Which illnesses the Fund covers

It is subsection (i) of Article 3 of Act 45-1935 — the table of occupational illnesses and their causes, with the exposure rules and the periods to claim — together with Article 3-A, on respiratory tuberculosis contracted at work, and Article 3-B, which triples the compensation where the harm came from an uncorrected occupational-safety violation.

For the illnesses in the table, that a worker contracts it in the course of the occupation the table lists and that the last exposure to the risk occurs within the twelve months before the date of the disability. Beyond the table, the Act compensates every illness contracted in the course of work as a consequence of a risk peculiar to the industry, process, occupation or employment, and as a result of the worker’s direct exposure to that risk in the normal performance of their work, with the same twelve-month window counted from the first manifestations of the disability. Contagious illnesses, epizootics, endemics and epidemics do not count as occupational, except when contracted by laboratory personnel exposed to the risk in the course of their work by handling or examining infective material.

• That the last exposure to the risk of acquiring the illness occurs within the twelve (12) months before the date of the disability it caused — or, beyond the table, before the date the first manifestations of that disability were observed.Verified against the official source
• Establishing the claim within a period not exceeding three (3) years from the date the worker acquires knowledge of the nature of the disability and of its relation to the work, “or could have acquired it through the exercise of reasonable diligence”.Verified against the official source
• For silicosis, that silicosis be the determining cause of the disability or death: the table’s own entry conditions it that way.Verified against the official source
• For brucellosis, that it be its acute form and that the patient’s blood-culture test be frankly positive: the Act limits the protection there.Verified against the official source

Information pending verification.

1. 1

   Step 1: The rule that opens the table

   Article 3(i) begins by fixing the condition common to all forty-two entries: the listed illnesses “shall be considered derived from the occupation when contracted by workers in the course of the occupations listed therein, where the last exposure to the risk of acquiring the illness occurs within the twelve months before the date of the disability it caused, due to the nature of the processes described in that table”. Twelve months from the last exposure: that is the clock, and later the Act itself sets an important exception to it.

2. 2

   Step 2: Metals and industrial poisons

   The table’s longest part is the poisonings, each tied to its process. Lead, in any industrial process involving its use, preparations or compounds, including paints containing it. Mercury, phosphorus and arsenic, in any industry whose process uses them. Benzol, nitro and its amido, dinitro and aniline derivatives. Carbon disulphide. Wood alcohol. Bronze or zinc, in manufacture, smelting or refining. Carbon dioxide and manganese dioxide. Radium and radioactive substances, including the use of X-rays or ultraviolet rays or direct exposure to their effects. Hydrocyanic acid, sulphur dioxide and hydrogen sulphide. Selenium, tellurium, beryllium and cadmium. Chromium and its compounds. Nickel carbonyl. Formaldehyde. Chlorine and ammonia. Methyl chloride and other halogenated hydrocarbons. Sulphuric, hydrochloric or hydrofluoric acid. Tetrachloromethane and the solvents for cellulose acetate or nitrocellulose. And carbon monoxide, in any process or occupation involving direct exposure to it “in buildings and enclosed places”.

3. 3

   Step 3: The dusts: silicosis, asbestosis and bagassosis

   Three entries in the table cover dust illnesses, and they generate the most cases. Silicosis, “provided silicosis is the determining cause of disability or death”, in the industries generally recognised as exposed to that risk: silica, rock and marble quarries; stone crushing and grinding work; silica pulverisation in tile and glass factories. Asbestosis, in any industry whose process involves exposure to or direct contact with asbestos dust. And bagassosis, which the table describes as “an occupational illness acquired when working with sugar cane bagasse”.

4. 4

   Step 4: Skin, eyes and contact illnesses

   The table covers skin infections or inflammations from contact with compound, irritant or lubricant oils, dusts, liquids, fumes, gases or vapours. Epitheliomatous cancer, or ulcerations of the skin or of the eye’s corneal surface, due to coal, pitch, tar or their compounds. Cataract in people working in glass factories, from exposure to the glare of molten glass. Corneal inflammations or skin infections from contact with cane fuzz. And respiratory, gastrointestinal or physiological nervous disorders, or eye disorders, due to contact with petroleum, its products or its gases.

5. 5

   Step 5: The animal ones, the muscle one and the writing one

   Four more entries worth knowing because almost nobody associates them with the Fund. Anthrax, from handling wool, hair, hides or skins. Glanders or carbuncle, from caring for equine animals suffering from them. Brucellosis, in any occupation requiring work with bovine, caprine or porcine cattle — “the Act’s protection being limited to cases in their acute form where the patient’s blood-culture test is frankly positive”. Disability resulting from bursitis or synovitis, in any industry whose process involves continuous rubbing, pressure or vibration of the affected parts. And mogigraphia or writer’s cramp, in any occupation involving the need to write by hand or in shorthand more or less continuously.

6. 6

   Step 6: The table is not the whole list

   It is the most important part of the whole subsection and it sits after the table, where few people get to. “In addition to the occupational illnesses included in the preceding table, there shall be considered compensable occupational illnesses all those illnesses contracted in the course of work, as a consequence of a risk peculiar to the industry, process, occupation or employment, and as a result of the worker’s direct exposure to that risk in the normal performance of their work”, provided the last exposure occurs within the twelve months before the date the first manifestations of the disability were observed. Not being in the table does not close the door.

7. 7

   Step 7: Contagious illness is out, with one exception

   The Act says it in one sentence: “Save as provided elsewhere in this Act, contagious illnesses, epizootics, endemics and epidemics shall not be considered occupational, except when contracted by laboratory personnel exposed to their risk in the course of their work by reason of handling or examining infective material.” The opening proviso — “as provided elsewhere in this Act” — is what keeps Article 3-A on tuberculosis alive.

8. 8

   Step 8: Delayed-effect illnesses

   The twelve-month window has an exception written for illnesses that take years to appear. The right to claim compensation for disability originating in illness caused by compressed air, “or by delayed pathological changes of the bones, blood or lungs of a malignant character caused by occupational exposure to or contact with arsenic, benzol, beryllium, cadmium, chromium, lead, fluorine, or exposure to X-rays, radium, or radioactive substances, or other substances of whatever nature that may produce delayed effects on the human organism, shall not be prejudiced by the running of the twelve-month term after the last exposure… if it is medically determined that the illness’s effects may occur after a longer lapse”.

9. 9

   Step 9: Three years from when you knew

   The period to claim is not counted from the exposure or from the formal diagnosis. “Claims in occupational-illness cases must be established within a period not exceeding three (3) years from the date the worker acquires knowledge of the nature of the disability, and of its relation to the work, or could have acquired it through the exercise of reasonable diligence.” Both things: the nature of the disability and its relation to the work. And the reasonable-diligence tail is what the Fund argues about when a long time has passed.

10. 10

    Step 10: The table can grow

    The subsection closes by giving the Administrator the key: “The State Insurance Fund Administrator is granted the authority and powers to add to this table all those illnesses which, after investigation, are determined to be compensable occupational illnesses.” We publish the table the Act carries; we read no administrative addition, so this may not be the complete list currently in force.

11. 11

    Step 11: The tuberculosis of Article 3-A

    Article 3-A treats as occupational every respiratory-system illness of tubercular origin contracted in the course of work by a person exposed to contagion in hospitals, dispensaries, offices or health centres devoted to diagnosing and treating tuberculosis, and in laboratories where infective tubercular material is handled, whether public or private. With conditions the Act itself says establish causation “beyond reasonable doubt”. The first: nobody may start work in those places, whatever the number of employees, without a determination before or within the month of taking up duties that they do not have respiratory tuberculosis — a determination made by the agency the Health Secretary designates and which “shall always include a radiographic examination of the lungs” — and without certification to the Fund’s Administrator.

12. 12

    Step 12: The ninety days of tuberculosis

    The rule that decides cases is in subsection 3 of Article 3-A: “Respiratory tuberculosis shall be considered contracted at work and in consequence of it if, not having had it before, it manifests after ninety (90) days from starting work.” And subsection 2(c) covers those already working: anyone determined to have active respiratory tuberculosis who has been working ninety days or more in one of those places “shall be considered ill as a result and in consequence of their work”, unless it is shown they had it active when they began service. The Act also allows employing in those places people with chronic tuberculosis classified as inactive, certified as such to the Administrator.

13. 13

    Step 13: Three times the compensation: Article 3-B

    It is the strongest provision in this block and almost nobody invokes it. “In cases where the injury, occupational illness or death giving the worker or their beneficiaries the right to compensation under this Act came as a consequence of violations of Act 16 of 5 August 1975, as amended, or of the rules or regulations approved under it, duly notified and not corrected within the time prescribed by the Secretary of Labour and Human Resources, the injured party or their beneficiaries in case of death shall be entitled to receive an additional compensation equivalent to three times that established by this Act.” The two conditions that must be provable are in that same sentence: violations duly notified, and not corrected within the prescribed time.

14. 14

    Step 14: Who pays that triple, and how it is appealed

    Article 3-B settles the mechanics. The additional compensation “shall be paid by the Administrator in one payment out of the Fund for Uninsured Employer Cases”, so the worker does not wait for the employer to pay. Afterwards, “the amount of that additional compensation shall be charged to the employer and shall constitute a lien on all their property”, enforced as compensation is collected in uninsured-employer cases. And a rule worth noting: “The sums payable under this Article shall not be taken into account for the purposes of fixing premiums.” The employer may appeal the Administrator’s decision imposing the additional compensation to the Industrial Commission “within a term of thirty (30) days after being notified”.

The occupational-illness claim is established before the State Insurance Fund, and the Administrator determines whether the illness is a covered one. The additional compensation under Article 3-B is paid by the Administrator in one payment out of the Fund for Uninsured Employer Cases and then charged to the employer; the employer may appeal that imposition to the Industrial Commission within thirty days. The tuberculosis determinations under Article 3-A are made by the Health Department agency the Health Secretary designates and are certified to the Fund’s Administrator. The Act publishes no addresses, phone numbers or forms in these articles, and we read none here.

• Believing that if the illness is not in the table it is not compensated: the Act adds an open clause for every illness contracted from a risk peculiar to the industry and by the worker’s direct exposure.
• Counting the three years from the diagnosis: they run from when the worker knows the nature of the disability and its relation to the work, or could have known with reasonable diligence.
• Giving up on a late-appearing illness because of the twelve months: the Act expressly excepts delayed pathological changes from arsenic, benzol, beryllium, cadmium, chromium, lead, fluorine, X-rays, radium and radioactive substances.
• Claiming silicosis where it is not the determining cause of the disability or death: the table’s entry conditions it that way.
• Claiming brucellosis in a non-acute form or without a frankly positive blood culture: the Act limits the protection there.
• Assuming every contagious illness is out: laboratory personnel exposed by handling or examining infective material are covered.
• Not invoking Article 3-B where there was a notified and uncorrected safety violation: the additional compensation is three times that established by the Act.
• Believing that triple compensation must be collected from the employer: the Administrator pays it in one payment out of the Fund for Uninsured Employer Cases, and the Fund then charges it to the employer.
• Starting work at a tuberculosis centre without the prior determination Article 3-A requires: that certification is what later proves you did not have it.
• Not knowing that tuberculosis manifesting after ninety days from starting work is considered contracted in it.

These are the government pages this guide is based on.

• Corporación del Fondo del Seguro del Estado (CFSE)

  Fondo del Seguro del Estado

  bvirtualogp.pr.gov