adventure/zurich v. Keffer

NOTICE: NOT FOR OFFICIAL PUBLICATION.
UNDER ARIZONA RULE OF THE SUPREME COURT 111(c), THIS DECISION IS NOT PRECEDENTIAL
AND MAY BE CITED ONLY AS AUTHORIZED BY RULE.

IN THE
ARIZONA COURT OF APPEALS
DIVISION ONE

ADVENTURE MEDICS LLC, Petitioner Employer,

ZURICH AMERICAN INSURANCE CO, Petitioner Carrier,
v.

THE INDUSTRIAL COMMISSION OF ARIZONA, Respondent,

STEVEN KEFFER, DECENDENT Respondent Employee.

No. 1 CA-IC 25-0025
FILED 07-06-2026

Special Action - Industrial Commission
ICA Claim No. 20241980041
Carrier Claim No. 2290056545
The Honorable Eric W. Slavin, Administrative Law Judge

AFFIRMED

COUNSEL

Ritsema Law, Phoenix
By Karolyn F. Clifford
Counsel for Petitioner Employer and Carrier

Industrial Commission of Arizona, Phoenix
By Afshan Peimani
Counsel for Respondent

Arizona Injury Law Group PLLC, Phoenix
By Briana E. Chua
Counsel for Respondent Employee

MEMORANDUM DECISION

Judge James B. Morse Jr. delivered the decision of the Court, in which
Presiding Judge Andrew M. Jacobs and Judge Brian Y. Furuya joined.

M O R S E, Judge:

¶1 This is a claim for death benefits by the surviving spouse
and children of Steven Keffer ("Keffer"). The Industrial Commission of
Arizona ("ICA") found Keffer's death compensable and awarded benefits.
Keffer's employer, Adventure Medics, LLC ("Adventure Medics"), and its
insurance carrier, Zurich American Insurance Co. ("Zurich"), challenge the
award. For the reasons below, we affirm.

FACTS AND PROCEDURAL BACKGROUND

¶2 Keffer worked seasonally as a firefighter and paramedic for
Adventure Medics, a company that provides first responders to wildland
fires. On a 106-degree day in August 2023, Keffer returned home from a
three-week deployment fighting a wildland fire. Keffer had to prepare
immediately to redeploy the next day to another fire. He was alone at the
house, and his wife and teenage children were in another state. He talked
to his wife on the phone at about 3:00 p.m. and was seen washing his
work truck in his driveway about 3:30 p.m. He sent a text message to a
co-worker around 5:30 p.m. which was the last outgoing communication
on his phone. The next day, the police conducted a welfare check and
found Keffer dead, lying face down in his bedroom. The coroner
conducted an autopsy and determined Keffer died of natural causes,
specifically a heart attack.

¶3 Keffer was 62 years old and in good health, with no reported
heart problems or any other health problems. Uncontested evidence
showed Keffer's preparation routine consisted of removing, cleaning and
checking, and repacking all his equipment from his work truck, including
both medical and camping equipment. This preparation was done in his
garage and driveway. The preparations usually took about three to four

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hours to complete. Adventure Medics admitted Keffer was on duty when
he died.

¶4 Keffer's wife and children filed a death benefits claim, which
Adventure Medics and Zurich denied. At the compensability hearing, the
ICA Administrative Law Judge ("ALJ") heard from two medical experts
addressing whether Keffer's activities that day were a substantial
contributing cause of the heart attack.

¶5 Dr. Ehrlich, a cardiologist, provided a medical opinion about
the relationship between Keffer's employment activities and his heart
attack. Dr. Ehrlich testified that Keffer "had a heart attack from a ruptured
plaque that blocked off his coronary artery" which caused "cardiac arrest."
He described risk factors that could cause a plaque to rupture such as
heavy physical activity and high temperatures. He determined those
factors were present on the day Keffer died, stating: "[I]t's the perfect
setup for a man who has these really easy-to-break plaques to have one
break." He opined that "the activities outside in the heat were what
triggered" the ruptured plaque, saying the rupture was "very, very, very
probably related to" what Keffer was doing outside before he went into
the house.

¶6 The medical examiner, Dr. Hu, also testified. He opined,
based on the circumstances in which Keffer's body was found, that the
rupture in the artery happened sometime during the day but he could not
say exactly when. He acknowledged that heavy lifting and exposure to
heat could have contributed to the heart attack. Dr. Hu testified that he
could not say with a "reasonable degree of medical certainty" that the
excess lifting and heat was a substantial contributing cause of the plaque
rupture because he did not know Keffer's activity before his death, but
these types of activities "could be substantial."

¶7 On cross-examination, Dr. Hu affirmed that lifting weight or
exposure to heat would not be considered insubstantial and completed his
testimony by noting if Keffer was doing heavy lifting that day it could
have been a substantial contributing factor to his heart attack.

¶8 After reviewing the evidence, the ALJ found Dr. Ehrlich's
opinion "more probably correct and well-founded" that the work activities
Keffer was performing were a substantial contributing cause of the heart
attack and death. He noted the only difference in the opinion of Dr. Hu
was he was less certain than Dr. Ehrlich about causation. The ALJ issued
an award finding the claim compensable.

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¶9 Upon administrative review, the ALJ affirmed his decision,
expressly stating he found the lay witnesses credible, and noted: "The
critical fact of [Keffer] working outside to prepare his truck in 106-degree
heat, with a subsequent cardiac event caused in substantial part by such
exertion, was supported by both medical experts as a classic situation that
falls well within what A.R.S. [§] 23-1043.01 requires. . . ."

¶10 Adventure Medics and Zurich filed this statutory special
action. We have jurisdiction under A.R.S. §§ 12-120.21(B) and 23-951(A).

DISCUSSION

¶11 An injury that leads to death is compensable if it arises out
of and in the course of employment. A.R.S. § 23-1021(A). But a heart-
related injury is not compensable "unless some injury, stress or exertion
related to the employment was a substantial contributing cause." A.R.S. §
23-1043.01(A). "Substantial . . . means more than insubstantial or slight."
Skyview Cooling Co. v. Indus. Comm'n, 142 Ariz. 554, 559 (App. 1984).
Furthermore, even an employee's customary occupational stress and
exertion can be sufficient to constitute a substantial contributing cause of a
heart attack. Konichek v. Indus. Comm'n, 167 Ariz. 296, 298 (App. 1990).
The employee need not be actively engaged in job duties at the time an
injury occurs. Dugan v. Am. Exp. Travel Related Servs. Co., 185 Ariz. 93, 101
(App. 1995).

¶12 Petitioners Adventure Medics and Zurich contend (1) the
factual findings by the ALJ are insufficient, (2) the evidence does not show
Keffer was in the course of employment when he died, (3) the foundation
relied upon by Dr. Ehrlich is too speculative to give weight to his medical
opinion, and (4) the compensability finding thwarts the legislative intent
of the heart-related claims statute. We disagree.

¶13 A reviewing court will not set aside an ICA award if it can
determine the basis for the ALJ's conclusions. Mace v. Indus. Comm'n, 204
Ariz. 207, 209–10, ¶¶ 4–5 (App. 2003). The basis for the ALJ's
compensability determination here was the testimony "from all the
witnesses, taken as a whole" and the expert medical opinions. We have no
difficulty discerning that evidentiary foundation. In the Decision Upon
Review, the ALJ stated Keffer was working outside in high heat to prepare
his truck and equipment for redeployment.

¶14 The ALJ's conclusion that Keffer was performing work
activities that contributed to his heart attack is supported by evidence,
including a letter from Adventure Medics's owner stating Keffer was on

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duty when he died. The testimony of Keffer's wife and adult daughter,
both of whom had observed Keffer perform those activities multiple
times, also supports that conclusion. Thus, evidence supports the legal
conclusion Keffer was in the course of employment when he suffered the
heart attack.

¶15 Regarding the expert testimony, the ALJ has the primary
responsibility to resolve conflicts in medical opinion evidence. Carousel
Snack Bar v. Indus. Comm'n, 156 Ariz. 43, 46 (1988). This court will affirm
the ALJ's resolution of conflicting medical opinions unless there is an
abuse of discretion. Kaibab Indus. v. Indus. Comm'n, 196 Ariz. 601, 605, ¶ 10
(App. 2000). An abuse of discretion occurs when no reasonable theory of
the evidence supports the ICA decision. Malinski v. Indus. Comm'n, 103
Ariz. 213, 217 (1968).

¶16 Here, there was no real conflict in the medical opinions. Dr.
Ehrlich was confident the activities and circumstances described to him
would have substantially contributed to Keffer's heart attack. Those
activities and circumstances were not speculative as other evidence in the
record supported the factual basis of Dr. Ehrlich's opinion. In addition,
the ALJ's conclusion that Keffer was performing work activities when he
suffered the heart attack is a reasonable theory of the evidence. Dr. Hu,
while not as confident in his understanding of the level of exertion
Keffer's activities required, agreed those activities could have substantially
contributed to the heart attack, provided they involved significant
physical exertion in high temperatures. Petitioners' argument here
devolves into an argument that Keffer's lay witness evidence was
insufficient to support Dr. Erhlich's opinion and that Dr. Hu's opinion
should have been given more weight. But, as we noted, the ALJ weighs
expert opinions, not this Court. The foundation for Dr. Ehrlich's medical
opinion was based not on speculation but on evidence provided by
competent, credible witnesses.

¶17 Finally, Petitioners argue the award thwarts the legislative
intent of the substantial contributing cause requirement. This argument
presupposes the evidence is not sufficient to show causation. But we have
found evidence in the record that supports the ALJ's findings and
conclusions and provides a reasonable theory of the evidence.

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CONCLUSION

¶18 We affirm.

MATTHEW J. MARTIN • Clerk of the Court
FILED: JR

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