Are Occupational Diseases Covered by Insurance?

Nurse holding vials of blood

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While most work-related injuries sustained by employees are caused by accidents, some result from occupational diseases. All states provide some coverage for occupational diseases under workers compensation insurance. Employees who sustain work-related diseases receive the same types of benefits as those injured in accidents. However, state laws vary widely in the types of diseases they cover. A disease covered by one state may not be covered by another.

What's an Occupational Disease?

State laws determine what conditions qualify as occupational diseases. Some states address occupational disease in their worker's compensation statute. Others define it in a separate occupation disease law. Some rely on the courts to determine which diseases are covered.

State laws that define occupational disease generally do so using a list or a general description. A minority of states use the list approach. An example is Pennsylvania. Its Occupational Disease Act cites 15 conditions that qualify as occupational diseases. Diseases not listed don't qualify. Many states use the descriptive method. Rather than citing specific diseases, they outline general parameters that a condition must meet to qualify as an occupational disease. For example, Virginia law defines occupational disease as follows (this is an excerpt, not the entire definition):

The term "occupational disease" means a disease arising out of and in the course of employment, but not an ordinary disease of life to which the general public is exposed outside of the employment.

Like many states, Virginia distinguishes between a disease that arises out of employment and an ordinary disease of life. A disease that a worker contracts on the job is not an occupational disease if the worker could easily have been exposed to it outside the workplace. For example, flu isn't an occupational disease even if a worker contracts the illness from a fellow employee. It is a disease to which the general public is widely exposed, and the worker could contract it virtually anywhere.

Some states require a worker to demonstrate a direct causal connection between the worker's employment and a disease. Other states require the worker to show that employment was the proximate cause of the disease.

Nature of Employment

An illness might qualify as an occupational disease for some workers but not others. For instance, suppose a medical lab technician contracts tuberculosis from bacteria that is released when a specimen tube breaks. A data entry worker contracts tuberculosis from an infected fellow employee. The lab worker's tuberculosis might qualify as an occupational disease since the illness was directly tied to the nature of his employment (testing specimens). The data entry worker's illness would not qualify as an occupational disease since there was no direct connection to her job duties (typing on a computer) and the disease.

Firefighters are often exposed on the job to smoke and other toxic substances that can cause disease. In some states, firefighters are presumed to have an occupational disease if they develop certain types of cancer or other ailments. When there is a presumption that a worker has an occupational disease, the employer has the burden of proving that the disease did not arise from the worker's employment.

Time Lags

Most on-the-job injuries result from accidents. If a worker breaks his arm in a slip-and-fall accident at a job site, the time of the injury is easy to establish. Unlike accidents, occupational diseases tend to occur over time. Diseases like silicosis and asbestosis may take decades to develop. When these illnesses finally produce symptoms, it can be difficult to establish a date of injury. In some states, a law or a court decision might specify how the injury date should be determined. This might be the date the employee shows symptoms or the date the employee was first exposed.

Some states impose a statute of limitations on workers compensation claims when employees are seeking benefits for an occupational disease. Claims may need to be filed within a specified time period (such as two years) of the date the worker became disabled by the disease or became aware that the disease was connected to his or her employment.

Insurance Coverage

An occupational disease is covered under workers compensation and employers liability insurance. Both cover claims for bodily injury by disease. Workers compensation insurance provides benefits, including medical treatment and disability payments, to employees who have contracted an illness that qualifies as an occupational disease under state law. Employers liability insurance covers suits against employers by workers who have been injured by an occupational disease.

Federal Occupational Disease Laws

The federal government has created two federal occupation disease programs. These programs are administered by the U.S. Department of Labor's Office of Workers Compensation. Some workers may be eligible for benefits under both a federal program and their state's workers compensation plan.

  • Black Lung Program provides medical coverage for the treatment of pneumoconiosis, the technical term for black lung disease. Black lung disease is caused by exposure to coal dust. The program provides benefits to workers disabled by the disease and death benefits to workers' survivors.
  • Energy Employees Occupational Illness Compensation Program provides medical and other benefits to current or former employees of the Department of Energy (and certain vendors or contractors) who have contracted cancer or other diseases as a result of exposure to radiation, beryllium, or silica.