Objectives

The Swedish official system for compensating workers with occupational injuries is regulated by law—the official act on occupational injury insurance (Official Act on Occupational Injury Insurance 1993). The system is organized to function as an integral part of the framework of Swedish national social security, receiving monetary contributions from levies on employers and a basic funding through government revenue sources.

The objective of occupational injury compensation, according to the law, is to compensate for loss of income and for assessed loss of earning capacity. In addition, a large part of the labour market has a supplementary system, based on collective agreements between the social partners on the labour market (employers organizations in the public and private sectors and corresponding trade unions) for compensation to the insured population for pain and suffering, disability and handicap and other types of incapacity. This collective insurance programme is referred to as the Labour Market No-Fault Liability Insurance (TFA). It operates on a no-fault basis, meaning that, for recognition of a claim, there is no requirement on the claimant to prove negligence on the part of the employer or anyone else involved in the claim at issue. This supplementary insurance system is not required or regulated by law, and is operated jointly on a partnership basis by the employers’ organizations and the trade unions.

The following discussion will focus on the official legislated system in Sweden.

Organization

The official system operates on the basis of notifications submitted by those insured when the injury occurs. The insured population consists of everyone employed on the labour market at the point in time when the disease or health problem manifests itself. The notification—which in practice means that the injured person fills out a form—is handed to the employer, who is obliged to forward it to a local or regional social insurance bureau. After due examination of the documentation and evidence appended to the notification, a decision is taken by a regional Social Insurance Board, approving or rejecting the claim.

If the claimant or somebody else involved is not satisfied with the decision taken by the Social Insurance Board, the case may be referred to an administrative court of appeal. This court is part of the Swedish judiciary.

The Swedish system in force as of 1 January 1993 is designed to operate on the basis of three fundamental principles:

• the concept of occupational injury

• the concept of hazardous agent at work

• the concept of causality of hazardous agent with regard to the disease at issue.

Occupational Injury

The occupational injury concept has two main components, namely occupational accidents and occupational diseases. The operative part of the concept lies in the term injury. This may be caused by either an accident at work or a hazardous factor causing a disease and operating at the present workplace or in some previously held work. The injury concept thus encompasses both consequences of bodily harm caused by accidents and diseases or impairments viewed as caused by other agents, such as physical, chemical, psychological or other types of environmental factors operating at work. The disease concept as implemented has a broad scope. It covers both diseases, as classified by, for instance, the WHO classification of diseases, and, in addition, functional disturbances, ailments or impairments perceived by the individual as health aberrations. This means that there is no officially defined list of occupational diseases or work-related diseases in Sweden. Any disease or impairment, as referred to above, may be regarded and recognized as occupationally induced, depending on the evidence presented to support a claim for economic compensation. This means that, in addition to a disease or health problem directly caused by work or workplace factors, the following factors may be included in the concept of occupational injury:

• early manifestation of disease that is work-related but which also occurs in the general population without any association to working conditions

• disease or functional disturbances causally unrelated to working conditions but where workplace factors may contribute to accelerating or worsening the disease.

This broad occupational injury concept has been applied since 1977, and it was not changed in the amended law in force since 1 January 1993. This means that there is no closed list of occupational diseases. Nor is any distinction made between diseases that are occupationally caused and those that are work-related. Recognition of a disease or functional disturbance reported by an injured person (who is covered by the social security system) as an occupational injury depends on the evidence presented by the claimant.

The use of this broad concept aims at making the system capable of identifying any health problem that may have been contributed to or caused by conditions at work.

The Hazardous Agent at the Workplace

The recognition of an occupational injury is dependent on identifying a hazardous agent at the workplace. If such an agent cannot be identified and assessed to be sufficiently relevant to the type of injury at issue, the disease or functional impairment cannot be approved as a case of occupational injury.

Hazardous agent implies any physical, chemical or other agent which may adversely affect the health status of the employees. There are some limitations with regard to scope. The law does not consider to be hazardous agents factors related to closing down enterprises, industrial disputes, lack of social support, or non-adaptation to prevailing workplace culture and other similar conditions.

The requirements in the law in force as of 1 January 1993 have been defined as: “A hazardous agent is a factor which in high probability may cause disease or impairment.”

This phrasing represents—in comparison with the law in force until 31 December 1992— an enhanced level of requirement on the evidence to be considered by the social insurance boards. It is also made explicit in the explanatory texts attached to the legislation that the assessments of hazardous properties of the agent under consideration should conform to a mainstream of opinion—or ideally a consensus—among qualified medical experts. If there are diverse and dissenting expert opinions on the assessment of hazardous properties the criterion of high probability will not be satisfied.

The assessment of the hazardous agent also implies an assessment of quantity. The exposure to the agent at issue is to be considered with regard to duration, intensity and other criteria judged to determine hazardous properties.

Causal Relationship

Once the existence or previous occurrence of a hazardous agent has been established as highly probable—which in this context also includes an assessment of quantity—the next step is to arrive at a conclusive judgement on the plausibility of a causal relationship in the individual case at issue. The general rule to follow is that the weight of evidence should be in favour of causality for recognition of the disease or health problem as an occupational injury. According to the earlier legislation, in force until 31 December 1992, the causality concept was significantly more flexible. Causality was presumed once the presence of a hazardous agent had been accepted as a probability and no evidence to the contrary could be presented. The burden of evidence has now been reversed. The requirement is now a positive weight of evidence in favour of a causal relationship. In practice it means that a need arises to also consider alternative causal explanations. This may include, for instance, aspects of the claimant’s lifestyle and leisure time activities or personal situation in general.

Assessment of Individual Vulnerability

The basic principle in implementing the legislation is that all insured are to be accepted, with their constitutional weaknesses and vulnerabilities. This principle may give rise to considerable difficulties, for instance in assessing health problems related to hypersensitivity reactions and allergic diseases. It may be very difficult to make informed judgements of the relative contributions from the person’s constitution and environmental/occupational factors, respectively. The difficulty in such instances arises in defining and assessing the properties of the hazardous agent. The agent (for instance, exposure to a workplace chemical or an air pollutant) may be harmless to most exposed persons but not to those who are particularly susceptible.

Occupational Injury Compensation and Preventive Action

The Swedish legal system for paying compensation to injured persons and the legal systems for enforcing occupational health preventive measures are separate and not directly related. The rate of workplace accidents or occupational injuries does not affect the level of financial contributions by employers or enterprises. This is sometimes referred to as a flat rate of payment.

The compensation system functions only for payments to persons with recognized occupational injury and has no bearing on enforcement of preventive action.

The same rules applies for occupational rehabilitation, regardless of whether the disease or injury has been recognized as an occupational injury or not. The employer has an obligation in principle to take steps to initiate a rehabilitation process when workers have been absent from work for 4 weeks or more.

The Role of Social Partners

The social insurance legislation accords the social partners (i.e., employers’ organizations and the trade unions) no role in rejecting or approving compensation claims for occupational injury. On the company level the employer is obliged by law to pass on to the social insurance system any claim for occupational injury submitted by an employee. The trade union organizations commonly provide advice and support to claimants among their members. Such assistance includes drafting claims, examining workplace conditions and giving advice.

The Present Situation

Since the present legislation has been officially in force, the supervising authorities have to a large extent been busy dealing with the considerable accumulation of injuries reported under the previous legislation. This means that there is only limited experience from the present law and the official public statistics are incomplete.

At the present time there is a need to elaborate practical guidelines for implementing the legislation. The Swedish Labour Market Insurance (TFA) trust—jointly with the National Institute for Working Life—recently published a report describing the extent of knowledge regarding disease and occupational factors for selected disease categories. At the present time such descriptions are available for tumour disease, diseases of the nervous system, diseases of the lung and pleura, malignant disease, cardiovascular disease, skin disease and work-related loss of hearing (National Institute for Working Life and Labour Market No-Fault Liability Insurance Trust 1995). A further volume on psychological disturbances and stress-related mental disorders is in preparation.

Before the change of the law on compensation for occupational injury, the level of occupational diseases in the early 1990s was around 50,000 to 55,000 claims recognized annually. The number of reported and recognized occupational accidents during this time was 20,000 to 22,000. Musculoskeletal disorders constituted a major part (80%) of the reported occupational diseases.

One important factor affecting levels of reported occupational injuries is the automatic coordination of payments received from the occupational injury system and the general sickness benefit system, respectively. In 1993 the coordination time was increased from 90 days to 180 days. This implies that an injury or disease, although causally related to work, is not compensated unless it leads to long-term absence from work (more than 180 days) or to permanent disability. The compensation during the first 180-day period is covered by the general sickness benefit scheme.

It is expected that the number of reported occupational injuries and, consequently, of recognized cases will decline significantly, starting in the near future. The official statistic routines have not yet been adapted to the changes in legislation. This means that the number of notifications and recognized occupational injuries recorded at the present time consist of a combination of claims under the previous legislation and claims that are settled on the basis of the legislation in force as of 1 January 1993. As a consequence, the official statistics cannot at the present time describe the impact of the amendments in the legislation referred to above.

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