What is an occupational disease?
An occupational disease is a disease caused by a working environment risk factor or the nature of the work included in the list of occupational diseases.
A medical examination at an occupational health doctor will help diagnose the disease. A doctor who suspects an employee of an occupational disease will refer them to an occupational health doctor. An occupational disease is diagnosed by an occupational health doctor, who determines the worker's state of health and collects data on their current and previous working conditions and the nature of the work. The occupational health doctor shall notify the employer, the Labour Inspectorate and the doctor who referred the employee to the occupational health doctor in writing of the occupational disease.
The list of occupational diseases established by a regulation of the Minister of Social Affairs sets out the causes of occupational skin diseases and tumours and the list of respiratory occupational diseases and tumours. The regulation also contains a list of chemical hazards in the working environment that may cause an occupational disease and occupational diseases caused by physical and physiological hazards in the working environment.
Groups and causes of the most common occupational diseases
- Physical overload diseases Physical overload is often the cause of occupational diseases. For example, computer work causes tension in the hands, neck and shoulder girdle. Important physical factors in the working environment also include strenuous physical work, lifting weights and working in cold and humid environments. Lung diseases Lung diseases can be caused by a number of working environment hazards, such as mineral dust, aerosols and gases from toxic substances, and strenuous physical work with poor weather conditions.
- Hearing impairments Noise-induced hearing loss still occurs today, although noise levels can already be controlled quite effectively with a variety of collective and personal protective equipment. Noise-induced hearing loss is also affected by age, exposure to neurotoxic chemicals, individual characteristics and non-occupational noise sources.
- Occupational skin diseases If a skin disease is proven to be caused by occupational contact with an allergen or toxic substance, an occupational disease can be diagnosed. This may be due to working in rubber shoes in humid and warm conditions, prolonged pressure from the working position or tool, etc.
- Occupational diseases caused by chemical hazards in the working environment Chemicals can cause damage to the skin, nails and upper and lower respiratory tract. Poisonings are less common. Skin lesions and allergic occupational diseases are more common. Skin damage can be caused by acid and alkaline solutions and by oil and coal products, arsenic compounds or gasoline. Calcium hypochlorite causes nail damage.
There is an official list of occupational diseases in the Republic of Estonia, which places allergens in the list of causes of occupational diseases. Subsection 5 (2) of the Regulation expressly states that the list also includes occupational skin diseases which have arisen as a result of scientifically proven allergenic or irritating substances.
About 10% of all registered occupational diseases are caused by hazardous chemicals in the working environment.
Dr. Kaja Julge writes on the portal kliinik.ee that allergy means a change in the reactivity of the body's immune system to a factor to which the immune system did not react on initial contact. Thus, it is an ‘alternative’ reaction, an unusual sensitivity or hypersensitivity to a substance or factor (antigen), which in this case is called an allergen.
Hypersensitivity can be caused by, for example, foodstuffs, medicines, inhaled particles, insecticides, animal hair, etc. An allergy is primarily a hypersensitivity reaction of the immune system, i.e. protection, but in this case too strong protection against some completely harmless or relatively safe factor. Another characteristic of allergy is specificity, i.e. an allergic reaction in a particular person only to certain allergens, the amount of which may increase over time.
As can be seen from the above quotation, a wide variety of substances can be allergens. In the working environment, these are mostly chemicals, but there may also be allergens of biological origin.
Whether or not one or the other chemical may cause hypersensitivity, the necessary information should be sought. The primary source of information is the packaging of the chemical, provided that the chemical is bottled in the original packaging and not re-poured into, for example, a lemonade bottle.
The labelling of hazardous chemicals that cause allergies distinguishes between respiratory or skin sensitization.
The label element for respiratory sensitisation is the torso in the diamond lined with red.
The skin sensitisation marker element is an exclamation mark in a diamond bordered with red.
Therefore, the feeling of danger must increase if you see these two hazard pictograms on the packaging of the chemical.
Next, of course, it is necessary to look at the hazard statement used. Hazard statements are given as a combination of the letter H and a three-digit number, and in the explanatory text we find the words ‘allergy’ and ‘allergic’.
Further instructions on how to work safely with one or another chemical can be found in the chemical safety data sheet. It specifies the working environment (for example, whether working with the chemical requires separate exhaust ventilation or simply a well-ventilated room), the personal protective equipment to be used and the appropriate method of storing the chemical.
There are 100,000 to 300,000 chemicals in use worldwide, and nearly a thousand new chemicals are introduced each year. Thus, the amount of chemicals used increases every year. Out of all the chemicals in use, 10–25% can also be allergens.
The best known substances that cause respiratory sensitisation are various adhesives, paints, resins, surface protection products, pharmaceuticals, food supplements, cleaning agents, welding fumes and metals, hair dyes, bleaching agents, textile chemicals, and textile fibres.
However, skin sensitisers include various metals (nickel, chromium, cobalt), resins, plastics (wood rosin, epoxy resins, isocyanates, acrylates, formaldehyde), dyes (paraphenylenediamine, fabric dyes), disinfectants, fragrances, rubber chemicals, solvents, film preservatives.
Measures to reduce health risks are listed in sufficient detail in a government regulation on occupational health and safety requirements for the use of hazardous chemicals. They are universal for all chemicals:
The primary task is to try to reduce risks by optimising the work process, and in particular, priority should be given to activities that could be called collective defence:
- replacing technology based on the use of hazardous chemicals with safer ones;
- replacing a hazardous chemical with a safer one;
- reducing the number of workers exposed to hazardous chemicals;
- shortening the working time with hazardous chemicals;
- reducing the amount of hazardous chemicals in the workplace.
However, if the above measures do not provide adequate protection and are not sufficiently effective, the risks must also be reduced by better work organisation, moving from general to the individual:
- use of the right work methods;
- use of equipment and technologies to ensure the safety of workers;
- use of appropriate tools and materials;
- regular technical inspection and maintenance of equipment.
Years ago, the Labour Inspectorate investigated a case in which an employee was diagnosed with an occupational disease, allergic contact dermatitis, in a small construction establishment. The worker had received it from exposure to epoxy resins.
The employer could not understand that an illness such as an allergy could also be an occupational disease and that the illness could be caused by the materials used in their establishment. According to the employer, the employee's exposure to epoxy resins was short-lived (estimated at two months) and during that time the employee could not possibly develop permanent damage! Epoxy resins are widely used as floor covering materials and the manager of the works was a highly experienced specialist who has gained knowledge of working with these materials outside Estonia. In the safety instructions prepared for the work, the employer had not considered the work with epoxy resins to be harmful and explicitly wrote that working with these floor covering materials (resins) was not harmful to health and did not prescribe any special protective measures or protective clothing. The work was routine and the protective equipment used was rather standard.
Unfortunately, the employer had not read the very important documents, which were the safety data sheets for the chemicals used. They clearly stated that these were irritating and hypersensitive chemicals and provided adequate respiratory protection as well as epoxy-resistant work clothes and work gloves as safety precautions.
In the light of this case, professional literature was also thoroughly examined to explain to the employer why the employee became ill.
- Allergic contact dermatitis is caused by many chemicals that are safe in themselves.
- Depending on the substance, symptoms may occur less than an hour or a few days after contact.
- In case of allergic contact dermatitis, dermatitis can sometimes be seen on the same day after contact. It is typical that the reaction becomes stronger within 4–5 days.
- The development of allergies is facilitated by external stress.
- Epoxy compounds are also the cause of allergic contact dermatitis.
- Epoxy compounds are substances that cause an early allergic contact reaction with symptoms 1–2 days after contact. In skin tests, epoxy resin has caused early contact reaction and anaphylactic symptoms. Epoxy resins are placed in the group of strong sensitisers.
(‘Allergology’, edited by Maie Laaniste, AS Medicina 2002).
- Exposure to epoxy resin until contact allergy develops can be quite short (less than one month up to a few years).
- Any single and accidental exposure to an allergen (epoxy resin) can trigger a hypersensitivity reaction.
- Epoxy compounds can cause contact dermatitis by direct contact with the skin, but also by airborne transmission. Typical areas involved are the fingers, the spaces between the fingers, the arms up to the wrists and the eyelids.
(‘Handbook of Occupational Dermatology’, L. Kanerva, P. Elsner, J. E. Wahlberg, H. I. Maibach, Springer 2000).
However, the lesson for the case described above could be this: chemicals that initially seem safe can also cause damage to health, and in particular the chemicals used need to be studied in more detail.
In fact, the epoxy resins used are not safe at all and are well known in the world of allergies.
- Hazards in the working environment must not be ignored! Even a seemingly (initially) safe substance can cause a lot of trouble.
- Physical load in the working environment also promotes the development of allergies.
- In most cases, dangerous chemicals have the necessary information (provided that they are not produced anywhere in third countries to which European Union directives do not apply).
- Every chemical is a poison. The amount of poison depends on the amount of the chemical, but sometimes a very small amount and short-term exposure are sufficient.
Investigation of occupational diseases
The occupational health doctor shall notify the employer, the Labour Inspectorate and the doctor who referred the employee to the occupational health doctor of the occupational disease in writing or in a format which can be reproduced in writing no later than five days after diagnosing the disease (hereinafter notice of occupational disease).
If the occupational health doctor finds that the employee's occupational disease may have been caused by working for previous employers, they shall also enter the names and addresses of these employers in the notice of the occupational disease and inform them of the employee's occupational disease.
The circumstances and causes of an occupational disease are explained by an investigation carried out by the employer, in which the working environment representative or, in the absence thereof, the employees' representative, must participate with the right to vote. If the employer does not have the necessary knowledge, they must involve a competent expert in the investigation.
In order to find out the circumstances and causes of an occupational disease, the occupational disease investigator:
- monitors the proper implementation of work organisation and medical measures taken to prevent work-related illnesses, including examination of documents reflecting employee health examinations, working environment risk assessment documents, safety instructions approved by the employer, documents certifying occupational health and safety guidance and training, documents certifying the employment relationship or work organisation, and prepares extracts and copies of the documents if necessary;
- takes statements from persons who have information on circumstances relevant to the occupational disease;
- identifies the persons responsible for compliance with occupational health and safety requirements.
The employer must carry out the investigation of the occupational disease no later than within 20 working days after receiving the notice of the occupational disease. The employer shall prepare a report on the results of the investigation and present it to the injured party or a person representing their interests and the Labour Inspectorate.
The report also outlines the measures taken by the employer to prevent a similar occupational disease. The employer registers cases of occupational diseases and communicates the relevant information to the working environment specialist, the working environment representative, the employees' representative and the working environment council.
Attention must be drawn to the fact that the data on the health status of an employee obtained in the course of an investigation of an occupational disease are sensitive personal data which are processed pursuant to the procedure provided for in the Personal Data Protection Act. Data on the investigation of accidents at work and occupational diseases shall be preserved for 55 years.
Illness caused by work
In the working environment, a person may be exposed to various risk factors, which are physical, chemical, biological, physiological and psychosocial risk factors. If their effects are long-lasting, the risk factors in the working environment can adversely affect the worker's health and cause health damage, which can be a work-related illness.
According to the Occupational Health and Safety Act, a work-related illness is an occupational disease and an illness caused by work.
An illness caused by work is an illness caused by a working environment risk factor that is not considered an occupational disease. Thus, in that case, there is no direct link between the worker's illness and the risk factor affecting the worker, but the risk factor may still have affected the worker's health in such a way that damage to health has occurred. Thus, the risk factor in the working environment has been only one factor in the list of causes of the disease.
It is possible to treat an illness caused by work identified in a timely manner, to achieve the recovery of the employee, to prevent the aggravation of the illness and the development of an occupational disease.
In Estonia, work-related illnesses (both occupational diseases and illnesses caused by work) are diagnosed by occupational health doctors, and once a doctor suspects a work-related illness, they shall refer the employee to an occupational health doctor.
The occupational health doctor notifies the Labour Inspectorate of the diagnosis of an illness caused by work, but does not inform the employee's employer.
The Labour Inspectorate also does not notify the employer that their employee has been diagnosed with an illness caused by work. In addition, the Labour Inspectorate does not conduct investigations in the case of illnesses caused by work, as it does in the case of occupational diseases. When the Labour Inspectorate receives a notice of the diagnosis of an illness caused by work, a general inspection is carried out at the employer in order to guide the employer to eliminate or reduce the impact of risk factors that have played a role in the development of the illness caused by work. Of course, the Labour Inspectorate does not inform during the inspection that one or another employee of the employer has an illness caused by work, but by reducing the effect of the risk factor in a timely manner, it is highly probable that the subsequent damage to the employee's health can be delayed and the damage to the health of other employees' can be prevented.
However, the employee should inform their employer about the illness caused by the work they have been diagnosed with, as the health disorder may impede the performance of work duties and the employee may develop an occupational disease if the risk factor continues to affect them. The employer must be able to make changes in the working environment or the organisation of working time in order to prevent further exposure to the risk factor and the aggravation of the illness.
As in the case of an occupational disease, in the case of an illness caused by work, the employee has the right to require the employer to transfer them temporarily or permanently to another job or to temporarily alleviate their working conditions on the basis of a doctor's decision.
An employee has the right to claim compensation from the employer if they have been diagnosed with an occupational disease or an illness caused by work and has suffered damage as a result. In order to receive compensation for illness caused by work, the employee must inform their employer of the illness caused by work, because otherwise the employer will not be aware of it. The employee's right to claim compensation arises in accordance with the Law of Obligations Act, and the damage subject to compensation may be proprietary or non-proprietary.
Compensation for occupational diseases
An employee has the right to receive compensation for health damage caused by work (for example due to an occupational disease) to the extent provided for in the Law of Obligations Act (clause 14 (5) 6) of the Occupational Health and Safety Act). The employer must compensate for the damage only if the circumstance on which their liability is based is related to the occurrence of the damage in such a way that the damage caused is a consequence of that circumstance (causal link).
The employer must, in particular, reimburse the reasonable costs of treatment for the damage to health and the damage caused by the injured party's incapacity for work and loss of income, and, in the event of the employee's death, their reasonable funeral expenses.
In addition to compensating for the loss of income due to an occupational injury, the employer responsible for the injury must compensate the victim for the additional costs caused by the occupational injury. Such additional costs may include:
- prostheses and aids;
- prescription medicinal products;
- expenditure on rehabilitation;
- travel expenses to a medical institution;
- victim care costs.
Compensation for damage is based on the provisions of the Law of Obligations Act. Subsection 130 (1) of the Law of Obligations Act stipulates that if there is an obligation to compensate for damage caused to a person's health or bodily injury, the injured person must be compensated for the expenses caused by the damage, including expenses arising from increased needs, and damages arising from total or partial incapacity for work, including the damage arising from lessening of income and further deterioration of economic possibilities. Pursuant to section 127 of the Law of Obligations Act, the purpose of compensation for damage is to place the injured person in a situation as close as possible to the situation they would have been in if the circumstance on which the obligation to compensate for damage was based had not occurred.
In other words, if a person has been diagnosed with an occupational disease for the development of which the employer is (partly) to blame, the person has the right to claim compensation for the costs related to the illness. In order to be reimbursed, the claim must be submitted to the employer in writing or in a format which can be reproduced in writing. Please note that the employer may ask for documents proving that the costs have been incurred, and that the employer may ask for explanations as to how a particular cost is related to the health damage caused by the accident at work. The employer is only obliged to reimburse the expenses related to the accident at work. If the employer does not agree to reimburse you to the extent you want, the employee can go to court to claim compensation.