Medical Criteria

Medical criteria are the proof of disease that an asbestos bankruptcy trust requires before it will pay a claim at a given disease level. They spell out what diagnosis is needed, what tests or reports must support it, and how much time must have passed since first exposure.

Origin

Medical criteria are written into each trust's distribution procedures, which are approved as part of the company's bankruptcy plan. Many trusts follow similar models, so the criteria for a given disease often look alike from trust to trust, though details differ.

Significance in Asbestos Context

Medical criteria decide which disease level, if any, a claim qualifies for, and so what it can be paid. For mesothelioma, trusts generally need a diagnosis supported by pathology. For asbestosis, they usually look for a qualifying chest film, typically an ILO B-read of 1/0 or higher, or pathology; severe asbestosis levels generally require a 2/1 B-read or higher, and some levels also look at breathing-test results. Lung cancer and other cancer claims generally require evidence of asbestosis or bilateral pleural disease (most trusts have a lower Lung Cancer 2 level for lung cancer without it); for other cancers such as colon, stomach, throat or esophagus without that evidence, these claims are usually denied, and the rare approvals pay very little. No currently open asbestos trust pays ovarian cancer claims. Most trusts also require at least 10 years between first exposure and diagnosis. Medical criteria are separate from exposure criteria; a claim has to meet both.

Example Sentence

His doctor's diagnosis of lung cancer was clear, but the trust's medical criteria also required evidence of bilateral pleural disease, so his lawyer obtained a B-read of his chest X-ray.

Related Terms

Disease Level, B-Read, ILO Classification, Trust Distribution Procedures, Pathology Report, Medical Criteria Statute, Latency

Notes

• Keep copies of pathology reports, imaging reports and the actual chest films or CT discs; trusts often want the underlying records.
• A free chest X-ray with a B-read can show whether you meet a trust's criteria for asbestosis or pleural disease.
• If a claim is denied on medical grounds, new tests or a later diagnosis may support a new claim.