Workers' compensation for nonmalignant asbestos-related lung disease

Our plain-English summary of Workers' compensation for nonmalignant asbestos-related lung disease, by C. Nevitt, W. Daniell, L. Rosenstock (American Journal of Industrial Medicine, 1994).

The study

• Authors: C. Nevitt, W. Daniell, L. Rosenstock
• Journal: American Journal of Industrial Medicine
• Published: 1994;26(6):821-30
• Cited by: 12 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Workers' compensation claims filed for occupational illness are generally more complicated to resolve than are injury claims, and they may therefore face higher likelihood of rejection. This study analyzed outcomes and predictive factors for claims filed from one clinic in Washington State between 1982 and 1986 by 157 male patients for nonmalignant asbestos-related lung disease. Among 50 federal Longshore claims, 46 (92%) were unresolved or could not be located by claims administrators. In contrast, 118 (89%) of State Fund claims had been resolved, with 48% accepted without consistent relationship to disease severity. Claims filed under both jurisdictions showed a twofold greater risk of rejection by the State Fund (relative risk, RR = 2.0; 95% confidence interval, 95% CI = 1.3-3.2). State Fund claims filed for nonwhite patients were rejected more often than those of white patients, although the association was explained at least partially by jurisdictional overlap (adjusted RR = 1.5; 95% CI = 1.05-2.1). This study indicates a need to scrutinize the handling of occupational disease claims by the federal Longshore system and to consider the adverse influences of jurisdictional conflicts and possible race-associated factors on compensation of occupational illness.

In plain English

This retrospective study examined workers' compensation claims for nonmalignant asbestos-related lung disease filed from July 1982 to July 1986 by 157 male patients of the University of Washington Occupational Medicine Clinic in Washington State. Of 50 federal Longshore claims the authors could ask about, administrators found no records for 32 (64%), 14 (28%) were still unresolved, and only four had been resolved. Of 132 Washington State Fund claims, 64 (48%) were accepted and 54 (41%) rejected. Acceptance did not differ significantly by measures of disease severity. Patients who filed under both the State Fund and a federal system had their State Fund claims rejected more often than those who filed only with the State Fund (relative risk 2.0, 95% confidence interval 1.3 to 3.2, after accounting for race). Claims for nonwhite patients were rejected more often than claims for white patients (16 of 23 versus 38 of 95). After adjusting for jurisdiction, the relative risk was 1.5 (1.05 to 2.1). The authors concluded that Longshore claim handling appeared grossly inadequate. They said the race finding should be interpreted cautiously.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Retrospective study of a cohort of clinic patients who had filed workers' compensation claims, using clinic records and claims administrators' records
• Who was studied: 157 male patients who filed workers' compensation claims for nonmalignant asbestos-related disease between July 1, 1982 and July 1, 1986 at the University of Washington Occupational Medicine Clinic in Washington State. Of 168 claimants, nine who had died or developed cancer and the two female patients were excluded. Nonwhite patients numbered 40, and 95% of them were black.
• Exposure: Occupational asbestos exposure in prior jobs. The 23 jobs were grouped as plumber/pipefitter (50%), shipscaler (15%), and others (35%). The article does not specify fiber types or doses.
• Main results:
  • Among 50 Longshore claims with signed patient consent, administrators reported no records for 32 (64%) and 14 (28%) still unresolved. Only four (8%) had been resolved: two were withdrawn and two were settled by compromise.
  • Of 132 State Fund claims, 64 (48%) were accepted and 54 (41%) were rejected. Nine (7%) were missing and five (4%) were unresolved.
  • Patients with accepted and rejected State Fund claims did not differ in most background and clinical measures, including measures of the severity of asbestos disease.
  • Unadjusted, State Fund claims were rejected more often for patients who filed under both the State Fund and a federal system than for those who filed only with the State Fund (RR = 2.2, 95% CI = 1.4-3.4).
  • Unadjusted, State Fund claims were rejected more often for shipscalers than for other job types (RR = 1.8, 95% CI = 1.3-2.7).
  • Unadjusted, State Fund claims were rejected for 16 of 23 nonwhite patients (70%) compared with 38 of 95 white patients (40%). The unadjusted relative risk was 1.7, with a 95% CI of 1.2-2.5.
  • After controlling for race, the higher risk of State Fund rejection with dual (state plus federal) filing persisted (stratified RR = 2.0, 95% CI = 1.3-3.2).
  • After adjusting for jurisdiction, the race-associated risk of State Fund rejection was smaller (stratified RR = 1.5, 95% CI = 1.05-2.1).
  • Among patients who filed with both the State Fund and a federal system, claims were rejected for 13 of 16 nonwhite patients (81%) compared with 24 of 43 white patients (56%) (RR = 1.5, 95% CI = 1.02-2.1).
• The authors' conclusion: The authors concluded that, in this sample, the handling of claims under the Longshore and Harborworkers' Act appeared grossly inadequate compared with State Fund processing, and should be scrutinized by regulators and future investigators.
• Limitations the authors state:
  • Analysis of Longshore claims was limited because outcome data were not available. Consent forms were not returned by 44% of Longshore claimants.
  • The race association could reflect differences on which no information was available, such as whether the patient had legal representation.
  • The number of nonwhite patients was small, which limited statistical power. The authors said no conclusive determination about race could be made.
  • Outcomes of claims filed under the Federal Employees Compensation Act were not collected because there were few of them.

Topics

Medical terms in this study, explained in our Lexicon: Jurisdiction, Relative Risk, confidence interval, Occupational Disease.

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