

In [2023] HKCA 75 a data-centre manager suffered an intracerebral haemorrhage in the lobby of the building housing the data centre and claimed that 14 days of excessive stress contributed to it; the trial judge found on the records no real change in workload. At ¶55 the Court of Appeal said the older authorities show that where a disease or bodily vulnerability "has been triggered, contributed to, or accelerated by some particular act at work, the injury may properly be called injury by accident", but "do not show that injury from a disease … may in itself be regarded as an accident or should without more be presumed to be injury by accident simply because it was suffered by an employee during working hours." At ¶64:

"For the injury to come within the ECO, there must be some evidence, at least sufficient to support an inference, that the stroke had something to do with the applicant's work, but there is simply none here".

The "ordinary exertion" route is not closed, but ¶26 says it "clearly requires evidence both medical and factual that, given the condition of the applicant, the making of what may for others be an ordinary exertion, is excessive for the applicant." And at ¶28: "it is best to avoid using the term 'external and internal accident'" — two District Court judgments in the table below, both given before this Court of Appeal decision, use those labels.

The District Court's three-part test — and why the dim-sum chef's claim failed

[2024] HKDC 1145 states the rule at ¶39:

"To succeed in a claim under s.5(1) of the ECO, the employee must prove: (1) an accident or a series of accidents arising out of and in the course of employment; and (2) the accident or series of accidents caused the employee's injury. In this context: (1) the injury per se cannot constitute the accident; (2) 'accident' denotes an undesigned untoward event in the employment; and (3) the accident must be 'a substantially contributing cause' ([an earlier Court of Appeal authority]) of the injury."

(The name of a cited case has been replaced in square brackets.)

On the family's pleaded case a dim-sum chef rostered from 3 am the previous day, more than 30 hours into the shift (¶41, ¶45), suffered a haemorrhagic stroke while pulling a tray of green peppers from a steam cabinet; the family's case was that the steam (cabinet 35–37°C) and repeated lifting of roughly 10 kg trays triggered the bleed, and both experts agreed it was spontaneous, with pre-existing hypertension the most likely underlying cause. At ¶81 the judge accepted that retrieving the tray "did not constitute a sudden and intense stimulus which caused a sudden surge in blood pressure …"; the study discussed at ¶83(2) treated lifts of more than 25 kg as heavy lifting, far above even the family's figures (¶83(2)(e)), and the family's own expert accepted that a 5–6°C change was only a fluctuation (¶80(4)(b)). Quantum had been agreed before trial (s.9 $936,000, s.8 $72,000, s.10(2) $104,520, s.10A $12,382, about $1.12 million); liability failed, and nothing was payable.

The other failures in one table

The employer's side contested every case below: in [2022] HKDC 59 the employer and main contractor appeared in person and the Employees Compensation Assistance Fund Board defended with counsel; in [2024] HKDC 522 and [2025] HKDC 697, which were applications to proceed out of time, the employer opposed through solicitors.

Case	Situation	Why it failed
[2022] HKDC 165	Car-workshop supervisor, with about 55 and 54 hours' overtime in December 2016 and January 2017, falling to 29 hours in February up to the day of the stroke (¶63); collapsed on a rest day he had come in to work; intracerebral haemorrhage.	¶48: the stroke "is something internal and therefore cannot constitute an 'accident'"; ¶64: the bleeding "can occur any time, no matter whether the patient is at work or at rest".
[2022] HKDC 902 (Chinese)	Site electrician said he stepped on broken pipe, struck his head and felt dizzy, then had an ischaemic stroke.	¶16 (this site's rendering): "put simply, an 'accident' is some 'external' factor — not the applicant's own disease — and that external factor caused the applicant's bodily or mental injury." ¶61 (this site's rendering): the fall was caused by the stroke, not the reverse. The assessment board's remark in Form 7 that, on the medical evidence then available, the stroke might not have been caused by a work injury or a compensable occupational disease (¶44) had not been appealed (¶45).
[2022] HKDC 59	Casual worker hired for one day to fit out an exhibition booth; fatal myocardial infarction after overtime (autopsy: ruptured coronary plaque).	¶35: identifying a trigger "requires support of reasonably convincing medical evidence and not by mere speculation …"; ¶69: dying at the workplace is not the same as the accident arising out of the employment.
[2024] HKDC 522 (Chinese)	Security guard who, on her account, felt chilled by the wind on duty, vomited, her legs gave way and she struck a wall; right-brain haemorrhage; known hypertension.	Out of time: extension refused and the application struck out (¶27). About seven months late (¶11), after a Labour Department letter of 28 April 2021 warning of the 24-month limit (¶15); ¶17 (this site's rendering): applying for legal aid is not a reasonable excuse for delay; at ¶27 the judge found no reasonable excuse had been shown. The judge also found no reasonable prospect of success: on her own case the haemorrhage was spontaneous, and the medical report rested only on her account of the wind, which the Observatory records did not bear out (¶18–25, this site's summary).
[2025] HKDC 697 (Chinese)	Security guard who fell while on patrol one evening.	Out of time: extension refused (¶24, ¶35). Almost four months late (¶15); ¶23 (this site's rendering): she had intended to give up and deliberately chose to do nothing until it was too late. The judge also found no reasonable prospect of success; ¶33 (this site's rendering): the medical evidence showed she fell because of a change in her own internal condition — vasovagal syncope — causing sudden dizziness.

A clarification on "overwork" criteria. At ¶57 of [2022] HKDC 59 the judge referred to recognition criteria for overwork-related cardiovascular disease established in Japan, Taiwan and South Korea (for example, 100 hours or more of overtime in the month before the event). These are not Hong Kong law — at ¶107 the judge treated them as "the best guidance to the court in the present case", and at ¶108 found that the deceased, hired for one day with a few hours' overtime that evening, came nowhere near them (¶58–59).

What can succeed

Route one: a specific, proved trigger. The Court of Appeal's words at ¶55 — "some particular act at work" — require a particular act, not that the job was always hard. Among the stroke and heart-attack cases discussed here, those decided at trial failed because no such act was identified, or the act relied on (steam, lifting trays, a fall and a knock to the head) did not stand up medically; the Court of Final Appeal case failed because the cause of death was unknown. That marks where the threshold sits, not that the door is shut.

Route two: psychiatric injury — but two kinds must be kept apart. Being criticised or argued with. In [2018] HKDC 766 a teacher was diagnosed with a situational stress reaction after a meeting of about 20 minutes with the principal and vice-principal. The judge drew on UK Social Security Commissioner decisions, one of which held that a conversation relied on as the accident must be "outrageous and untoward" as well as an "unexpected mishap" (¶45, quoted from the Judiciary's English translation), and found that asking her to account for her late attendance was ordinary school administration, with nothing "unexpected and untoward" (¶91–95). In [2026] HKDC 1703 a laboratory technician said a colleague shouted into his left ear at close range for five to ten minutes, damaging his hearing (the claim was for an ear injury, not psychiatric injury, but the 'accident' threshold is the same). The court found only an argument with raised voices, and no sustained shouting at close range (¶54, ¶65); at ¶64 the judge held (this site's rendering) that disagreements and even quarrels between colleagues over work arrangements, resources or rules are not uncommon, and the verbal clash "was neither sudden nor out of the ordinary". The court also found that the ear injury was not shown to have been caused by the argument (¶71–72).

Psychiatric injury after a physical accident. This is different, because the accident already exists. In [2021] HKDC 1456 a clerk missed her footing stepping down from a lorry cab and fell, suffering a scalp haematoma; about two to three months later she developed psychiatric symptoms (¶55), and the employer appealed the Form 9 alleging malingering, with surveillance footage. The appeal was dismissed; at ¶55:

"Taking into account the fact that the applicant did suffer from head injuries with scalp hematoma of 2cm and the close proximity in time of the Accident and the time when the applicant developed psychiatric symptoms, I find that the applicant's psychiatric impairment was caused by the accident."

The Form 9 assessment of 21.25% (20% of it for psychiatric impairment) and its sick-leave certification were upheld (¶58, ¶78). In [2025] HKDC 1283 a daily-paid metal-recycling worker who fell from a ladder was found by the joint psychiatric expert to have an adjustment disorder mainly caused by the accident (¶19), and the court added three months' psychiatric sick leave to the 285 days allowed for the orthopaedic injuries (¶42, ¶44) — the employer was uninsured and did not attend (its solicitor had no instructions), and the Employees Compensation Assistance Fund Board contested quantum with counsel.

Occupational disease is a different door — and stroke and heart disease are not behind it

Section 32(1) wires the Second Schedule diseases into the accident scheme: the employee or the family "shall be entitled to compensation under this Ordinance as if such incapacity or death had been caused by an accident arising out of and in the course of employment", and paragraph (a) provides that "the incapacity or the death shall be treated as the happening of the accident". Section 34 adds a presumption: an employee who, within the period in the fourth column of the Second Schedule immediately preceding the incapacity or death, was "employed in any trade, industry or process specified opposite to that disease in the third column of that Schedule" has it "presumed, until the contrary is proved, that such disease was due to the nature of such employment."

This door needs no "accident" — but it opens only for the diseases listed in the Second Schedule, and the disease must be due to the nature of employment in which the employee was engaged within the prescribed period immediately preceding the incapacity or death (s.32(1)). If, within the period in the fourth column immediately preceding the incapacity or death, the employee was employed in the trade, industry or process listed against that disease in the third column, s.34 presumes that the disease was due to the nature of that employment; the presumption can be displaced by proof to the contrary. The Schedule (version in force 14 May 2026) has 48 items in four parts, A to D; none is stroke, heart disease, myocardial infarction, hypertension or cerebrovascular disease. How ss.32 and 34 operate is in the occupational-disease section of the employees' compensation guide .

[2025] HKDC 2131 is the example. An accounts clerk said typing and mouse work caused right-shoulder tendinitis. At ¶45 (this site's rendering) her case identified no single unintended and unexpected occurrence; the typing was part of her duties. At ¶55 (this site's rendering): "items A4 and A8 both concern conditions of the hand or forearm and do not include the shoulder, so the injury alleged by the applicant is not an occupational disease listed in the Second Schedule." The shoulder is off the list in the same way a stroke is: the Second Schedule is a closed list.

The statistics say the same. The Labour Department's Occupational Safety and Health Statistics Bulletin Issue No. 26 (August 2026), p. 5, records 332 "confirmed cases of occupational diseases and gas poisoning" in 2025: occupational deafness 186, silicosis 89, mesothelioma 22, tenosynovitis of the hand or forearm 13, asbestosis 9, tuberculosis 4, compressed-air illness 4, Streptococcus suis infection 1, occupational dermatitis 1, gas poisoning 3. None is a stroke or heart disease. The occupational-disease figures cover diseases reported under four Ordinances, not only Cap. 282 (Bulletin p. 8); occupational deafness, silicosis, asbestosis and mesothelioma are compensated under their own Ordinances (Cap. 469 and Cap. 360; see s.36(2)).

What the family should know after a fatal collapse

Cause-of-death evidence comes first. [2013] HKCFA 32 failed because no autopsy was done and the cause of death could not be determined; ¶17: "Without a known cause of death, the injury can hardly be found to be an injury by accident." [2022] HKDC 59 had an autopsy; the claim still failed, but on the trigger, not on an unknown cause.

The 24 months run from the date of death. Section 14(1) requires the application, "in the case of death, within 24 months from the date of death or prior to a determination made by the Commissioner under section 6B(1)(a), whichever is the earlier". Section 14(4) provides the exit: the Court "may receive and determine any application for compensation" out of time "if it is satisfied that there was reasonable excuse for the failure so to give notice or to make an application, as the case may be." The two security-guard cases (both injury claims, where the 24 months run from the accident) show how "reasonable excuse" is examined: in [2024] HKDC 522 the applicant gave no reason for the delay (¶14), and the court said that applying for legal aid is not a reasonable excuse for delay (¶17, ¶27); in [2025] HKDC 697, deciding to give up and then changing one's mind was not one (¶23). The two 24-month lines (ss.14(1) and 16A(1A)) and the six-month application period for fatal cases under s.6B (which the Commissioner may extend) are in the employees' compensation guide .

Frequently asked questions

The Labour Department has the employer's Form 2. Is it already a work injury?

No. Form 2 is the employer's notice of the accident to the Commissioner under s.15, which must be given "irrespective of whether the accident gives rise to any liability to pay compensation"; it does not decide liability. Nor does an assessment board's form: the applicant in [2026] HKDC 1703 had a Form 9 with a percentage (¶74), and the claim still failed: there was no accident, and causation was not proved (¶72).

I had months of overtime before the stroke. Does overtime count as the accident?

Not in these two cases: [2022] HKDC 165 and [2023] HKCA 75 both failed because no "particular act" could be identified; sustained overtime is a process, not an event. The foreign overwork criteria are not Hong Kong law.

So what is a "particular act"?

An event that can be pointed to, is distinct from the injury, and is shown medically to have triggered, contributed to or accelerated it. [2024] HKDC 1145 shows how that is tested: even on the family's figure of about 10 kg a tray (the court found about 14 lb), and a 5–6°C change, the literature did not support a trigger. What is enough is a medical and factual question in each case.

A family member died suddenly at the workplace. What is the first thing to know?

The cause of death. [2013] HKCFA 32 failed because there was no autopsy. After that, time: 24 months from the date of death under s.14(1) (or before any earlier determination by the Commissioner under s.6B(1)(a)); the "reasonable excuse" in s.14(4) was refused in both [2024] HKDC 522 and [2025] HKDC 697.

Sources

Statutory text is from the Employees' Compensation Ordinance (Cap. 282), version in force 14 May 2026: ss.5(1), 5(4)(a), 14(1), 14(4), 15, 32(1), 34, 36 and the Second Schedule.

Labour Department, Occupational Safety and Health Statistics Bulletin Issue No. 26 (August 2026), p. 5 — confirmed cases of occupational diseases and gas poisoning, 2025 https://www.labour.gov.hk/common/osh/pdf/Bulletin2025_issue26_en.pdf

Judgments quoted

[2013] HKCFA 32 — https://www.hklii.hk/en/cases/hkcfa/2013/32
[2023] HKCA 75 — https://www.hklii.hk/en/cases/hkca/2023/75
[2024] HKDC 1145 — https://www.hklii.hk/en/cases/hkdc/2024/1145
[2022] HKDC 165 — https://www.hklii.hk/en/cases/hkdc/2022/165
[2022] HKDC 902 (Chinese) — https://www.hklii.hk/tc/cases/hkdc/2022/902
[2022] HKDC 59 — https://www.hklii.hk/en/cases/hkdc/2022/59
[2024] HKDC 522 (Chinese) — https://www.hklii.hk/tc/cases/hkdc/2024/522
[2025] HKDC 697 (Chinese) — https://www.hklii.hk/tc/cases/hkdc/2025/697
[2018] HKDC 766 (Chinese; Judiciary's English translation) — https://www.hklii.hk/en/cases/hkdc/2018/766
[2026] HKDC 1703 (Chinese) — https://www.hklii.hk/tc/cases/hkdc/2026/1703
[2021] HKDC 1456 — https://www.hklii.hk/en/cases/hkdc/2021/1456
[2025] HKDC 1283 — https://www.hklii.hk/en/cases/hkdc/2025/1283
[2025] HKDC 2131 (Chinese) — https://www.hklii.hk/tc/cases/hkdc/2025/2131
[2025] HKCA 243 (Chinese) — https://www.hklii.hk/tc/cases/hkca/2025/243

About these case summaries: the summaries above were prepared by this site based on our own reading and understanding of the judgments. They are not legal advice, have no legal effect, and must not be cited as authority. Cases are identified by neutral citation only, with no party names given. Outcomes turn on the totality of each case's circumstances; everything cited here is what the cited case actually decided, never a prediction for any other case. Passages from Chinese-language judgments are given in this site's own English rendering or in the Judiciary's published English translation, marked as such.

Matters this article does not address

This article makes no statement either way on the following.

Any Hong Kong judgment in which a stroke or heart-attack claim succeeded. Every such claim cited in this article failed; nothing is said about whether any has succeeded, or about what evidence would suffice.
Medical questions. What exertion, temperature or stress can trigger a stroke or myocardial infarction is reported only as the expert evidence and literature thresholds recorded in the judgments cited; no medical statement is made.
A statutory "overwork" standard. The Employees' Compensation Ordinance contains none; the foreign criteria referred to in [2022] HKDC 59 are not Hong Kong law, and nothing is said about their content or applicability.
The item-by-item contents of the Second Schedule. Only the number of items (48), the absence of stroke, heart disease, myocardial infarction, hypertension and cerebrovascular disease, and the fact that items A4 and A8 concern the hand or forearm (A8 including the elbow) and not the shoulder, are stated; the remaining items, trades and prescribed periods are not set out.
Paragraphs 54–60 and 67–74 of [2022] HKDC 165, and the final outcome of the appeal in [2024] HKDC 522. Only ¶48, ¶63 and ¶64 of the former are cited; in the latter the Court of Appeal ([2025] HKCA 243) made an order for security for costs only.
Death compensation amounts and distribution (ss.6, 6A, Seventh Schedule), the detail of s.6B, and whether an infectious disease can be an "accident". Not addressed; the first two are in the employees' compensation guide.
Any individual reader's case. Every ruling here is the finding in the case cited; no prediction is made for any other case.