A Study of Occupational Disease in the Workers’ Compensation System
q q New York State Workers’ Compensation Board Governor George E. Pataki
Chairman Robert R. Snashall
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Table of Contents
Chapter I: Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Legislative Mandate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 The History of Occupational Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Occupational Disease in Modern Times . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 Occupational Disease Study Committee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Chapter II: Legal Analysis of Occupational Disease in the Workers’ Compensation System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
Summary of Legal Analysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
History of New York’s Workers’ Compensation Law . . . . . . . . . . . . . . . . . . . . . 6 Interpretation of the Term “Occupational Disease” . . . . . . . . . . . . . . . . . . . . . . . 7 Accidents and Occupational Diseases: Comparisons and Contrasts . . . . . . . . . . . 8 Occupational Loss of Hearings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 Comparison with Select Other States . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
Legal Analysis of Occupational Disease in the Workers’ Compensation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Occupation and Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . History of Occupational Disease Law in New York State . . . . . . . . . . . . . . . . . “Nature of Employment” Requirement for Occupational Disease Claims . . . . . . Aggravation of a Pre-existing Condition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Occupational Disease and Accident: Comparisons and Contrasts . . . . . . . . . . . Disease as Accidents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Statute of Limitations: Differences between Occupational Disease and Accidents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Notice to Employers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Occupational Loss of Hearing Under the Workers’ Compensation Law . . . . . . Adequacy of Existing Law and Definitions . . . . . . . . . . . . . . . . . . . . . . . . . . . . General Definition of the Term “Occupational Disease” . . . . . . . . . . . Board Use of Term “Injury” . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Occupational Disease as a Separate Act . . . . . . . . . . . . . . . . . . . . . . . . Statutory Schedules for Defining Occupational Disease . . . . . . . . . . . . Apportionment and Dual-Causation . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 11 12 13 17 19 19 22 24 25 27 27 28 28 30 33
Chapter III: Statistical Analysis of Occupational Disease Cases in the Workers’ Compensation System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
Background . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36 Data Sources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37 Findings for 1989-90 Closed Indemnity Cases . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40 Findings for 1993-95 Closed Indemnity Cases . . . . . . . . . . . . . . . . . . . . . . . . . 60 Findings for Nonfatal OD Trial Hearing Cases Closed in 1996 . . . . . . . . . . . . . 83 Findings for OD-Related Claims Indexed in 1995 . . . . . . . . . . . . . . . . . . . . . . 88
Chapter IV: Occupational Disease Cases in Selected Industry Subgroups . . . . 96 Chapter V: Findings and Initiatives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 102
Adequacy of the Law of Occupational Disease . . . . . . . . . . . . . . . . . . . . . . . . . . 102
The Definition of Occupational Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 102 Other Related Provisions of the Law . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105
Adequacy of the Process of the Adjudication of Occupational Disease Claims . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 106 Board Recommendations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109
Appendices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
I Outreach Letter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I Coverage of Occupational Diseases Chart . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . II Notice to Chair of Carrier’s Action on Claim for Benefits ~ Form C-669 . . . . . . III Bibliography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . IV
List of Tables and Figures
Tables
Table X-1: Summary of Indemnity Death Cases Closed (1989-90) . . . . . . . . . . . . . . . 41 Table X-2: Summary of Nonfatal Occupational Disease Indemnity Cases Closed (1989-90) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42 Table X-3: Occupational Disease Cases as Percent of All Nonfatal Indemnity Cases Closed (1989-90), for Geographic Regions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46 Table X-4: Geographic Regions and Nonfatal Occupational Disease Indemnity Cases Closed (1989-90) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47 Table X-5: Summary of Geographic Regions for Nonfatal Occupational Disease Indemnity Cases Closed (1989-90) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49 Table X-6: Occupational Disease Cases as Percent of All Nonfatal Indemnity Cases Closed (1989-90), for Occupational Groups . . . . . . . . . . . . . . . . . . . . . . . . . . . 50 Table X-7: Occupational Groups and Nonfatal Occupational Disease Indemnity Cases Closed (1989-90) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51 Table X-8: Summary of Occupational Groups for Nonfatal Occupational Disease Indemnity Cases Closed (1989-90) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52 Table X-9: Occupational Disease Cases as Percent of All Nonfatal Indemnity Cases Closed (1989-90), for Industry Divisions and Selected Industry Groups . . . . 54-55 Table X-10: Industry Divisions and Selected Industry Groups: Nonfatal Occupational Disease Indemnity Cases Closed (1989-90) . . . . . . . . . . . . . . . . . . . . 56-57 Table X-11: Summary of Industry Divisions and Selected Industry Groups for Nonfatal Occupational Disease Indemnity Cases Closed (1989-90) . . . . . . . . . . . . . 58-59 Table X-12: Selected Occupational Disease Indemnity Death Cases (1994-95) . . . . . . 61 Table X-13: Estimated Change in Annual Number of Nonfatal Occupational Disease Indemnity Cases (1993-95 versus 1989-90) . . . . . . . . . . . . . . . . . . . . . . . . . . 63 Table X-14: Summary of Nonfatal Occupational Disease Indemnity Cases
Closed (Estimated 1993-95) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65 Table X-15: Estimated Change in Annual Number of Nonfatal Occupational Disease Indemnity Cases(1993-95 versus 1989-90), by Geographic Region . . . . . . . . . . . . . . . 66 Table X-16: Geographic Regions and Nonfatal Occupational Disease Indemnity Cases Closed (Estimated 1993-95) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68 Table X-17: Summary of Geographic Regions for Nonfatal Occupational Disease Indemnity Cases Closed (Estimated 1993-95) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69 Table X-18: Estimated Change in Annual Number of Nonfatal Occupational Disease Indemnity Cases (1993-95 versus 1989-90), by Occupational Group . . . . . . . 70 Table X-19: Occupational Groups and Nonfatal Occupational Disease Indemnity Cases Closed (Estimated 1993-95) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71 Table X-20: Summary of Occupational Groups for Nonfatal Occupational Disease Indemnity Cases Closed (Estimated 1993-95) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75 Table X-21: Estimated Change in Annual Number of Nonfatal Occupational Disease Indemnity Cases Closed (1993-95 versus 1989-90), by Industry Divisions . . . . . . . . . 76 Table X-22: Industry Divisions and Selected Industry Groups: Nonfatal Occupational Disease Indemnity Cases Closed (Estimated for 1993-95) . . . . . . . . . . . . . . . . . . . . 78-79 Table X-23: Summary of Industry Divisions and Selected Industry Groups for Nonfatal Occupational Disease Indemnity Cases Closed (Estimated for 1993-95) . . 80-81 Table X-24: Part of Body Injured for Nonfatal Occupational Disease Cases Classified at Trial Hearings in 1996 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84 Table X-25: Physicians Involved in (Nonfatal) Carpal Tunnel OD Indemnity Cases Closed Via Trial Hearings During 1996 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87 Table X-26: Cases Indexed in 1995 and Described as Asbestosis Injuries (Through November, 1997) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88 Table X-27: Cases Indexed in 1995 and Described as Silicosis Injuries (Through November, 1997) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89 Table X-28: Cases Indexed in 1995 and Described as Tuberculosis Injuries
(Through November, 1997) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90 Table X-29: Cases Indexed in 1995 and Described as (Unspecified) Respiratory Disorders (Through November, 1997) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91 Table X-30: Cases Indexed in 1995 and Described as Hearing Loss Injuries (Through November, 1997) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92 Table X-31: Specific Industry Categories and Nonfatal Occupational Disease Indemnity Cases Closed (Estimated for 1993-95) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98
Figures
Figure X-1: Percentage Distribution of Total Indemnity Costs ($51.3 million) in Nonfatal Occupational Disease Cases Closed During 1989-90 . . . . . . . . . . . . . . . . . . 43 Figure X-2: Economic Development Regions of New York State . . . . . . . . . . . . . . . . 45 Figure X-3: Percentage Distribution of Total Estimated Indemnity Costs ($197.6 million) in Nonfatal Occupational Disease Cases Closed during . . . . . . . . . . 64 Figure X-4: Percentage of Cases and Total Indemnity Costs in Nonfatal Occupational Disease Indemnity Cases Closed, by Geographic Region (Estimated for 1993-95) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72 Figure X-5: Percentage Distribution of Total Indemnity Costs in Nonfatal Occupational Disease Indemnity Cases Closed, by Major Occupational Groups (Estimated for 1993-95) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74 Figure X-6: Percentage Distribution of Total Indemnity Costs in Nonfatal Occupational Disease Indemnity Cases Closed, by Major Industry Divisions (Estimated for 1993-95) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82
Chapter I: Introduction/Executive Summary
A. LEGISLATIVE MANDATE
For some, workers’ compensation claims may call to mind the manufacturing and mining injuries associated with the industrial age. In recent times, however, as the nature of economic activity has changed, so too has the nature of injuries and illnesses suffered by employees at the workplace. While traditional job-related accidents and injuries continue to be of concern, much attention has naturally focused on new types of occupational diseases, ranging from repetitive stress injuries to Lyme disease. It was thus fitting that as part of its reform of the Workers’ Compensation Law in 1996, the Legislature chose to mandate a review of occupational diseases and the workers’ compensation system. This study of occupational disease is respectfully submitted to the Governor, the Temporary President of the Senate, the Speaker of the Assembly and the Chairs of the respective labor committees pursuant to the terms of Section 85 of Chapter 635 of the Laws of 1996, which provides as follows: The chair of the workers’ compensation board shall implement a study of occupational disease. The study shall examine existing law and the adequacy of existing law and definitions regarding issues of adjudication and eligibility and controversion. It shall determine the incidence of occupational disease, its impact and presence in certain industries, including but not limited to the garment industry, the publishing industry, the utility industry, and the sanitation and waste removal industries. The chair shall conduct such study in consultation with the Mt. Sinai Medical Center Irving J. Selikoff Occupational Health Clinical Center, the Bellevue/NYU Occupational and Environmental Health Clinic, the various regional occupational health and safety committees and any other interested parties or concerned citizens. B. THE HISTORY OF OCCUPATIONAL DISEASE
Occupational disease has been recognized for virtually as long as organized employment has existed. Some of the oldest references to occupational diseases can be found in the descriptions of ailing workers made by ancient Greek physicians. Hippocrates described a severe attack of colic due to lead poisoning in a man who worked as a miner extracting metals.1 Hippocrates also noted the correlation between a paralysis in the hand and the worker’s occupation involving the twisting of
Chojnacki, Robert J., “Occupational Disease Under the New York Workmen’s Compensation Law,” 42 ST. JOHN’S LAW REV. 473, 475 (1968), citing D. Hunter, THE DISEASES OF OCCUPATIONS 9 (1957).
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twigs.2 Other European physicians described lung diseases afflicting miners during the sixteenth century: [S]ome mines are so dry that they are entirely devoid of water and this dryness causes the workmen even greater harm, for the dust, which is stirred and beaten up by digging, penetrates into the windpipe and lungs, and produces difficulty in breathing and the disease which the Greeks called asthma. If the dust has corrosive qualities, it eats away the lungs, and implants consumption in the body. In the mines of the Carpathian Mountains women are found who have married seven husbands, all of whom this terrible consumption has carried off to a premature death.3 In the seventeenth century the Father of Occupational Medicine, Bernardino Ramazzini, an Italian professor of medicine, published his work, The Diseases of Tradesmen.4 Ramazzini studied miners, bakers, coppersmiths, chemists, mirror makers, stone cutters and cleaners of cesspits. It was Ramazzini who revised the Hippocratic art of medicine by requiring physicians to ask in which occupation ill workers were employed.5 Ramazzini described hand pain and numbness among professional scribes and notaries: The maladies that afflict the clerks arise from . . . incessant movement of the hand and always in the same direction . . . Incessant driving of the pen over paper causes intense fatigue of the hand and the whole arm because of the continuous and almost constant strain on the muscles and tendons, which in the course of time results in failure of power in the right hand. An acquaintance of mine, a notary by profession, still living, used to spend his whole life continually engaged in writing . . . and he made a good deal of money by it; first he began to complain of intense fatigue in the whole arm, but no remedy could relieve this, and finally the whole right arm became completely paralyzed. In order to offset this infirmity he began to train himself to write with the left hand, but it was not very long before it too was attacked by the same malady.6
During the nineteenth century Industrial Revolution in England, occupational diseases became a topic of keen interest. One English physician, Charles Turner Thackrah, published two treatises on
Dembe, Allard E., Occupation and Disease, How Social Factors Affect the Conception of Work-Related Disorders, 27 (1996).
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Chojnacki, supra, at 476, quoting Hunter, supra, note 1, at 26-27. Id., at 477, citing Hunter, supra, note 1, at 32. Id., at 478. Dembe, supra, note 2, at 27. Quoting Ramazzini, B. 1713, Diseases of Workers, p. 229, 421, 423.
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occupational disease. He urged prevention to those who believed that certain occupations inevitably brought about certain illnesses: [I]n many of our occupations, the injurious agents might be immediately removed or diminished. Evils are suffered to exist, even when the means of correction are known and easily applied.7 Nineteenth century physicians also noticed a large number of work-related hand disorders among weavers, tailors, seamstresses, carpenters, and metalworkers.8 Thackrah described musculoskeletal ailments among factory workers: Certain classes of muscles are for twelve or fourteen hours a day scarcely moved, and postures maintained injurious to the proper actions of the internal organs. Tailors are very unfortunately situated in this respect. Sitting all day in a confined atmosphere, and often in a room too crowded, with the legs crossed and the spine bowed, they cannot have respiration, circulation, or digestion well performed . . . . The sensibility of the right fore-finger is sometimes greatly reduced, and sometimes the right brachial nerves have their function impaired . . . .9 Writers’ cramp or scriveners’ palsy were terms used beginning in 1830 to describe ailments to those who wrote for a living.10 Scriveners and notaries were required to sit in an office and write all day long, without a break. Most experts at the time attributed writers’ cramp to the incessant exertion of the nerves and muscles without the ability to pause or recover.11 “After the introduction of mechanical typewriters, in the 1880s, it was also commonly recommended that use of a typewriter be substituted for manual writing, so as to relieve the need for constant grasping.”12 In other words, the occupational disease would subside if the worker ceased performing that type of work. As this brief introduction illustrates, occupational diseases have been observed virtually as long as occupations have existed. Ailments that are rarely seen today, such as caissons disease, black lung disease, mad hatters’ disease, painters’ colic, woolsorters’ disease and writers’ cramp once forced legislators to amend the workers’ compensation law to provide for their coverage. C. OCCUPATIONAL DISEASE IN MODERN TIMES
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Chojnacki, supra, note 1, quoting D. Hunter, supra, note 1, at 118. Dembe, supra, note 2, at 27. Dembe, supra, note 2, at 28. Id., at 29. Ibid. Id., at 33.
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Although bouts of caissons disease may be rare today, occupational diseases do continue to occur. According to the most recent study published by the Bureau of Labor Statistics, in 1996 there were approximately 439,000 newly reported cases of occupational illnesses in private industry.13 Nevertheless, the incidence of workplace illnesses continues to decline.14 For example, the Bureau of Labor Statistics reported cases of carpal tunnel syndrome dropped from 41,000 in 1993 to 29,900 in 1996.15 This study discusses the principles of law generally applicable to all occupational diseases. In addition, a concise analysis of the particular rules applying to occupational loss of hearing is provided. D. OCCUPATIONAL DISEASE STUDY COMMITTEE
The study was conducted by an Occupational Disease Study Committee (“the Committee”) composed of Workers’ Compensation Board employees appointed by Robert R. Snashall, Chairman of the Workers’ Compensation Board. The members of the Committee are: Joan L. ShirikianHesselton, Agency Safety Director; Elizabeth A. Lott, Associate Attorney, General Counsel's Office; Elizabeth Moore, Secretary; Tony Paletta, Associate Statistician; and Mark Finkelstein, Special Counsel to the Chairman, Committee Chair. Ms. Nicole Kerein of SUNY Albany served as the Committee’s research associate. Participating in the review and editing of the study were the following Board employees: Carl Copps, Douglas Fitzgerald, Howard Mierek and Brenda Rigas. E. ACKNOWLEDGMENTS
Many individuals and organizations made important contributions to the work of this study. The Committee wishes to express its appreciation to all contributors and to thank the following individuals for providing the Committee with their professional and institutional perspectives on a wide range of occupational disease related issues: Drs. Steven Levin and Robin Herbert, Mt. Sinai Medical Center Irving J. Selikoff Occupational Health Clinical Center; Dr. George Friedman-Jimenez, Bellevue/NYU Occupational and Environmental Health Clinic; Edward Cleary and Arthur Wilcox, AFL-CIO; Timothy Schmidle, Stuart Basefsky and Deb Joseph, Cornell University School of Industrial and Labor Relations; and Diane Kennedy, New York Newspaper Publishers Association. The study is organized as follows: Chapter II, which follows this introduction, traces the evolution and current status of the law and jurisprudence of occupational disease in New York. This is followed by a chapter describing the statistical analysis of Workers’ Compensation Board occupational disease claims that the Committee undertook for purposes of this study. Chapter IV profiles the incidence of occupational disease in selected industries. Chapter V describes current
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“Workplace Injury and Illness Summary,” Bureau of Labor Statistics, December 1997. Id. Id.
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issues in the area of occupational disease and incorporates the input received from the various labor, health organization, claimant and management representatives in response to the Committee’s outreach efforts. The last chapter sets forth the findings of the Committee and describes various relevant initiatives undertaken by the Board.
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