What Is an Occupational Disease? Diagnosis and Notification

What is an occupational disease? Two laws, two definitions

There are two official answers to the question of what an occupational disease is, and both need to be read together.

Law No. 6331 on Occupational Health and Safety gives a short definition: an occupational disease is a disease arising as a result of exposure to occupational risks. This definition focuses on prevention; the employer's risk assessment and health surveillance are built on it.

Art. 14 of Law No. 5510 on Social Insurance and General Health Insurance, on the other hand, gives the definition that gives rise to insurance rights: an occupational disease is a temporary or permanent illness, physical or mental disability suffered by the insured person through a repeated cause due to the nature of the work they do, or due to the conditions in which the work is carried out.

The difference from a work accident is time. A work accident happens in a single moment; an occupational disease develops through exposure lasting months or years and is often silent. Well-known examples in industry are:

• Noise-induced hearing loss (weaving, presses, metalworking),
• Lung diseases due to crystalline silica, coal or metal dust,
• Occupational asthma due to solvents, isocyanates or flour dust,
• Contact dermatitis due to cement, detergents, cutting fluids or rubber additives,
• Poisoning due to lead, chromium and similar metals.

Suspected occupational disease: what signs should you watch for?

An occupational disease diagnosis often begins with a suspicion, and the people who will first notice it are the workplace physician, the OHS specialist and the worker themselves. The following signs strengthen the suspicion:

1. Similar complaints in the same department. More than one worker on a line complaining of the same kind of cough, skin rash or ringing in the ears.
2. Complaints that improve on leave. Symptoms that ease at weekends or during annual leave and worsen on return to work.
3. Change in periodic examinations. Loss in a hearing test compared with the previous result, a fall in lung function, or changes in blood values consistent with exposure.
4. Measurement results exceeding the limit value. Values close to or above the limit in noise or chemical measurements.
5. Frequently recurring sick leave. One of the workplace physician's duties is to investigate whether there is a relationship between absence from work due to health problems and health hazards at the workplace.

The frequency of periodic examinations and which tests depend on the physician's decision were explained in our article on periodic examinations and tests.

Who diagnoses an occupational disease?

The process has two stages, and this distinction is very important: the preliminary diagnosis and the final determination are made by different people.

Preliminary diagnosis and referral. Under Art. 14/3 of Law No. 6331, the workplace physician or healthcare providers refer cases in which they have made a preliminary diagnosis of occupational disease to healthcare providers authorised by SGK. The regulation governing the duties of the workplace physician repeats the same obligation and gives the physician a further duty: repeating the health examinations of the other workers in the environment where the worker with the preliminary diagnosis works.

Health board report. Healthcare providers authorised by SGK issue the health board report on which the diagnosis is based. Occupational diseases hospitals are the well-known addresses in this field, but authority is not limited to them; the institution referred to may be an occupational diseases hospital or another hospital authorised by SGK. The workplace physician decides which hospital to refer to according to the current authorisation.

Final determination. Under Art. 14 of Law No. 5510, it is mandatory for the fact that the insured person has contracted an occupational disease to be established by the SGK Health Board following an examination of the health board report issued by the authorised healthcare provider and the supporting medical documents and, where necessary, inspection reports showing the working conditions at the workplace. Disputes over whether a disease counts as an occupational disease are decided by the Social Insurance High Health Board.

Liability period. The list of occupational diseases in the SGK regulations sets a "liability period" for each disease; this shows the maximum time within which the disease must appear after the worker has actually left that job. The Law also allows some flexibility here: if the disease has been established by clinical and laboratory findings and the agent causing it has been identified by an investigation at the workplace, it may be accepted as an occupational disease with the approval of the Social Insurance High Health Board even if the liability period in the list has been exceeded. This is why keeping measurement reports, the risk assessment and personal health files in good order for years protects both the worker's rights and the employer's defence.

Occupational disease notification: who, to whom, within how many days?

The notification obligation is spread across more than one person. Know which one falls to you:

Under Law No. 5510, the employer's notification is made with the work accident and occupational disease notification form.

When putting the time limit on the calendar, take weekends and public holidays into account. The safest way to avoid doubt about how the last day is counted is to make the notification on the day you receive the information or at the latest on the next working day. To do this, put in writing in advance to whom and how occupational disease information is passed on from the workplace physician and who will prepare the notification form.

From suspicion to decision: the process flow

1. Suspicion: The worker's complaint, a periodic examination result or a workplace exposure measurement points to an occupational disease.
2. Assessment: The workplace physician examines the worker and reviews the exposure history, the risk assessment and the measurement results.
3. Preliminary diagnosis and referral: If the physician makes a preliminary diagnosis, they refer the worker to a healthcare provider authorised by SGK.
4. Health board report: The authorised hospital carries out the necessary examinations, issues the health board report and notifies SGK of the case it has diagnosed within 10 days at the latest.
5. Employer notification: The employer to whom the occupational disease has been reported notifies SGK within 3 working days.
6. SGK investigation: Where necessary, SGK inspectors or labour inspectors carry out an investigation at the workplace.
7. Final determination: The SGK Health Board examines the report and documents and establishes whether the disease is an occupational disease.

What to do at the workplace after diagnosis

An occupational disease is not only a matter for notification but a sign of a point where risk management has failed. After diagnosis, take these steps:

• Renew the risk assessment. An occupational disease is one of the situations that requires the risk assessment to be renewed regardless of its validity period.
• Have exposure remeasured. We plan noise or chemical exposure measurements with authorised laboratories and enter the results into the risk assessment. For what to do about chemical exposure, see our article on working with chemical substances.
• Examine other workers. The health examinations of those working in the same environment are repeated.
• Place the worker in suitable work. The workplace physician examines and issues a report for placing a worker with a diagnosis or preliminary diagnosis of occupational disease in suitable work. If the worker requests it, a return-to-work examination is carried out on returning to work.
• Give additional training. A worker who has contracted an occupational disease is given additional training before starting work on the causes of the disease, ways of protection and safe working methods (6331 Art. 17/4).
• Protect confidentiality. Health information is confidential; the details of the diagnosis stay only in the physician's file.

The approach we use for root cause analysis after a work accident also applies to occupational disease; details are in our article on the first 72 hours after a work accident.

At textile, metal and chemical businesses in Bursa and the surrounding provinces, an exposure-based health surveillance programme is the foundation of Bursa Sistemer OSGB's workplace physician services and health surveillance services. For sector risks such as noise in weaving halls, see our textile page.

Frequently Asked Questions

Does a disease that appears after leaving the job count as an occupational disease?

It can. Law No. 5510 also covers diseases that appear after leaving the job and arise from the work done while insured. For this, no longer than the period specified for that disease in the regulation must have passed between actually leaving the job and the disease appearing. The person can apply directly to SGK with the necessary documents.

Can a family doctor diagnose an occupational disease?

Any physician can suspect an occupational disease, make a preliminary diagnosis and refer the worker to a healthcare provider authorised by SGK. For insurance rights, however, the final determination is made by the SGK Health Board.

In which hospital is an occupational disease diagnosed?

The health board report on which the diagnosis is based is issued by healthcare providers authorised by SGK; occupational diseases hospitals are the well-known addresses in this field. The workplace physician decides which hospital to refer to according to the current authorisation.

Who should a worker with a suspected occupational disease go to?

First to the workplace physician. The physician examines the worker, assesses the exposure information and refers them if needed. The worker may also go to their own doctor if they wish; in that case, if the doctor makes a preliminary diagnosis, they start the referral process.