Professional Documents
Culture Documents
Jehremias M. Florante, MD1, and Maria Beatriz G. Villanueva, MD, MOH, PhD2
1
Occupational Health Officer, 2Division Chief III
Occupational Safety and Health Center
Abstract
The Employees’ Compensation and State Insurance Fund or PD 626, as amended, was
created in 1974 to secure the workers and their dependents an adequate income benefit and
medical or related benefits in the event the worker suffered a work-related disability or death.
Thereafter, a List of Occupational and Work-Related Diseases was generated to serve as a
reference to government evaluators on whether certain illnesses that manifested on workers
can be compensated by the government or not, given other requirements. Several
amendments had already been made since it was first crafted. The current list comprises of
32 occupational and work-related diseases including 54 specific diseases some assigned to
the 32 listed. However, the Amended Rules on Employees’ Compensation stipulated the
increased risk theory which has somehow expanded the List of Occupational and Work-
Related Diseases.
Adapting the criteria set by international experts in coming up with an updated and
validated list is recommended. This is notwithstanding to another recommendation for a
possible partnership with stakeholders in coming up with diagnostic criteria of occupational
and work-related diseases which may be used both for compensation and in clinical practice
of physicians.
Page 2 of 14
Title
Lead Investigator
Jehremias M. Florante, MD
Occupational Health Officer
Health Control Division
Funding Agency
Introduction
The Employees’ Compensation and State Insurance Fund or Presidential Decree (PD)
626, as amended, was created in 1974 to secure the workers and their dependents an adequate
income benefit and medical or related benefits in the event the worker suffered a work-related
disability or death. Thereafter, a List of Occupational and Work-Related Diseases (Annex
“A” of the amended Implementing Rules and Regulations of PD 626 or the Amended Rules
on Employees’ Compensation) was generated to serve as a reference to government
evaluators on whether certain illnesses which manifested on workers can be compensated by
the government or not, given other requirements. Several amendments had already been
made since it was first crafted. In 1992, the Occupational Safety and Health Center (OSHC)
conducted a study which resulted to updating the list of then 29 compensable diseases. Those
added were musculoskeletal disorders (low back pain, carpal tunnel syndrome, etc.),
occupational eye diseases, post-traumatic disorder, occupational skin diseases (contact
dermatitis, irritant and allergic, chloracne, etc.), infectious diseases (tetanus, endemic viral
diseases, and parasitism), diseases caused by chemicals (benzoquinone, n-hexane, methyl-n-
butyl ketone), and chemical asphyxiants (carbon monoxide, hydrogen cyanide, and hydrogen
sulfide). Subsequently, OSHC reviewed employees’ compensation (EC) claims coming from
both the Social Security System (SSS) and the Government Service Insurance System (GSIS)
at various instances. The second review focused on determining the prevalence of work-
related illnesses and injuries filed with the present systems (OSHC, 1993). This study was
able to recommend for another review on the List of Occupational and Work-Related
Diseases and to standardize the diagnosis of the different compensable occupational and
work-related diseases using the 10th revision of the International Classification of Diseases
(ICD-10). The third and fourth review focused on the examination and analysis of the claims
filed by private and government workers on the different occupational and work-related
diseases approved by SSS and GSIS, respectively, on certain period of time (OSHC, 2009).
These reviews on EC claims were also used as bases in updating the list. The List of
Occupational and Work-Related Diseases was last amended in 2014 when changes on
occupational hearing loss were made.
Page 3 of 14
The current list comprises of 32 occupational and work-related diseases including 54
specific illnesses some assigned to the 32 listed. However, Section 1(b) of Rule III of the
Amended Rules on Employees’ Compensation stipulated the increased risk theory which was
further explained through Employees’ Compensation Commission’s (ECC) Board Resolution
No. 93-08-0068 approved last August 5, 1993. This, somehow, expanded the List of
Occupational and Work-Related Diseases. Increased risk, as stated in the resolution, would
mean any illness caused by or arising from factors integral of the job of the worker and the
working conditions but does not include aggravation of the worker’s pre-existing health
issues. The worker has the burden of proof of establishing the work relatedness of the
disease in order for him/her to invoke this rule. The required burden of proof the worker has
to produce consists of essential and sensible documents adequate enough to support a
conclusion on the work-relatedness of the disease. As such, certain parameters have to be
considered to strengthen this rule paving the way for possible update in the current List of
Occupational and Work-Related Diseases.
Objective/s
This was intended particularly to compare the Philippines’ existing list to the lists of
selected countries on its purpose, system of determining work-relatedness of the illness, and
system of updating. This paper will also study how the emerging exposures of the selected
countries were included in the list.
Methodology
Results
Page 4 of 14
Table 1. Comparison among selected countries on list of occupational and work-related
diseases.1
New
Parameter France Denmark Finland Sweden UK1,2 Singapore5 Philippines6
Zealand3,4
Availability
X
of List
Purpose of
C C/P C/P C C/P/S C C/S C
List
System of
Determining
Work List List Mix Open Mix List Mix Mix
Relatedness
of Disease
G
G G G
Updating of G G W
M W W G G
List M M E
I E E
M
Legend: C – Compensation
P – Guide to insurance providers
S – Medical surveillance
G – Government agency tasked to do the updating of the list
M – Medical experts
I – Insurance organizations
W – Labor organizations
E – Employers’ groups
Sources: 1 – Walters, 2007
2 – A. Money, et. al., 2014
3 – Driscoll, Wagstaffe, and Pearce, 2011
4 – ACC, 2008
5 – WSHC, 2011
6 – ECC Amended Rules on Employees’ Compensation
Table 1 shows the comparison on the respective list of occupational and work-related
diseases among selected countries, including the Philippines, and was found out that these are
being used for compensation purposes. Other countries like United Kingdom (UK) (Money,
et. al., 2015) and Singapore (WSHC, 2011) use their list for medical surveillance also. It was
also noted that Sweden has no list of occupational and work-related diseases among the
selected countries reviewed in this study. Thus, Sweden employs an open system in
determining occupational and work-related disease cases for compensation. Walters (2007)
defined open system as each EC claim on occupational and work-related disease as being
evaluated based on its own merits similar to the Philippines’ increase risk theory principle.
Meanwhile, France, Denmark, and New Zealand utilize a list system in determining
occupational and work-related disease cases for compensation. Walters (2007) defined list
system as having the cases of occupational and work-related diseases enumerated in a
government policy alongside with a criteria which may include the description of each case
(i.e., signs and symptoms, common pathological findings, etc.), the type of job or industry to
which the case is commonly attributed to, and the prescription period for the claim to be
processed. On the other hand, Finland, UK, Singapore, and the Philippines have their
respective list of compensable occupational and work-related diseases but still consider other
disease entities not listed which may be attributed to the nature of work of the worker and the
working conditions. These countries are examples of those which use a mix type of system
in determining occupational and work-related disease cases for compensation.
Page 5 of 14
respective list of occupational and work-related diseases serve as guide to either private or
government insurance organizations in their investigation of EC claims (Walters, 2007).
Updating the list vary among countries and may be done by technical working
committees or ministerial councils such in the case of UK and New Zealand. Money, et. al.
(2015) and the Accident Compensation Corporation (2008) did not elaborate the composition
of the said committee or council. Denmark and Sweden update their list through tripartism, a
group composed of government, labor and employers’ representatives (Walters, 2007). The
Philippines updates its list through technical working group involving experts and through
tripartism (ECC, 2014). The governments of Finland (Walters, 2007) and Singapore (WSHC,
2011) update their respective list with the assistance coming from the medical experts. Social
insurance fund providers are involved in the updating of the list of occupational and work-
related diseases in France. These updates are usually annexed to an existing law or
government regulation.
Table 2. List of occupational and work-related diseases of selected countries not included in the
ILO’s List of Occupational Diseases Recommendation No. 194 (R194).1
Category Agent/Condition Country
Austria, Belgium, Finland, Romania,
Switzerland, France
Chemical agents Phenol and its derivatives
Costa Rica, El Salvador
China, Turkey
Trichloroethylene
Denmark
Tetrachloroethylene
Ortho-toluidine France
Aluminum Denmark
Canada
4-nitrodiphenyl
Japan
Denmark
Formaldehyde
Taiwan, Malaysia
Radon Denmark
Ireland, Italy, United Kingdom
Leather
Saudi Arabia
Page 6 of 14
United Kingdom, Russia, Portugal, Spain,
Austria
Biological agents Rickettsia
Mexico, Nicaragua
Saudi Arabia
France, Portugal, Romania, United
Kingdom
Algeria, Angola
Streptococcus
Mexico
Saudi Arabia, Hong Kong
New Zealand
Bulgaria, France, Ireland, Italy, Romania,
Thermophilic actinomycetes United Kingdom
El Salvador, Mexico
Switzerland, Spain, Portugal, Ireland,
Finland, Belgium
Malaria Angola
Nicaragua, Mexico
Turkey, Philippines
France, Hungary, Poland, Portugal,
Romania, Spain
Ameba Algeria, Angola
Nicaragua
Saudi Arabia, Turkey
Romania
Illnesses Onychodystrophy from humidity
Colombia, Mexico
Dermatitis from sunlight Costa Rica
Ischemic heart disease from
Romania
increased strain and other physical
and neuropsychological burdens Korea
Myocardial infarction
Dissection aneurysm
Subarachnoid haemorrhage Korea, Japan, Taiwan2
Cerebral haemorrhage
(All from psychological stress)
Sudden death from psychological
Korea, Japan
stress
Hypertension from
Romania
neuropsychological stress
Essential hypertension Philippines3
Cardiovascular disorder from
Korea2, Japan2, Taiwan2, Philippines
psychological stress
Neurosis from long-term direct Russia, Romania
service to people Mexico
Peptic ulcer from
psychological stress
Philippines3
Intestinal hernia from severe
straining
Congenital viral infection
Hydrocephalus
Microcephalus
Developmental retardation Denmark
Skin changes
Premature birth
Low birth weight
Toxic autonomic neuropathy from
Bulgaria
Esters
Page 7 of 14
Vinyl chloride
Unsaturated aliphatic
hydrocarbons
Carbon monoxide
Vibration
Ophthalmia from electrical light China
ILO R194 was established both for medical surveillance and compensation purposes
(ILO, 2010). Most countries based their own list of occupational and work-related diseases
from R194 (Driscoll, Wagstaffe, and Pearce, 2011). However, ILO itself did not limit
member-states from adding other occupational and work-related illnesses to their respective
list (ILO, 2010). Table 2 exhibits the list of occupational and work-related diseases of
selected countries not mentioned in ILO R194.
Kim and Kang (2013) reported that the current ILO list has expanded its coverage to
include occupational cancer, musculoskeletal diseases, and psychological illnesses. Despite
its comprehensiveness, other disease entities related to work were not included. The authors
inferred that the list produced by ILO cannot represent the EC system of each member-state.
This can be exemplified by Japan, Korea, and Taiwan wherein they provide compensation to
workers who suffered work-related cardiovascular diseases or cerebrovascular accidents
(Park, et. al., 2012). These disease entities are not included in ILO R194. These are cases
brought about by or are associated with overwork. Kim and Kang (2013) also included
Romania and Philippines as those countries who provide compensation to workers who
suffered work-related cardiovascular diseases or cerebrovascular accidents, particularly
ischemic heart disease from increased strain and other physical and neuropsychological
Page 8 of 14
burdens and hypertension from neuropsychological stress for Romania, and cardiovascular
disease from psychological stress for the Philippines.
Mental and behavioral disorders such as neurosis suffered by those workers involved
in the frontline delivery of service are covered in Russia, Romania, and Mexico (Kim and
Kang, 2013).
Walters (2007), in his study, found out that the list of occupational and work-related
diseases among selected European countries is also lacking of good evidence of causal
relationship to exposures in the workplace. Driscoll, et. al. (2011) emphasized in their review
of New Zealand’s Schedule 2 the importance of being specific in developing a list of
occupational and work-related diseases. Example provided in this study is the substance
chromium and related compounds which are associated with lung cancer, chronic renal
failure, dermatitis, respiratory tract irritation, among others (ATSDR, 2012). The study
emphasized that these disease entities may also be caused by other substances aside from
chromium and its related compounds. Hence, it was suggested that the occupational and
work-related disease be presented followed by the associated exposures or occupation which
the disease is commonly attributed to.
Further, three criteria were proposed by Driscoll, et. al. (2011) to make sure that lists
contain occupational and work-related diseases with good evidence of causal relationship to
exposures in the workplace
1. Strong scientific evidence of a causal link between the disease and the
exposure;
2. Clear diagnostic criteria for occupational and work-related diseases; and
3. Large proportion of cases.
Singapore, on the other hand, came up with its own Workplace Safety and Health
Guidelines: Diagnosis and Management of Occupational Diseases (2011) which details the
diagnoses and reporting of occupational diseases in their country which may be useful in
dealing with compensation claims of its workers. The same guidelines mentioned the clinical
presentation of the illness, any available predisposing factor, differential diagnosis, and
management. Included in these guidelines is the presence of sections on Diagnostic Criteria
on Work-Relatedness and on Investigation to Establish Work-Relatedness.
Page 9 of 14
Reporting of Occupational and Work-Related Diseases
Table 3. Selected countries with system on reporting of occupational and work-related diseases
Country Reporting System
The Health and Occupational Reporting (THOR) network
Reports from physicians submitting to government institutions enforcing
United Kingdom1 OSH and to social insurance system
Health statistics
Death Certificates and reports from coroner’s office
The Health and Occupational Reporting (THOR) network
Reports from physicians and employers submitting to government
institutions enforcing occupational safety and health and to social
Ireland2 insurance system
Employee surveys
Health statistics
Death Certificates and reports from coroner’s office
Reports from physicians to the Ministry of Manpower on occupational
diseases as required by Workplace Safety and Health (WSH) Act
Singapore3 Reports from employers to the Ministry of Manpower on workers who
contracted occupational and work-related illness and injury as mandated
by Work Injury Compensation Act (WICA)
Periodic submissions of reportorial requirements to Department of Labor
and Employment mandated by the Occupational Safety and Health
Standards (OSHS), as amended
Philippines Employee’s Compensation claims
Nationwide sampling survey, i.e., Integrated Survey on Labor and
Employment (ISLE) of the Philippine Statistics Authority
Researches and case studies
Sources: 1 – Money, et. al., 2015
2 – Drummond, 2007
3 – WSHC, 2011
In 2004, Leigh and Robbins made a review on the coverage and costs of occupational
diseases and workers’ compensation to understand the extent of the EC coverage of diseases
using epidemiological data and compensation data of the workers in the US. Based on their
review, health effects, and even death, brought about by the workers’ previous jobs affect
them after retirement due to the latency of occupational diseases. Among these diseases
include job-related cancers, chronic respiratory diseases, and circulatory diseases. Some of
which are not covered by EC system in some states. This non-coverage represented
significant budgetary challenge to the affected worker and his/her family, and to both the
private and government health insurance systems.
Page 10 of 14
On the other hand, Ireland adapted UK’s The Health and Occupational Reporting
(THOR) network which is a data collection system for occupational disease prevention
(Money, 2015). The network was observed to be an ideal system in the analysis of trends and
identification of emerging health issues in the workplace. The network also provides
validated information on the incidence of occupational and work-related illnesses
(Drummond, 2007).
Discussion
The Philippines employs a mix type of system in determining occupational and work-
related disease cases for compensation. Annex “A” of the Amended Rules on Employees’
Compensation is the List of Occupational and Work-Related Diseases which is updated as the
need arises through tripartism after consultation with experts as provided by Section 3
(Authority of the Commission), Rule III (Compensability) of the same regulations. However,
an occupational and work-related disease may still be compensated even if the said illness is
not included in the list by invoking the increased risk theory as previously mentioned in the
Introduction. The worker will then be asked to show proof of work relatedness of the disease
in order to effect this rule. Belgium, Italy, and Luxembourg also use the same principle in
determining work-relatedness of the disease in order for it to be compensated (Walters,
2007).
Conformity to the criteria set by Driscoll, et. al. (2011) is essential in coming up with
a validated list of occupational and work-related diseases. Singapore’s Workplace Safety and
Health Guidelines: Diagnosis and Management of Occupational Diseases (2011) presents a
good framework as it has sections on Diagnostic Criteria on Work-Relatedness and on
Investigation to Establish Work-Relatedness which will aid our occupational health
physicians and medical insurance evaluators in identifying whether the case can be
considered as occupational or work-related or not. The guidelines will help facilitate a
speedy resolution of compensation cases.
Page 11 of 14
of occupational and work-related illnesses in UK, Northern Ireland, and Republic of Ireland.
The network involves not only occupational health physicians but also from different
specialties that handle occupational and work-related diseases. Though not available in the
Philippines but can be adapted to improve the country’s recording and notification system on
occupational health issues in the workplace. The system can also be a tool for recognizing
emerging health issues in the workplace as done in other countries (Drummond, 2007).
Conclusions
Recommendation/s
Presidential Decree 626, as amended, was crafted in 1974 to assure the workers and
their dependents of a fair and decent income benefit and medical or related benefits in cases
workers suffer work-related illnesses, injuries, or death. The List of Occupational and Work-
Related Diseases was later created and annexed to the Amended Rules on Employees’
Compensation to serve as a guide to government evaluators on the work-relatedness of the
disease cases filed by the workers for EC benefit claim. Adapting the criteria set by
international experts in coming up with an updated and validated list is recommended. This
is notwithstanding to another recommendation for a possible partnership with stakeholders in
coming up with diagnostic criteria of occupational and work-related diseases which may be
used both for compensation and in clinical practice of physicians.
Page 12 of 14
Lastly, it is recommended to strengthen and improve the data collection system on
occupational and work-related illnesses by looking at the possibility of making the companies
report to the social insurance systems directly, furnished the government’s enforcing
agencies.
References:
4. Occupational Safety and Health Center. 1992. Updating the List of ECC Compensable
Diseases.
7. Occupational Safety and Health Center (unpublished). Work-Related Injuries and Illnesses
of Public Workers: A Review of Employees’ Compensation Claims from GSIS, 2010-2012.
9. A. Money, et. al. 2015. Work-related ill-health: Republic of Ireland, Northern Ireland,
Great Britain 2005-2012, Occupational Medicine, 2015; 65:15-21. DOI:
10.1093/occmed/kqu137.
10. Tim Driscoll, Mark Wagstaffe, and Neil Pearce. 2011. Developing a List of
Compensable Occupational Diseases: Principles and Issues, The Open Occupational
Health and Safety Journal, 3, pp. 65-72.
12. Workplace Safety and Health Council. 2011. Workplace Safety and Health Guidelines:
Diagnosis and Management of Occupational Diseases. Retrieved from
Page 13 of 14
https://www.wshc.sg/files/wshc/upload/infostop/attachments/2015/IS2015041600000003
20/WSH_Guidelines_Occupational_Diseases.pdf.
13. International Labour Organization. 2010. ILO List of Occupational Diseases (Revised
2010). Switzerland: Programme on Safety and Health at Work and the Environment
(SafeWork).
14. Eun-A Kim and Seong-Kyu Kang. 2013. Historical review of the List of Occupational
Diseases recommended by the International Labour Organization (ILO), Annals of
Occupational and Environmental Medicine, 25:14. Retrieved from http://www.ncbi.nlm.
nih.gov/pmc/articles/PMC3923370/pdf/2052-4374-25-14.pdf.
15. Annie Leprince, 2007. The Importance of Training: Occupational Diseases, Training
Needs, Target Groups. ISSA Conference, Kribi, Cameroon, 13-15 March 2007.
Retrieved from http://www.issa.int/pdf/kribi07/2leprince.pdf.
16. Jungsun Park, et. al. 2012. A Comparison of the Recognition of Overwork-related
Cardiovascular Disease in Japan, Korea, and Taiwan, Industrial Health, 50, pp. 17-23.
17. US Department of Health and Human Services. 2012. Toxicological Profile for
Chromium. Atlanta. Retrieved from https://www.atsdr.cdc.gov/toxprofiles/tp7.pdf.
18. Anne Drummond. 2007. A Review of the Occupational Diseases Reporting System in the
Republic of Ireland. Ireland: Health and Safety Authority. Retrieved from
http://www.hsa.ie/eng/Publications_and_Forms/Publications/Research_Publications/A_
Review_of_the_Occupational_Diseases_Reporting_System_in_the_Republic_of_Ireland.
pdf.
19. J. Paul Leigh and John A. Robbins. 2004. Occupational Disease and Workers’
Compensation: Coverage, Costs, and Consequences, The Milbank Quarterly, 82:4, pp.
689-721. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2690178/pdf/
milq0082-0689.pdf.
Page 14 of 14