IR Medical Requirements

WRG Medical Requirements and Evidence Required to Establish an Asbestos-Related Disease for Individual Review Claimants

Level I: Other Asbestos Disease

Medical Criteria

1. Diagnosis of a bilateral asbestos-related non-malignant disease or an asbestos-related malignancy other than mesothelioma based upon either:
   • A physical exam of the claimant by the physician providing the diagnosis, or
   • If the claimant is deceased at the time the claim was filed, pathological evidence of the non-malignant asbestos-related disease.
2. Evidence of a bilateral asbestos-related non-malignant disease based upon:
   • A chest x-ray read by a certified B-reader of 1/0 or higher¹; or
   • A chest x-ray read by a certified B-reader or read by a qualified physician², or
   • A CAT scan read by a qualified physician², or
   • A pathology report, in each case, showing bilateral interstitial fibrosis, bilateral pleural plaques, bilateral pleural thickening, or bilateral pleural calcification.
3. 10 year latency.

Exposure Criteria

1. WRG Exposure as defined in Section 5.7(b)(3) of the TDP prior to December 31, 1982, or prior to the Effective Date (February 3, 2014) if the exposure qualifies under Section 5.7(b)(3)(ii).

Note:  Individual Review Process may not be elected for Level I claims unless the PI Trust deems that it has failed to meet the presumptive Medical/Exposure criteria.

Level II: Asbestosis/Pleural Disease

Medical Criteria

1. Diagnosis of an asbestos-related non-malignant disease based upon either:
   • A physical exam of the claimant by the physician providing the diagnosis, or
   • If the claimant is deceased at the time the claim was filed, pathological evidence of the non-malignant asbestos-related disease.
2. Evidence of a bilateral asbestos-related non-malignant disease based upon:
   • A chest x-ray read by a certified B-reader of 1/0 or higher¹; or
   • A chest x-ray read by a certified B-reader or read by a qualified physician², or
   • A CAT scan read by a qualified physician², or
   • A pathology report, in each case, showing bilateral interstitial fibrosis, bilateral pleural plaques, bilateral pleural thickening, or bilateral pleural calcification.
3. 10 year latency.

Exposure Criteria

1. Six months WRG Exposure prior to December 31, 1982, or prior to the Effective Date (February 3, 2014) if the exposure qualifies under Section 5.7(b)(3)(ii) of the TDP; and
2. For claimants whose WRG Grace exposure is not described Section 5.7(b)(3)(ii) of the TDP, five years cumulative occupational exposure to asbestos.

Level III: Asbestosis/Pleural Disease

Medical Criteria

1. Diagnosis of an asbestos-related non-malignant disease based upon either:
   • A physical exam of the claimant by the physician providing the diagnosis, or
   • If the claimant is deceased at the time the claim was filed, pathological evidence of the non-malignant asbestos-related disease.
2. Evidence of a bilateral asbestos-related non-malignant disease based upon:
   • A chest x-ray read by a certified B-reader of 1/0 or higher¹; or
   • A chest x-ray read by a certified B-reader or read by a qualified physician², or
   • A CAT scan read by a qualified physician², or
   • A pathology report, in each case, showing bilateral interstitial fibrosis, bilateral pleural plaques, bilateral pleural thickening, or bilateral pleural calcification.
3. Pulmonary Function Testing with either:
   • A TLC less than 80%, or
   • FVC less than 80% and FEV1/FVC ratio greater than or equal to 65%, or
   • Pulmonary Function Test must be in compliance with the quality criteria established by the ATS³.
4. 10 year latency.
5. Supporting medical documentation establishing asbestos exposure as a contributing factor in causing the pulmonary disease.

Exposure Criteria

1. Six months of WRG Exposure prior to December 31, 1982, or prior to the Effective Date (February 3, 2014) if the exposure qualifies under Section 5.7(b)(3)(ii) of the TDP;
2. For claimants whose WRG Grace exposure is not described in Section 5.7(b)(3)(ii) of the TDP, Significant Occupational Exposure to asbestos

Level IV-A: Severe Asbestosis

Medical Criteria

1. Diagnosis of asbestosis based upon either:
   • A physical exam of the claimant by the physician providing the diagnosis, or
   • If the claimant is deceased at the time the claim was filed, pathological evidence of the non-malignant asbestos-related disease.
2. An ILO of 2/1 or greater, or
   • Pathological evidence of asbestosis.
3. Pulmonary Function Testing with either
   • TLC less than 65%, or
   • FVC less than 65% and FEV1/FVC ratio greater than 65%, or
   • Pulmonary Function Test must be in compliance with the quality criteria established by the ATS³.
4. 10 year latency.
5. Medical documentation establishing asbestos exposure as a contributing factor in causing the pulmonary disease in question.

Exposure Criteria

1. Six months of WRG Exposure prior to December 31, 1982, or prior to the Effective Date (February 3, 2014) if the exposure qualifies under Section 5.7(b)(3)(ii) of the TDP;
2. For claimants whose WRG Grace exposure is not described in Section 5.7(b)(3)(ii) of the TDP, Significant Occupational Exposure to asbestos

Level IV-B: Severe Disabling Pleural Disease

Medical Criteria

1. Diagnosis of diffuse pleural thickening (extent “2” and at least width “a”) based upon:
   • A physical exam of the claimant by the physician providing the diagnosis, or
   • If the claimant is deceased at the time the claim was filed, pathological evidence of the non-malignant asbestos-related disease.
2. Evidence of diffuse pleural thickening of at least extent “2” and at least width “a”.
3. Pulmonary Function Testing with either
   • TLC less than 65%, or
   • FVC less than 65% and FEV1/FVC ratio greater than 65%, or
   • Pulmonary Function Test must be in compliance with the quality criteria established by the ATS³.
4. 10 year latency.
5. Medical documentation establishing asbestos exposure as a contributing factor in causing the pulmonary disease in question.

Exposure Criteria

1. Six months of WRG Exposure prior to December 31, 1982, or prior to the Effective Date (February 3, 2014) if the exposure qualifies under Section 5.7(b)(3)(ii) of the TDP;
2. For claimants whose WRG Grace exposure is not described in Section 5.7(b)(3)(ii) of the TDP, Significant Occupational Exposure to asbestos

Note:  The definition of diffuse pleural thickening, extent and width must come from the 2000 ILO Classification for Pneumoconiosis.  Use of this category requires adherence to the 2000 ILO classification.

Level V: Other Cancer

Medical Criteria

1. A diagnosis of a primary colo-rectal, laryngeal, esophageal, pharyngeal, or stomach cancer based upon either:
   • A physical exam of the claimant by the physician providing the diagnosis of the asbestos related disease, or
   • A diagnosis of such a malignant disease by a board-certified pathologist or by a pathology report prepared at or on behalf of a JCAHO accredited hospital.
2. Evidence of an underlying bilateral asbestos-related non-malignant disease based upon:
   • A chest x-ray read by a certified B-reader of 1/0 or higher¹, or
   • A chest x-ray read by a certified B-reader or read by a qualified physician², or
   • A CAT scan read by a qualified physician², or
   • A pathology report, in each case, showing bilateral interstitial fibrosis, bilateral pleural plaques, bilateral pleural thickening, or bilateral pleural calcification.
3. A causal statement from a medical doctor linking the other cancer in question to asbestos exposure.
4. 10 year latency.

Exposure Criteria

1. Six months of WRG Exposure prior to December 31, 1982, or prior to the Effective Date (February 3, 2014) if the exposure qualifies under Section 5.7(b)(3)(ii) of the TDP;
2. For claimants whose WRG Grace exposure is not described in Section 5.7(b)(3)(ii) of the TDP, Significant Occupational Exposure to asbestos

Level VI: Lung Cancer 2

Medical Criteria

1. A diagnosis of a primary lung cancer based upon either:
   • A physical exam of the claimant by the physician providing the diagnosis of the asbestos related disease, or
   • A diagnosis of such a malignant disease by a board-certified pathologist or by a pathology report prepared at or on behalf of a JCAHO accredited hospital.
2. A causal statement from a medical doctor linking the lung cancer to asbestos exposure.
3. 10 year latency.

Exposure Criteria

1. WRG Exposure as defined in Section 5.7(b)(3) of the TDP prior to December 31, 1982, or prior to the Effective Date (February 3, 2014) if the exposure qualifies under Section 5.7(b)(3)(ii).

* Lung Cancer 2 (Level VI) claims are claims that do not meet the medical and/or exposure criteria of Lung Cancer 1(Level VII).  All claims with this Disease Level will be individually evaluated.

There is no distinction between non-smokers and smokers for either Lung Cancer 1 (Level VII) or Lung Cancer 2 (Level VI).  A claimant who meets the requirements of Lung Cancer 1, and is a non-smoker may wish to have his or her claim individually evaluated by the Trust.

Level VII: Lung Cancer 1

Medical Criteria

1. A diagnosis of a primary lung cancer based upon either:
   • A physical exam of the claimant by the physician providing the diagnosis of the asbestos related disease, or
   • A diagnosis of such a malignant disease by a board-certified pathologist, or by a pathology report prepared at or on behalf of a JCAHO accredited hospital.
2. Evidence of an underlying bilateral asbestos-related non-malignant disease based upon:
   • A chest x-ray read by a certified B-reader of 1/0 or higher¹, or
   • A chest x-ray read by a certified B-reader or other qualified physician², or
   • A CAT scan read by a qualified physician², or
   • A pathology report, in each case showing bilateral interstitial fibrosis, bilateral pleural plaques, bilateral pleural thickening, or bilateral pleural calcification.
3. A causal statement from a medical doctor linking the lung cancer to asbestos exposure.
4. 10 year latency.

Exposure Criteria

1. Six months of WRG Exposure prior to December 31, 1982, or prior to the Effective Date (February 3, 2014) if the exposure qualifies under Section 5.7(b)(3)(ii) of the TDP;
2. For claimants whose WRG Grace exposure is not described in Section 5.7(b)(3)(ii) of the TDP, Significant Occupational Exposure to asbestos.

Level VIII: Mesothelioma

Medical Criteria

1. A diagnosis of a mesothelioma based upon either:
   • A physical exam of the claimant by the physician providing the diagnosis of the asbestos related disease, or
   • A diagnosis of such a malignant disease by a board-certified pathologist or by a pathology report prepared at or on behalf of a JCAHO accredited hospital.
2. 10 year latency.

Exposure Criteria

1. WRG Exposure as defined in Section 5.7(b)(3) of the TDP prior to December 31, 1982, or prior to the Effective Date (February 3, 2014) if the exposure qualifies under Section 5.7(b)(3)(ii).

Note:  A finding by a physician after the Effective Date that a claimant’s disease is “consistent with” or “compatible with” asbestosis will not alone be treated by the Trust as a diagnosis.

¹For claims filed before the petition date, if an ILO reading is not available, then WRG will accept a chest x-ray report (read by a Qualified Physician) regardless of whether it was read by a qualified B-reader.

²Qualified Physician – Physician board-certified in a specialized field of medicine, such as pulmonology, radiology, internal medicine, or occupational medicine.

³ATS – American Thoracic Society.

⁴Significant Occupational Exposure – Employment for a cumulative period of at least five years with a minimum of two years prior to December 31, 1982 in an industry and an occupation in which the claimant:

A. handled raw asbestos fibers on a regular basis;

B. fabricated asbestos-containing products so that the claimant in the fabrication process was exposed on a regular basis to raw asbestos fibers;

C. altered, repaired or otherwise worked with asbestos-containing products such that the claimant was exposed on a regular basis to asbestos fibers;

D. was employed in an industry and occupation such that the claimant worked on a regular basis in close proximity to workers engaged in the activities described in (a), (b) and/or (c).