COMPENSABILITY OF ASBESTOS- RELATED DISEASES IN THE PHILIPPINES 5 th AAI Conference Commodore Hotel, Busan, Korea 6-8 November 2012

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1 COMPENSABILITY OF ASBESTOS- RELATED DISEASES IN THE PHILIPPINES 5 th AAI Conference Commodore Hotel, Busan, Korea 6-8 November 2012 Dr. Ma. Sarah Antonia I. Concepcion Medical Officer Employees Compensation Commission Department of Labor and Employment Philippines

2 Outline: Background - Facing the Facts - Subic Naval Base - The Asbestos Screening Program & the first rule on compensability of Asbestosis The ECC and the Employees Compensation Program Rules on Compensation of ARD - Revised rules on ARD - EC-appealed cases of ARD Challenges/Way Forward

3 Facing the Facts Lung cancer is the leading cause of death worldwide (WHO, Cancer; Fact Sheet N 297, Feb 2012) One in every three deaths from occupational cancer is estimated to be caused by asbestos (WHO Fact Sheet N 343, July 2010) At least one case of mesothelioma goes unreported for every four to five known cases worldwide (EHP 2011 April;119(4): ; Park et al) Pneumoconiosis is the most common occupational lung disease in developing countries (Schuitemaker et al., 2007) The Philippines has a long history of asbestos use, awareness must be increased for cases to be detected (U.S. Naval Base Subic Bay The country should advocate prevention but should be able to provide adequate social and medical rehabilitation and appropriate compensation to workers with Asbestos-related Diseases (Pres. Decree 626: The Philippine Employees Compensation Program)

4 Subic Naval Base, 92 years Maintain ships for fleet in the Western Pacific Biggest US military base outside of mainland US w/ > 50,000 Filipino employees About 10,000 workers exposed to asbestos in ship repair facilities (plumbing, piping, welding, etc.) U.S. Naval Base Subic Bay, Wikipedia

5 To determine the prevalence of ARD among exposed workers To support disability compensation 1,542 Subic Base ex-workers screened 38% (587) had ARD Diaz, VD. Asbestos-related Diseases in the Philippines: The Lung Center of the Philippines Asbestos Screening Program. Acta Medica Philippina. 2009;43(3):64-69

6 August 1,1996: Asbestosis approved as a compensable occupational disease under ECC Resolution No : 18 Subic Base ex-workers filed for SSS disability claims Diaz, VD. Asbestos-related Diseases in the Philippines: The Lung Center of the Philippines Asbestos Screening Program. Acta Medica Philippina. 2009;43(3):64-69

7 Government corporation mandated by law to manage the Employees Compensation Program (ECP) and attached to the Department of Labor and Employment for policy coordination and guidance Created under PD 626 Package of benefits for private and public sector employees and dependents during work connected contingencies Funding support to the ECP and generated from employers contributions collected by the Systems (GSIS and SSS) P38.12B (928M USD) total reserves for future claims (June 2012)

8 Government corporation that collects contributions and processes the claims for the public sector Government corporation that collects contributions and processes the claims for the private sector

Major Functions: Formulate policies and guidelines for the improvement of the employees compensation program Review and decide on appeal all EC claims

9 Major Functions: Formulate policies and guidelines for the improvement of the employees compensation program Review and decide on appeal all EC claims disapproved by the Systems Initiate policies and programs toward adequate occupational health and safety, work accident prevention and rehabilitation of ODWs

10 Rules on Compensation of Occupational Diseases total diseases #10 Pneumoconiosis 1977 (plus 11) (plus 5) (plus 1) (plus 1) - 30 Asbestosis ECC Resolution approved on September 27, Asbestos-related Diseases Hypersensitivity Pneumonitis Byssinosis

12 Rules on Compensation of Asbestosis August 1, Asbestosis All of the following: a. The employee must have been exposed to asbestos dust in the workplace, as duly certified to by the employer, or by a medical institution or competent medical practitioner acceptable to, or accredited by the System; b. The chest x-ray report of the employee must show findings of asbestos, or asbestos related disease, e.g. pleural plaques, pleural thickening, effusion, neoplasm and interstitial fibrosis; and c. In case the ailment is discovered after the employees retirement/separation from the service, the claim thereof must be filed with the System within three (3) years from discovery.

13 Rules on Compensation of ARD September 27, Asbestos-related Diseases (a) Asbestosis (b) Benign Asbestos-related Pleural Disease (c) Asbestos-related Malignancy i. Lung Cancer ii. Mesothelioma

14 30. Asbestos-related Diseases (ARD) All of the following: a) The employee must have been exposed for a prolonged/sufficient duration to asbestos dust in the workplace, as duly certified by the employer or by a competent medical practitioner/institution acceptable to the System; b) Clinical diagnosis consistent with the signs and symptoms of ARD and supported by any appropriate diagnostic tests such as chest x-ray or computer tomography (CT) scan and lung function test or positron emission tomography (PET), magnetic resonance imaging (MRI), biomarkers, histological findings; c) Latency period of 10 years or more unless proven otherwise; d) Except for lung cancer and mesothelioma, ARD must be accompanied with impaired lung function for compensation.

15 Disabilities for ARD Temporary Total Disability (based on workdays lost, LFT result as proof of impairment) Asbestosis Benign Asbestos-related Pleural Disease Permanent Partial Disability (based on workdays lost, LFT result as proof of impairment) Asbestosis Benign Asbestos-related Pleural Disease Permanent Total Disability Asbestos-related malignancy

16 Benefits provided Loss of income Medical treatment and Rehabilitation Services Caregiver s allowance Livelihood opportunities or income generating skills for the disabled or the beneficiary Funeral and Death Benefits

17 ARD Cases Compensated by the SSS 15 Ex-Subic base workers - 4 diagnosed with lung cancer during the screening program - 6 granted with death benefits by SSS 11 Non-Subic base workers - 9 mesothelioma (8 diagnosed at the LCP; jobs: autodenter, warehouseman, pipefitter, lineman, printing operator, 2 drivers) - 2 pleural disease with COPD - 3 appealed to ECC 26 total cases granted by SSS

employment in glass manufacturing company,17 years latency period.

18 1. Mesothelioma 2. Pleural thickening w/ Restrictive Lung Disease 3. Pleural thickening w/ Restrictive Lung Disease 3 APPEALED CASES OF ARD Denied at System (SSS) and reversed at ECC 76 year old male, 1yr boiler/2 years mechanic, 46 years total employment in glass manufacturing company,17 years latency period. Denied at SSS: no employee-employer relationship (diagnosed 58 year old with male, PTB) 7 years driver/mechanic in Subic, 26 years latency period; Denied at SSS: no employee-employer-relationship, does not meet impairment criteria (diagnosed 66 year old with male, PTB) 8 years rigger (Subic SRF), 27 years latency period. Denied at SSS: no employee-employer relationship (diagnosed with PTB)

19 Challenges Clinicians and medical evaluators must have a high index of suspicion for ARDs Prompt diagnosis and case evaluation for coverage under the SIF during therapy and rehabilitation and for appropriate compensation Viability of the SIF must be maintained/ liability of manufacturers, importers, construction owners Rules must be responsive to the needs of the claimants

Way Forward Network with local and international organizations and academe for capacity building Exchange of information on developments and best practices on ARD prevention and social

20 Way Forward Network with local and international organizations and academe for capacity building Exchange of information on developments and best practices on ARD prevention and social and medical rehabilitation Exchange of resources Update rules when needed/new findings from research, vigilance in observing the gray areas in appealed cases, establish reliable database

21 The 1987 Constitution mandates that full protection shall be afforded to labor. PD 626, being a social legislation, should be given liberal construction to fully carry into effect its aim to promptly provide benefits to workers and/or their beneficiaries in the event of work connected disability or death.

22 EMPLOYEES COMPENSATION COMMISSION 355 Senator Gil J. Puyat Avenue Makati City, Philippines Tel +(632) local 224

Health effects of occupational exposure to asbestos dust

Health effects of occupational exposure to asbestos dust Authors: N.Szeszenia-Dąbrowska, U.Wilczyńska The major health effects of workers' exposure to asbestos dust include asbestosis, lung cancer and