Cancer compensation
Compensation for injured workers and mesothelioma
In this issue of the Canadian Respiratory Journal, the article by Payne and Pichora ( a ) (pages 148-152 ), on claims for mesothelioma in Ontario between 1980 and 2002, disturbed me. The authors compared these requests to the number of cases of mesothelioma diagnosed according to the Ontario Cancer Registry (OCR). The method was relatively simple, as it was to compare two solid databases. To check consistency, the authors have paralleled all claims for occupational cancer and data from the ROC, they found a concordance rate of 86% and 93% between mesothelioma claims honored and the references to the ROC. Among the subjects compensated for mesothelioma, about 85% had diagnosed appropriate for the ROC.
Alternatively, an average of about 35% of mesothelioma patients had a claim over the 22 years covered by the study. Claim rates have gradually increased from 20% to 30% and 43%, during the period of 22 years. The complaints were mostly made for men (peak 57% of cases of mesothelioma), and for subjects 50 to 59 years rather than older subjects, although most cases of mesothelioma registered in ROC involved individuals over 60 years.
These results were unpleasantly surprised me. Mesothelioma is a disease distinct, caused by exposure to asbestos in the vast majority of cases ( 2 ). One could argue that in men, mesothelioma is almost by definition, a marker of exposure to asbestos usually, usually work related. Although it can occur in contexts other than work-related exposure, mesothelioma affects, supporting evidence, people who were exposed to asbestos either because they live near mines or industries that use it, either, because they are exposed to the clothes of asbestos workers, often women in this case ( 2 ). It is recognized that since the 1960s, of all occupational lung diseases, mesothelioma is one of the most clearly associated with a specific agent and not to other factors related to lifestyle. It is precisely this piece of information that motivated and Pichora Payne ( 1 ) to research on mesothelioma. They expressed concern at the sight of evidence that the compensation claims for occupational disease were generally low, and they believed that mesothelioma could be an excellent test case because of its particular etiology.
How does one explain this low rate of compensation claims? It is amazing that the majority of mesothelioma patients have not been exposed to asbestos, while the workplace is the main source of such exposure. Many patients who did not complain to necessarily have been exposed to asbestos. One possible reason to explain the few complaints is that people with mesothelioma have a extremely short life expectancy, so it is often very little to compensate. In reality, compensation may be paid to survivors, and I suspect that few mesothelioma patients leave their heirs a legacy well stocked. This bias in survival could explain that the claims were higher after pre-retirement, although the window 20 to 40 years between exposure, and the development of mesothelioma makes it much more likely the occurrence of the disease after retirement.
I believe, like the authors, only part of the answer lies in the results recorded in Lambton County, Ontario. I do not know where is this county, but I think there were a shipyard or other asbestos-related industries at a time. Regardless, the incidence of mesothelioma in Lambton County is about four times higher than the provincial average and 77% of these mesothelioma patients have addressed a claim for work injury. Clearly, there is much more familiar than elsewhere with the problems of asbestos in Lambton County and, in my opinion, this fact can be explained largely by the involvement of the medical community. Doctors Lambton County had heard the message about mesothelioma, and this is what should other doctors. It is encouraging to learn that several provinces have or are about to make mesothelioma a notifiables disease, thereby notifying doctors that their patients are suffering from a disease that gives most likely entitled to compensation for accident of work.
