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The Involvement of Occupational Hygiene in the Adjudication of

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					The Involvement of Occupational Hygiene
      in the Adjudication of WSIB
      Occupational Disease Claims


    Derrick Chung, Occupational Hygienist
      Lou Riklik, Occupational Hygienist

   Occupational Disease and Survivor Benefits Program
                        (ODSBP)
     Workplace Safety and Insurance Board (WSIB)
       So, what’s in it for you?


A better understanding of the exposure data
needed for the proper adjudication of
occupational disease claims.




              WSIB: 2006 OHAO Fall Symposia   2
             Objectives
Highlight some differences between
“traditional & non-traditional” OH

Provide an overview of how OHs are
involved in the claims adjudication
process

Provide an overview of some of our EA
tools
            WSIB: 2006 OHAO Fall Symposia   3
    Disclaimers



Too many to mention




    WSIB: 2006 OHAO Fall Symposia   4
      Format of Presentation
Background information

Case Example

Closing comments and Q/A




           WSIB: 2006 OHAO Fall Symposia   5
   Statistics (2005)



Total OD claims: 16,408




     WSIB: 2006 OHAO Fall Symposia   6
           Scope of Work
Client base (internal & external)

Structure of occupational hygiene in
ODSBP (n=5)




             WSIB: 2006 OHAO Fall Symposia   7
               Challenges
Variety of claims: majority are long-latency
multi-factorial diseases

Volume and complexity of claims (in-take
clinics)

Adversarial process

Majority of work involves “non-traditional”
OH techniques

              WSIB: 2006 OHAO Fall Symposia    8
Traditional vs. Non-Traditional

                      Health
                      Effect

retrospective




                                            prospective
                      Job/
                    Process
                    (Agent)
                WSIB: 2006 OHAO Fall Symposia             9
   G en eric O D S B P                         C laim filed w ith
A d ju d ication P rocess                            W S IB




                        O ccu p atio n al d isease claim assig n ed to O D S B P




                                               C laim allo catio n
                                                    p ro cess




                          C laim assig n ed to secto r-sp ecific A d ju d icato r




                                              D ata co llectio n b y
                                                  A d ju d icato r




                          o ccu p atio n al                            p o licy
                                                    m ed ical




                                               M ed ical o p in io n
                                                                               p o licy o p in io n
         E xp o su re o p in io n                 fro m O M C /
                                                                               fro m Po licy &
               fro m O H                        o ccu p atio n al
                                                                             R esearch B ran ch
                                               sp ecialty clin ic




                                                 D ecisio n to
                                              accep t/d en y claim
                                    WSIB: 2006 OHAO Fall Symposia                                     10
            Typical Questions
Depends on the type of claim and who’s
asking

– Hazard identification

– How much, long, often

– Presence or absence

– Estimation of “dose”


                WSIB: 2006 OHAO Fall Symposia   11
     Reconstruction of the Past
Employment history

Work processes

Environmental conditions




            WSIB: 2006 OHAO Fall Symposia   12
Generic Exposure Assessment Process             Data collection &
                                                  cataloguing

                                   Identify client needs and assessment method


                                                     Identify
                                                   information
                                                       gaps


                                      fill gaps with new data or assumptions

                                                     conduct
                                                   preliminary
                                                    exposure
                                                   assessment
                                                       (EA)




                          re-calibrate              findings
                                           no
                          assessment               validated?



                                                       yes


                                                   finalise EA
                                                      report



                                             communicate findings
                              no


                                                     client
                                                    satisfied



                                                       yes


                                                      end
                           WSIB: 2006 OHAO Fall Symposia                         13
Conducting EA: Where to begin

 Narrowing Agents of Interest




                           Process


                          Work AOI
                                               Disease




                        WSIB: 2006 OHAO Fall Symposia    14
D etermining Agents of Interest
                                                                         Em ploym ent
                                               Tentative                     data
                                              diagnosis?



                                                  yes


                                                                reconstruction of work histrory
                                            Is there a WSIB             and processes
                                           policy/guideline?



                                                  no


                                                                        Identify Job/
                                           Identify disease
                                                                       process related
                                            related agents
                                                                           agents


                                   yes



                                             Able to narrow
                            no             lists to agents of
                                                                           no
                                                interest?



                                                  yes


                                                                    Describe job-task
                                             Conduct EA




                                  WSIB: 2006 OHAO Fall Symposia                                   15
          Data Analysis Tool Kit
Quantitative: air sampling

Semi-Quantitative: modeling (e.g. 2-zone)

Qualitative: modeling

Statistical tools (BDA, MCS): uncertainty analysis



                 WSIB: 2006 OHAO Fall Symposia   16
         Presentation of Findings
Non-technical: keep it simple, but not too
simple

Transparent: opinions, assumptions &
sources

Succinct: don’t leave anything out, but get
to the point


               WSIB: 2006 OHAO Fall Symposia   17
               Scope of Work

Was asbestos present- Mesothelioma policy

How many yrs. exposed- Asbestosis policy

Approximate conc. – Compare with epidemiology

Cumulative dust- COPD guidelines

OFTEN: given a diagnosis, were there agents in the
work environment which could have contributed to
the disease?

                WSIB: 2006 OHAO Fall Symposia    18
ric E x p o s u re A s s e s s m e n t P ro c e s s                   D a ta c o lle c tio n &
                                                                          c a ta lo g u in g

                                                 Id e n tify c lie n t n e e d s a n d a s s e s s m e n t m e th o d


                                                                             Id e n tify
                                                                          in fo rm a tio n
                                                                               gaps


                                                     fill g a p s w ith n e w d a ta o r a s s u m p tio n s

                                                                           conduct
                                                                         p re lim in a ry
                                                                          e x p o s u re
                                                                         assessm ent
                                                                              (E A )




                                     re -c a lib ra te                       fin d in g s
                                                              no
                                     assessm ent                           v a lid a te d ?



                                                                                yes


                                                                          fin a lis e E A
                                                                             re p o rt



                                                             c o m m u n ic a te fin d in g s
                                          no
                                      WSIB: 2006 OHAO Fall Symposia                                                 19
                                         Employment
               Tentative                    data
              diagnosis?



                  yes


                                reconstruction of work histrory
            Is there a WSIB             and processes
           policy/guideline?



                  no


                                        Identify Job/
            Identify disease
                                       process related
             related agents
                                           agents


     yes



             Able to narrow
no         lists to agents of              no
                interest?



                  yes


                                 Describe job-task
             Conduct EA
           WSIB: 2006 OHAO Fall Symposia                          20
  Agents of Interest: Data Sources
Carcinogens – IARC, EPA’s NTP
Others- NLM’s HAZMAP, TOXSEEK

Process Information- NIOSH, ILO,
EPA, Kirk Othmer Encl. Chem Tech
Many other print & electronic sources


            WSIB: 2006 OHAO Fall Symposia   21
Example: Grey Iron Foundry Worker
Silicosis and lung cancer diagnosed post
mortem a year ago

Minimal medical history from more than five
years ago

Pack a day smoker, quit 15 yrs. ago

Work history very sparse from widow co-
worker, most recent employer

              WSIB: 2006 OHAO Fall Symposia   22
    Lung Cancer Foundry Policy
10 yrs. minimum prior to 1956

20 yrs. predominant sand moulds,
floor pouring of castings, evidence of
ventilation less than satisfactory

Latency (risk cessation to diagnosis)
15 yrs. for smoker, 20 yrs. for non-
smoker
             WSIB: 2006 OHAO Fall Symposia   23
            Other Policies
Silicosis-Clear & adequate history of at
least two years of exposure to silica
dust

Lung Cancer-ASBESTOS- Clear &
adequate history of at least 10 years
exposure to asbestos


             WSIB: 2006 OHAO Fall Symposia   24
           Sparse Work History
SOURCE     DATES       EMPLOYER                TASKS

Widow      55-60       Windsor                 ????
                       Machine Shop
USWA       62-70       Foundry?                ????

Employer  65-75        Small foundry           Labourer
Record
Co-worker 75-90        Engine block            Grinder
                       plant
Employer   1990-       Foundry                 Lead-hand
           2000
               WSIB: 2006 OHAO Fall Symposia               25
     Tentative Employment History

YEAR/DEPT.     JOB TITLE/TASK             POTENTIAL
                                          EXPOSURES
55-60          Machinist?                 Chromium?
Machine Shop                              Nickel?
                                          Metal dust/fume
62-75          Labourer                   Silica, Asbestos,
Foundry                                   Metal fume,
                                          PAHs




                 WSIB: 2006 OHAO Fall Symposia                26
                                         Employment
               Tentative                    data
              diagnosis?



                  yes


                                reconstruction of work histrory
            Is there a WSIB             and processes
           policy/guideline?



                  no


                                        Identify Job/
            Identify disease
                                       process related
             related agents
                                           agents


     yes



             Able to narrow
no         lists to agents of              no
                interest?



                  yes


                                 Describe job-task
             Conduct EA
           WSIB: 2006 OHAO Fall Symposia                          27
     Communicating Uncertainty
PROBABILITY IN THE ABSENCE OF DATA

Unlikely= 0.001
Not likely
Probable
Very likely
Almost certain=0.999

             WSIB: 2006 OHAO Fall Symposia   28
               Silica Assessment
TASK             TIME                            PROBABILITY

Machine Shop     55-60                           Unlikely

Foundry          62-75                           Very likely
Labourer




                 WSIB: 2006 OHAO Fall Symposia                 29
           Closing Comments
Air sampling data: include descriptions
of job, work process & conditions

Investigation of health incidents:
include description of worker’s current
& previous work



              WSIB: 2006 OHAO Fall Symposia   30

				
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