IIAC’s PD-D1 (Pneumoconiosis) review highlights ongoing burden of respiratory disease and risks for latent claims portfolios

  • Market Insight 21 November 2023 21 November 2023
  • UK & Europe

  • Insurance

The IIAC has published a Command Paper sent to the Secretary of State for Work and Pensions following its long-awaited review of the PD D1 prescription (relating to pneumoconiosis). The current prescription for PD D1 has been in place for nearly 80 years, and contains criteria relating to exposure settings which are in some cases largely historical and of limited relevance to modern working environments.

The IIAC has recommended that, for the purposes of prescription of disease for benefits, the criteria are somewhat simplified to relate to: 

  1. Asbestos
  2. Coal or mine dust
  3. Silica-containing dusts
  4. Metal dusts: aluminium, beryllium, cobalt, Indium tin oxide, rare earth metals and tungsten carbide.

The IIAC recommends that there is no prescribed connection to any particular employment, and the only factor of relevance is occupational exposure in any setting.

Further, the IIAC does not attempt a definition of pneumoconiosis, considering instead that this is sufficiently well-understood by specialist medical practitioners, although the intention is that the definition should relate to essentially (but not necessarily solely) fibrotic conditions, excluding malignant conditions or other types of airways disease such as COPD and asthma. Mining-related COPD is dealt with separately, and the IIAC is continuing its current review in relation to occupational links between COPD and other occupational settings. The IIAC has recommended that, for benefits purposes, there should be no automatic award on diagnosis irrespective of actual disability, with actual impact on respiratory disability to become a factor.

The role of the IIAC is to make recommendations to the Secretary of State with respect to the prescription of certain diseases for IIDB scheme purposes and its work has no direct bearing on insurers' exposure to damages claims and related liability issues. Insofar as the work of the IIAC requires an analysis of occupational connection between exposure, disease and work-related settings, however, its research and analysis is highly relevant when considering causation issues in disease claims. What this latest IIAC Command Paper highlights is the fact, well known to insurers and other paymasters exposed to asbestos-related liabilities, that asbestos exposures can no longer be assumed to derive from historic heavy industrial practices, and can arise in a variety of different settings, albeit that the focus of this Command Paper is (in the asbestos-related disease context) focused on asbestosis, which does require a minimum threshold level of lifetime exposure.

The Command Paper also shines a light on the concern over the increasing incidence of diagnosis of silicosis arising from novel settings rather than traditional heavy industry settings – in particular construction, counter/worktop production and processes relating to the grinding of mineral graphite and the manufacture of carbon electrodes, and also arising in dental technician and jewellery manufacture settings. The IIAC paper has identified what it describes as historically "generally poor compliance with the legal limits on occupational exposure" in relation to RCS (respirable crystalline silica) and "poor use of respirators throughout industry". The IIAC suggests that "the possibility of disease emerging in other novel settings remains a concern". Insurers and larger employers may well be aware of the significant increase in incidence, and related claims, arising from silica exposure in recent years in Australia, and concerns remain that a similar trend may be seen in the UK.

The timing of the IIAC Command Paper relating to pneumoconiosis, and its ongoing and separate work in relation to links between COPD and various occupational exposure settings, highlights the ongoing relevance of respiratory disease for UK employers and the UK liability insurance market and we consider that such claims will continue to be a feature of both shorter tail and legacy medium to long tail claims portfolios for some time to come.


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