Surveillance of mesothelioma and workers’ compensation in British Columbia, Canada

Mesothelioma is a cancer that develops on the protective membranes that line the cavity holding the lungs, the abdominal cavity, and the heart sac. It is mainly caused by asbestos exposure. An estimated 85-90% of cases in men and 20-30% of cases in women are due to occupational exposure.  Therefore, mesothelioma is considered a compensable occupational disease in Canada. However, not all those who are eligible for compensation apply to receive it. Information on the characteristics of those who do not seek compensation is needed to help develop interventions to improve the compensation rate. Therefore, Kirkham and coworkers recently designed a study to determine the rate at which mesothelioma cases are compensated by the Workers’ Compensation Board of BC, and identify factors associated with compensation status.

The study linked mesothelioma cases listed in the provincial cancer registry to accepted mesothelioma claims in the BC workers’ compensation system from 1970-2005. A total of 391 cases were linked. Kirkham and coworkers found that the overall compensation rate for mesothelioma over the study period was 33%. The rate slowly increased over time, with a high of 49% reached in both 1999 and 2004. Few of the mesothelioma claims submitted for compensation are denied, so the low compensation rate is probably due to workers not seeking compensation.

The researchers found that a number of factors such as gender, age at diagnosis, and geographic location were associated with compensation status. Women were eight times more likely to be uncompensated for their mesothelioma than men. One possible explanation is that female workers and their physicians may not recognize mesothelioma as an occupational disease for women. It has traditionally been linked to more male-dominated industries such as construction, asbestos mining or manufacturing, while support roles in industrial settings with asbestos exposures, or working near construction sites may have been overlooked. Age at diagnosis was also found to be associated with compensation status. The highest compensation rate was found for workers aged 55-64. People aged 75 and older at the time of diagnosis were four times more likely to be a non-compensated case than those aged 55-64. Retired workers may be less likely to realize that their cancer is due to occupational exposure, physicians may be less likely to investigate their job history, or they may be unaware that retired workers can receive compensation benefits. Finally, researchers found that people living in rural areas or in northern BC had higher rates of compensation than those living in urban areas. Workers and doctors in areas with large industrial settings and known asbestos exposure may be more likely to associate mesothelioma with occupational exposure, and may be more knowledgeable about the compensation available.

Since the compensation rate is only 33%, the researchers recommend that regulatory agencies develop more effective notification systems to ensure that workers and physicians are informed of the potential for compensation. The low compensation rate is a concern both for the effected individuals, and for society in general. Funds given out by workers’ compensation are paid by employers’ insurance premiums, but non-compensated medical costs are paid for by the general healthcare system and tax revenue, which is a burden on all taxpayers. As well, workers’ compensation covers medical care that is not paid for by the public healthcare system, and patients would therefore receive added coverage.

In order to improve the rate of compensation in BC, the researchers propose that new education campaigns are needed to improve awareness of mesothelioma as an occupational disease. Therefore, physicians were mailed a letter asking them to let their patients know about the possibility of receiving workers’ compensation for mesothelioma. Future work will include investigating the effect of this intervention on the claim rate.

Kirkham, T.L., Koehoorn, M.W., McLeod, C.B., Demers, P.A. Surveillance of mesothelioma and workers’ compensation in British Columbia, Canada. Occupational and Environmental Medicine, 2011; 68(1): 30-35.

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