Occupational Disease Claims Research Articles

A Scoping Review of Causal Associations between Occupation and Cancer Occurrence and Legal Burden of Proof.

Occupational diseases, characterized by the gradual accumulation of work-related harmful effects over extended periods, often lack a distinct, identifiable incident causative of the disease. This ambiguity in pinpointing the work-relatedness of such diseases stems from the intricate interplay between occupational risks, workers' pathophysiological predispositions, and pre-existing health conditions, all of which evolve slowly over time. Consequently, establishing a definitive causal relationship between occupational exposure and disease manifestation becomes a pivotal, yet challenging, aspect in securing industrial accident insurance benefits. In contrast to occupational accidents, where causality is relatively more discernible, the complexity escalates in the context of occupational diseases. Typically, employers maintain the majority of data pertinent to establishing causality, but this data is frequently inadequate. Furthermore, the onus of proving the work-relatedness of a disease falls on the worker, a process that necessitates specialized medical knowledge, thereby compounding the difficulty. Imposing the burden of proof on workers in occupational disease litigation could lead to a lapse in worker protection. This paper critically explores methodologies to safeguard workers, focusing specifically on the burden of proof concerning causality in occupational diseases. This analysis aims to highlight the challenges workers face in establishing a connection between their work and disease, proposing potential legal and policy solutions to ensure more equitable and just outcomes in occupational disease claims.

Outcome of the Compensation Process Initiated by an Occupational and Environmental Diseases Center.

Regional Centers for Occupational and Environmental Pathologies (CRPPE) are responsible for identifying possible occupational etiologies of pathologies. When an occupational origin is determined, an Initial Medical Certificate (IMC) is given to the patient to allow him to initiate a procedure for recognition as an occupational disease (OD) by his health insurance organization. The main aim of this study was to investigate the outcome of occupational disease claims in patients who received an IMC delivered by the CRPPE of Lyon. A telephone interview was systematically conducted with patients who consulted the CRPPE for a claim for occupational disease recognition between 07/2020 and 06/2021, about six months after the consultation. It was conducted by a physician using a standardized questionnaire. Out of 128 patients eligible for this study, 98 were included. Diseases of the respiratory system (34.7%) and cancers (28.6%) were the most common pathologies in our population. A process of OD compensation was initiated by 86 patients (87.8%). At the time of the study, the outcome was favorable for 63 patients (73.3%). Moreover, 18 patients (18.4%) wished for additional help from the CRPPE to carry out the procedures. Nine patients requested a new consultation, including five who still needed to complete the process. This study shows the benefit of a consultation by occupational disease consultants. However, difficulties still need to be solved in these procedures. Thus, the systematic follow-up of patients shows its advantages. The provision of support to carry out the process seems necessary.

Occupational disease predictors in the nickel pyrometallurgical production: a prospective cohort observation

BackgroundPyrometallurgical nickel production exposes workers to a wide range of occupational risk factors, including nickel aerosol, occupational noise and heat, but occupational (compensation) claims do not get enough attention in the literature. We, therefore, aimed to identify and analyze new occupational disease predictors in order to tailor prevention measures in the nickel pyrometallurgical production workers.MethodsIn a prospective observational study, a cohort of workers grouped in 16 occupations (N = 1424, 88% males, median age 39 (interquartile range (IQR) 31–47 years)), was fixed in 2007 at a large nickel production plant in the Russian High North. We then followed the cohort until 2021 and analyzed the association of selected predictors, including exposure to nickel and occupational group, with the risk of an occupational (compensation) claim in a Cox regression analysis.ResultsWith 18,843 person-years of observation, occupational disease claims were confirmed in 129 workers (9% of the initial cohort, N = 108 men (84%)). Top three diagnoses were chronic bronchitis (3.81 cases/1000 workers/year), sensorineural deafness (2.36 cases/1000 workers /year) and musculoskeletal disorders (1.90 cases/1000 workers/year). Smoking was significantly associated with each diagnosis (adjusted hazard ratio (HR) ranged from 2.56 (95% confidence interval (CI) 1.17–5.57) for bronchitis to 6.69 (95% CI 1.46–30.64) for chronic obstructive pulmonary disease (COPD)). High nickel exposure was associated with occupational bronchitis and occupational asthma, whereas associations of occupational groups were also identified for COPD, asthma and musculoskeletal disorders.ConclusionSmoking, high exposure to nickel and specific exposure in the occupational groups increase the risk of occupational disease claims and should be prioritized directions for targeted intervention.

Occupational disease claims and non-occupational morbidity in a prospective cohort observation of nickel electrolysis workers

Exposure to nickel aerosol in the nickel production is associated with greater occupational risk, yet little is known how many workers will develop an occupational disease and claim compensation. The aim of this analysis was to prospectively observe a cohort of nickel electrolysis workers and quantitatively assess confirmed occupational disease claims. We observed a cohort of nickel electrolysis workers (N = 1397, median age 39, 68% males) from 2008 till 2020 in one of the largest nickel producers in the Russian High North. Cumulative incidence of confirmed occupational disease claims in seven occupational groups, including electrolysis operators, hydrometallurgists, crane operators, final product cleaners, metalworkers, electricians and ‘other’ was analyzed and supplemented with Cox proportional hazards regression, yielding hazard ratios (HR) with their 95% confidence intervals (CI) of occupational disease claims for each group. N patients with occupational disease claims varied from 1 in 2016 to 22 in 2009, and in total 87 patients developed one or more occupational diseases (cumulative incidence 6.2%, p < 0.001 between seven groups). Accounting for 35,527 person-years of observation in total, cleaners exhibited the greatest risk (HR 2.58 (95% CI 1.43–4.64)), also adjusted for smoking, number of non-occupational diseases and group 2 (hydrometallurgists). Smoking was independently associated with having an occupational disease claim in all groups (p < 0.001), as was the number of non-work-related diseases in six groups of seven. Despite consistent improvement in the exposure control measures in nickel production, occupational morbidity persists. More effort is needed to reduce exposure in final product cleaners.

Approval status and characteristics of work-related musculoskeletal disorders among Korean workers in 2020.

This study aimed to investigate the characteristics of work-related musculoskeletal disorders (WRMSDs) in occupational disease claims and identify patterns of WRMSDs for each body part by industry and occupation. This study analyzed the raw data of occupational disease claims for musculoskeletal disorders deliberated by the Occupational Disease Decision Committee of the Korea Workers' Compensation & Welfare Service in 2020. The data was classified into 6 body parts with the highest numbers of occupational disease cases by using the complete enumeration data on principal diagnoses and 4 types of subdiagnoses in the raw data. The characteristics and approval rates of WRMSDs by body part, industry and occupation were examined and summarized. A total of 13,015 occupational disease cases for WRMSDs were classified, and lumbar spinal (back) diseases accounted for the largest proportion of claimed diseases, followed by shoulder, elbow, wrist, knee, and neck diseases in a descending order. The occupations with the highest and second highest numbers of occupational disease cases by body part were found to be automobile assemblers and production-related elementary workers for the neck, school meal service workers and cooks for the back, construction frame mold carpenters and school meal service workers for the shoulder, elementary workers in mining and food service workers for the elbow, food service workers and automobile parts assemblers for the wrist, and ship welders and school meal service workers for the knee. This study examined the characteristics and approval status of WRMSDs by body part and occupation. Based on the study results, management strategies for the prevention of WRMSDs should be established regarding occupations with a high risk of WRMSDs for each body part.

What COVID-19 Laid Bare: Adventures in Workers’ Compensation Causation

This essay performs a close analysis of workers’ compensation coverage of COVID-19 and arrives at the conclusion that it should not be “impossible” to prove in a legal sense that an employee’s COVID-19 was caused by work. Scientific proof is not the same as legal proof: workers’ compensation law has never required that claims must be supported by irrefutable scientific proof of workplace causation. Yet repeatedly one heard this suggestion during public discussion on workers’ compensation coverage of employees.Still, there is good evidence that even when workers’ compensation undisputedly covers work-related disease employers seldom pay benefits (and states do not compel them to do so). This is one reality that COVID laid bare: the workers’ compensation system rigidly resists paying occupational disease claims. The essay also explores a news account from Minnesota stating that nine hundred and thirty-five of nine hundred and thirty-five workers’ compensation COVID-19-related claims from meatpacking employees had not been paid as of February 2021. There was no shortage of other stories during the pandemic of mass denial of workers’ compensation claims in the meatpacking industry, a development having a disparate impact on communities of color, where more than half of all meatpacking employees are Latinx. These unpaid claim numbers suggest that something was “wrong” with causation analyses lower down in the administrative system. Another truth COVID laid bare is that, aside from workers’ compensation, there is no nationwide short-term disability program in the United States. This leads to the conclusion that, if workers’ compensation insists upon super-strict versions of causation to cover claims, a different method of compensating short-term disability during pandemics or other “environmental” crises may become necessary. The conclusion seems almost inescapable because public health experts like Dr. Fauci are warning that we remain at risk for “new disease emergences” for the “foreseeable future.”

Lessons from Asbestos Litigation Apply to COVID Claims

The rapid emergence of COVID-19 creates new challenges for the nation’s patchwork of state run workplace benefit delivery systems. This paper draws a comparison between COVID claims and asbestos claims, the “Largest and Longest” wave of occupational disease claims in the United States. The comparison offers insight into avoiding past economic, administrative and benefit delivery pitfalls. The lessons from asbestos claims provide an insight into maintaining a sustainable workers’ compensation system to meet the surge of COVID claims.

The characteristics of asbestos-related disease claims made to the Korea Workers\u2019 Compensation and Welfare Service (KCOMWEL) from 2011 to 2015

BackgroundThis study aimed to enhance understanding of the epidemiologic characteristics of asbestos-related diseases, and to provide information that could inform policy-making aimed at prevention and compensation for occupational asbestos exposure, through analyzing asbestos-related occupational disease claims to Korea Workers’ Compensation and Welfare Service from 2011 to 2015.MethodsWe analyzed 113 workers who filed medical care claims or survivor benefits for asbestos exposure and occupational-related disease from 2011 to 2015. Among these claims, we selected approved workers’ compensation claims relating to malignant mesothelioma and lung cancer, and analyzed the general characteristics, exposure characteristics, pathological characteristics, and occupation and industry distribution.ResultsMalignant mesothelioma and lung cancer occurred predominantly in males at 89.7 and 94%, respectively. The mean age at the time of diagnosis for malignant mesothelioma and lung cancer was 59.5 and 59.7 years, respectively, while the latency period for malignant mesothelioma and lung cancer was 34.1 and 33.1 years, respectively. The companies involving exposed workers were most commonly situated within the Busan-Ulsan-Gyeongnam region. Histology results for lung cancer indicated adenocarcinoma as the most common form, accounting for approximately one half of all claims, followed by squamous cell carcinoma, and small cell lung cancer. The most common occupation type was construction in respect of malignant mesothelioma, and shipbuilding in respect of lung cancer.ConclusionsConsidering the long latency period of asbestos and that the peak period of asbestos use in Korea was throughout the mid-1990s, damage due to asbestos-related diseases is expected to show a continued long-term increase. Few studies providing an epidemiologic analysis of asbestos-related diseases are available; therefore, this study may provide baseline data to assist in predicting and preparing for future harm due to asbestos exposure.Trial registrationDUIH 2018–02–004-001. Registered 28 Februrary 2018.

Persistent failure of the COIDA system to compensate occupational disease in South Africa

Cases of occupational disease, solvent encephalopathy and occupational asthma are used to exemplify failings of the workers' compensation system in South Africa, that include delays in processing claims, non-response to requests for information, and inadequate assessment of disability. These and other systemic deficiencies in administration of the Compensation for Occupational Injuries and Diseases Act of 1993 (COIDA) reduce access by workers with occupational disease to private medical care, and shift costs to workers and to public sector medical care. Another unintended effect is to promote underreporting of occupational disease by employers and medical practitioners. Reforms have been tried or proposed over the years, including decentralisation of medical assessment to specialised units, which showed promise but were closed. Improved annual performance reporting by the Compensation Commissioner on the processing of occupational disease claims would promote greater public accountability. Given the perennial failings of the system, a debate on outsourcing or partial privatisation of COIDA's functions is due.

Experience Rating and Occupational Disease: a New Zealand Case Study

AbstractOccupational disease claims raise distinct challenges for the experience-rating model, demonstrating that it is not wholly effective in preventing occupational diseases or accurately attributing the claims costs of compensation or rehabilitation to employers. Experience rating is also incapable of effectively incentivising employers to manage most occupational disease claims, as there is likely to be a mismatch between the employer where exposure occurred, and the employer where the disease manifests itself. In fact, there may be a perverse incentive on employers, where employers may not be concerned about exposing workers to potential diseases as the employer is unlikely to be accountable for them.

Workers’ Compensation for Asbestos Related Disease in Five Canadian Provinces

Workers’ Compensation for Asbestos Related Disease in Five Canadian Provinces

Work-related accidents and occupational diseases in veterinarians and their staff

We assessed the occupational hazards in veterinary practice by analysing accident insurance data in order to stimulate strategies to prevent occupational accidents and diseases in veterinarians and their staff. Approximately 10,000 veterinary practices comprising about 27,500 veterinarians and their staff are covered by the Institution of Statutory Accident Insurance of the Health and Welfare Service (BGW). Each year about 2,000 accident and occupational disease claims are filed by these veterinarians and their staff. The claims for the 5-year period from 1998 to 2002 are analysed in this paper. For 2002, the incidence rate for accidents in the workplace was 105.4 per 1,000 full-time workers, a rate 2.9-times higher than for general practitioners of human medicine. When only severe accidents resulting in a loss of work time of more than 3 days were analysed, the relative risk increased to 9.2. Approximately 66% of the reported accidents are due to scratches, bites, or kicks from animals. Claims of occupational disease are filed 2.7-times more often by veterinarians and their staff than by general practitioners and their staff. The occupational diseases filed most often concern the skin (39%), followed by allergic respiratory diseases (30.5%), and infectious diseases (19.1%). Prevention strategies for veterinarians should focus on accidents caused by animals. The prevention of occupational diseases should focus on skin diseases, respiratory disease, and infections.

Compensation for musculoskeletal disorders in Quebec: systemic discrimination against women workers?

Criteria for evaluating workers' compensation claims for occupational disease are strongly linked to medical expertise as supported by scientific study, yet decision-makers are not necessarily familiar with the meaning of these studies. While this is a problem for all claimants, who bear the burden of proving that work caused their injury, the adverse impact of misunderstanding of scientific data can have particular consequences for women, whose work more often appears to be benign. This article reports on a study of empirical data drawn from analysis of 314 workers' compensation appeal tribunal decisions on compensation claims, in Quebec, for musculoskeletal disorders alleged to be related to repetitive work. The study considers randomly selected decisions rendered between 1994 and 1996 on diagnoses of tendonitis, epicondylitis, and carpal tunnel syndrome and, in a follow-up, looks at significant legal decisions by the same tribunals, rendered over a longer period (1987-96). Results indicate that women workers are significantly less likely than their male counterparts to have their occupational disease claims accepted by the appeal tribunal. Evidence suggests that inappropriate overreliance on scientific studies for adjudication purposes contributes to a greater rate of refusal of claims by women workers.

Compensating wage differentials for job stress

Recent medical studies have demonstrated a strong relationship between mental stress and cardiac events such as myocardial infarction and stroke. In the workplace, stress once accounted for less than 5% of all occupational disease claims, but it now accounts for over 15%. Although research on the effects of mental stress is increasing, few studies offer an economic perspective. In this paper, we examine the effects of job stress on weekly wages and explore the possibility that stress commands a compensating wage differential. Our findings suggest that, ceteris paribus, a wage differential does exist between workers experiencing mental stress and their ‘non-stressed’ cohorts. After controlling for other demographic and occupational factors, we found a statistically significant wage premium ranging from 3 to 10% attributable to mental stress. In addition, the magnitude of the differential varies by gender.

Occupational obstructive airway diseases in Germany

In industrialized countries, occupational asthma caused by allergens and irritants due to workplace exposure is increasing. More than 8,000 such claims were made in Germany (10.5% of all decided occupational disease claims) in 1995; 1,900 were confirmed (6.5% of all confirmed claims). The legal basis and the occupational disease-related regulations of trade-assigned statutory accident insurance institutions (‘Berufsgenossenschaften’) in Germany are described. Hitherto, three occupational disease categories for obstructive airway disorders existed: due to sensitizing agents, due to chemical-irritative or toxic agents, and due to isocyanates. Approximately 40% of accepted claims for occupational asthma and rhinitis result from exposure to flour. Ongoing changes in the recognition of work-related airway disease symptoms account for differences in the incidence and prevalence as reported over the years. Recently, chronic obstructive bronchitis and/or emphysema of hard coal miners have been included in the German list of occupational diseases. Am. J. Ind. Med. 33:454–462, 1998. © 1998 Wiley-Liss, Inc.

Occupational obstructive airway diseases in Germany.

In industrialized countries, occupational asthma caused by allergens and irritants due to workplace exposure is increasing. More than 8,000 such claims were made in Germany (10.5% of all decided occupational disease claims) in 1995; 1,900 were confirmed (6.5% of all confirmed claims). The legal basis and the occupational disease-related regulations of trade-assigned statutory accident insurance institutions ('Berufsgenossenschaften') in Germany are described. Hitherto, three occupational disease categories for obstructive airway disorders existed: due to sensitizing agents, due to chemical-irritative or toxic agents, and due to isocyanates. Approximately 40% of accepted claims for occupational asthma and rhinitis result from exposure to flour. Ongoing changes in the recognition of work-related airway disease symptoms account for differences in the incidence and prevalence as reported over the years. Recently, chronic obstructive bronchitis and/or emphysema of hard coal miners have been included in the German list of occupational diseases.

Workers' compensation for nonmalignant asbestos‐related lung disease

Workers' compensation claims filed for occupational illness are generally more complicated to resolve than are injury claims, and they may therefore face higher likelihood of rejection. This study analyzed outcomes and predictive factors for claims filed from one clinic in Washington State between 1982 and 1986 by 157 male patients for nonmalignant asbestos-related lung disease. Among 50 federal Longshore claims, 46 (92%) were unresolved or could not be located by claims administrators. In contrast, 118 (89%) of State Fund claims had been resolved, with 48% accepted without consistent relationship to disease severity. Claims filed under both jurisdictions showed a twofold greater risk of rejection by the State Fund (relative risk, RR = 2.0; 95% confidence interval, 95% CI = 1.3-3.2). State Fund claims filed for nonwhite patients were rejected more often than those of white patients, although the association was explained at least partially by jurisdictional overlap (adjusted RR = 1.5; 95% CI = 1.05-2.1). This study indicates a need to scrutinize the handling of occupational disease claims by the federal Longshore system and to consider the adverse influences of jurisdictional conflicts and possible race-associated factors on compensation of occupational illness.

Legal vs. Medical Criteria for Determining Causation in Occupational Disease Claims

Annals of the New York Academy of SciencesVolume 572, Issue 1 p. 17-22 Legal vs. Medical Criteria for Determining Causation in Occupational Disease Claims LESLIE CHEEK III, Corresponding Author LESLIE CHEEK III Crum & Forster Insurance Companies Washington, D.C. 20036aAddress for correspondence: Federal Affairs Department, Crum & Forster Insurance Co., Suite 414, 1025 Connecticut Avenue, N.W., Washington, D.C. 20036.Search for more papers by this author LESLIE CHEEK III, Corresponding Author LESLIE CHEEK III Crum & Forster Insurance Companies Washington, D.C. 20036aAddress for correspondence: Federal Affairs Department, Crum & Forster Insurance Co., Suite 414, 1025 Connecticut Avenue, N.W., Washington, D.C. 20036.Search for more papers by this author First published: December 1989 https://doi.org/10.1111/j.1749-6632.1989.tb13566.xAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Volume572, Issue1Occupational Health in the 1990s: Developing a Platform for Disease PreventionDecember 1989Pages 17-22 RelatedInformation

A Study of Signaling Behavior in Occupational Disease Claims

A LARGE theoretical literature has developed in the last decade describing informational asymmetries and quality signaling in markets. However, very few empirical studies have tested the signaling hypothesis. Most of these have addressed the signaling role of education in determining wage rates and hiring practices. This paper expands the empirical literature by examining the signaling incentives within a disability compensation program. In particular, we focus on the incentives of air traffic controllers to alter their work performance when applying for disability compensation. Our theory offers an explanation for the observed association between controller burnout and air safety incidents as an alternative to the one popularized by the controllers' union during the last decade. The circumstances prompting signaling by the controllers are present in many compensation programs covering occupational diseases. Disability resulting from occupational disease and/or exposure to hazardous wastes has been termed the health problem of the 1980s. This claim gained credibility when the conventional vehicles for compensating victims, namely, the tort liability system and workers' compensation statutes, suffered several well-publicized failures (most notably, the asbestos cases) in delivering timely awards. A major reason these systems failed to handle disease claims is the critical but often futile emphasis placed on determining the exact cause of the disability. To use the tort system effectively in order to sue for damages a victim must be able to identify

The Law and Economics of Workers' Compensation

This Institute for Civil Justice (the Rand Institute) report is as important for physicians as it is for attorneys and policymakers. After outlining the history of workers' compensation, the authors examine coverage, income protection, medical care and rehabilitation, safety incentives, and delivery systems. An analysis of how the system works, current policy issues, and suggestions for research complete the report. The authors debunk the myth that the system provides a speedy, relatively certain, and uncomplicated remedy: workers' compensation has "replaced litigation over who is at fault with litigation over what is at fault... and what the effects... will be on the victim." Nearly two thirds of occupational disease claims are contested, as compared with one tenth of accident claims and one fifth of all claims. A US Department of Labor estimate that only 3% of occupational diseases enter the claims process may not surprise physicians, but should cause them to