An occupational disease is an illness that has been caused by the occupational (insured) activity and is also formally recognized as an occupational disease according to the applicable law. Typical occupational diseases are noise-induced hearing loss , skin diseases , diseases of the musculoskeletal system and diseases caused by inorganic dusts ( asbestosis and silicosis ). Mental exhaustion such as burnout syndrome , mental disorders or psychiatric illnesses have not counted among the occupational diseases so far.
Every year more than twenty thousand people in German-speaking countries develop occupational diseases. You will be medically rehabilitated and financially compensated by the accident insurance institutions.
Often, however, the connection between work and illness was not obvious. Many occupational diseases develop gradually in long, chronic processes and are based on a variety of causes, some of which are unknown. In addition to professional influences, individual lifestyle, personal constitution and disposition and the interaction of professional and non-professional factors also play a role. If there are several competing causes, the decisive factor is which cause, from a legal point of view, contributed significantly to the disease (so-called theory of the essential condition ). The reason for this is the design of the statutory accident insurance as a so-called causal security system, in which - in contrast to the "final" security systems - only those damage to health are to be compensated that are due to a specific cause - here: an occupational disease. The distinction between occupational accidents and occupational diseases arose in the early social justice rulings from decisions of the Reich Insurance Office, which decided in 1887 that only temporally delimited incidents were to be regarded as eligible for compensation in the sense of the Accident Insurance Act of 1884, but not the gradually emerging occupational diseases.
In the case of some diseases, there are latencies of several decades between the damaging effect and the outbreak. The mean latency period for asbestos-related diseases is 38 years. People who worked with asbestos in the 1950s became ill in the 1990s. After such a long time, it is usually difficult to prove the connection between the occupational activity and the illness. It is true that the accident insurance institution as well as the social court determine the facts ex officio ( SGB X , SGG ). However, the person concerned must cooperate so that one can say that the burden of proof lies at least in fact with the sick person. Depending on the legal system, however, he or she is given easier evidence or certain causal relationships are presumed by law ( (3) SGB VII ). Especially with diseases that have several (possible) causes, those affected can easily find themselves in need of evidence.
The medical and scientific complexity of these work-related illnesses is the main reason why many of these illnesses were overshadowed by occupational accidents for a long time . It was not until the 20th century that it was generally recognized that work-related illnesses are not a personal stroke of fate, but, like work-related accidents, are the result of a special risk arising from work. Occupational illnesses are now a research area in occupational medicine .
“Occupational disease” is a legal term, not a medical term. A disease that, according to medical and scientific knowledge, is job-related is not necessarily an occupational disease at the same time. Rather, the clinical picture must also be recognized as an occupational disease by the respective legal system. The distinction is important because recognized occupational diseases in Germany, Austria, Switzerland and other countries are financially compensated by social insurance. In the German-speaking countries, the occupational disease is one of the insured events in the statutory accident insurance alongside the work or occupational accident.
In Germany, Austria and Switzerland the so-called list principle applies: The recognized occupational diseases are finally listed in an official list, in Germany the Occupational Diseases Ordinance (BKV). Diseases that are not on the list are - with a few exceptions - not considered occupational diseases. Most of the EC Member States also work according to this principle. The Federal Constitutional Court found it constitutional that this enumeration principle leaves gaps in protection against occupational diseases.
As part of their duty of care , employers are required to carry out a risk assessment. For example, through the key feature method in the area of physical workload when manually lifting, holding, carrying, pulling and pushing loads.
A disease is only considered an occupational disease if it is caused by the occupational activity of the sick person. That is why occupational diseases are usually not systematized according to their effects, but rather according to their causes. Be differentiated
- Diseases caused by chemical agents, for example skin diseases and diseases caused by metals and semi-metals , solvents and pesticides .
- Illnesses that are caused by physical influences, for example spinal column illnesses from lifting or carrying heavy loads, noise-induced hearing loss, illnesses caused by vibrations , compressed air or radiation ( Schneeberger disease )
- diseases caused by infectious agents or parasites
- Tropical diseases such as malaria
- Diseases caused by inorganic dusts, including diseases caused by asbestos fibers and silicosis
- Diseases caused by organic dust
Occupational disease as an insured event
In Germany, occupational diseases are diseases that the Federal Government designates as occupational diseases in the Occupational Diseases Ordinance with the consent of the Federal Council and which the insured suffer as a result of an activity that gives rise to statutory accident insurance.
Only those diseases are included in the ordinance which, according to the knowledge of medical science, are caused by special effects to which certain groups of people are exposed to a significantly higher degree than the rest of the population through their insured activities. This restriction serves to distinguish occupational diseases from so-called widespread diseases , which can affect anyone regardless of the respective activity. The Federal Ministry of Labor and Social Affairs issues leaflets for medical examinations in the case of occupational diseases, in which sources of danger , clinical pictures and diagnoses are described.
In Germany, doctors and employers are legally obliged to report possible occupational diseases to the professional association or the accident insurance company. Standardized forms are used for this. Those affected can also contact the accident insurance institution directly if they think they are suffering from an occupational disease.
80 occupational diseases registered
In the Federal Republic of Germany, the current list of occupational diseases, as a result of the amendment to the Occupational Diseases Ordinance, has included over 80 diseases since 2019. According to the construction industry in this industry, the increasing white skin cancer is one of the newly recognized ailments . In 2018 it was "the most common occupational disease with 2,944 new suspected cases". In the first half of 2019, according to a preliminary evaluation, the status was already 1,400 reports. BG BAU General Manager Klaus-Richard Bergmann and the German Cancer Aid Foundation demanded , against the background of climate change, that “increased prevention work against skin cancer” be carried out. The course should be set to protect against UV radiation in the construction industry in order to contain skin cancer diseases.
Recognition as an occupational disease
The decision on the recognition of an occupational illness is the task of the statutory accident insurance ( employers' liability insurance association , municipal accident insurance associations , federal and state authorities, etc.). Recognized occupational diseases are insured events within the meaning of accident insurance law ( (1) SGB VII). In principle, they are compensated just like accidents at work . The legal basis is the Seventh Book of the Social Code (SGB VII) and the Occupational Diseases Ordinance (BKV) of October 31, 1997.
Restriction to specific hazard areas; Forbearance
Some diseases are only legally considered to be occupational diseases if they have been caused by activities in certain hazardous areas. These include, for example, infectious diseases. In principle, these are only recognized as occupational diseases if the sick insured person worked in the health service, in welfare work or in a laboratory.
In the case of other diseases, the sick person must refrain from all activities that were or may be the cause of the development, aggravation or resurgence of the disease. If he continues to work despite the illness, there is no legal occupational illness. Serious skin diseases and certain obstructive respiratory diseases belong to these occupational diseases with an obligation to omit. Vibration-related circulatory disorders and diseases of the tendon sheaths and intervertebral discs. This does not include B. the noise-induced hearing loss, since it is difficult to prove that the occupation is the main cause.
According to German law, an illness that is not mentioned in the Occupational Diseases Ordinance or for which the requirements stated in the Ordinance are not met can be recognized by the accident insurance institution "as an occupational disease". This presupposes that, according to new findings in medical science, the disease is caused by special effects to which certain groups of people are exposed to a significantly higher degree than the rest of the population through their insured activities ((2) SGB VII). Illnesses that are recognized as an occupational disease, although they are not formally legally recognized, are referred to as how or quasi-occupational diseases.
This regulation on how occupational diseases is intended to counteract the disadvantages of the otherwise applicable list principle. They are intended to compensate for illnesses such as an occupational disease that are not included in the list of occupational diseases only because the findings of medical science about the particular risk to certain groups of people in their work were not yet available in the last version of the list or despite being checked not enough yet. The decision as to whether an illness is to be equated with an occupational illness in individual cases is made by the responsible accident insurance institution. It is fully verifiable in court.
In 2005, 62,569 potential cases of occupational diseases were reported in Germany. In the same year, 15,701 illnesses were recognized as occupational diseases and compensated. In addition, there were 818 cases that were classified as occupational diseases. The recognition rate was a good 26 percent. 13,546 cases of occupational diseases were recognized in Germany in 2008, of which 5,158 were noise-related hearing loss.
Among the occupational diseases, skin diseases dominated with 16,986 cases and noise-induced hearing loss with 9,787 cases. However, almost 95 percent of all job-related skin diseases were not recognized as occupational diseases, as the special legal requirements that the Occupational Diseases Ordinance placed on recognition were not met.
In 2005, 2,600 people died in Germany as a result of an occupational disease, in 2008 it was 2,430 people. The most common cause of death was work with asbestos: 1,589 people died of asbestos-related occupational diseases. This means that more people in Germany die from occupational diseases than from work-related accidents (863 deaths) and commuting accidents (572 deaths).
Compared to previous years, the number of suspicious transaction reports as well as recognized occupational diseases are decreasing. However, there is a contrary trend in deaths from occupational diseases: the number of occupationally ill people who die from the consequences of the occupational disease increased from 2004 to 2005. It rose from 2,093 cases in 2004 to 2,600 cases in 2005.
In 2007, the number of fatal occupational diseases fell by 288 to 2,315 cases compared to the previous year, although the number of occupational diseases increased, with skin and respiratory diseases being particularly common.
In the case of the trade associations, the costs for treatment, rehabilitation and compensation for the occupationally ill amounted to 1.3 billion euros in 2005. The employers' liability insurance association invested another 189 million euros in the prevention of occupational diseases.
In prevention , prevention of industrial accidents and occupational diseases and work-related health hazards ie by all appropriate means. Work design measures must already be taken with regard to work-related health hazards - not just when an occupational disease threatens.SGB VII the legislature calls for the tasks of accident insurance in the first place the
The Occupational Safety and Health Act obliges every employer to take measures to prevent accidents at work and work-related health hazards, including the humane design of work.
The legal situation in the Republic of Austria shows parallels to German law: The diseases described in an annex to the General Social Insurance Act (ASVG) of 9 September 1955 are considered occupational diseases. They must be caused by exercising the "employment establishing the insurance" in a company specified in the annex ( (1) sentence 1 ASVG). Skin diseases are only considered occupational diseases if and as long as they force you to give up harmful activities (Section 177 (1) sentence 2 ASVG). Occupational diseases are, for example, illnesses caused by tick bites in forest workers.
As in Germany, illnesses that are not included in the list can also be recognized as quasi-occupational diseases in Austria. If it is established on the basis of reliable scientific knowledge that an illness has arisen exclusively or predominantly through the use of harmful substances or radiation during an occupation carried out by the sick person, then it is considered an occupational disease. The decision is made by the relevant accident insurance institution with the consent of the Federal Minister for Labor, Health and Social Affairs (Section 177 (2) ASVG).
The Workers' Compensation Board recognized in the year of 2014 1.229 diseases as occupational diseases, including 597 cases of noise induced hearing loss and 191 skin diseases.
The Austrian Employee Protection Act (AschG) provides for a risk evaluation with the aim of preventing occupational diseases. Occupational diseases arise due to unhealthy working conditions and working materials in the company. If these and the employees at risk are recorded and periodically checked, those responsible can assess the risk of dangerous diseases and prevent them. This includes the investigation of the working conditions, the investigation of the endangered workers as well as organizational, technical and personal protective measures in the company.
In Switzerland , illnesses that are exclusively or predominantly caused by harmful substances or specific work are considered to be occupational diseases. The harmful substances and work as well as work-related illnesses are recorded in a list. The list is drawn up by the Swiss government, the Federal Council , and kept as an appendix to the Ordinance on Accident Insurance.
In addition to the list diseases, such diseases are also considered to be occupational diseases that are not included in the list, but of which it can be proven that they were caused exclusively or predominantly by the occupational activity. These non-list diseases include in particular diseases of the musculoskeletal system, of which a total of 206 cases were recognized as occupational diseases in 2004.
Relatively strict requirements are placed on the acceptance of an occupational disease: the sick person must have been exposed to a typical occupational risk for a certain period of time. A one-off damage to health that occurs at the same time as the occupation is not sufficient. In the case of list diseases, the occupational share of the damage must be at least fifty percent. In the case of non-list diseases, at least seventy-five percent of the illness must have been caused by professional activity.
The statistics of the accident insurance show a total of 3,597 newly recognized cases of occupational diseases for 2004. Of these, 1,387 cases were caused by harmful substances and 1,279 cases were caused by physical influences. The cases of occupational illnesses due to physical exposure included 696 cases of "considerable damage to hearing" caused by work in noise. 931 cases were due to other diseases, particularly infectious diseases. The cost of occupational disease cases in 2004 amounted to around CHF 95 million; this corresponded to around 59 million euros.
The revised ASA guideline has been in effect since February 1, 2007 . The aim is to use a systematic approach to prevent accidents and occupational diseases and thus to avoid human suffering, lost hours and costs.
A European list of occupational diseases has existed since 1990 and was last updated in 2003. The list was drawn up by the European Commission and is intended as a recommendation for the member states of the European Community. It is divided into two parts. Part I lists the diseases which, according to the recommendations of the EC Commission, should be recognized as occupational diseases in the nation states. These include silicosis, asbestosis, skin diseases caused by certain substances, noise-induced hearing loss and carpal tunnel syndrome. Part II lists diseases that are suspected to have an occupational cause and which should therefore possibly be included in Part I at a later date. Among other things, diseases caused by ozone, diseases caused by hormones, tropical diseases and damage to the intervertebral discs of the lumbar spine from repeated vertical whole-body vibration loads are mentioned.
A study by the Statistical Office of the European Communities (Eurostat) showed that tendonitis of the hand and wrist as well as epicondylitis ("tennis elbow ") are numerically among the most common occupational diseases within the EC member states . Skin diseases and noise-related hearing loss are also of great importance. In addition to these common but less severe occupational diseases, Eurostat recorded more than 2,500 deaths from chronic obstructive pulmonary diseases and emphysema in miners and more than 2,400 deaths related to asbestos.
The prevention of occupational diseases is the purpose of the European Occupational Safety and Health Directive, which has been in force since 1989 and was last amended in 2003, and which regulates measures to improve the safety and health of workers at work. It forms the basis for the national occupational health and safety legislation of the EU member states .
The occupational diseases are naturally closely related to the world of work. It is therefore in constant change, just like that. For example, in the 1950s, silicosis, a typical disease of miners, dominated occupational diseases. With the decline of mining, the classic occupational diseases of miners also declined. Extensions to the list of occupational diseases, improved prevention, new medical knowledge and changes in case law also have an impact on the development of occupational diseases. In the 1970s, for example, as a result of a change in the law, the number of recognized occupational diseases “noise-induced hearing loss” increased in Germany. In 1993, certain diseases of the spine were added to the German list of occupational diseases, which led to a large number of reports of occupational diseases from employees with back problems. 1993 was therefore entered in the German statistics as the year with the most reports of suspected occupational disease. In the 1990s, asbestos-related occupational diseases increased significantly - a consequence of the careless handling of asbestos in the 1960s and 1970s. In view of these diverse uncertainties, predictions about the future development of occupational diseases are speculative.
Whether and when an illness is included in the list of occupational diseases depends only in part on medical knowledge. As a rule, socio-political and economic considerations also play a role in the decision. The inclusion of a disease in the list of occupational diseases leads to a shift in costs within the respective social security system, which is not always politically desirable. For example, the recognition of passive smoking in the workplace as an occupational disease required by the German Cancer Aid would result in additional financial burdens for the employers' liability insurance association while at the same time relieving the health insurance companies.
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