American Journal of Industrial Medicine 21:295-309 (1992)
ARTICLES
Workmens’ Compensation and Byssinosis in South Africa: A Review of 32 Cases Neil W. White, MBChB, MD, FCP (SA), Halton Cheadle, BA(Hons), BProc, LLB, and R.6. Dyer, MBChB, MRCP
Byssinosis has been compensable in the Republic of South Africa (RSA) since 1973. The legal and administrative provisions for byssinosis compensation are reviewed. A series of 32 cases of presumed byssinosis was submitted to the compensation authorities by the authors. Identical reports were submitted to an independent medical panel. The findings and outcomes in these cases are presented and compared. Seventeen of the 32 claims initially received compensation and four were subsequently accepted following appeals. Analysis of the medical basis of decision making indicated that seven claims were refused and at least four had their awards reduced as a consequence of inconsistent decisions. Arguable decisions resulted in five claims being refused and one award being reduced. Our experience illustrates problems inherent in the compensation system in South Africa. Initiation of a claim is expensive relative to wages in the industry, and awards are low since they are linked to wages (mean $60.47 per week). Processing of a claim took a mean of 13.8 months, while appeals for refusal to compensate took a further 29.8 months. It is argued that consensus medical definitions of compensable occupational disease should be used routinely and that provision must be made to facilitate entry of claimants into the compensation system. Key words: diagnostic criteria, disability evaluation, pulmonary function values, cotton textile industry, workmen’s compensation, black occupational disease
INTRODUCTION
In the early 1980s it become apparent to the National Union of Textile Workers (NUTW) that the problem of byssinosis was being ignored in the Republic of South Africa (RSA). The country’s cotton textile mills employed approximately 45,000 (predominantly black) people. In none of them was there any form of environmental surveillance for cotton dust, nor were pulmonary function tests being used for medical Respiratory Clinic, Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, Republic of South Africa (N.W.W.). Center for Applied Legal Studies, University of Witwatersrand, Republic of South Africa (H.C.). Department of Medicine, University of Natal, Republic of South Africa (R.B.D.). Address reprint requests to Dr. Neil W. White, Respiratory Clinic, Department of Medicine, University of Cape Town and Groote Schuur Hospital, Rochester Post Office, Cape Town, Republic of South Africa 1925. Accepted for publication August 20, 1991.
0 1992 Wiley-Liss, Inc.
296
White et al.
surveillance. Only one case of byssinosis had ever been compensated. This totally unsatisfactory situation led the NUTW to initiate an investigation of the cotton mills where many thousands of its members are employed. This investigation first documented the prevalence of byssinosis in the RSA cotton textile industry [White, 19891. The environmental situation in the industry appeared to broadly correspond to that in the Uiiited States prior to 1978. Respirable dust levels measured in the preparation (blow room, carding) and spinning areas were in excess of the World Health Organization (WHO) permissible exposure limit of 0.2 mg/m3 [WHO, 19831 in many of the areas surveyed. Peak exposures were increased by the use of compressed air cleaning. The prevalence of byssinosis symptoms was modest and this was thought related to the exceptionally high labor turnover rate documented. Direct consequences of this investigation were the introduction of some form of environmental and biological surveillance into many cotton textile mills. It also resulted in the referral of a series of cases for compensation. The first black worker in cotton textiles in RSA received compensation in 1982 [White, 19831. By May 1984, we had submitted many more claims. Our experience in these claims was characterized by delays, a high refusal rate, and a strong impression of inconsistent decisions and unfair refusals. This experience motivated the present study. We have reviewed the medical findings, decisions, and outcomes of 32 claims for byssinosis compensation that were submitted to the compensation authorities. Simultaneously, the medical reports from this series of cases were submitted to an independent medical panel in order that their assessment could be compared with that of the Workmens’ Compensation Commissioner (WCC). This review begins with a description of current practices for the compensation of occupational lung diseases in RSA. During 1984, we were party to a process wherein presumptive criteria for byssinosis compensation in RSA were developed and proposed to the compensation authorities. We describe and advocate these criteria which have not previously been published.
CURRENT PRACTICES IN BYSSINOSIS COMPENSATION IN RSA Legislation Occupational lung diseases have been cornpensable in RSA’s mining industry since 1903 and a well-developed system exists For this purpose. Compensation for occupational lung diseases in manufacturing and agriculture is more recent, and is covered by the Workmens’ Compensation Act (WCA) (Act 30 of 1941). The WCC administers the Accident Fund on behalf of the Department of Manpower. The Fund operates as a form of compulsory insurance and accrues from contributions by employers. The original purpose of the WCA was to provide for workers injured in industrial accidents by the payment of medical expenses, by recompense for lost wages, and by pensions or lump sum payments in the event of permanent disability. At the same time, the WCA precludes civil claims for damages against employers. More recently, occupational diseases have been included within the ambit of the WCA, and 18 occupational disease categories are recognized in the Second Schedule of the WCA. Byssinosis was added to this Second Schedule in 1973. The WCA lists the disease but does not define it.
Compensating Byssinosis in South Africa
297
TABLE I. Changes in Guidelines Used by the WCC ~~
~
1985
1959
Percentage impairment
ARTICLES
Workmens’ Compensation and Byssinosis in South Africa: A Review of 32 Cases Neil W. White, MBChB, MD, FCP (SA), Halton Cheadle, BA(Hons), BProc, LLB, and R.6. Dyer, MBChB, MRCP
Byssinosis has been compensable in the Republic of South Africa (RSA) since 1973. The legal and administrative provisions for byssinosis compensation are reviewed. A series of 32 cases of presumed byssinosis was submitted to the compensation authorities by the authors. Identical reports were submitted to an independent medical panel. The findings and outcomes in these cases are presented and compared. Seventeen of the 32 claims initially received compensation and four were subsequently accepted following appeals. Analysis of the medical basis of decision making indicated that seven claims were refused and at least four had their awards reduced as a consequence of inconsistent decisions. Arguable decisions resulted in five claims being refused and one award being reduced. Our experience illustrates problems inherent in the compensation system in South Africa. Initiation of a claim is expensive relative to wages in the industry, and awards are low since they are linked to wages (mean $60.47 per week). Processing of a claim took a mean of 13.8 months, while appeals for refusal to compensate took a further 29.8 months. It is argued that consensus medical definitions of compensable occupational disease should be used routinely and that provision must be made to facilitate entry of claimants into the compensation system. Key words: diagnostic criteria, disability evaluation, pulmonary function values, cotton textile industry, workmen’s compensation, black occupational disease
INTRODUCTION
In the early 1980s it become apparent to the National Union of Textile Workers (NUTW) that the problem of byssinosis was being ignored in the Republic of South Africa (RSA). The country’s cotton textile mills employed approximately 45,000 (predominantly black) people. In none of them was there any form of environmental surveillance for cotton dust, nor were pulmonary function tests being used for medical Respiratory Clinic, Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, Republic of South Africa (N.W.W.). Center for Applied Legal Studies, University of Witwatersrand, Republic of South Africa (H.C.). Department of Medicine, University of Natal, Republic of South Africa (R.B.D.). Address reprint requests to Dr. Neil W. White, Respiratory Clinic, Department of Medicine, University of Cape Town and Groote Schuur Hospital, Rochester Post Office, Cape Town, Republic of South Africa 1925. Accepted for publication August 20, 1991.
0 1992 Wiley-Liss, Inc.
296
White et al.
surveillance. Only one case of byssinosis had ever been compensated. This totally unsatisfactory situation led the NUTW to initiate an investigation of the cotton mills where many thousands of its members are employed. This investigation first documented the prevalence of byssinosis in the RSA cotton textile industry [White, 19891. The environmental situation in the industry appeared to broadly correspond to that in the Uiiited States prior to 1978. Respirable dust levels measured in the preparation (blow room, carding) and spinning areas were in excess of the World Health Organization (WHO) permissible exposure limit of 0.2 mg/m3 [WHO, 19831 in many of the areas surveyed. Peak exposures were increased by the use of compressed air cleaning. The prevalence of byssinosis symptoms was modest and this was thought related to the exceptionally high labor turnover rate documented. Direct consequences of this investigation were the introduction of some form of environmental and biological surveillance into many cotton textile mills. It also resulted in the referral of a series of cases for compensation. The first black worker in cotton textiles in RSA received compensation in 1982 [White, 19831. By May 1984, we had submitted many more claims. Our experience in these claims was characterized by delays, a high refusal rate, and a strong impression of inconsistent decisions and unfair refusals. This experience motivated the present study. We have reviewed the medical findings, decisions, and outcomes of 32 claims for byssinosis compensation that were submitted to the compensation authorities. Simultaneously, the medical reports from this series of cases were submitted to an independent medical panel in order that their assessment could be compared with that of the Workmens’ Compensation Commissioner (WCC). This review begins with a description of current practices for the compensation of occupational lung diseases in RSA. During 1984, we were party to a process wherein presumptive criteria for byssinosis compensation in RSA were developed and proposed to the compensation authorities. We describe and advocate these criteria which have not previously been published.
CURRENT PRACTICES IN BYSSINOSIS COMPENSATION IN RSA Legislation Occupational lung diseases have been cornpensable in RSA’s mining industry since 1903 and a well-developed system exists For this purpose. Compensation for occupational lung diseases in manufacturing and agriculture is more recent, and is covered by the Workmens’ Compensation Act (WCA) (Act 30 of 1941). The WCC administers the Accident Fund on behalf of the Department of Manpower. The Fund operates as a form of compulsory insurance and accrues from contributions by employers. The original purpose of the WCA was to provide for workers injured in industrial accidents by the payment of medical expenses, by recompense for lost wages, and by pensions or lump sum payments in the event of permanent disability. At the same time, the WCA precludes civil claims for damages against employers. More recently, occupational diseases have been included within the ambit of the WCA, and 18 occupational disease categories are recognized in the Second Schedule of the WCA. Byssinosis was added to this Second Schedule in 1973. The WCA lists the disease but does not define it.
Compensating Byssinosis in South Africa
297
TABLE I. Changes in Guidelines Used by the WCC ~~
~
1985
1959
Percentage impairment
