This policy deals with the adjudication of claims that involve disease. Disease can be a factor in adjudication in two ways. In the first type of claim the worker may be presenting a claim in which the disease itself is at issue and the belief is that the employment of the worker has caused the disease. In cases where the deemed date of the accident is after December 31,1991 the concept of dominant cause is applicable and the claim must be adjudicated using what could be described as "occupational disease" criteria. In the second type of claim the disease may be believed to be not work related, but a workplace accident has interacted with the disease in some way and the result is an enhancement or aggravation of a pre-existing condition which happens to be a disease. In this situation a claim must be adjudicated using the usual criteria.
The adjudication of any claim involving disease is complex because the WCB must determine which adjudication approach applies: the adjudication of occupational disease or the adjudication of an accident that is not an occupational disease. The second source of complexity arises from the difficult task of trying to determine the cause of a particular disease in a particular person. Medical science has historically concentrated insufficient effort on this task to be of assistance in making such determinations with a reasonable degree of confidence.
This policy introduces an approach for adjudication of claims involving disease whether that claim is to be adjudicated as a claim for compensation of an occupational disease, or if the disease is a pre-existing condition and the claim is to be adjudicated as an accident.
It is important to note that if a worker makes a claim for compensation the worker has the right to have the claim adjudicated as an accident or an occupational disease, dependent upon the facts which emerge from the WCB's adjudicative enquiry and investigation.
|44.20 Disease General|