Date: May 2015
The Workers’ Compensation Act provides coverage for personal injuries, including by definition occupational disease. Occupational disease is a health problem caused by exposure to a workplace health hazard. Employees and employers can keep their workplace healthy by being aware of health hazards in the environment.
Workplace health hazards can cause three kinds of reactions in the body:
- Immediate or acute reactions, such as shortness of breath or nausea, can be caused by a one-time event (e.g., chemical spill). These reactions are not usually permanent.
- Gradual reactions, such as asthma or skin rashes, can get worse and persist when a person is exposed over days, weeks or months. These reactions tend to last for a longer period.
- Delayed reactions or diseases that take a long time to develop, such as lung cancer or loss of hearing, can be caused by long-term exposure to a substance or work activity. These reactions can be noticed long after the job is over.
Ordinary diseases of life to which the general public are equally exposed are not covered under the Workers’ Compensation Act. The challenge becomes to determine what exposure occurred in the workplace and what occurred outside of the workplace.
Two common claims from exposure to health hazards in the workplace are noise-induced hearing loss and exposure to dust, mold or fumes. To determine if the occupational disease claim is compensable, MCIT claims representatives proceed as follows.
Noise-induced Hearing Loss
Many MCIT members have a hearing testing policy in place for certain departments or positions that may have a hearing loss exposure. It is not necessary to test all employees. Organizations without a hearing testing policy are encouraged to review the need for one with their loss control consultant. If an employee indicates that he or she has suffered a work-related hearing loss, the organization is obligated under the law to complete a First Report of Injury (FROI). The submission of the FROI is not an admission of liability.
MCIT begins investigating the claim when the First Report of Injury states there is lost time or medical care. Investigation includes gathering medical records related to care from the date of injury to the present and prior to the date of injury.
The injured employee is asked to sign medical authorizations allowing MCIT to secure prior medical records. Those authorizations are sent to the employee within a few business days of the claim being set up. MCIT staff may also ask the employee to complete a questionnaire asking him or her to outline the onset and treatment of the injury.
MCIT also asks for any outside activities, such as hunting or farming, as these can be causes of hearing loss, too. MCIT also requests that member send any pertinent information regarding the claimed loss.
Just like any work-related injury, a hearing loss needs to occur in the course and scope of employment. If the hearing loss is due to outside activity or aging, the loss would not be compensable and, therefore, MCIT would not owe benefits.
Dust, Mold and Fumes
Another common claim is that an employee is exposed to something in the work environment (the building) that is precipitating the need for medical care. Most often the complaints are of dust, mold or fumes. As stated before, if an employee makes a work-related claim due to these exposures, the member is obligated to file a First Report of Injury. That filing does not equate to an admission of liability.
The claim representative completes the same process outlined above gathering information both before and after the injury from the employee, the member and the medical provider. Symptoms vary in these cases, but are often respiratory or eye- or skin-related symptoms. Sometimes there is a claim for headaches or other pain symptoms.
MCIT encourages members to contact loss prevention and workers’ compensation claim staff if they have concerns about these exposures. Often it is difficult to complete the FROI because there may not be a specific date of injury. Members should feel free to contact the workers’ compensation claim staff if they need help completing the FROI or if they have other questions about these exposures.