DIAGNOSING WORK-RELATED ILLNESSES AND COMPENSATING HEALTH DAMAGE

The study gives an overview of the system for diagnosing work-related illnesses and compensating work-related health damage in Estonia. The analysis mapped how a person moves from the onset of a health problem to the diagnosis of an occupational disease or an illness caused by work, and from there to compensation for health damage, as well as the problems that arise along this path. The aim of the study is to propose solutions for improving Estonia’s system for diagnosing and compensating work-related illnesses, without redesigning universal social protection as a whole.

At present, very few work-related illnesses are registered in Estonia: in 2024, 20 occupational diseases and 45 illnesses caused by work were registered, while the number of registered occupational accidents was 3,384. Since there is a large gap between registry data and people’s own assessments, and since the number of occupational accidents has not declined over time in the same way as the number of work-related illnesses, there is reason to believe that many work-related illnesses remain undiagnosed.

Work-related illnesses develop over a long period and often affect a person’s working life before an official diagnosis is made. By the time of diagnosis, more than seven years have passed on average since the first symptoms appeared. For this reason, diagnosing work-related illnesses in Estonia is currently, to a large extent, the retrospective identification of health damage that has already developed.

The problem with the current system is that several aims are expected from the diagnostic process at the same time. In addition to identifying a work-related illness, the process is also expected to support the early detection of health problems and the adjustment of working conditions in order to prevent work-related health damage from worsening. In practice, however, a diagnosis is usually reached too late for it to help prevent the health damage from worsening. At the same time, there is no occupational health service through which the employee and the treating physician could assess at an early stage whether a health problem may be related to work, and obtain input for treatment and the adjustment of working conditions.

A diagnosis of an occupational disease has important legal consequences, as it serves as evidence when claiming compensation for health damage from the employer. At present, a person has the right to compensation for work-related health damage if the employer’s liability can be established under the Law of Obligations Act. This means that the employer has done something, or failed to do something, and thereby caused health damage to the employee. Proving the right to compensation is complicated, and many parties, including employees, employers and doctors, do not know under what conditions, for what type of damage and how the right to compensation arises.

The main obstacles to claiming compensation are employees’ low awareness, the complexity of proof, long and costly disputes, and the lack of uniform guidelines for applying for and calculating compensation. In 2024, the payment of compensation for work-related health damage was declared for 1,585 people.

The study recommends distinguishing between two pathways in the identification of work-related illnesses: an early intervention pathway for prevention purposes, and an occupational disease identification pathway for compensation purposes. The early intervention pathway, which Estonia currently lacks, would be centred on an occupational physician consultation service. A family physician or specialist doctor could refer a person there if the health problem may be related to work, but there is not yet a need to start the occupational disease diagnosis process required for compensation. The aim of the compensation pathway would be to collect and create the evidence needed to apply for compensation. On this pathway, people need advice in order to understand under what conditions and from whom compensation can be claimed.

As a result of the study, it is not recommended that Estonia create a separate new benefit for work-related health damage that would compensate the employee regardless of whether the employer is liable for the damage or not. There is currently no consensus in Estonia on creating such a benefit. Supporters consider that a new benefit would make it possible to avoid the current complicated process of proof. Opponents, however, find that such a solution would not be fair, as it would create different guarantees for work-related health damage than for health damage caused by other reasons, and that this is not justified. The study’s recommendations therefore focus on increasing the transparency and efficiency of compensation under the Law of Obligations Act, including advising employees, helping them collect evidence, and creating templates and guidelines on how and in which cases to claim compensation.