Filing a Workers’ Compensation Claim for Silicosis: A Complete Guide

Workers exposed to respirable crystalline silica may face lifelong health problems, including a progressive and incurable lung disease known as silicosis. Many develop this condition after years of cutting, grinding, or drilling materials like concrete, stone, or drywall without proper respiratory protection. If you’ve been diagnosed with silicosis, this silicosis workers’ compensation guide can help you determine whether you qualify for benefits.

Understanding the Cause and Symptoms of Silicosis

Before you can file for workers’ compensation for silicosis, you must be diagnosed with a serious medical condition. Silicosis is caused by breathing in fine particles of crystalline silica, often found in dust from cutting or grinding stone, concrete, or similar materials. Over time, these particles scar the lungs and reduce the ability to breathe.

Early signs include coughing, fatigue, and chest tightness. In severe cases, the disease can be fatal. Health professionals estimate that between 2,500 and 5,000 new silicosis cases occur in the United States each year, though underreporting likely means the true number is higher. Workers in construction, countertop fabrication, mining, and manufacturing are among those at highest risk.

Report the Illness as Soon as Possible

Once you receive a diagnosis, you should notify your employer right away. Prompt reporting ensures that you meet filing deadlines and receive timely benefits. Any delay in reporting could potentially give insurers a reason to deny your claim. Document the date of your diagnosis and maintain a written record of when and how you reported your claim.

Always keep any medical records related to your diagnosis or symptoms. By reporting the work-related illness early, you can position yourself for a fair settlement that allows you to receive the benefits you need to pay for medical treatments and lost wages. It’s important to keep track of the total costs of your ongoing medical treatment.

Gather Medical and Work History Documentation

One reason that workers experience denied claims is due to incomplete medical documentation. Workers’ compensation carriers are notorious for denying claims that are not backed up with sufficient medical evidence. You will also need to link your work history to exposure to respirable silica. This is because workers’ compensation is not the same as personal health insurance. It only covers medical expenses tied to your time at work.

You can do this by collecting pay stubs, job descriptions, and statements from coworkers. Proper paperwork can play a crucial role in whether your claim is accepted or rejected. One unfortunate case in 2024 is a reminder of how even legitimate cases can be wrongfully denied. In a 2024 investigation by NBC Los Angeles, a 36-year-old worker with a confirmed diagnosis was denied compensation.

File Your Workers’ Compensation Claim

After notifying your employer, you must file your claim with the company that provides workers’ compensation benefits for your company. The form must be carefully filled out and supported with medical documents. The insurer then reviews the claim before deciding to approve or deny the claim. If your claim is approved, you will receive payments at monthly intervals that typically cover your medical bills and lost wages.

According to national data, workers’ compensation programs in the United States paid out approximately $60 billion in 2021. Of that amount, 28.5 billion went toward medical costs, and 31.5 billion covered wage loss and related benefits. Despite the size of this system, claims involving long-term illnesses like silicosis are frequently contested.

Insurance companies are not always cooperative when it comes to accepting claims, and even valid claims may be initially denied. Workers’ comp policies vary by state and allow applicants to appeal denials or resubmit incomplete application forms.

FAQs

Q: How Much Compensation Can You Receive for a Silicosis Claim?

A: The compensation for a silicosis claim depends on the severity of the condition, medical costs, and the ability to work. Workers may receive payments for lost wages, permanent disability, and related medical expenses. State-specific guidelines affect benefit limits.

Claims with strong medical documentation and work history tend to receive more favorable outcomes. The more evidence you have connecting your illness to workplace exposure, the stronger your position when demanding full and fair compensation.

Q: What Factors Affect the Value of a Silicosis Settlement?

A: The value of a silicosis settlement depends on the diagnosis stage, level of disability, and available evidence. Other key factors include length of exposure, type of job, and whether protective measures were in place. Medical documentation showing long-term health effects adds weight to a claim. Workers with strong evidence of exposure at specific job sites are more likely to secure higher compensation amounts.

Q: Can Workers’ Compensation Cover Silicosis?

A: Workers’ compensation can cover silicosis if the condition was caused by on-the-job exposure to respirable crystalline silica. The worker must show that the exposure occurred during employment and provide a confirmed medical diagnosis. Compensation may include wage replacement, medical care, and disability payments. Claims should be filed promptly with supporting evidence to avoid delays or denials from the insurance carrier or employer.

Q: Can You File a Claim Against an Employer for Silicosis?

A: You could file a claim for silicosis through the workers’ compensation system if the exposure occurred during your employment. These claims do not require proving fault but must show that workplace conditions caused the illness. Filing a claim involves reporting the diagnosis, submitting medical records, and cooperating with insurance evaluations. Some cases may also involve third-party claims, depending on the exposure source.

You Deserve Support. Contact Wallace & Graham, P.A. Today

Silicosis is a serious and preventable disease caused by long-term exposure to respirable crystalline silica. For workers in construction, mining, and manufacturing, filing a workers’ compensation claim can be the first step toward securing medical care and financial relief. However, these claims can be complex, and delays or denials are common.

At Wallace & Graham, P.A., we help workers and families navigate the workers’ compensation system with clarity and confidence. If you’ve been diagnosed with silicosis due to workplace conditions, we’re ready to help you pursue the benefits you’re entitled to. Contact Wallace & Graham, P.A. today to schedule your consultation.