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

Transcription

1 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)

2 So, what s 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

3 Objectives Highlight some differences between traditional & non-traditional 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

4 Disclaimers Too many to mention WSIB: 2006 OHAO Fall Symposia 4

5 Format of Presentation Background information Case Example Closing comments and Q/A WSIB: 2006 OHAO Fall Symposia 5

6 Statistics (2005) Total OD claims: 16,408 WSIB: 2006 OHAO Fall Symposia 6

7 Scope of Work Client base (internal & external) Structure of occupational hygiene in ODSBP (n=5) WSIB: 2006 OHAO Fall Symposia 7

8 Challenges Variety of claims: majority are long-latency 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

9 Traditional vs. Non-Traditional retrospective Health Effect Job/ Process (Agent) prospective WSIB: 2006 OHAO Fall Symposia 9

10 Generic ODSBP Adjudication Process Claim filed with WSIB Occupational disease claim assigned to ODSBP Claim allocation process Claim assigned to sector-specific Adjudicator Data collection by Adjudicator occupational medical policy Exposure opinion from OH Medical opinion from OM C/ occupational specialty clinic policy opinion from Policy & Research Branch Decision to accept/deny claim WSIB: 2006 OHAO Fall Symposia 10

11 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

12 Reconstruction of the Past Employment history Work processes Environmental conditions WSIB: 2006 OHAO Fall Symposia 12

13 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 assessment no findings validated? yes finalise EA report no communicate findings client satisfied yes end WSIB: 2006 OHAO Fall Symposia 13

14 Conducting EA: Where to begin Narrowing Agents of Interest Process Work AOI Disease WSIB: 2006 OHAO Fall Symposia 14

15 Determining Agents of Interest Tentative diagnosis? Employment data yes Is there a WSIB policy/guideline? reconstruction of work histrory and processes no Identify disease related agents Identify Job/ process related agents yes no Able to narrow lists to agents of interest? no yes Conduct EA Describe job-task WSIB: 2006 OHAO Fall Symposia 15

16 Data Analysis Tool Kit Quantitative: : air sampling Semi-Quantitative Quantitative: : modeling (e.g. 2-zone) 2 Qualitative: : modeling Statistical tools (BDA, MCS): : uncertainty analysis WSIB: 2006 OHAO Fall Symposia 16

17 Presentation of Findings Non-technical technical: : keep it simple, but not too simple Transparent: : opinions, assumptions & sources Succinct: : don t t leave anything out, but get to the point WSIB: 2006 OHAO Fall Symposia 17

18 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

19 ic Exposure Assessment Process D ata collection & cataloguing Identify client needs and assessment m ethod Id en tify in fo rm ation gaps fill g aps w ith n ew d ata o r assu m p tion s conduct prelim in ary exposure assessm ent (E A) re-calibrate assessm ent no findings validated? yes finalise EA report comm unicate findings no WSIB: 2006 OHAO Fall Symposia 19

20 Tentative diagnosis? Employment data yes Is there a WSIB policy/guideline? reconstruction of work histrory and processes no Identify disease related agents Identify Job/ process related agents yes no Able to narrow lists to agents of interest? no yes Describe job-task Conduct EA WSIB: 2006 OHAO Fall Symposia 20

21 Agents of Interest: Data Sources Carcinogens IARC, EPA s s NTP Others- NLM s s HAZMAP, TOXSEEK Process Information- NIOSH, ILO, EPA, Kirk Othmer Encl. Chem Tech Many other print & electronic sources WSIB: 2006 OHAO Fall Symposia 21

22 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

23 Lung Cancer Foundry Policy 10 yrs. minimum prior to 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

24 Other Policies Silicosis-Clear & adequate history of at least two years of exposure to silica dust Lung Cancer-ASBESTOS ASBESTOS- Clear & adequate history of at least 10 years exposure to asbestos WSIB: 2006 OHAO Fall Symposia 24

25 Sparse Work History SOURCE DATES EMPLOYER TASKS Widow Windsor Machine Shop???? USWA Foundry????? Employer Record Small foundry Co-worker Engine block plant Employer Foundry Labourer Grinder Lead-hand WSIB: 2006 OHAO Fall Symposia 25

26 Tentative Employment History YEAR/DEPT Machine Shop Foundry JOB TITLE/TASK Machinist? Labourer POTENTIAL EXPOSURES Chromium? Nickel? Metal dust/fume Silica, Asbestos, Metal fume, PAHs WSIB: 2006 OHAO Fall Symposia 26

27 Tentative diagnosis? Employment data yes Is there a WSIB policy/guideline? reconstruction of work histrory and processes no Identify disease related agents Identify Job/ process related agents yes no Able to narrow lists to agents of interest? no yes Describe job-task Conduct EA WSIB: 2006 OHAO Fall Symposia 27

28 Communicating Uncertainty PROBABILITY IN THE ABSENCE OF DATA Unlikely= Not likely Probable Very likely Almost certain=0.999 WSIB: 2006 OHAO Fall Symposia 28

29 Silica Assessment TASK TIME PROBABILITY Machine Shop Unlikely Foundry Labourer Very likely WSIB: 2006 OHAO Fall Symposia 29

30 Closing Comments Air sampling data: : include descriptions of job, work process & conditions Investigation of health incidents: include description of worker s s current & previous work WSIB: 2006 OHAO Fall Symposia 30