Occupational diseases cause 860,000 illnesses and 60,300 deaths in the United States annually according to the American Academy of Family Physicians. Illness directly attributable to work conditions and exposures is diagnosed in approximately 10 percent of hospitalized patients.

Judged against the standard that to be compensable an injury or illness must arise out of and in the course and scope of employment, rarely do employers or even employees view an illness as clearly crossing the required threshold. Qualifying an illness as a compensable occupational disease often requires industrial commission or court intervention. Occupational disease claims can be further complicated, in the legal sense, by environmental factors, personal habits, pre-existing conditions and the individual's medical history.

To be considered "occupational" and therefore compensable, the disease must arise out of or be caused by conditions peculiar to the work. Black lung disease (coal workers' pneumoconiosis (CWP) or anthracosis) results from prolonged exposure to coal dust in higher-than-normal concentrations, making the disease peculiar to the coal mining industry. Another example of a compensable occupational disease peculiar to an industry is a healthcare worker contracting an infectious disease such as HIV or hepatitis as a result of exposure to and contact with infected blood.

Sources of Occupational Disease

Conditions attributable to occupational exposure cover the gamut of common and uncommon illnesses, making it all the more difficult to connect the dots between the illness or injury and the course and scope of employment. Injuries commonly connected to work conditions include: carpal tunnel syndrome (and other repetitive-motion type injuries), hearing loss (when around noisy operations), black lung disease, asbestosis, silicosis, contact dermatitis and even Lyme disease contracted by employees working in wooded areas. Some illnesses are less clearly attributable to work-related exposure, including:

• Asthma: Usually affects employments working with animal and plant products, wood dust, metals such as cobalt, cutting oils, and irritants such as sulfur dioxide;

• Bronchitis: Common among employees working around high concentrations of acids, smoke and nitrogen oxides;

• Hypersensitivity pneumonitis: Most often found in workers around moldy hay and cutting oils (common among farming and agricultural operations, may want to recommend coverage to farms without the requisite number of employees);

• Respiratory irritation and infections: Affects mainly office workers arising out of indoor air pollution (a.k.a. sick building syndrome);

• Liver cancer: Generally results from exposure to vinyl chloride common in plastics manufacturing;

• Bladder cancer: Found in employment exposed to benzidine (common in plastics and chemical manufacturing);

• Skin cancer: Common in workers with long-term exposure to ultraviolet light (i.e. landscapers, construction workers, etc.);

• Brain and other tumors: May be the result of employee's long-term exposure to radiation;

• Spontaneous abortion: Often results from exposure to ethylene oxide;

• Sperm abnormalities: Can result from exposure to dibromochloropropane commonly used in the manufacture of pesticides;

• Birth defects: Usually the result of exposure to ionizing radiation (may open the employer to an Employers' Liability claim (discussed in a future post));

• Coronary artery disease: Mostly attributable to employees exposed to carbon monoxide and stressful working conditions;

• Neurologic disorders: Nervous system disorders are generally the result of employee exposure to toxins, organic solvents, metals and pesticides. Prolonged exposure or exposure to a high concentration of these substances can cause headaches, fatigue, cognitive disorders and even depression;

• Parkinson's disease: Associated with employment exposed to carbon monoxide poisoning and/or chronic exposure to manganese fumes or dust;

• Stress-related illnesses: Heart attacks, stroke and other like injuries will be explored below; and

• Eye and sight problems: Office-bound employees often experience eye and sight problems due to the need to focus on a computer screen for long periods.

Medicine and the Courts

Classifying illness as an occupational disease making it compensable under workers' compensation requires the combination of medical opinion and testimony and a legal finding of fact. Each case is judged on its own merits and its encompassing circumstances, thus there is no singular test that can be applied to every case to declare the illness as compensable or non-compensable.

Medical opinion leading to the conclusion that an illness is work-related is not necessarily based on the disease but on the facts surrounding the patient's sickness. Physicians will investigate:

• The timing of the symptoms relational to work: Do symptoms worsen at work and improve following prolonged absence from work (in the evening and on weekends);

• Are coworkers showing similar symptoms: Do coworkers show some of the same symptoms currently or in the past (may not be to the same degree as the patient as each individual has varying tolerances);

• If such illness is common to employees in that particular industry;

• If the employee has a predisposition that may lend itself to the illness such as an allergy; and

• Personal habits and medical history of the patient: Patients in poor medical condition (overweight, smokers, unrelated heart disease, etc.) and poor family medical histories may be more likely to contract a disease or illness that others would not in similar circumstances, clouding the relationship between the occupation and the illness. For example, smokers may be ill-equipped to fight off the effects of chemical concentrations to which others may have no problem being exposed

Industrial commissions and courts 1) compile the opinion of the treating physician and the opinions of other expert medical witnesses; 2) couple the medical evidence with the facts surrounding the case; and 3) compare the subject case with precedent to render a compensability ruling. This process can sometimes take years.

Stress-Related Illness

Establishing an illness as work-related is difficult even with ample evidence to show a causal connection between the exposures applicable to the position and the contracted disease. It is made more difficult when the "cause" of the illness leading to bodily injury is a concept as intangible as "stress."

Stress is most commonly pulled into occupational injury claims when the employee is seeking compensation for a heart attack, stroke or some other related cardiovascular injury. Case law surrounding the compensability of a "stress-induced" heart attack is less than consistent.

Tennessee's Supreme Court provided some relevant guidance regarding the compensability of stress-related injury in its March 2007, Lane v. City of Cookeville ruling. After considering the disparate medical evidence and the facts surrounding the heart attack Lane suffered allegedly due to the stress related to his police detective role, the Court ruled that Lane's heart attack was not the result of any extraordinary stress and subsequently denied his petition for permanent total disability benefits.

Tennessee's Supreme Court declared in this ruling that a heart attack is compensable if caused by the worker's physical exertion or by mental or emotional stimulation. The stimulation would have to result from a specific acute or sudden stressful event rather than a generalized condition of stress. Presumably, a long build up of stress would not fall into the compensable category.

Other published court findings and general "rules of thumb" require that the stress be of an unusual or abnormal nature, not normal stress as would be common to a certain job.

Which Policy Responds?

Occupational illnesses generally have a long "gestation" period. Employees may be exposed to the harmful condition for many years before the illness manifests. It is also possible that the employee doesn't contract the disease until years after the exposure ends.

The workers' compensation policy specifically states that the policy in effect at the employee's LAST exposure responds to the illness. Even if the employee is working from another employer at the time the disease manifests itself.

Conclusion

Occupational disease resulting in bodily injury tends to lend itself to litigation. Since there is rarely a definable place or time of the injury, industrial commissions and courts will likely continue to play a large role in these claims.

Employee's personal habits and medical histories will, likewise, continue to find their way into the piles of evidence as workers' compensation carriers look for legitimate ways to deny coverage. Employee's who are overweight (or even obese), with high blood pressure and smoke will likely have to prove that those conditions in no way contributed to the "work-related" heart attack for which they are seeking benefits.

Employees contracting cancer from long-term exposure to radiation may see carriers digging into their medical history to find a family history of cancer.

Not to blame or accuse, but the nature of occupational disease claims will see and has seen both extremes in court.

This article does not intend to provide legal advice regarding the compensability of any workers compensation claim. This is intended for educational and discussion purposes only.

All terms in this glossary and the glossary itself is taken from the book "The Insurance Professional's Practical Guide to Workers' Compensation: From History through Audit." The book is available now to add to your insurance library.