Appendix 1: How are occupational cancers compensated in Ontario?

Legislative and policy framework

Four types of policy instruments form the decision-making hierarchy for the compensation of occupational cancer claims in Ontario (Figure 9).

This figure shows the hierarchy of policy instruments as a pyramid, with administrative practice documents as the base, operational policy as the next level up, regulation as the next higher level, and legislation as the apex.

Figure 9: Hierarchy of policy instruments

Source: WSIB (70).

Governing legislation: The WSIB derives its authority to compensate workers for occupational diseases from Section 15 of the Workplace Safety and Insurance Act, 1997 (the "Act"). Under Section 15, a worker is eligible to receive compensation for an occupational disease, including cancer, provided the following medical and legal criteria are met:

  1. the worker must have a clinical diagnosis of an illness or a disease
  2. the clinical diagnosis must be made by a recognized health professionalfootnote 47
  3. the worker must "suffer from" and be impaired by the illness or disease, and
  4. the disease must have been "due to the nature of one or more employments in which the worker was engaged"

If all of these criteria are met, the worker is entitled to compensation under the insurance plan "as if the disease were a personal injury by accident and as if the impairment were the happening of the accident"footnote 48

Section 2(1) of the Act defines "occupational disease" to include the following:

  1. a disease resulting from exposure to a substance relating to a particular process, trade or occupation in an industry
  2. a disease peculiar to or characteristic of a particular industrial process, trade or occupation
  3. a medical condition that in the opinion of the Board requires a worker to be removed either temporarily or permanently from exposure to a substance because the condition may be a precursor to an occupational disease
  4. a disease mentioned in Schedule 3 or 4footnote 49, or
  5. a disease prescribed under clause 15.1(8)(d)footnote 50

The Act also provides legislative presumptionsfootnote 51 regarding the work-relatedness of the occupational diseases listed in Schedules 3 and 4 of Ontario Regulation 175/98 (O. Reg. 175/98). Section 15(3) provides a rebuttable presumption for the work-relatedness of the diseases listed in Schedule 3. Under this presumption, if a worker develops a disease listed in Schedule 3 and was employed in the process described opposite the disease before the date of disablement, it is presumed the disease was caused by the nature of the worker's employment, unless the contrary is proved. Section 15(4) provides a non-rebuttable presumption for the work-relatedness of the diseases listed in Schedule 4. Under this presumption, if a worker develops a disease listed in Schedule 4 and was employed in the process described opposite the disease before the date of disablement, the disease is deemed to have occurred due to the nature of the worker's employment.

Regulations: Regulations have the force of law but are subordinate to the governing legislation (70). As a result, they must be authorized by specific provisions in the Act. Section 2(1) of the Act authorizes the WSIB to recognize the occupational diseases listed in Schedules 3 and 4 of O. Reg. 175/98. Under these schedules, three cancers are afforded a presumption of work-relatedness: epitheliomatous (skin) cancer, primary cancer of the nasal cavities or of the paranasal sinuses, and mesothelioma of the pleura or peritoneum (Table 8) footnote 52. The presumptions for skin cancer and for nasal cancer in the nickel producing industry are rebuttable. The presumptions for mesothelioma and for nasal cancer in two sintering plants at Inco Limited are non-rebuttable.

Table 8a: Occupational cancer presumptions listed in O. Reg. 175/98, Schedule 3,
with rebuttable presumption of work-relatedness
Description of Disease Description of Process
Cancer — epitheliomatous (skin) cancer Any process involving use or handling of tar pitch, bitumen, mineral oil or paraffin or any compound, product or residue of these substances
Cancer — primary cancer of the nasal cavities or of paranasal sinuses Concentrating, smelting or refining in the nickel producing industry
Table 8b: Occupational cancer presumptions listed in O. Reg. 175/98, Schedule 4,
with non-rebuttable presumption of work-relatedness
Description of Disease Description of Process
Primary malignant neoplasm of the mesothelium of the pleura of peritoneum [sic] Any mining, milling, manufacturing, assembling, construction, repair, alteration, maintenance or demolition process involving the generation of airborne asbestos fibres
Primary cancer of the nasal cavities or of paranasal sinuses Any process at the Copper Cliff sinter plant of Inco Limited
Primary cancer of the nasal cavities or of paranasal sinuses Any process in the Port Colborne leaching, calcining and sintering department of Inco Limited that was practised before January 1, 1966

Operational policies: The meaning and the application of the Act (and its supporting regulations) are clarified in the Operational Policy Manual (OPM). Policies do not have the force of law (like the Act or the regulations); however, they are binding on the Workplace Safety and Insurance Appeals Tribunal (WSIAT)footnote 53 (70). Three chapters of the OPM that provide guidance to decision-makers for determining entitlement are relevant to this review. The WSIB’s occupational cancer policies considered in this review are listed in Appendix 2.

  • Chapter 11: Decision Making includes 11 general decision-making policies that are applicable to all claims (e.g., determining the date of injury, the merits and justice of the claim, and the benefit of the doubt).
  • Chapter 16: Long Term Exposures includes 28 policies and is divided into two sections. The first section includes 9 policies on disablements, none of which focus on occupational cancers. The second section includes 19 policies under the heading of "occupational diseases". Of these, 17 focus on occupational cancers.
  • Chapter 23: Occupational Diseases includes 5 policies and is divided into two sections (acute vs. chronic exposures). The section on acute exposures includes 2 infectious disease policies, while the section on chronic exposures includes 3 occupational cancer policies.

Occupational cancers account for 20 of the 33 occupational disease policies included in Chapters 16 and 23.

Administrative practice documents: Administrative practice documents (APDs) provide guidance to assist decision-makers in understanding the interpretation and practical application of operational policies. APDs – which fall under the categories of worker claims, employer accounts, and adjudicative advice documents – do not have the force of law or policy and, as a result, are not binding on the WSIAT. Of the 21 APDs currently available online, the only one relevant to this review is Weighing of Medical Evidence (May 2017).

General principles governing compensation of occupational cancers in Ontario

Like all workers' compensation systems in Canada, the system in Ontario is founded on the Meredith Principles. Because it is a no-fault inquiry system, neither the worker nor the employer is required to prove their case. Responsibility for gathering the relevant information, weighing the evidence, and making decisions on entitlement rests with the WSIB, the independent public agency with the legislative mandate to administer and interpret the Act. In determining entitlement to compensation for occupational cancers specifically, and for occupational diseases more generally, the key adjudicative question to be resolved is that of causation. Thus, in adjudicating a claim, decision-makers seek to determine whether the disease is due to the nature of the worker's employment (i.e., is the disease work-related?).

The Act and the policies are silent on the legal test for causation in determining entitlement for occupational diseases. However, as noted in a number of WSIAT decisions, the proper legal test for causation for these claims is "whether, on a balance of probabilities, a worker's duties at work significantly contributed to the onset of an injury or medical condition" [emphasis added] (71). This approach is influenced by the Supreme Court of Canada's position on causation in the context of tort cases (19).

The Tribunal (like the courts) accepts that a contributing cause does not need to be the major cause of an injury or disease in order to be a "significant contributing" cause or to have made a "material contribution" to the development of an injury/disease. But employment will not be shown to have been a "significant contributing" cause of an injury/disease if the injury/disease would have occurred when it did even in the absence of the employment.

2003 ONWSIAT 2153, Decision 600/97

The following three general principles govern how causation is evaluated and entitlement is determined:

  1. Employment does not have to be the predominant or primary cause. The exposure has to contribute in a significant or material way to the development of the disease, but there is no requirement in law or policy that the employment or the exposure be the only cause. Decision-makers are expected to apply the de minimus test (i.e., did the worker have a more than trifling amount of exposure?) to determine if the exposure was of causative significance.
  2. Absolute certainty is not required. Because the standard of proof is the balance of probabilities, absolute certainty is not required to evaluate causation and to determine entitlement. Decision-makers must weigh the evidence and be satisfied that it is more likely than not that the work exposure was a significant contributing factor in the development of the worker's cancer.
  3. The worker is afforded the benefit of the doubt. Where the evidence for and against causation is evenly weighted, the Act requires that the benefit of the doubt be given to the claimant and the issue be resolved in their favourfootnote 54

Methods of adjudicating occupational cancer claims in Ontario

Occupational cancer claims are handled by the Occupational Disease and Survivor Benefits Program, which includes teams of specially trained and experienced staff (e.g., senior adjudicators, physicians, an occupational hygienist, and nurse case managers). These teams adjudicate the claims using the following four methods:

  1. by reference to presumptions provided in Schedules 3 or 4 of O. Reg. 175/98
  2. through the application of sections 15.1 and 15.2 of the Actfootnote 55
  3. by application of operational policies in Chapters 16 and 23 of the OPM
  4. on a case-by-case basis

When determining entitlement to a disease claim, a decision-maker considers the worker's clinical condition and exposure at work, the up-to-date clinical and scientific information, any pertinent non-occupational factors, and all of the relevant policy instruments.

Adjudication under the presumptions: In claims with a diagnosis of a cancer recognized by presumption, entitlement is determined by considering whether the worker's exposure meets the entitlement criteria set out in the second column of the appropriate schedule. If the presumptive criteria are not met, entitlement is then considered under any relevant policy or on a case-by-case basis. A histopathological confirmation of diagnosis is the first step in determining entitlement for these claims. Once the diagnosis is confirmed, entitlement is first considered under Schedule 4. The next step is to determine whether the worker meets the employment criteria in column 2 of Schedule 4. If those criteria are met, the claim is allowed. If those criteria are not met, entitlement is considered under the rebuttable presumption of Schedule 3. If the employment criteria and the latency requirementsfootnote 56 are met, the claim is allowed. For example if it is determined that the cancer is not due to the nature of employment in concentrating, smelting or refining in the nickel producing industry, the adjudicator then considers the claim on a case-by-case basis to examine the worker's full job history and determine if causation is due to another well-established occupational cause of nasal cancer (e.g., woodworking in the furniture and cabinet making industry).

Application of the policies: In claims where the presumptions do not apply, entitlement is determined by applying the guidelines set out in the policies on general decision making in Chapter 11, as well as the policies on long-term exposure and chronic exposures in Chapters 16 and 23, respectively, of the OPM.

Case-by-case adjudication: Adjudication of diseases that are not listed in the published policies or schedules may proceed under either the occupational disease or injury by accident provisions of the Act. This also applies when a worker has a disease listed in Schedule 3 or 4 but was not employed in the related process specified in the schedule. Case-by-case adjudication in these claims is based on the facts of the claim and an assessment of evidence of causal connection between occupational exposure and the disease.

Steps in the adjudicative process

Occupational disease claims are adjudicated in a 7-step process: initial claim assessment, information gathering, analysis of evidence, determination of initial entitlement, determination of benefits, communication of the decision, and continuing management of the claim (18). The key step in all occupational disease claims – and the one that is most relevant to this review – is information gathering. In this step, regardless of the method of adjudication, the decision-maker gathers, analyzes and weighs the following information: employment history, detailed exposure history, medical history (e.g., diagnostic reports and medical opinions), current scientific evidence on occupational exposures and diseases, and relevant personal information (18). As appropriate, the decision-makers will consult internal and external resources footnote 57to resolve any questions they have on causation and work-relatedness.

Appendix 2: WSIB occupational cancer policies considered in this review

Adjudication principles:

Long term exposures – occupational diseases:

Chronic exposures:

Appendix 3: Background on British Columbia's Bladder Cancer Policy

Policy 30.10 of the Rehabilitation Services and Claims Manual sets out guidelines for adjudicating claims for bladder cancer from aluminum smelter workers which do not meet the descriptions contained in BC's presumptive schedule. This policy, which was first adopted in 2000 and subsequently updated in 2009, requires that these claims be adjudicated on the basis of cumulative (or total) exposure to benzo-a-pyrene (BaP), a constituent of coal tar pitch volatiles. The two primary issues faced during the development of the policy were: how should exposure be assessed and what level of exposure should be required for entitlement? In its consultation paper, WorkSafeBC acknowledged that while science could inform the first question, it could only partially inform the second. To answer the first question, it utilized research studies conducted in Quebec and subsequently commissioned a research study in British Columbia. The findings of the BC study were used to update the policy guidelines in 2009.

To determine the level of exposure required for entitlement, WorkSafeBC was faced with considering two questions: at what level of risk is an exposure causally significant and should scientific uncertainties be taken into account? On the issue of causal significance, BC's legislation and policies on occupational disease require that the workplace exposures be a significant contributing factor. Unfortunately, like many jurisdictions, they are silent on what that means in terms of the minimum level of risk. In developing its policy options, WorkSafeBC was aware that, unlike lab-based research, epidemiology is not an exact science and often there is uncertainty associated with the exposure estimates. This uncertainty can have an impact on the dose-response relationship.

In its consultation paper, WorkSafeBC acknowledged that these two questions were social policy questions as opposed to scientific questions and as a result, science could only help inform the policy choices. Therefore, affected stakeholders were asked to provide input on (1) whether the minimum level of risk should be set at a relative risk of 2 or between 1 and 2; and, (2) whether the minimum level of risk should be determined using the point estimates or the 95% upper confidence limit.

The final policy incorporates the research evidence on BaP being a better predictor of risk, it reflects the input received from affected stakeholders on the question of the minimum threshold required for entitlement and it also explicitly addresses the synergistic relationship between smoking and exposure to benzo-a-pyrene. If the worker's relative risk calculated in accordance with the principles set out in the policy is 2 or greater, the worker's smoking history does not change the conclusion that the bladder cancer was due to the employment.

Appendix 4: References

  1. Meredith W. Final Report on laws relating to the liability of employers to make compensation to their  employees for injuries received in the course of their employment which are in force in other countries, and as to how far such laws are found to work satisfactorily. Toronto, ON: L.K. Cameron, Printer to the King's Most Excellent Majesty; 1913.
  2. Safe Work Australia. Comparison of workers' compensation arrangements in Australia and New Zealand, 2013–14. (Deemed Diseases in Australia). Canberra, ACT: Safe Work Australia; August 2015. [Available online: Safe Work Australia].
  3. OED Online. Oxford University Press; December 2019.  OED Online (accessed January 04, 2020). "related, adj. and n.".
  4. Canadian Cancer Statistics Advisory Committee. Canadian Cancer Statistics. Toronto: ON: Canadian Cancer Society; 2019 [ Available from: cancer.ca/Canadian-Cancer-Statistics-2019-EN].
  5. Labrèche F, Kim J, Song C, Pahwa M, Ge CB, Arrandale VH, et al. The current burden of cancer attributable to occupational exposures in Canada. Prev Med 2019;122:128-39.
  6. Brenner DR, Friedenreich CM, Ruan Y, Poirier AE, Walter SD, King WD, et al. The burden of cancer attributable to modifiable risk factors in Canada: methods overview. Prev Med. 2019;122:3-8.
  7. Loomis D, Guha N, Hall AL, Straif K. Identifying occupational carcinogens: an update from the IARC Monographs. Occupational and Environmental Medicine. 2018;75:593-603.
  8. Jardine K, Peters CE, Demers PA. Established and suspected occupational carcinogens evaluated by IARC. (Manuscript in preparation).
  9. Tompa E, Kalcevich C, McLeod C, Lebeau M, Song C, McLeod K, et al. The economic burden of lung cancer and mesothelioma due to occupational and para-occupational asbestos exposure. Occup Environ Med. 2017;74:816-22.
  10. Occupational Cancer Research Centre. Burden of occupational cancer in Ontario: major workplace carcinogens and prevention of exposure. Toronto: ON: Occupational Cancer Research Centre; 2017.
  11. Jung YL, Tompa E, Longo C, Kalcevich C, Kim J, Song C, et al. The economic burden of bladder cancer due to occupational exposure. J Occup Environ Med. 2018;60(3):217-25.
  12. Mofidi A, Tompa E, Spencer J, Kalcevich C, Peters CE, Kim J, et al. The economic burden of occupational non-melanoma skin cancer due to solar radiation. J Occup Environ Hyg. 2018;15(6):481-91.
  13. Occupational Cancer Research Centre. Burden of occupational cancer in Canada: major workplace carcinogens and prevention of exposure. Toronto, ON2019.
  14. Del Bianco A, Demers PA. Trends in compensation for deaths from occupational cancer in Canada: a descriptive study. Can Med Assoc J. 2013;1:E1-E6.
  15. Association of Workers' Compensation Boards of Canada. Scope of coverage - industries/occupations. Toronto: ON: AWCBC/ACATC; 2013. [Available from: Association of Workers' Compensation Boards of Canada].
  16. Demers PA, Kim J, Song C, Rydz E, McLeod C. Impact of gender, age and province on compensation for asbestos-related cancer. Presentation  at the 2016 conference of the Canadian Association for Research on Work and Health. 2016.
  17. EUROGIP. Incidence and detection of occupational cancers in nine European countries (EUROGIP-141/E). Paris, France 2018. Contract No.: EUROGIP-141/E.
  18. Workplace Safety and Insurance Board. Decision-making process for occupational disease claims. Ministry of Labour Briefing. Toronto, ON: WSIB/CSPAAT; 2017.
  19. Lippel K. Workers' compensation for asbestos related disease in five Canadian provinces. Final report. Ottawa, ON: Canadian Partnership Against Cancer, Occupational Health Clinic for Ontario Workers; 2010.
  20. Lippel K. Workers' compensation for occupational disease: medicolegal challenges. Presentation to: University of Toronto Occupational and Environmental Health Seminar Series. September 27, 2019. Toronto, ON.
  21. International Agency for Research on Cancer. IARC Monographs on the Identification of Carcinogenic Hazards to Humans. Preamble. Lyon, France: International Agency for Research on Cancer; 2019 [Available from: IARC Monographs Preamble].
  22. Samet JM, Chiu WA, Cogliano V, Jinot J, Kriebel D, Lunn RM, et al. The IARC Monographs: Updated procedures for modern and transparent evidence synthesis in cancer hazard identification. J Natl Cancer Inst. 2019:pii: djz169 [Epub ahead of print].
  23. Smith MT, Guyton KZ, Gibbons CF, Fritz JM, Portier CJ, Rusyn I, et al. Key characteristics of carcinogens as a basis for organizing data on mechanisms of carcinogenesis. Environ Health Perspect. 2016;124(6):713-21.
  24. Siemiatycki J, Thomas DC. Biological models and statistical interactions: an example from multistage carcinogenesis. Int J Epidemiol. 1981;10(4):383-7.
  25. Hofseth LJ, Weston A, Harris CC. Chemical carcinogenesis. 2017. [Available from: Oncohema Key].
  26. Hauptmann M, Pohlabeln H, Lubin JH, Jockel KH, Ahrens W, Bruske-Hohlfeld I, et al. The exposure-time-response relationship between occupational asbestos exposure and lung cancer in two German case-control studies. Am J Ind Med. 2002;41(2):89-97.
  27. Rothman K.J. Causes. American journal of epidemiology. 1976;104:587-92.
  28. Last JM, editor. A Dictionary of Epidemiology. Fourth Edition. New York, NY: Oxford University Press; 2001. [Available from: pestcontrol.ru].
  29. Thomas DC. Pitfalls in the analysis of exposure-time-response relationships. Journal of chronic diseases. 1987;40 Suppl 2:71S-8S.
  30. Brown CC, Chu KC. Additive and multiplicative models and multistage carcinogenesis theory. Risk Anal. 1989;9(1):99-105.
  31. Hammond EC, Selikoff IJ, Seidman H. Asbestos exposure, cigarette smoking and death rates. Ann NY Acad Sci. 1979;330:473-90.
  32. ACGIH. 2019 TLVs® and BEIs®. Cinncinati, OH: ACGIH; 2019. [Available from: American Conference of Governmental Industrial Hygienists].
  33. Government of Ontario. Occupational Health and Safety Act. R.R.O. 1990, Regulation 833: Control of exposure to biological or chemical agents. Toronto, ON.1992 (amended, 2020).
  34. Rosenstock L, Cullen MR, Brodkin CA, Redlich CA, editors. Textbook of Clinical Occupational and Environmental Medicine, 2nd edition. Philadelphia, PA: Elsevier Saunders; 2005.
  35. National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention. Exposome and exposomics. Cincinnati, OH: CDC/NIOSH; 2014 [Available from: Centers for Disease Control and Prevention].
  36. Wild CP. Complementing the genome with an "exposome": the outstanding challenge of environmental exposure measurement in molecular epidemiology. Cancer Epidemiology, Biomarkers & Prevention. 2005;14(8):1847–50.
  37. Schulte PA, Ehrenberg RL, Singal M. Investigation of occupational cancer clusters: theory and practice. Am J Public Health. 1987;77:52-6.
  38. Astrakianakis G, Bigelow P, Corneil T, Omelchenko V, Steinberg M, Yassi A, et al. Cancer cluster investigation within the Mission Memorial Hospital laboratory. Final report. Vancouver, BC: Occupational Health and Safety Agency for Healthcare in BC; March 31, 2006. [Available online: Cancer Cluster Investigation within the Mission Memorial Hospital Laboratory].
  39. International Labour Organization. List of occupational diseases (revised 2010). Identification and recognition of occupational diseases: criteria for incorporating diseases in the ILO list of occupational diseases. Occupational Safety and Health Series, No. 74. Geneva, Switzerland: International Labour Office; 2010. [Available from: International Labour Organization].
  40. Australia SW. Comparison of workers' compensation arrangements in Australia and New Zealand. 26th Edition. Canberra, ACT: Safe Work Australia; 2018 [Available from: Safe Work Australia].
  41. U.S. Department of Labor Office of Workers' Compensation Programs. Division of Energy Employees Occupational Illness Compensation (DEEOIC) 2019 [Available from: Department of Labor Office].
  42. IOM (Institute of Medicine). Review of the Department of Labor's Site Exposure Matrix Database. Washington, DC: The National Academies Press; 2013.
  43. U.S. Department of Labor Office of Workers' Compensation Programs. Division of Energy Employees Occupational Illness Compensation (DEEOIC). Special Exposure Cohort Employees (SEC) 2019 [Available from: U.S. Department of Labor].
  44. Howard J. Minimum latency and types or categories of cancer. World Trade Center Health Program. Atlanta, GA: Center for Disease Control 2015.
  45. Rothman KJ, Greenland S. Modern Epidemiology. 2nd ed. Philadelphia, PA: Lippincott-Raven; 1998.
  46. United States Nuclear Regulatory Commission. Fact Sheet on Biological Effects of Radiation. 2011. [Available at: United States Nuclear Regulatory Commission].
  47. U.S. Government Accountability Office. Energy Employees Compensation: Labor Could Better Assist Claimants through Clearer Communication (GAO-19-90). Washington, D.C., U.S.; 2018.  Contract No.: GAO-19-90.
  48. Committee on the Review of the Department of Labor's Site Exposure Matrix (SEM) Database, Board on the Health of Select Populations, Institute of Medicine and Health Sciences Policy Program. Review of the Department of Labor's site exposure matrix database. Washington, D.C., USA: The National Academies Press; 2013. [Available from: National Center for Biotechnology Information].
  49. U.S. Center for Disease Control (CDC). World Trade Center Health Program: STAC Charter 2019 [Available from: U.S. Center for Disease Control].
  50. UBC Partnership for Work Health and Safety. Mesothelioma awareness and compensation: Partnership for Work, Health and Safety; Undated. [Available from: Partnership for Work Health and Safety]].
  51. WorkSafeBC-CHSPR Research Partnership. The Burden of Asbestos-Related Disease in British Columbia: Final Workshop Report. Vancouver, BC: Centre for Health Services and Policy Research; 2011 [Available from: WorkSafeBC].
  52. Kirkham TL, Koehoorn MW, McLeod CB, Demers PA. Surveillance of mesothelioma and workers' compensation in British Columbia, Canada. Occupational and Environmental Medicine. 2011;68(1):30-5.
  53. Peters CE, Ge CB, Hall AL, Davies HW, Demers PA. CAREX Canada: an enhanced model for assessing occupational carcinogen exposure. Occup Environ Med. 2015;72(1):64-71.
  54. Vincent R, Jeandel B. COLCHIC-occupational exposure to chemical agents database: current content and development perspectives. Appl Occup Environ Hyg. 2001;16(2):115–21.
  55. Stamm R. MEGA-database: one million data since 1972. Appl Occup Environ Hyg. 2001;16(2):159–63.
  56. Burns D, Beaumont P. The HSE National Exposure Database—(NEDB). Ann Occup Hyg. 1989;33(1):1-14.
  57. Boiano JM, Hull RD. development of a National Occupational Exposure Survey and Database associated with NIOSH hazard surveillance initiatives. Appl Occup Environ Hyg. 2001;16(2):128-34.
  58. Lavoue J, Friesen MC, Burstyn I. Workplace measurements by the US Occupational Safety and Health Administration since 1979: descriptive analysis and potential uses for exposure assessment. Ann Occup Hyg. 2013;57:77-97.
  59. Government of Canada. National Dose Registry  [Available from: Government of Canada].
  60. Health Canada, National Dose Registry, Environmental and Radiation Health Sciences Directorate, Healthy Environments and Consumer Safety Branch. Report on occupational radiation exposures in Canada 2018. Ottawa, ON: Queen's Printer for Canada; September 2019.
  61. DeMatteo R, DeMatteo D, G.E. Retiree Members of Advisory Committee. The report of the Advisory Committee on Retrospective Exposure Profiling of the Production Processes at the General Electric production facility in Peterborough, Ontario. 1945-2000. Toronto, ON: UNIFOR; February 2017.
  62. Babik KR, Shockey TM, Moore LL, Wurzelbacher SJ. Standardizing industrial hygiene data collection forms used by workers' compensation insurers. J Occup Environ Hyg. 2018;15(9):676-85.
  63. Shockey TM, Babik KR, Wurzelbacher SJ, Moore LL, Bisesi MS. Occupational exposure monitoring data collection, storage, and use among state-based and private workers' compensation insurers. J Occup Environ Hyg. 2018;15(6):502-9.
  64. U.S. Department of Labor Occupational Safety and Health Administration. Establishment search 2020 [Available from: Occupational Safety and Health Administration]].
  65. U.S. Department of Labor Occupational Safety and Health Administration. Chemical Exposure Health Data 2019 [Available from: Occupational Safety and Health Administration].
  66. International Agency for Research on Cancer. IARC Monographs on the Evaluation of Carcinogenic Risks to Humans. Volume 83: Tobacco Smoke and Involuntary Smoking. "Synergistic carcinogenic effects of tobacco smoke and other carcinogens". Lyon, France: International Agency for Research on Cancer; 2004 [Available from: International Agency for Research on Cancer].
  67. Jamil H, Campbell-Voytal K, Arnetz JE. Perceptions of training in occupational and environmental medicine among family medicine residents. J Occup Environ Med. 2010;52(2):202-6.
  68. Arnaud S, Cabut S, Viau A, Souville M, Verger P. Different reporting patterns for occupational diseases among physicians: a study of French general practitioners, pulmonologists and rheumatologists. Int Arch Occup Environ Health. 2010;83(3):251-8.
  69. Yildiz AN, Piskin TM, Alaguney ME, Kurt OK, Ozlu A, Basarali MK. Attitudes and behaviors of family physicians regarding occupational diseases. Arch Environ Occup Health. 2019;74(1-2):85-92.
  70. Policy and Consultation Services, Workplace Safety and Insurance Board. Framework for operational policy development and renewal. Toronto, ON.: WSIB/CSPAAT; February 2016. [Retrieved from: Workplace Safety and Insurance Board].
  71. Workplace Safety and Insurance Appeals Tribunal. 2003 ONWSIAT 2153. Decision No. 600/97. Toronto, ON: Workplace Safety and Insurance Appeals Tribunal; 2003.

Footnotes

  • footnote[47] Back to paragraph Defined in Section 2(1) of the Act as “a member of the College of a health profession as defined in the Regulated Health Professions Act, 1991”
  • footnote[48] Back to paragraph Defined in Section 2(1) to include: “(a) a wilful and intentional act, not being the act of the worker, (b) a chance event occasioned by a physical or natural cause, and (c) disablement arising out of and in the course of employment”.
  • footnote[49] Back to paragraph Schedules 3 and 4 are found in Ontario Regulation 175/98.
  • footnote[50] Back to paragraph These are diseases prescribed by regulation, made under the authority of the Lieutenant Governor in Council
  • footnote[51] Back to paragraph Section 15.1(4) of the Act also provides presumptive coverage for occupational diseases of firefighters, fire investigators, or classes of firefighters or fire investigators. However, as noted elsewhere in this report, discussion of issues related to the compensation of occupational cancers in firefighters is outside the scope of this report.
  • footnote[52] Back to paragraph Ontario Regulation 253/07 also includes a list of 17 cancers that are prescribed diseases for the purposes of Section 15.1(4) of the Act.
  • footnote[53] Back to paragraph Section 126(1) of the Act states that “if there is an applicable Board policy with respect to the subject-matter of an appeal, the Appeals Tribunal shall apply it when making its decision”.
  • footnote[54] Back to paragraph The benefit of the doubt provisions are set out in Section 119(2) of the Act and are interpreted in Policy 11-01-13.
  • footnote[55] Back to paragraph These sections apply to the adjudication of cancer claims from firefighters. As noted previously, consideration of the science underpinning these sections is outside the scope of this report
  • footnote[56] Back to paragraph Workers who meet the disease and employment criteria set out in Schedule 3 and have a latency of 15 years or greater are, in most cases, deemed to be entitled to compensation under the presumption. Before determining that the presumption is rebutted for those workers who meet the criteria set out in Schedule 3 but have a latency of 15 years or less, Policy 16-02-01 requires that the adjudicator consider other factors, including the nature and duration of the worker’s employment.
  • footnote[57] Back to paragraph Internal resources include the following: occupational and other specialist physicians, advanced practice nurses, occupational hygienists, and Operational Policy Branch support (includes policy and scientific support).