Occupational Health Perspective

1. Occupational Health Perspective • Hazel Armstrong • Chair of the Gradual Process and Occupational Disease Panel • Lawyer working in employment and personal injury law

2. Outline of Presentation • The assumption in this presentation is that everyone wants workers to be healthy, but those workers who suffer occupational disease ought be covered and compensated by the NZ accident compensation scheme. • The Gradual Process Panel was established by the IPRC Act 2001 to address issues concerning GP conditions, and occupational disease. • This presentation focuses on one aspect of ACC’s work: occupational disease.

3. Outline of Presentation • We will identify the Law Commission approach to extension of the scheme to cover sickness and disease. • We will look at how the scheme has evolved over the last 50+ years . • We will identify the areas where NZers are failing to makes claims. • We will look at the challenges for ACC under the existing scheme. • How NZers would be affected if private insurers administered work cover.

4. The Woodhouse Report: 1967 • Proposed to retain cover for certain industrial diseases as provided for in the WC Act. • Deafness from noise should be included. Deaf persons should have the advantage of a rebuttable presumption.

5. Personal Injury: prevention and recovery Report of the Law Commission 1988Authored by Sir Owen Woodhouse and Sir Ken Keith • The Law Commission recommended: • Extension of the scheme in stages • Phasing in through acceptance of industrial disease • Adding a detailed specification of injury causes as a schedule to the legislation • Using the International Classification of Diseases – WHO • That classes could be added or reduced • That the requirement of relevant employment within 2 years be removed; and • That all incapacity (within scope of legislation) arising after 1 April 1974 should be covered.

6. The scheme has evolved • The accident compensation scheme is adaptable. • This presentation shows how the Law Commission recommendation of phasing or staging the extension of scheme by extending cover for occupational diseases has occurred over the last 50+ years.

7. Timeline of changes to the scheme • 1956 – prescribed period – 2 years from date of employment • 1972 – prescribed period – 2 years • 1982 – exposures from employment after 1.4.74 • 1988 – Law Commission Report • 1992 – incapacity arises after 1.4.74 • 1998 – incapacity arises after 1.4.74 and presumptive schedule lists 11 diseases • 2001 – presumptive schedule lists 17 diseases • 2008 – presumptive schedule lists 41 diseases • 2008 – legislation changes to ease burden of proof on claimants, provide greater flexibility to amend schedule 2, clarifies ACC’s responsibility to pay for the investigation of claims • 2009- What happens if National gives the scheme to private insurers?

8. ACC - claims for occupational disease - 2006 • 25,014 claims lodged • 17,103 claims accepted • 7911 (32% declined) • $130 m spent per annum • Most common claims accepted: • hearing loss, • musculoskeletal, • skin disorders

9. NOHSAC: How many work related diseases and injuries occur in NZ each year? • 700- 1,000 people die from work related disease • 100 die from injuries received at work • 20,000 new cases of work related disease and injury occur • Speculation that there is under claiming for occupational disease claims

10. Why are NZers not claiming for occupational disease cover? • The DOL says: • NZers lack of awareness of occupational disease; and • There is a lack of awareness that the scheme covers occupational disease; and • Are reluctant to make a work injury claim • Reluctance to claim because it will require disclosure of personal details/life style/health information • Cost, time, effort

11. What are the occupational diseases in NZ? • NOHSAC says: • Noise induced hearing loss – noise • Dermatitis – hazardous substances – skin • Cancers – hazardous substances – carcinogens • Musculoskeletal disorders – physical and psychosocial disorders • Respiratory disease – hazardous substances

12. What occupational diseases should ACC focus on in order to raise awareness? • Cancers • Heart/circulatory disease • Respiratory disease

13. Occupational Cancer • Of the 700-1,000 workers who die – 30-40% are caused by cancer – mainly lung cancer • Lung cancer due to asbestos, diesel fumes, environmental tobacco… • Mesothelioma due to asbestos • Leukaemia from benzene.. • Bladder cancer from dyes, paints, solvents….

14. Circulatory system • Work strain, e.g. shift work • Carbon monoxide from engine exhausts • Environmental tobacco smoke

15. Respiratory Disease • Exposures to dusts • Occupational asthma • Asbestosis

16. What is being done? • Two workplace surveys are underway (Massey – 5,000 workers) & Uni of Otago – smaller number but more detailed). • Some of the larger employers collect information about occupational disease. • Some Govt agencies collect data.

17. What should we be doing better? • Overall – information is: fragmented, under resourced, lacks strategic direction and co-ordination. • Surveys have not routinely or systematically been done across NZ. • Therefore surveying of workers, workplaces and specific exposures is a priority. • Measurement of personal and area exposures is required.

18. If we want to improve knowledge in NZ • We need to describe the hazards by occupation, industry, geography and worker demographics. • Describe hazard controls. • Identify new and emerging hazards.

19. Changing Workforce: some challenges • Casual and part time workers • The Self employed • Ageing workforce • Mobile workforce • Workers less unionised

20. The Challenges to ACC • Getting information out to the medical fraternity, workers, unions, employers and the self employed about occupational disease. • Co-ordinating the surveys and data collection of workers and workplaces. • Publicising the fact that workers can be covered for occupational disease. • Giving effect to the 2008 amendments in the IPRC Act. • Understanding the purpose of a presumptive schedule. • Reducing barriers to access by claimants to ACC cover and entitlements.

21. Challenges to workers if the scheme is administered by private insurers • Risk rating will discourage employers from participating in surveys – why would you identify problem areas in your industry? • Culture of ignorance about occupational disease will continue to prevail • No incentive on insurers to ensure claimants are covered for occupational disease • Difficulties proving cause will be magnified

22. Conclusion • The Law Commission recommendation to phase in an extension of the scheme through coverage of occupational disease remains sound. • ACC has many challenges ahead. • If private insurers are involved we will not see improvement in the coverage and delivery of entitlements for NZ workers who suffer from occupational disease.