Occupational Illnesses Frequently Denied by Insurers

By Jason Weinstock on January 7, 2016

It isn’t always clear what the difference between a work-related illness and  an illness that doesn’t originate in work activities but is made worse when the employee must try to work.    Even when it is obvious and doctors directly report that an illness is caused by an employee’s particular work duties, you can count on most workers’ compensation insurers and their administrators to deny the claim.  The reasons for denial of these occupational illness claims cited by administrators in their denial letters often make no sense.  It is as if administrators are not aware that in addition to work injures  caused by specific accidents that diseases caused by work are often compensable too.

Some occupations have coverage for diseases that are not covered under workers’ compensation law in Nevada.  For example, police officers and fire fighters are specifically allowed coverage for heart disease, lung disease, some cancers, and other illnesses that have been legally presumed to be caused by their work.  However, even when a specific law allows benefits, police officers and fire fighters often have a fight on their hands to get medical care and compensation benefits for an illness presumed to be caused by their work.

Yesterday I had a conversation with a local hand surgeon who has been treating patients for several decades.  We talked about how carpal tunnel syndrome was routinely accepted ten years ago  as an occupational illness by industrial insurers and hearings and appeals officers.  Then the tide shifted and insurers started denying most claims.  Some of those denials were based on the American Medical Associations’ view that carpal tunnel syndrome was not likely caused by only repetitive  hand or wrist motion at work.  However, he and I agreed that whether  claims for repetitive motion hand and elbow problems are accepted or denied has more to do with what insurers arbitrarily decide will be designated as an occupational illnesses than what medical science shows about the cause of these problems.

Here is the link to an interesting article about the plight of an ill employee and his family as they fought to get his occupational illness claim accepted.

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