Medico-legal aspects of malignant mesothelioma

The object of this investigation was to discuss medico-legal aspects of malignant mesothelioma in relation to social insurance legislation for occupational injuries and diseases in Norway. During the period 1960-79 the Cancer Registry of Norway recorded a total of 155 men and 35 women with malignant mesothelioma. However, only 21 men and no women were notified to the National Insurance Institution as occupational disease cases before 31 December 1979, in spite of the well established causal association between occupational asbestos exposure and the disease. The investigation is based on these 21 patients. The long latency period from first asbestos exposure until appearance of the disease and the short survival were evident in this study. Furthermore, the legislation and provisions for occupational injuries and diseases in Norway are obviously intended for occupational accidents, and consequently the legal assessment of patients with malignant mesothelioma was complicated. For those notified, the delay in notification was considerable, and only 50% were notified before death. Delay in the claim procedure was also substantial, and few patients survived the claim procedure period. The decisions were not consistent, particularly decisions regarding "the year of injury" and appeared to have been more restrictive during recent years. One of the 21 cases was not accepted as occupational disease, because domestic exposure was considered more probable than occupational exposure.