Compensation of Occupational Illnesses in France

Abstract

Workers' compensation is an insurance program in which employers pay for job-related injuries and occupational disease. This no-fault insurance coverage pays medical bills and lost wages, without assigning blame to workers or their employers. Payment is supposed to be prompt and usually covers 100 percent of medical costs and two-thirds of wages. In the United States, state departments of labor and insurance regulate coverage by this 82-year-old program. In the absence of uniform federal standards, the laws, administration, coverage, and ability to receive compensation vary widely from state to state. Nationwide fewer than 5 percent of compensation settlements are for occupational disease, and of these, most are for noise-induced hearing loss. Although the relation of the workplace to an acute injury is often readily established, that between toxic exposures and disease (especially conditions with long latency periods) is difficult for workers to prove. Employers contest more than 80 percent of all compensation claims for chronic occupational diseases. The result is undercompensation and underrecognition of occupational illness, failure to take cases into the system, and inadequate feedback into the workplace for prevention. In the United States, the burden of proving that disease is occupational in origin lies with workers, who must find doctors able and willing to make a differential diagnosis between, for example, occupational lung disease and other chronic lung diseases. In contrast, French workers are eligible once they demonstrate an illness on the list of compensable conditions and show proof of occupational exposure. For this reason, the French system has been the envy of American workers, and herein lies the interest of the study by Annie Thébaud-Mony. Many analysts believe that most claims are contested because American workers are required to establish a causal link between a specific job and a particular illness. But, as Dr. Thébaud-Mony. shows, even when this requirement is removed, few claims are made for occupational illnesses in France. This study shows just how the French system fails its workers.