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Occupational illness. The issue of causality.

Following European precedents, workers' compensation statutes and the Social Security Disability Insurance program were developed in the United States to deal with the problem of work incapacity. The former was designed to insure for loss of wages consequent to workplace injury, the latter to insure against poverty consequent to work incapacity. Issues such as employer or product culpability, quantification of the magnitude of work incapacity, and insurance for partially restricted work capacity have greatly distorted the intent of these programs; both now provide financial awards based more on damage and disease rather than on the illness of work incapacity. Understanding this evolution will allow physicians to offer more appropriate guidance to their patients, to contribute their voices and perspective to the sociopolitical ethos, and to distinguish the legal issue of culpability from the clinical issues of pathogenesis of disease and of the role of human and work-place factors in causing the disease to be manifest as the illness of work capacity.

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