123

Fine tuning our practical approach to the new Hearing Conservation Legislation

Dr Stefanus Snyman
(snymans@new.co.za)

Background to 168 & 171

1994 - Compensation Commissioner, without consultation and without proper evaluation of financial or logistical impact, issued Instruction 168

The previous Instruction was perceived as being unfair (3 average frequencies, etc...)

II 168 was wrongly considered to be a viable alternative - lack of a proper actuarial valuation

Background (2)...

It was done unilaterally by the Commissioner

II 168 was based on American AMA / ENT formula

More than a dozen of these AMA assumptions are based ± arbitrary nature

Background (3)...

The “low fence” of average hearing loss was lowered from 43dB to 26dB without any transitional arrangements

12% of miners immediately became compensatable - 3% previously

Background (Summary)

168 - no consultation - not even Compensation Board

Unwillingness to acknowledge mistake

Scientific base questioned

Implementation cost tremendous

NIHL Compensation in South Africa

Technical Committee

Must address NIHL comprehensively

Focus on prevention

Developed 7 supportive modules

New Instruction 171

Approved by Board end 1999

NIHL Legislative framework

Where did II 171 originate from?

Based on German model

Refined by Australia

Adapted by actuaries for RSA to accommodate local equipment

What is better in II 171?

Real incentive for prevention

Employer accountable for NIHL caused (risk rating)

No discrimination

Compares with best in the world

“Window opportunity” to correct and manage risk

Problems with II 171

To co-ordinate all the legislation

Baselines are cumbersome - Administration and better software are required

Failure to utilise “window opportunity” will be costly (failure will benefit the employee)

Information technology & software still lacking

168 vs 171

Low fence of 26 dBA

No baseline

Frequency of compensation uncertain

No weighting of frequencies

No low fence

Baseline

Compensation only when 10% PLH from baseline

Weighting of critical hearing frequencies

168 vs 171 (cont.)

No incentive for prevention

ENT certified

Difficult to monitor stats

Strong incentive for prevention

ENT if PLH >30% from baseline (>15% disability)

Easy to monitor stats

Baseline

By 16 November 2003 or within 30 days of employment

16h noise free (no PPE (& no taxi noise!!) prior to testing

Better of 2 screening audiograms (not to differ >10 dB at 0.5, 1, 2, 3, 4 kHz)

If difference >10dB - audiologist to perform baseline

Baseline (2) ...

Same sitting

Basis for future NIHL - baseline for life

If no baseline done by Nov 2003 the baseline PLH will be considered 1.1%

Periodic Screening

Annually

16h noise free (PPE allowed)

PLH calculation

If PLH >10% from baseline - Repeat

If still >10% from baseline - Refer to OHMP

Then for diagnostic, ENT (if >30 % from baseline) & Comp Comm.

Periodic Screening (cont…)

Deterioration of PLH in workers with PLH <10% from baseline

Compare 3, 4, 6 kHz - (>15 dB difference)

or >15 dB increase at 4kHz only

or Schilling (good for general pathology, not NIHL necessarily)

or PLH criteria (but what is arbitrary and what scientific?)

Exit audiometry

If you leave noise zone permanently

16h noise free (no PPE allowed)

Calculate PLH

Enter baseline, “pre-employment” (if applicable), exit and PLH onto exit certificate

Diagnostic Audiometry

24h noise free (no PPE)

Pure tone & bone

2 audiograms - different sittings; same day

If more than 10dB difference between audiograms (X3) - try in 6 months again.

Diagnostic (cont…)

If PLH 10-30% from baseline - OHMP

If PLH >30% from Baseline - ENT

>10% from baseline - compensation

Percentage disability = ½ X PLH

Compensation Commissioner

Employee

to report incident within 12 months (with medical reports)

Employer

WCl 1 (E) - Report of occupational disease

WCl 14 - Notice of an occupational disease

OD2 – Industrial Hearing Loss Exposure Form

Comp. Comm. (cont…)

Employer...Supporting documentation:

history

period of exposure

daily duration of exposure

? still exposed

? last exposed

noise levels dBA

baseline audiogram

2 diagnostic audiograms

copy of employee’s ID

Comp. Comm. (cont…)

OHMP / ENT submit via employer

Submit WCl 22 (First & Final Report)

Medical reports (all other causes excluded)

Admin. challenge – the following info needed for each employee

Surname, Names, ID, DOB, age, Clock #

Employer (code), department (Code)

Date of employment

Current & Previous Noise levels and Exposure (dates)

Admin. challenge (cont)
Info on each worker

Hearing Protection (Y/N/Sometimes) - since when?

Medication (ototoxic)

Colds, Allergies, Wax

Family history

Admin. challenge (cont)
Info on each worker

Head injury

Ear discharge / infections

Previous diseases (TB, meningitis, etc.)

Tinnitus

Military Service; Hobbies

Physical Examination

Admin. challenge (cont)
Info on each worker

Baseline audiometric data & PLH

Current hearing threshold levels & PLH

Difference between baseline & current - relevant comments

Details of actions

Name of OHMP, audiologist, ENT (& codes

Medical Reports

Slide 28


	Fine tuning our practical approach to the new Hearing Conservation Legislation Dr Stefanus Snyman (snymans@new.co.za)


	1994 - Compensation Commissioner, without consultation and without proper evaluation of financial or logistical impact, issued Instruction 168
	The previous Instruction was perceived as being unfair (3 average frequencies, etc...)
	II 168 was wrongly considered to be a viable alternative - lack of a proper actuarial valuation


	It was done unilaterally by the Commissioner
	II 168 was based on American AMA / ENT formula
	More than a dozen of these AMA assumptions are based ± arbitrary nature


	The “low fence” of average hearing loss was lowered from 43dB to 26dB without any transitional arrangements
	12% of miners immediately became compensatable - 3% previously


	168 - no consultation - not even Compensation Board
	Unwillingness to acknowledge mistake
	Scientific base questioned
	Implementation cost tremendous


	Must address NIHL comprehensively
	Focus on prevention
	Developed 7 supportive modules
	New Instruction 171
	Approved by Board end 1999


	Based on German model
	Refined by Australia
	Adapted by actuaries for RSA to accommodate local equipment


	Real incentive for prevention
	Employer accountable for NIHL caused (risk rating)
	No discrimination
	Compares with best in the world
	“Window opportunity” to correct and manage risk


	To co-ordinate all the legislation
	Baselines are cumbersome - Administration and better software are required
	Failure to utilise “window opportunity” will be costly (failure will benefit the employee)
	Information technology & software still lacking



	Low fence of 26 dBA
	No baseline
	Frequency of compensation uncertain
	No weighting of frequencies

	No low fence
	Baseline
	Compensation only when 10% PLH from baseline
	Weighting of critical hearing frequencies



	No incentive for prevention
	ENT certified
	Difficult to monitor stats

	Strong incentive for prevention
	ENT if PLH >30% from baseline (>15% disability)
	Easy to monitor stats


	By 16 November 2003 or within 30 days of employment
	16h noise free (no PPE (& no taxi noise!!) prior to testing
	Better of 2 screening audiograms (not to differ >10 dB at 0.5, 1, 2, 3, 4 kHz)
	If difference >10dB - audiologist to perform baseline


	Same sitting
	Basis for future NIHL - baseline for life
	If no baseline done by Nov 2003 the baseline PLH will be considered 1.1%


	Annually
	16h noise free (PPE allowed)
	PLH calculation
		If PLH >10% from baseline - Repeat
		If still >10% from baseline - Refer to OHMP
		Then for diagnostic, ENT (if >30 % from baseline) & Comp Comm.


	Deterioration of PLH in workers with PLH <10% from baseline
		Compare 3, 4, 6 kHz - (>15 dB difference)
		or >15 dB increase at 4kHz only
		or Schilling (good for general pathology, not NIHL necessarily)
		or PLH criteria (but what is arbitrary and what scientific?)


	If you leave noise zone permanently
	16h noise free (no PPE allowed)
	Calculate PLH
	Enter baseline, “pre-employment” (if applicable), exit and PLH onto exit certificate


	24h noise free (no PPE)
	Pure tone & bone
	2 audiograms - different sittings; same day
	If more than 10dB difference between audiograms (X3) - try in 6 months again.


	If PLH 10-30% from baseline - OHMP
	If PLH >30% from Baseline - ENT
	>10% from baseline - compensation
	Percentage disability = ½ X PLH


	Employee
		to report incident within 12 months (with medical reports)
	Employer
		WCl 1 (E) - Report of occupational disease
		WCl 14 - Notice of an occupational disease
		OD2 – Industrial Hearing Loss Exposure Form


		Employer...Supporting documentation:
			history
			period of exposure
			daily duration of exposure
			? still exposed
			? last exposed
			noise levels dBA
			baseline audiogram
			2 diagnostic audiograms
			copy of employee’s ID


	OHMP / ENT submit via employer
		Submit WCl 22 (First & Final Report)
		Medical reports (all other causes excluded)


	Surname, Names, ID, DOB, age, Clock #
	Employer (code), department (Code)
	Date of employment
	Current & Previous Noise levels and Exposure (dates)


	Hearing Protection (Y/N/Sometimes) - since when?
	Medication (ototoxic)
	Colds, Allergies, Wax
	Family history


	Head injury
	Ear discharge / infections
	Previous diseases (TB, meningitis, etc.)
	Tinnitus
	Military Service; Hobbies
	Physical Examination


	Baseline audiometric data & PLH
	Current hearing threshold levels & PLH
	Difference between baseline & current - relevant comments
	Details of actions
	Name of OHMP, audiologist, ENT (& codes
	Medical Reports