Navigating Workers’ Comp Claims for Occupational Disease

The workers’ compensation landscape is intricate where occupational disease claims are concerned. These claims differ significantly from standard workplace injuries and often require unique policies to protect against niche risks based on industry.

Some examples of occupational diseases include cancer or lung disease caused by proximity to chemicals, fumes, asbestos, and other dangerous workplace elements.

Due to the complexity of occupational disease workers comp, these cases usually require specialized knowledge through a wholesale broker.

Understanding Workers Comp by State

Occupational disease workers comp varies from state to state. Regulations differ depending on state insurers and employer responsibilities. With specific rules for each state, working with a specialist with inside knowledge of state laws is important.

As an example of how workers’ compensation laws vary, Alabama requires any business with five or more employees to offer workers’ compensation insurance. In California, every business is required to offer workers’ compensation insurance, even if the business has only one employee.

Where you live and work impacts how claims need to be filed, what criteria are recognized for compensation, and even what can be claimed as an occupational disease in a workers' compensation claim.

What Qualifies as Occupational Disease?

To be classified as an occupational disease

1. There must be a clear and direct connection between the working conditions and the onset of the disease.
2. The disease should naturally arise as a consequence of the specific job, attributable to the inherent nature of the work.
3. The ailment should not be one to which the employee could have been significantly exposed outside the workplace. Additionally, it should not pertain to issues involving the neck, back, or spinal column.
4. The disease must have originated from a risk associated with the job and naturally emerged from that source, irrespective of whether it was anticipated beforehand.

Common Workers' Compensation Claims Related to Occupational Disease

There are many types of workers’ compensation claims related to occupational diseases. Here is a breakdown of a few common cases you might encounter as an insurance agent.

Diseases Caused by Physical Conditions

Some occupational diseases arise through prolonged environmental exposure or physical strain. Some examples of this include:

• Carpal tunnel syndrome: Caused by repetitive motions of the wrists, hands, and fingers.
• Hearing loss: Constant loud noise in work areas with construction equipment, airplanes, and other loud machinery can lead to hearing loss.

In a recent case study, a 33-year-old female sought medical help for shortness of breath. Initially, the physicians thought she had bronchitis caused by smoking but realized it was Histoplasmosis, also known as Ohio Valley disease, brought on by exposure to dimorphic fungi.

Infectious Disease

Following the COVID-19 pandemic, more employers are paying attention to occupational exposure to infectious diseases. Some other diseases spread this way in the workplace include hepatitis and tuberculosis, although less widespread.

In a report focusing on infectious diseases in the U.S. workplace from 2005 to 2016, 66 cases were found in connection to niche areas of employment, including medical, lab employees, and animal workers.

Specific examples in the report include drum makers exposed to anthrax, automobile manufacturers contracting Legionnaire’s disease, and cases of Salmonellosis amongst poultry vaccine production workers.

Respiratory Disease

Respiratory diseases are one of the most common occupational disease workers’ comp claims. Exposure to diseases such as chronic obstructive pulmonary disease (COPD) or asthma is often caused by jobs with exposure to debris, including:

• Mining
• Manufacturing
• Construction

These diagnoses require specific preventative measures, and also specific treatments which may not be covered under standard workers’ compensation claims.

Cardiovascular Disease

Cardiovascular issues are often influenced by a combination of lifestyle factors and work stressors. This makes it difficult to claim them as specifically related to occupational diseases.

Some occupational cardiovascular diseases include:

• Hypertension
• Heart attacks
• Stroke
• Cardiomyopathy
• Arrhythmia

First responders, truck drivers, fishery workers, and professional sports players are common contenders for occupational cardiovascular diseases due to demanding jobs, long hours, shift work, workplace stress, and low job security.

Skin Disease

Like lung problems, workplace skin disease is often caused by contact with contaminants or toxins. Some types of occupational skin conditions include:

• Dermatitis
• Skin cancer
• Eczema
• Burns
• Frost Bite
• Pigment changes
• Xerosis

Preventative strategies for occupational skin disease include wearing high SPF sun block and protective clothing and equipment on the job.

Musculoskeletal Disorders

Musculoskeletal workplace disorders are often caused by ongoing strain, lack of ergonomic equipment, and lack of training for proper handling of equipment, lifting, etc.

Some common musculoskeletal conditions include:

• Chronic back pain
• Carpal tunnel syndrome
• Hernia
• Strains
• Muscle tears
• Sprains

Ergonomic resources are often implemented to prevent these conditions or as potential resolutions.

Mental or Behavioral Disorders

Workplace diseases and disorders aren’t only physical. Some jobs are especially stressful, contributing to mental injuries which require ongoing support for recovery. Usually, diagnosis requires a psychological report, which may help indicate a cause in the workplace. Some workplace causes include:

• Workplace stress
• Bullying
• Sexual harassment
• Dangerous conditions and fear of injury
• Poor working conditions
• Low company morale
• Traumatic events (common among first responders)

Following an assessment, an employee may receive mental health support through counseling, medication, shorter working hours, short-term disability leave, and other treatments.

Occupational Cancers

Occupational cancer claims are tricky. Cancer must be linked to something ongoing in the workplace, rather than due to lifestyle or genetic factors. Some common causes of compensation claims related to occupational cancers include:

• Exposure to radiation
• Working with chemicals
• Inhaling asbestos
• Exposure to diesel exhaust fumes

Common industries associated with these claims include painters, aluminum production, auto mechanics, and aerospace.

Covid-19 and Workers Comp

The Federal Employees' Compensation Act was updated in January 2023 to include procedures for COVID-19 cases. To qualify for workers’ compensation in the event of COVID-19, there are five qualifiers which must be met, these are:

• FECA time limits must be adhered to for filing the claim.
• Employee must be a worker within the definition of FECA.
• The claimant has proof of COVID-19 diagnosis and that exposure occurred on-site at work.
• The Claimant has proof that exposure occurred while performing workplace duties.
• A physician establishes the link between the COVID-19 diagnosis and the employee’s workplace.

Some emerging challenges stem from the ability to prove that COVID-19 occurred in the workplace while performing duties unless other employees have come forward with a similar claim. The diagnosis must also be made quite early, and COVID-19 symptoms don’t always present themselves physically within the first 14 days of exposure.

The Role of Wholesalers for Insurance Retailers

Wholesaler insurance retailers are particularly useful in cases of occupational disease workers comp. As cases can be quite niche, it is difficult to find blanket coverage through a standard insurance agency.

Wholesalers work with a wide network of specialty insurers and can find pre-made packages designed for niche markets or work with insurance writers who specialize in custom occupational disease workers comp.

High-Risk Workers’ Comp With Novatae

Novatae is an insurance wholesaler with a longstanding commitment to unique and niche insurance products. We work closely with insurance brokers and retailers to find or develop specialized coverage. Our team of experienced agents can help you navigate complex occupational disease claims for workers’ compensation.

For access to more workers’ compensation markets and expertise in high-risk workers’ comp claims, contact Novatae today.

This article is not intended to be exhaustive, nor should any discussion or opinions be construed as legal advice. Readers should contact legal counsel or an insurance professional for appropriate advice.