Compensation of occupational diseases related to asbestos

Transcription

1 International Social Security Association Cycle of seminars on the challenges of occupational diseases worldwide Seminar III: Respiratory diseases in Asia: Reporting, recording, prevention and rehabilitation Shenzhen, People's Republic of China, 5-7 September 2006 Compensation of occupational diseases related to asbestos Compensation of occupational diseases related to asbestos in Switzerland Legal Adviser Insurance Benefits Division Suva (Swiss National Accident Insurance Fund) Switzerland ISSA/COMTECH05-07/ATMP/SHENZHEN/2006

2 Compensation of occupational diseases related to asbestos Compensation of occupational diseases related to asbestos in Switzerland Legal Adviser Insurance Benefits Division Suva (Swiss National Accident Insurance Fund) Switzerland Introduction Let me please thank our host, the Ministry of Labour and Social Security (MOLSS) of the People's Republic of China, and the International Social Security Association (ISSA) for inviting the Suva to the present seminar, and allowing us to come and try to introduce the compensation system related to occupational respiratory diseases related to asbestos, in Switzerland. Short view of the social compensation system related to occupational diseases Compulsory accident insurance was reorganized in Switzerland in 1984, based on the federal accident insurance law (AIL). The largest of the insurance carriers is the Suva, at work since Beside Suva, a further 38 insurance companies private insurance organizations, recognized health insurance funds as well as accident insurance funds provide social accident insurance. To avoid any misunderstood, we should already notice that compensation of occupational diseases belongs to the social accident insurance scheme. We shall see shortly the role of the Swiss federal disability insurance. Suva Suva is an independent, non-profit company under public law. It mainly insures companies in the secondary business sector, i.e. industrial, trading and commercial enterprises. It means more than half of all employees in Switzerland. Suva's primary goal is the prevention of occupational diseases and accidents. The way to achieve this goal is by crating a culture of safety and health in the companies insured that also extend to how employees act outside working hours. Suva does not receive any state subsidies. Its revenues consist mainly of the premiums paid by insured persons, of the returns on capital invested to provide pensions, and of recourse claims.

3 2 Legal basis Compulsory accident insurance is regulated by the Federal law governing accident insurance of 20 March 1981, which came into effect on 1 January 1984 (AIL). The law on accident insurance covers two mandates: the prevention of accidents and occupational diseases (prophylaxis/occupational safety) and accident and occupational diseases compensation (insurance). Occupational diseases The law on accident insurance differentiates between two groups of occupational Diseases (mixed system). We only mention here the group in which asbestos is concerned: Diseases caused by specific substances or specific types of work that are set forth in a list (list system or method of enumeration). The condition for acknowledging an occupational disease is that this disease has been caused exclusively or mainly, i.e. more than 50 per cent, by these substances or works. It means insurance based on AIL is clearly a causality system. Asbestos Related to the occupational diseases due to asbestos, the list describes dust containing asbestos and pneumoconiosis, works with dust containing silicates. The role of doctors is prevalent. The diagnosis must be supplied in a dominating way. Possibility does not open rights. The exposure to asbestos at workplace under AIL coverage must be proved as well. The time of exposure is important too: at least 15 up to 45 years between the first exposure and the day at which the disease outbreaks. The entitlement to benefits begins when the occupational disease outbreaks. The first medical treatment or the first disease-related inability to work determines that outbreak. Insurance benefits Insurance benefits can be subdivided into care benefits and the reimbursement of expenses as well as cash benefits. Care benefits Suva provides cover outpatient care (doctor, medical staff), medication, hospital treatment in a general ward as well as spa treatment. The reimbursement of expenses includes auxiliary equipment, travel, transportation and rescue costs. Cash benefits Daily benefits Daily allowances replace the loss of earning in the case of disease-related inability to work and amount to 80 per cent of the wage prior to the accident. They are abstractly paid for each day until the restoration of full ability to work or an invalidity pension entitlement. In case of partial incapacity daily benefits are correspondingly fixed. Invalidity pension

4 3 If not substantial improvement in the patient's state of health can be expected from continued medical treatment, daily benefits are stopped and permanent incapacity of earning is covered by invalidity pensions. These pensions amount to a maximum of 80 per cent of the insured and affected person's earning full year prior disease. Integrity benefit A person's physical or mental integrity or functions can suffer lasting harm after occupational disease due to asbestos. Integrity benefit takes the form of a single financial benefit, as a compensation for these non-material impairments. Important and durable disease related to asbestos could bring up to 80 per cent of the highest insured earning after the AIL (CHF 106,800 currently). Total dependency benefit If the recipient is totally dependent on the help of others, in order to cope with most of or part everyday tasks, Suva provides a dependency benefit. Three levels: weak, middle or severe. Survivor's pension Widows and widowers or orphans can claim a survivor's pension. Basically, death should be related to the disease. Disability insurance Disability related to asbestos could also open right to benefits from another source than Suva, the Swiss federal disability insurance (DI), which depends of Swiss government. This insurance provides essentially rehabilitation measures (before pension) and cash benefits. If both DI and Suva benefits meets together, they cannot exceed 90 per cent of the person's insured earning. Settlements of disputes Three levels system. Each important formal decision from Suva can be objected free of fee within 30 days at Suva itself. Everything is re-examined and a new decision will be done. An appeal can be lodged against it to the Cantonal (regional) Insurance Court within 3 months. At least, an appeal can be lodged to the Federal Insurance Court. Cost analysis To clarify the following cost analysis, we should keep some events in memory. Suva accepted first time asbestosis as an occupational disease in The use of asbestos in building has been forbidden in Since 1990 Importation and production of products containing asbestos are forbidden as well. Statistics have been strongly developed after The total amount of insurance benefits between 1939 and 1984 is close to CHF 40,000,000. The total amount from 1984 to 2004 is close to CHF 380,000,000, related to 1,412 occupational diseases, in which 781 with pleural mesotheliom (appendix 1).

5 4 Forecast According to the period between 1939 and 1984, compared with the last period mentioned above we cannot sideline the forecast, keeping the events of 1979 and 1990 in memory (also mentioned above), the baby-boom after world war 2nd, life expectancy, exposure (?) and latency between exposure and disease. Suva forecasting is essentially based on pleural mesotheliom cases. We are still expecting an increase about the next ten years. After then, we hope that the situation will be better and better. Comparing the asbestos import scale with the observed mesotheliom scale (appendix 2), thinking at the costs, in life and cash, to the untutored eye it looks like we did not make earlier enough the job according to the future. Regarding to the past, one among thousand problems, the solution should have been not about "whether" but about "how quickly". We try to move ahead while expending mutual trust and improving relation with population of manager and workers. To fulfill the targets, the focus should be put on the years 2030, 2040? Conclusion As you read, we just tried and go on to try our best. The costs of the solutions are enormous. But the costs of inaction could have been far greater. Anyway, no single solution or range of solutions in occupational diseases looks like successful without the cooperation of all the interested parties. In conclusion I want to thank you again for inviting Suva in China to take part at this seminar.

6 Appendix 1 Costs Year Care benefits Daily benefits Integrity benefit Capital value/ Capital value/ invalidity benefit survivors' benefit Total ' , ,435,786 1,884, , ,204 55, ,899 5,357,951 6,468, , ,489 67, ,977 7,923,746 10,230, , ,359 17, ,418 6,160,206 7,736, , , , ,625 5,694,199 7,226, , , , ,611 10,349,375 12,233, ,041 1,055, ,346 1,643,015 10,635,029 14,370, ,072,791 1,092, , ,989 11,256,210 13,891, ,006, ,803 45,528-5,351 9,687,032 11,566, ,123,173 1,106, ,772 63,090 10,875,688 13,380, ,303,456 1,044, , ,943 16,149,891 19,242, ,118,612 1,098,905 98, ,274 13,902,943 16,506, , ,741 17, ,512 8,445,983 9,834, ,779,181 1,863, , ,634 15,624,089 20,001, ,993,836 1,760,780 84, ,442 20,679,766 24,969, ,056,645 1,781, ,380 1,708,014 32,270,108 37,976, ,505,098 2,304, , ,284 19,590,681 25,128, ,787,284 2,432, ,604 1,033,519 16,583,828 23,065, ,159,376 2,622,044 84, ,393 27,036,097 32,050, ,537,255 3,348, ,230 1,636,979 25,844,798 34,580, ,038,775 3,126, ,642 2,039,589 25,199,624 34,776, ,324,787 29,802,060 2,891,394 11,402, ,703, ,123,317

7 Appendix 2