Occupational disease: when a disease is recognised as a work injury
The National Insurance Institute recognises an occupational disease on two cumulative conditions: that the disease was caused by the work, and that it is listed in the register of occupational diseases in the regulations. Unlike an accident, what must be proved here is exposure over time.
What an occupational disease is
The National Insurance Institute defines an occupational disease as a disease the insured person contracted as a result of the work, and adds a second condition: the disease will be recognised as an occupational disease if it is listed in the register of occupational diseases in the regulations.
The two conditions are cumulative. It is not enough that the disease was caused by the working conditions, and it is not enough that it appears on the list. Both must be satisfied.
The first question in any such case is therefore not medical but a matter of mapping: whether the diagnosed disease appears on the list, and on what exposure conditions the list makes recognition depend.
Source: National Insurance Institute, what is an occupational disease; work injury booklet.
How this differs from a work accident
A work accident is an event. It has a time, a place and circumstances that can be described. An occupational disease develops over time, sometimes years, and has no single point in time to which one can point.
That difference changes what must be proved. In an accident one proves the event and the connection between it and the injury. In an occupational disease one proves exposure: to what agent, at what intensity, over what period, and under what conditions.
The material that supports such a claim is therefore different too: a detailed account of roles over the years, the substances and equipment the worker came into contact with, workplace data, and at times the evidence of colleagues.
When the disease is not on the list
The list in the regulations is a closed list. A disease that does not appear on it is not recognised as an occupational disease, even where the connection to the work seems clear.
That does not mean the door is closed. Where the disease was caused by repeated movements or actions, a different route is examined - the microtrauma doctrine - which does not depend on the list.
In practice, one of the first professional decisions in a case is which route to open, because each route calls for different evidence.
What has to be proved
Even where the disease appears on the list, recognition is not automatic. Three elements are examined together:
- The medical diagnosis - that the disease diagnosed is indeed the one on the list.
- Actual exposure - that the working conditions included the agent and the degree of exposure the list makes a condition.
- Causal connection - that the disease was caused by the work and not by another source.
The second element is usually the hardest, particularly where the exposure occurred years ago and the workplace has changed or closed. Early documentation, even before a claim is filed, is what makes it possible to prove the point later.
The deadline for filing
The National Insurance Institute publishes that a claim must be filed within 12 months of the date of the injury, and warns that late filing may impair the right to the benefit, in whole or in part.
In an occupational disease the date of injury is not always clear, since there is no single event. It is therefore usual to refer to the date on which the disease was discovered or on which its connection to the work was established.
Because of that uncertainty, delaying filing until the position is fully clarified is an unnecessary risk. It is better to open the process and complete the material later.
Source: National Insurance Institute, work injury booklet.
After recognition
Recognition of an occupational disease places the injured person on the same track as any work injury victim: injury allowance, and after it a claim for determination of the degree of work disability before a medical committee.
There the familiar rules return: a stable degree of 9% up to less than 20% gives a one-time grant, and a degree of 20% to 99% gives a monthly pension.
In parallel, as with any work injury, the tort question is also examined - whether there was a party whose responsibility for the conditions of exposure gives rise to a separate cause of action.
Source: National Insurance Institute, work injury booklet.
In summary
An occupational disease is a disease caused by the work and also appearing on the register of occupational diseases in the regulations. Both conditions are required together. Unlike an accident, what is proved here is exposure - to what agent, at what intensity and over what period. Where the disease is not on the list, the possible route is the microtrauma doctrine. The filing deadline the Institute publishes is 12 months, and after recognition the ordinary rules on the degree of disability apply.
The central difficulty in these cases is not medical but evidential: establishing what the working conditions actually were years ago. The earlier documentation is gathered, the easier the task.
If you have been diagnosed with a disease you believe is connected to your working conditions, contact us with the diagnosis and an account of your roles and exposure. We will review the route and the first step.
The questions that come up most
Is every disease caused by work recognised as an occupational disease?
What happens if the disease is not on the list?
What is the difference between an occupational disease and a work accident?
How long is there to file the claim?
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