The United States, Canada, and most European countries recognize OA as a compensable disease, and the clinician should support workers compensation claims when appropriate. WEA is less commonly recognized as compensable, although certain compensation systems have started to, such as the one in Ontario, Canada. Workers’ compensation is typically a no-fault compensation system paid for by employers and administered by governmental agencies (in Canada Pharmacy and Europe) or private insurance companies (in the United States). Compensation typically covers related medical expenses, variable income replacement, and some job retraining; however, the systems vary, with different diagnostic criteria, and variable acceptance of claims and benefits.

Data on compensation systems, such as the extent of benefits, or which compensation strategies may more effectively mitigate the adverse socioeconomic outcomes related to OA, are limited. A substantial number of workers with diagnosed sensitizer-induced OA remain exposed to the causative agent, presumably to avoid unemployment or lesser employment. In one study, workers in whom OA had been diagnosed were more likely to receive compensation benefits than those in whom WEA had been diagnosed. It is difficult to draw conclusions regarding the impact of compensation benefits, as there are other differences between comparison groups in these studies, such as the severity of asthma.

The standard used for workplace causality in most compensation systems is “more probable than not” or > 50% likely to be work related. As noted above, it is in the patient’s best interest for the physician to obtain as much objective diagnostic information as possible, both to avoid unemployment in workers who do not have WRA and to be able to assist those who do have WRA to obtain appropriate compensation. Workers should be evaluated for respiratory impairment by the objective assessment of asthma severity using appropriate guidelines, such as that published by the American Thoracic Society. The extent of disability, the ability to work at a specific job, depends on several factors, including the presence of the sensitizing agent, in which case the worker may be completely disabled from workplaces with that specific exposure.