By the point that Dennys Rene Rivas Williams had fallen so unwell that he wanted new lungs, physicians at Olive View-UCLA Clinical Heart expressed little question about what used to be in charge for his illness.Docs had recognized the 36-year-old with silicosis: an incurable illness led to via breathing in tiny bits of lung-scarring silica. It used to be an affliction that had debilitated dozens of employees in Los Angeles County like him, who had toiled reducing counter tops sure for kitchens and lavatories.Well being officers had sounded the alarm {that a} new epidemic of the sickness used to be killing younger laborers amid the emerging acclaim for engineered stone, which is usually a lot upper in silica than herbal slabs. In recent times, greater than a dozen California employees who minimize counter tops have misplaced their lives to the illness. Rivas Williams’ scientific information state that his silicosis used to be because of “engineered stone fabrication/reducing,” with a physician advising him to hand over his task to stop additional injury. But Rivas Williams have been grew to become down when he carried out for employees’ repayment, which is meant to hide hospital treatment and different advantages for laborers injured at the task. Lawyers representing the younger father have been galled, asking the place else he would have inhaled such a lot silica.Rivas Williams mentioned that the Pacoima store the place he labored used to be blanketed in mud, and that he and different employees have been introduced handiest flimsy mask, slightly than protecting respirators. In January, he gained a double lung transplant — a lifesaving surgical treatment however one who regularly manner handiest an extra six years of survival. Silicosis has been referred to as an occupational sickness for hundreds of years, afflicting miners, stonecutters and others uncovered to silica mud. The vast majority of instances are tied to paintings, mentioned Dr. Jane Fazio, a pulmonary crucial care doctor and UCLA researcher. Amongst countertop cutters, if “anyone has this task and they’ve silicosis, it will have to obviously be presumed to be work-related.” But as California sees surging numbers of younger employees affected by the illness, many have no longer effectively tapped employees’ repayment. Help can come with hospital treatment, incapacity bills and dying advantages for households. Fazio and different researchers inspecting dozens of instances of California countertop employees struggling silicosis discovered that handiest 13% had employees’ repayment advantages when recognized and handled. Just about part saved operating within the trade even after you have the prognosis.Staff’ repayment is meant to make certain that if employees are harmed at the task, “they don’t must switch their livelihood for his or her well being” and “can get get admission to to hospital treatment and time clear of paintings and incapacity and different sorts of assets they are going to want to make themselves complete once more,” mentioned Kevin Riley, director of the UCLA Exertions Occupational Protection & Well being Program.California employers are required to offer employees’ repayment advantages for his or her staff, usually via purchasing insurance plans. A state fund can care for such claims if a trade flouts the necessities, however advocates say many employees — particularly immigrants — worry retaliation for even pursuing the advantages.And employees’ repayment lawyers say accommodation a declare isn’t any be sure that laborers gets support briefly, even for a illness roundly identified as stemming from paintings. Attorney Gary Rodich mentioned this summer time that his company used to be representing greater than a dozen employees with silicosis who have been denied employees’ repayment advantages once they carried out — together with Rivas Williams. Earlier than he were given his prognosis, Rivas Williams had filed a declare that discussed injury to his lungs along side “repetitive paintings” accidents to his knees, shoulders and different portions of his frame, aided via a special legal professional. The denial letter from Amtrust North The united states mentioned there wasn’t sufficient proof that “your alleged damage resulted out of your employment at Primus Marble,” the store the place he used to be operating.In a while after he used to be recognized with silicosis, Rivas Williams submitted an amended software with the assistance of Rodich. In scientific experiences acquired for his case, docs have drawn an instantaneous line to his paintings reducing counter tops. One wrote that his silicosis used to be “100% paintings connected.”Amtrust mentioned in Would possibly that his case “comes to a number of advanced problems our claims staff is operating diligently to unravel.” It didn’t reply to questions from The Occasions about what the ones problems have been.Rivas Williams’ state incapacity bills ran out remaining 12 months. In January, his lawyers accused the insurance coverage corporate of “unreasonable and/or frivolous lengthen” in a court docket submitting, announcing it had left him at the verge of homelessness. At that time, just about a 12 months and a part had handed since his preliminary declare.That very same month, consistent with his lawyers, Amtrust agreed to pay transient advantages as the 2 aspects endured negotiating. Amtrust mentioned in a Would possibly electronic mail that “we’re assured a answer will probably be reached quickly.”Rivas Williams has to take an array of capsules morning and evening to stop his frame from rejecting the brand new lungs. The drugs disarm his immune gadget, leaving him at risk of different threats. His docs warn him to steer clear of cigarette and marijuana smoke, so he shuts the home windows of his South Los Angeles house. 
Rivas Williams, 36, displays the scar from a double lung transplant. (Al Seib / For The Occasions) “I’m close up virtually at all times,” Rivas Williams mentioned in Spanish in an April interview. “I’m afraid to head out as a result of I haven’t any defenses.” He is aware of 3 males who’ve already died of the illness. When he went to mention good-bye to one in every of them, “that mentally ruined me. I spiraled. I noticed his youngsters cry. And I felt like I used to be seeing my very own youngsters cry.”The 36-year-old mentioned his function used to be to fortify his youngsters, whom he dropped at the U.S. from Guatemala. Rivas Williams mentioned he burned thru financial savings and piled up money owed after falling unwell. “Now not the whole lot on this lifestyles is cash,” Rivas Williams mentioned. “However consider if I’m no longer right here.“Their lives are going to modify.”In June — just about two years after Rivas Williams first filed for employees’ repayment — the 2 aspects reached a agreement. Rodich mentioned his consumer declined to publicly divulge the quantity.Primus Marble, the place Rivas Williams as soon as labored, didn’t reply to messages searching for remark. As of early July, the California Division of Public Well being had known 156 instances of silicosis associated with engineered stone lately — greater than 90 of them amongst citizens of Los Angeles County. Just about part of the ones instances have been known remaining 12 months by myself, amid rising consciousness of the silicosis epidemic. Public well being officers imagine many extra instances have long gone undetected as immigrant employees cross with out care or are misdiagnosed with different lung diseases. Outbreaks of the fatal illness have erupted international as engineered stone has soared in recognition. In Australia, the place an alarming surge in instances led govt officers to prohibit engineered stone, silicosis has been labeled amongst “deemed illnesses” for employees’ repayment — the ones assumed to be led to via paintings until there’s sturdy proof on the contrary.If an Australian employee has silicosis, “I diagnose any person. I fill out” the bureaucracy, mentioned Dr. Ryan Hoy, lead doctor for the occupational breathing illness hospital at Alfred Sanatorium in Melbourne. “It is going to the regulator they usually settle for the declare. They may be able to’t deny it.” That doesn’t exist for countertop cutters right here. California has granted “presumptive eligibility” for employees’ repayment for some diseases — comparable to COVID-19 sickness suffered via well being employees and primary responders previous within the pandemic — however no longer for silicosis claims from stonecutters.Within the U.S., employees’ repayment differs from state to state, however the issues that silicosis victims in California have encountered aren’t distinctive. In a single learn about of silicosis sufferers in Wisconsin, researchers discovered many had run into issues getting employees’ repayment “and are pissed off via having to end up the work-relatedness of silicosis — a situation which seldom is bought out of doors of labor.” Nearly all have been to start with rejected as a result of scientific information lacked details about their paintings histories, which isn’t robotically collected via many clinicians, the learn about famous. 
Rivas Williams says he doesn’t cross out a lot as a result of he is taking drugs that suppress his immune gadget after his double lung transplant. (Al Seib / For The Occasions) Too regularly, “docs both don’t have the time, don’t take some time, or don’t know the way to take an entire occupational historical past,” mentioned Dr. Cecile Rose, an occupational pulmonologist at Nationwide Jewish Well being in Denver. Silicosis would possibly display up years after anyone is uncovered, requiring docs to additionally probe into previous employment. Many sufferers by no means pursue the method. One research of silicosis sufferers in Michigan, the place the illness has sickened other folks whose paintings comes to steel casting or abrasive blasting, discovered handiest 35% had carried out for employees’ repayment — and the share had tumbled over the years. Different research involving a variety of industries have put the numbers even decrease. “Even for straight forward accidents, handiest about 50% of people practice for repayment,” mentioned Dr. Kenneth Rosenman, leader of the department of occupational and environmental medication at Michigan State College. 
Rivas Williams together with his spouse, Monica Abigail Santos. He worries about his circle of relatives. “Now not the whole lot on this lifestyles is cash,” Rivas Williams mentioned. “However consider if I’m no longer right here.” (Al Seib / For The Occasions) Professionals mentioned the California gadget has a tendency to be smoother for employees accommodation claims involving one-time accidents than for the ones dealing with illnesses that advanced over the years. Rand senior economist Michael Dworsky estimated more or less 1 in 8 claims for employees’ repayment are to start with denied in California, however mentioned rejection charges have tended be upper for diseases tied to place of business publicity, comparable to most cancers or middle illness.If injured employees fail to get employees’ comp, “it places the load on different assets. It places the load for your medical health insurance,” mentioned legal professional Cheryl Wallach, a board member with the advocacy team Worksafe. Like many California employees afflicted with silicosis, Rivas Williams mentioned he used to be insured thru Medi-Cal, California’s Medicaid program. State officers didn’t promptly supply figures for a way a lot Medi-Cal will pay for such care, however physicians estimated the prices of a double lung transplant exceed $1 million.As extra employees develop unwell, “it’s an enormous pressure on taxpayers, when it actually will have to be employees’ comp” shouldering the ones prices, mentioned Dr. Sheiphali Gandhi, an assistant professor of drugs at UC San Francisco who has studied silicosis.
