A Scoping Review of Causal Associations between Occupation and Cancer Occurrence and Legal Burden of Proof

Occupational diseases, characterized by the gradual accumulation of work-related harmful effects over extended periods, often lack a distinct, identifiable incident causative of the disease. This ambiguity in pinpointing the work-relatedness of such diseases stems from the intricate interplay between occupational risks, workers' pathophysiological predispositions, and pre-existing health conditions, all of which evolve slowly over time. Consequently, establishing a definitive causal relationship between occupational exposure and disease manifestation becomes a pivotal, yet challenging, aspect in securing industrial accident insurance benefits. In contrast to occupational accidents, where causality is relatively more discernible, the complexity escalates in the context of occupational diseases. Typically, employers maintain the majority of data pertinent to establishing causality, but this data is frequently inadequate. Furthermore, the onus of proving the work-relatedness of a disease falls on the worker, a process that necessitates specialized medical knowledge, thereby compounding the difficulty. Imposing the burden of proof on workers in occupational disease litigation could lead to a lapse in worker protection. This paper critically explores methodologies to safeguard workers, focusing specifically on the burden of proof concerning causality in occupational diseases. This analysis aims to highlight the challenges workers face in establishing a connection between their work and disease, proposing potential legal and policy solutions to ensure more equitable and just outcomes in occupational disease claims.