Industrial Accident Compensation

Chapter 2. Criteria for Determining an Incident as an Industrial Accident/Illness and related Cases

Section 4. Working Environment-related Industrial Accidents - Ⅰ. Lung Disease Verified as Occupational Illness through Epidemiological Investigation

I. Lung Disease Verified as Occupational Illness through Epidemiological Investigation

A. Introduction

When an employee applies for compensation for an occupational illness, the Employee Welfare Corporation (EWC) determines whether the employee has an occupational illness or not through its own investigation, the opinions of a medical professional (or professional agency), and a review by the Occupational Illness Determination Committee. In cases where its own investigation is unable to determine whether there is a relationship to work, EWC can ask a professional agency to conduct an epidemiological investigation, through which it will determine whether the illness in question is an occupational illness or not. Such illnesses as black lung disease (Pneumoconiosis) and lead poisoning, and conditions such as noise-induced deafness are more easily linked to occupation than some other illnesses such as cancer, hemoptysis (vomiting blood), asthma, and dermatitis. In this case, gathering information on the working environment will be of considerable help.
I would like to introduce a case of occupational illness which resulted in death from vomiting of blood. The employee in question had had a lung illness for a long period of time, and along with severe coughing, became worse from his harmful working environment. The labor attorney for this case claimed, on the basis of a statement from his surviving family, that the industrial illness victim (hereinafter referred to as “the Employee”) died from his long-term illness deteriorating through exposure to harmful chemicals like sulfuric acid in the process of zinc smelting. The labor attorney submitted an application for survivor’s benefits without a direct investigation. After receiving the application, EWC asked a professional agency (the Occupational Lung Disease Research Institute The Occupational Lung Disease Research Center (run by EWC and under the Ministry of Employment and Labor) was established in Ansan Sanje Hospital for the purpose of clinical and preventive studies on lung diseases.
) to conduct an epidemiological investigation. Once the results were in, EWC concluded a close relationship between the Employee’s workplace environment and exacerbation of his illness, accepting his death as due to a work-related illness.

B. Summary Survivor’s Compensation Case (Daegu-2013-0000296, May 9, 2013) – Park, Kyuhee, Labor Attorney with Kangnam Labor Law Firm, represented the case.

(1) The employee had worked at a zinc smelting factory since 2006. When he died at Ajou University hospital at age 61 on December 16, 2011, his spouse applied for Survivor’s Benefits on February 29, 2012 to the EWC Youngju Office.
(2) On December 9, 2011 when the Employee began vomiting blood and experienced difficulties in breathing, he was admitted to Wonju Christian Hospital where he continued to vomit blood and suffer from pneumonia. He died from respiratory and organ failure on December 16, 2011.
(3) Since being hired by OO zinc smelting company Zinc smelting process: ore mined à milling à smelting à refining. Then, 90% of zinc is retrieved.
on June 12, 2006, the Employee had worked as a machine operator in charge of a filter press machine for a total of 5 years and 3 months. The smelting process at a filter press extracts zinc by dividing cake (solids) and filtrate (liquid) after melting sludge coming from a sludge container. The Employee swept up the cake on the floor when it fell in the process of dividing from the filtrate. In this smelting process, sulfuric acid Sulfuric acid (H2SO4) is a highly corrosive mineral acid that is pungent, ethereal, colorless to slightly yellow viscous liquid and is soluble in water at all concentrations.
was used and the Employee was continuously exposed to the sulfuric acid gas.
(4) Before beginning employment at OO company, the Employee had worked as a street cleaner from 2001 to 2005 (aged 51 to 55) from 4 am to 4 pm, during which he began suffering from, and receiving treatment for, bronchitis and obstructive lung disease due to early morning cold air.
(5) As mentioned, the Employee had been exposed to sulfuric acid gas, mineral dust, etc. continuously at the workplace while suffering from existing bronchitis and obstructive lung disease. In addition to this, the Employee had to work longer hours than normal for a long period, which, combined with the stress from worry he would lose his job due to his poor health, was claimed to have caused pulmonary (lung) hypertension, resulting in his vomiting blood and ultimately his death.
(6) Fifteen months after his spouse applied for Survivor’s Benefits, during which EWC conducted an investigation, received medical opinions, and the results of an epidemiological investigation, the Occupational Illness Determination Committee agreed that the Employee died from an occupational illness.
C. The Limits of Investigation and Request for Epidemiological Investigation

1. The applicant’s difficulties in investigating for herself
In the application for Survivor’s Benefits, the applicant claimed that the Employee had suffered from chronic fatigue due to working two shifts for a long period of time; had stress and insomnia due to worries over losing his job because of his illnesses; and had been exposed to a harmful working environment (including sulfuric acid), which had caused pulmonary hypertension, vomiting of blood, and death. The claim that the Employee suffered from fatigue and stress could be causes for stroke or heart disease, but not for vomiting blood. Accordingly, the applicant had to verify that the workplace’s harmful substance (sulfuric acid) had exacerbated the employee’s existing conditions of bronchitis and obstructive lung disease and had caused pulmonary hypertension and vomiting of blood. However, the applicant was not able to gain access to the workplace, and had to depend on the EWC investigation. The following is the result of the epidemiological investigation from the professional agency commissioned by EWC.

2. EWC request for an epidemiological investigation
When there is difficulty in determining whether an illness is occupational or not, EWC can ask for professional opinions from a medical doctors’ advisory council, the industrial safety and research centers of the Korea Industrial Safety Corporation, or other agencies that can evaluate occupational diseases. Enforcement Rule-Article 39-2 of the Industrial Accident Compensation Act.
Also, the Medical Care Processing Rules describe that when it comes to difficulty in determining recognition of an occupational illness concretely, EWC may ask relevant institutes (such as medical doctors’ associations or industrial safety research institutes) to give advice and participate in the investigation. Article 24 of the Medical Care Processing Rules.
This includes cases 1) where it is difficult to verify whether the employee’s existing illness affected the occupational illness, 2) where meaningful difference exists between the medical doctor in charge and the advisory doctor regarding clinical signs that will show the degree of the employee’s exposure to harmful materials, 3) where it is difficult for a doctors’ advisory council to determine relation of an illness to occupation, or where there are no criteria for the occupational illness, and 4) where an epidemiological investigation is necessary to recognize whether a cause-and-effect relationship exists between work and illness. Upon concluding this investigation, as long as there is no clear evidence to disprove the illness was work-related, it should be accepted as an occupational illness. Kim, Kyusang, “Examples of Occupational Disease,” Monthly Labor Law Magazine, Jan. 2008, Joongang Economy.


3. Epidemiological investigation and recognition of occupational disease by the Occupational Lung Disease Research Center

(1) Understanding the workplace environment
The Employee’s work involved operating a filter press (F/P disintegration) machine to retrieve a small amount of metal out of sludge coming from a sludge container. In this process, the Employee was exposed to steam and carbon monoxide (CO) from the leftover liquid and cake. There is no artificial ventilation system in the disintegration process of the filter press, but there is natural ventilation in the roof of the three-story building. The agency measured the air quality of the workplace twice: on October 10, 2012, for 5 hours and 40 minutes to check the internal air of the workplace with a multiple gas measurement instrument; and on March 26 & 27, 2013, for 20 hours to check carbon monoxide concentrations in the air near the filter press, with a carbon monoxide measurement device. Additionally, workers’ individual exposure was measured by affixing the measurement instruments to the waist of three workers onsite for 20 hours.
The results of measurement showed an average density of 38 ppm of carbon monoxide in the work area around the filter press. At the height the Employee was breathing at the top of the F/P machine, concentrations exceeded 500 ppm, the limit of the measurement instrument. Individual measurement done over 20 hours averaged 19 ppm, 60% of the exposure limit according to the Ministry of Employment and Labor. However, as time passed, the density of carbon monoxide increased up to a maximum of 185 ppm. Besides carbon monoxide, hydrogen sulfide was detected at an average of 5.1 ppm.

(2) Effects of carbon monoxide & hydrogen sulfide on the human body
The normal concentration of carbon monoxide is 0.1~0.2 ppm. This carbon monoxide When this gas is inhaled at a high concentration, workers suddenly collapse because it blocks oxygen delivery in the tissues.
combines with hemoglobin delivering oxygen to the body, and results in carboxy-hemoglobin, causing hypoxia (low oxygen levels in the blood). This contracts blood vessels in the lungs and increases lung vessel resistance (lung rigidity), which causes pulmonary hypertension. As mentioned, hydrogen sulfide was also measured at an average of 5.1 ppm around the filter press. If a healthy adult is exposed to hydrogen sulfide up to a density of 50 ppm, pulmonary edema (fluid in the lungs) appears. Exposure to a density of 5.1 ppm of hydrogen sulfide could not cause lung damage, but hydrogen sulfide just like carbon monoxide is also a chemical that influences lung hypertension. Accordingly, as the Employee had repeatedly been exposed to a high concentration of carbon monoxide, this exposure, when mixed with hydrogen sulfide exposure, could have facilitated the occurrence of lung hypertension.

(3) Occupational illness
The Employee, who had been exposed to concentrations of carbon monoxide since December 2006, experienced headaches and a decline in physical abilities that could have been due to the carbon monoxide exposure. Moderate lung hypertension was diagnosed in August 2010, four years after beginning employment at the zinc smelting company. This had become severe hypertension by October 2011. Upon reviewing medical records from that time, no diseases were diagnosed that would be responsible for lung hypertension. It could, however, have occurred from the repeated exposure to a high density of carbon monoxide in the course of working at his last workplace, and possibly from the exposure to hydrogen sulfide. Lung hypertension causes vomiting of blood. This hemoptysis (vomiting of blood) does not reverse easily, and can easily reoccur even upon improvement. It was therefore concluded that the Employee died from the vomiting of blood, caused by lung hypertension.

D. Conclusion & Content of the Letter on Determination of Occupational Illness

1. Conclusion:
Determining whether occupational illness exists or not through epidemiological investigation requires time and money, but provides objective and scientific processes, allowing both employer and the decision-making body to easily accept the findings. Accordingly, the use of a professional agency to conduct the epidemiological investigation is recommended, and can help stop further occupational illness in the early stages by providing accurate data on harmful factors in the workplace.

2. The letter on determination of occupational illness Occupational Illness Determination Committee (Daegu-2013-0000296, May 9, 2013).

1) According to the epidemiological investigation submitted by the professional agency that EWC commissioned, the Employee had been exposed to carbon monoxide and hydrogen sulfide together, causing lung hypertension which in turn resulted in vomiting of blood and death. It is therefore determined that the Employee’s death was from occupational illness.
2) The advisory medical doctor to EWC stated that lung hypertension had been the result of repeated exposure to a high concentration of carbon monoxide, which had caused acute respiratory failure and acute pneumonia, leading to death.
3) The Occupational Illness Determination Committee reviewed the investigation findings, the examinations submitted by EWC and based on medical opinions, and the measurements at the workplace environment conducted by the professional agency. The Committee determined that the Employee’s lung hypertension was the result of repeated exposure to carbon monoxide and hydrogen sulfide, with complications such as vomiting blood, and resulted in the Employee’s death.
Based upon the above facts and medical opinions, this Employee’s death was recognized as a result of occupational illness according to Article 37 of the Industrial Accident Compensation Insurance Act.

For further questions, please
call (+82) 2-539-0098 or email bongsoo@k-labor.com

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