He lost his lungs and had to fight for workers' compensation

By the time Dennys René Rivas Williams became so ill that he needed new lungs, doctors at Olive View-UCLA Medical Center had little doubt about the cause of his illness.

Doctors had diagnosed the 36-year-old with silicosis, an incurable disease caused by inhaling tiny bits of lung-scarring silica. It was a condition that had debilitated dozens of Los Angeles County workers like him who had been toiling away cutting countertops for kitchens and bathrooms.

Health officials had sounded the alarm that a new epidemic of the disease was killing young workers amid the growing popularity of engineered stone, which typically contains much more silica than natural slabs. More than a dozen California countertop-cutting workers have died from the disease in recent years.

Rivas Williams' medical records show that his silicosis was the result of “manipulated stone processing/working.” A doctor advised him to quit his job to prevent further damage.

Yet Rivas Williams was rejected when he applied work compensationwhich is supposed to cover medical care and other benefits for workers injured on the job. Lawyers representing the young father were irked, wondering where else he could have inhaled so much silica.

Rivas Williams said the Pacoima store where he worked was covered in dust, and he and other employees were offered only thin masks, rather than protective respiratory equipment. In January, he underwent a double lung transplant — a life-saving operation that often provides only an extra six years of survival.

Silicosis has been known as an occupational disease for centuries, affecting miners, quarry workers and others exposed to silica dust.

The vast majority of cases are work-related, says Dr. Jane Fazio, a pulmonologist and researcher at UCLA. Among countertop cutters, “if someone has this job and they have silicosis, it should clearly be assumed that it’s work-related.”

But while California is seeing a growing number of young workers suffering from the disease, many have not yet applied for workers’ compensation. Help can include medical care, disability benefits and death benefits for families.

Fazio and other researchers analyze Dozens of cases of California counter workers suffering from silicosis showed that only 13 percent were eligible for workers’ compensation when they were diagnosed and treated. Nearly half continued working in the industry even after they were diagnosed.

According to Kevin Riley, director of the UCLA Labor Occupational Safety & Health Program, workers' compensation should ensure that workers who are injured on the job “do not have to trade their income for their health” and “have access to medical care and time off from work and disability and other types of resources they need to get back to full health.”

Employers in California are required to provide workers’ compensation benefits to their employees, usually by purchasing insurance. A state fund can handle such claims if a company violates the requirements, but advocates say many workers — especially immigrants — fear retaliation for even pursuing the benefits.

And workers’ compensation attorneys say filing a claim is no guarantee that workers will get help quickly, even for an illness that is widely recognized as work-related. Attorney Gary Rodich said this summer that his firm represented more than a dozen workers with silicosis who were denied workers’ compensation benefits when they filed — including Rivas Williams.

Before his diagnosis, Rivas Williams had filed a claim alleging damage to his lungs, along with “repetitive work” injuries to his knees, shoulders and other parts of his body, aided by another attorney. The denial letter from Amtrust North America said there was insufficient evidence that “your alleged injury resulted from your employment at Primus Marble,” the store where he worked.

Shortly after he was diagnosed with silicosis, Rivas Williams filed an amended claim with Rodich’s help. In medical reports obtained for his case, doctors drew a direct line to his work as a countertop cutter. One wrote that his silicosis was “100% work related.”

Amtrust said in May that its case “involves several complex issues that our claims team is working diligently to resolve.” It did not respond to questions from The Times about what those issues were.

Rivas Williams's state disability benefits expired last year. In January, his attorneys accused the insurance company of “unreasonable and/or frivolous delay” in a court filing, saying it had pushed him to the brink of homelessness. At the time, nearly a year and a half had passed since his first claim.

That same month, according to his lawyers, Amtrust agreed to pay temporary benefits while the two sides continued to negotiate. Amtrust said in a May email that “we are confident that a resolution will be reached shortly.”

Rivas Williams must take a series of pills morning and night to keep his body from rejecting his new lungs. The drugs disarm his immune system, leaving him vulnerable to other threats. His doctors warn him to avoid cigarette and marijuana smoke, so he boards the windows of his South Los Angeles home.

Rivas Williams, 36, shows the scar from a double lung transplant.

(Al Seib / For The Times)

“I’m locked up almost all the time,” Rivas Williams said in Spanish in an April interview. “I’m afraid to go out because I have no defense.”

He knows three men who have died from the disease. When he went to say goodbye to one of them, “it destroyed me mentally. I went into a downward spiral. I saw his children crying. And I felt like I was seeing my own children crying.”

The 36-year-old said his goal was to support his children, whom he brought to the U.S. from Guatemala. Rivas Williams said he blew through his savings and racked up debt after becoming ill.

“Not everything in this life is money,” Rivas Williams said. “But imagine if I wasn’t there.

“Their lives are going to change.”

In June — nearly two years after Rivas Williams first filed for workers’ compensation — the two sides reached a settlement. Rodich said his client declined to disclose the amount.

Primus Marble, where Rivas Williams once worked, did not respond to requests for comment.

As of early July, the California Department of Public Health had identified 156 cases of silicosis linked to engineered stones in recent years — more than 90 of them among Los Angeles County residents. Nearly half of those cases were identified last year alone, amid growing awareness of the silicosis epidemic.

Public health officials believe many more cases have gone undetected because immigrant workers are not receiving care or are misdiagnosed with other lung diseases. Outbreaks of the deadly disease have erupted worldwide as engineered rock has become so popular.

In Australia, an alarming rise in cases led government officials to ban constructed stonesilicosis is categorized under “dear diseases” for workers compensation — those probably caused by work unless there is strong evidence to the contrary.

If an Australian worker has silicosis, “I diagnose someone. I fill out” the paperwork, said Dr Ryan Hoy, chief physician at the occupational respiratory clinic at Melbourne’s Alfred Hospital. “It goes to the regulator and they accept the claim. They can’t deny it.”

That doesn't exist here for countertop cutters. California has granted “presumed eligibility” for workers' compensation for some ailments, such as COVID-19 illness suffered by health care workers and first responders earlier in the pandemic — but not for silicosis claims from stonemasons.

In the US, workers' compensation varies from state to state, but the problems that silicosis patients have experienced in California are not unique. In a study of silicosis patients in Wisconsin, researchers found that many had experienced difficulty obtaining workers' compensation “and were frustrated by having to prove the work-related nature of silicosis — a condition rarely acquired outside of work.”

Nearly all applications were initially denied because their medical records did not contain information about their employment history. However, information about their employment history is not routinely collected by many clinicians, the study found.

Dennys Rene Rivas Williams sits on the steps of his home.

Rivas Williams says he doesn't go out much anymore because he takes medication that suppresses his immune system after his double lung transplant.

(Al Seib / For The Times)

Too often, “physicians don't have the time, don't take the time, or don't know how to take a full occupational history,” says Dr. Cecile Rose, an occupational pulmonologist at National Jewish Health in Denver.

Silicosis can develop years after exposure, so doctors should investigate previous work experiences.

Many patients never continue the process. analysis of silicosis patients in Michigan, where the disease sickens people who work in metal casting or blasting, found that only 35 percent had filed for workers’ compensation. That percentage had declined over time. Other studies Collaboration with various industries means the figures are even lower.

“Even with obvious injuries, only 50 percent of individuals seek compensation,” said Dr. Kenneth Rosenman, chief of the division of occupational and environmental medicine at Michigan State University.

Dennys Rene Rivas Williams with his wife Monica Abigail Santos.

Rivas Williams with his wife, Monica Abigail Santos. He worries about his family. “Not everything in this life is money,” Rivas Williams said. “But imagine if I wasn't here.”

(Al Seib / For The Times)

Experts say California’s system is more lenient for workers who file claims involving one-time injuries than for workers dealing with illnesses that developed over time. Rand senior economist Michael Dworsky estimates that about 1 in 8 workers’ compensation claims are initially denied in California, but said denial rates are higher for illnesses linked to workplace exposures, such as cancer or heart disease.

When injured workers don’t get workers’ compensation, “it puts a strain on other resources. It puts a strain on your health insurance,” said attorney Cheryl Wallach, a board member of the advocacy group Worksafe.

Like many California workers stricken with silicosis, Rivas Williams said he was insured through Medi-Cal, California’s Medicaid program. State officials did not immediately provide figures on how much Medi-Cal pays for such care, but doctors estimate the cost of a double-lung transplant is more than $1 million.

As more workers get sick, “it’s a huge burden on taxpayers, when it should really be workers’ compensation” that bears those costs, said Dr. Sheiphali Gandhi, an assistant professor of medicine at UC San Francisco who has studied silicosis.

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