It takes a Special Adjuster to Manage Asbestosis and Mesothelioma Work Comp Claims
Asbestosis and mesothelioma are occupational diseases accounting for a disproportionate amount of the cost of workers’ compensation claims and are financially devastating to a company. Asbestosis and mesothelioma are caused by breathing in asbestos fibers. Asbestos is a mined mineral used as a fire retardant, in insulation, and various building products prior to the Environmental Protection Agency restricting its use in 1989. Today only a few products contain asbestos and its production and use is strictly regulated.
Asbestosis is the fibrous scarring of the lungs due to breathing in asbestos fibers. The scarring of the lungs makes it difficult to breathe.
Mesothelioma is a malignant form of cancer developing in the mesothelium a protective sac covering most of the body's internal organs, including the lungs. Most people who develop mesothelioma have worked at jobs where they were exposed to asbestos fibers. Asbestos was commonly used in building construction prior to 1975.
Workers' Compensation Claims
A person unfamiliar with asbestosis and mesothelioma might ask why a product rarely used in the last 20 years is responsible for workers’ compensation claims. Both asbestosis and mesothelioma are very slow developing diseases. It normally takes 10 to 20 years after exposure to asbestos for asbestosis to develop. Asbestosis can vary from no symptoms to being severely disabling and in some cases, fatal. Mesothelioma may develop 20 to 50 years after asbestos exposure. The average life expectancy after a mesothelioma diagnosis is short, with 75% of patients dying within the first year.
The cost of asbestosis and mesothelioma is staggering. Over 750,000 people have filed claims in the last 80 years against more than 6,000 companies. The number of companies filing for bankruptcy due to asbestosis and mesothelioma is continuing to rise. Workers' compensation insurance in industries associated with asbestos is extremely expensive, if obtainable at all.
Adjuster Specialist
While an employer cannot control the filing of a workers’ comp claim for asbestosis or mesothelioma, having a workers’ comp adjuster experienced in handling asbestosis claims and mesothelioma claims is essential. The adjuster assigned to these claims needs to be a strong investigator, due to the long-tail development of the diseases.
Just because an employee worked for your company for ten years, 20 to 30 years ago does not necessarily make you liable for the asbestos related workers’ comp claim. The total work history of the former employee must be established by the adjuster. The employee's association with asbestos related mining, manufacturing, or use over the employee's total lifetime must be determined. The workers’ comp claim could be exclusively yours, but it could also be shared by other employers the employee worked for with asbestos related exposure. If this is the case, your portion of the claim could be significantly reduced.
The adjuster needs a strong understanding of the medical treatment of these two diseases. The nature and course of medical treatment for asbestosis is different from the medical treatment of mesothelioma. Let's look at them separately.
Asbestosis
When a new asbestosis claim is received and the adjuster establishes the liability for the workers’ comp claim rests with your company, the adjuster must dig deeply into the medical information available on the employee to understand the current medical status of the affected person. Asbestosis can be treated but it cannot be cured. The physician treating the disease can ease the symptoms and try to prevent further medical complications. Further employment with exposure to asbestos must stop immediately when an employee is diagnosed with asbestosis. Further employment without exposure to asbestos can continue for the patient diagnosed with asbestosis.
One of the first things a doctor determines with an asbestosis patient is whether or not the patient is a smoker. Smoking significantly increases the problems with asbestosis and increases the risk of the patient developing mesothelioma. The physician strongly encourages the employee to quit smoking immediately. If the employee is unable to do so, a smoking cessation clinic is a workers’ comp expense the adjuster should be glad to incur.
The adjuster reviews the medical records to verify:
1. a functional impairment test is completed to determine the disease severity and the results used to create a treatment plan
2. the employee is being treated with antibiotics to prevent or delay other respiratory ailments,
3. the employee has influenza and pneumococcal immunizations on the recommended schedule
4. the employee is cautioned to avoid crowds where there may be exposure to respiratory ailments,
5. the doctor prescribed an ultrasonic, mist humidifier to loosen bronchial secretions,
6. the doctor instructed the employee on how to perform bronchial drainage.
Other possible medical care the adjuster looks for with the asbestosis claim include:
1. Bronchodilators providing inhaled or oral medications to open the bronchial tubes to make breathing easier,
2. Respiratory therapist using chest physical therapy techniques to improve the employee's ability to remove secretions through coughing,
3. Supplemental oxygen may be necessary in severe cases of asbestosis.
If the adjuster sees medical care outside of the normal prescribing realm for asbestosis, the adjuster engages the services of a physician not involved in the employee’s treatment to review all medical information. Employees with asbestosis often have compromised immune systems making them more susceptible to incurring other diseases. It often takes a trained medical professional to separate asbestosis related medical care from other medical care the employee might need.
Mesothelioma
As with asbestosis, the adjuster needs to dig deeply into the medical information available on the employee to understand the employee’s current medical status. There are no cures for mesothelioma, and the employee normally has a short life span after the disease is diagnosed. Mesothelioma becomes a very expensive workers’ comp claim as the employee, the employee's family, and the medical providers attempt various treatments to postpone death.
Mesothelioma is often difficult for the physician to diagnose, as it often resembles less serious medical conditions. Symptoms of mesothelioma include persistent cough, shortness of breath, chest pain, fatigue, weight loss, nausea, and lumps under the skin on the chest. If the physician suspects mesothelioma, the physician reviews the patient's medical history, completes a physical examination, and orders several diagnostic test including chest X-rays, pulmonary function test, Gallium lung scan, MRI scans, lung CT scan and PET scans. These tests are followed by a biopsy. The adjuster should expect to see most or all of these procedures in the medical records of the employee diagnosed with mesothelioma.
Some of the treatment options the adjuster may see being tried by the employee and physician may include:
1. Surgical removal of part of the cancer
2. Chemotherapy
3. Radiation
4. Experimental procedures, including gene therapy and immunotherapy
5. Experimental medications and un-tested new procedures
The workers’ comp adjuster is often in a difficult position with mesothelioma claims. The employee can incur tens of thousands or even hundreds of thousands of dollars in medical expense trying to delay the inevitable. An adjuster denying any of the medical treatment is seen as cold and heartless, yet often the adjuster is the realistic one who realizes the eventual outcome will be the same, regardless of how much medical treatment the employee can endure before succumbing to mesothelioma. Before the adjuster denies any medical care, the adjuster needs to review with the defense attorney assisting with the claim the impact of denying medical care. (workersxzcompxzkit)
Summary
Some experts in the study of asbestosis and mesothelioma believe we have peaked in the number of new cases being reported and in the years ahead will see a slow, gradual decline in the number of asbestosis and mesothelioma claims. Other experts estimate perhaps only a third of all claims have been filed, due to the slow development of the diseases. Regardless of how many current claims and future asbestos related claims there may be, it is very important a workers’ comp adjuster specializing in asbestos related claims be assigned to handle them. By using the expert adjuster on these claims, it is possible to mitigate the total cost of these claims.
Author Rebecca Shafer J.D. Consultant, Amaxx Risks Solutions, Inc. has worked successfully for 20 years with many industries to reduce Workers’ Compensation costs, including airlines, healthcare, manufacturing, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. He can be contacted at: RShafer@ ReduceYourWorkersComp.com or 860-553-6604.
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