Frequently Asked Questions

In 2021, the NSW Government (Department of Regional NSW) commissioned an independent quality assurance review of the NSW Health Surveillance Scheme for Coal Mine Workers (the Review). The University of Illinois School of Public Health (Chicago) was selected through an open tender process to conduct the Review. The review was recommended and overseen by the Mine Safety Advisory Council (MSAC). 

The independent Review was a recommendation by mining companies, unions, government and independent experts, and was overseen by the NSW Mine Safety Advisory Council (MSAC). 

The final report found that CS Health has a robust system of medical health surveillance and noted the considerable improvements to the scheme since the re-identification of black lung in Australia in 2015. The report also included recommendations to consider for further improvement.  

These recommendations included making changes to the way lung abnormalities are investigated and managed in the mining industry.  

The MSAC Review identified developments to medical standards, including testing requirements and screening processes to identify respiratory conditions. The Review recommended that these be adopted in the NSW mining industry to adhere to best practice medicine.  

The NSW Resources Regulator has directed Coal Services (through) CS Health to implement these recommendations. 

• All abnormal lung function tests must now be investigated with further testing. 

• Depending on the level of abnormality detected, testing may include complex lung function tests (CLFT), high-resolution CT (HRCT) scans and sometimes an assessment by a respiratory physician. 

• Some findings may require coal mine dust exposure restrictions be applied to a coal mine worker, and in some cases eliminate further exposure to coal mine dust in the workplace. 

CS Health has developed protocols with reference to current guidelines from the Thoracic Society of Australia and New Zealand (TSANZ) for respiratory monitoring in resource sector workers. These protocols align with the following clinical pathways in place in the Queensland mining industry:    

Standards for the delivery of Spirometry for resources sector workers – TSANZ 2022  

Mine Dust Lung Disease Clinical Pathways Guideline – RSHQ 2023 

Returning workers with mine dust lung disease to the workplace – released by WorkSafe Qld Workers’ Compensation Regulatory Services.   

The Respiratory Health Standard establishes a clear and consistent process for Order 43 approved medical practitioners to follow when a coal mine worker presents with abnormalities with their chest x-ray or spirometry results. 

The Respiratory Health Standard was released on Monday, 19 August 2024.  It is expected that approved medical practitioners apply the protocols as soon as practicable.

CS Health has provided communication and education to all Order 43 approved medical practitioners to notify them of the Respiratory Health Standard and related pathways and guidelines.  

The RHS has been developed through the Coal Services Standing Health Committee (SHC) and the MSAC Review Implementation (the Working Group). CS Health drafted clinical guidelines based on best-practice medical guidance this was developed into a medical health standard (the Respiratory Health Standard) with input from a leading Respiratory Physician.  In additions the working group undertook an impact assessment, which has led to the inclusion of transitional threshold levels for inhalable mine dust. 

The Respiratory Health Standard has undergone extensive consultation and endorsement from medical experts and industry representatives.  

The restrictions contained within the guidelines were adopted from the publication ‘Returning Workers with Mine Dust Lung Diseases to the Workplace’ in Queensland – this is the only published medical guidance for returning workers with lung disease to the workplace (developed by an expert medical panel).

A fundamental finding of the MSAC Review was that when workers are identified with respiratory disease or respiratory impairment, and once that disease results in a certain level of impaired function, medical practitioners should act to minimise further exposure, to protect the remaining lung function.   

 Airborne contaminates, coal mine dust, silica and coal can cause damage to different parts of the respiratory tract, in different workers. For some workers it will cause damage to the larger airways, restricting the diameter, affecting the flow of air in and out of the lungs – this causes chronic constructive pulmonary disease (this is detected in spirometry); in other cases the dust can damage the alveoli (air sacs) deep in the lungs, which gives you emphysema (DLCO can assess this); and in other workers it can cause scarring that develops into nodules (seen on x-ray).  These 3 assessments are used to determine the type of impairment / disease and when restrictions to further exposure are required.  

CS Health use the following three fundamental assessments to determine respiratory function or respiratory disease:  

1. Spirometry (assessment of airflow),   
2. DLCO testing (assessment of gas exchange), and   
3. X-ray (imaging of lungs). 

• Coal dust 
• Silica dust 
• Isocyanates (hazardous chemicals) 
• Diesel particulate 
• Welding fumes 

• Smoking and vaping 
• Bird keeping (bird fanciers lung) 

• Stop smoking/vaping 
• Get vaccinated against influenza and COVID 
• Use puffers when prescribed by your doctor 
• Regular exercise 
• Minimise exposure by wearing appropriately fitted PPE 

The guidelines will apply to any coal mine worker, regardless of whether they work in an underground or surface coal mine environment, who presents with an abnormal chest x-ray or decline in respiratory function. 

The Order 43 approved medical practitioner (CS Health and Order 43 External Doctor Network) will determine fitness for work.  

The coal mine worker’s GP or the respiratory physician cannot determine fitness for work. 

In most cases it is possible that a coal mine worker can continue to work while the investigations (i.e. CLFT, HRCT, respiratory physician referral) are completed. There may be circumstances where the Order 43 approved medical practitioner recommends a change in fitness for work during this period –to preserve respiratory function.  

The Order 43 approved medical practitioner will discuss the determination with the coal mine worker. 

• A CLFT can take a few weeks to get an appointment due to the specialised equipment required.   
• An HRCT can normally be obtained within one or two weeks.   
• It can take a few months to secure an appointment with a Respiratory Physician.   

Sometimes it is not possible to reach a diagnosis without repeat testing after a period of time. In these circumstances, the approved medical practitioner will discuss the clinical requirements with the coal mine worker. 

CS Health may not be able to complete the health assessment as this information is required to determine whether the coal mine worker can safely continue in their role. A current health certificate is required to work on a NSW coal mine. 

Yes. This will be communicated to employers on the health assessment certificate, including an outline of suggested actions for an employer to take to support the health and safety of the coal mine worker.  

It is up to both the coal mine worker and the employer to ensure attendance at a health assessment review. CS Health will send appointment reminders to the coal mine worker and the employer prior to the review date. 

CS Health will cover the costs of the consultation with the respiratory physician for existing coal mine workers. CS Health will also cover the cost of some specific tests requested by the respiratory physician during the first visit.  

These tests are limited to the following:  

• High resolution CT chest scan (initial and progress scan) 
• Pulmonary lung function testing 
• Pathology blood test 
• Follow-up consultations to establish diagnosis

Any workers who are new to industry and require investigations will need to pay for these at their own expense.

This is as per current health assessment review requirement (i.e. three yearly) .

This is determined by a radiologist and generally requires follow up with the worker’s GP. Examples may be solitary nodule, enlarged heart, diaphragm in the wrong place etc.

This will depend on when the diagnosis occurred and the current symptoms / level of respiratory impairment.  Some workers with a previous diagnosis may still need to go through the new clinical pathways, when they complete their periodic medical. 

A worker may see a Respiratory Physician for a diagnosis and/or Occupational Physician who will help determine whether the condition is occupational (resulting from work exposure) or non-occupational (caused by something other work exposure).  Regardless of whether the respiratory condition is work or non-work related, the clinical pathway needs to be followed to determine the severity of the condition.   

The roles and responsibilities have been defined in the Respiratory Health Standard:  

Approved Medical Practitioner (AMP)  

• The AMP must ensure their assessment and management of the worker continually adheres to the Respiratory Health Standard.  
• The AMP is accountable for assessing fitness for work using their own clinical judgement and providing a medical certification consistent with the Respiratory Health Standard.  
• The AMP may by an Occupational Physician (OP) or may seek advice from an OP in determining fitness for work.  

Respiratory Physician (RP)  

• The RP is responsible for diagnosing respiratory conditions that cause respiratory impairments and/or radiological abnormalities and providing advice about the timely, appropriate medical management of disease and injury.  
• The RP has a duty to consult and/or otherwise collaborate with an OP where there is uncertainty about the clinical correlation, if any, between hazard, exposure, biological effect, and disease or injury.  
• The RP is not responsible for determining the worker’s fitness for work.  This determination remains the responsibility of the AMP.  

 Unless the RP has particular training in workplace assessments, it is not their field of work. Their expertise is the diagnosis of lung conditions and the clinical management of those lung conditions, it’s not deciding their role to determine their suitability for work. This sits with the OP or Approved Medication Practitioner.  

 The Queensland pathways also show the authorised medical doctor, who may refer a worker to the RP for diagnoses, is responsible for the worker’s suitability to work, not the RP.  

CS Health will attempt to involve the employer early, following the worker’s consent.  Some workers are happy for CS Health to do that.  If consent is given, CS Health discuss with the employer that their worker is being referred to an RP for respiratory investigations.    

If a worker does not give consent, the employer will only be notified when:  

• A reportable condition is identified (consent is not needed),  
• A worker has restrictions – if the condition is not notifiable, it will not be disclosed.   

The diagnosis and follow up requirements will be explained to the coal mine worker. Information will be provided to them so that it can be followed up with their GP.   

 If the diagnosis is related to coal mine dust exposure, the coal mine worker can discuss making a claim with their GP. The opportunity to have a case conference with the employer will be offered to them.

It may still be possible to work in many roles in coal mining after diagnosis. Some roles with higher dust exposures may not be suitable to protect against further respiratory damage and restrictions may be applied. If the respiratory disease progresses to more severe stages, it may be necessary to cease further coal mine dust exposure altogether. 

The MSAC Review found that many medical practitioners were allowing coal mine workers with non-occupational respiratory disease to continue working with unrestricted mine dust exposure.  

 The MSAC Review recommended that exposure restrictions be applied for identified respiratory disease regardless of the underlying cause, based on the degree of respiratory impairment. This is now considered medical best practice. 

To preserve remaining respiratory function (and quality of life) for a coal mine worker. 

If the investigation involves a referral to a respiratory physician, the process may take 3 to 4 months due to the availability of appointments. 

CS Health does not monitor the implementation of workplace restrictions.  This is the employers responsibility, they may need to engage with a occupational hygiene provider to ensure the appropriate controls are implemented and exposure levels are being monitored. For any coal mine worker who has dust restrictions, CS Health will usually monitor their respiratory health every 6 – 12 months depending on the clinical pathways. 

The clinical pathways provide guidance about what restrictions should be applied for different levels of lung impairment and when a worker should be removed from further mine dust exposure altogether. 

All workers will be assessed as part of the health surveillance scheme. Where a worker may have previously exited the pathway, they may need to undergo additional testing to assess any lung impairment or to determine if coal mine dust exposure has contributed to any disease process found depending on their clinical presentation when reassessed.   

It will depend on the level of their impairment and/or disease.  In most cases workers can continue to work during the investigation phase.  In some cases they may require a dust restriction, but this will depend on their clinical presentation and the pathway recommendations.

If an employer gets a certificate for a coal mine worker with dust-related restrictions, the employer needs to review SEG exposure monitoring data for that site or work area to see if the available data is adequate and allows the coal mine worker to continue in their current role with the dust restrictions. If the data is not adequate, the employer may consider additional monitoring to determine the workplace exposure for that SEG. If the exposure data exceeds the proposed restrictions, the employer may consider reviewing controls in line with the hierarchy of controls and implement additional controls, and then reassess the exposure data after further monitoring. Additionally, the employer may also consider alternative work areas or tasks for the coal mine worker. 

The IMD thresholds are based on the QLD WCRS document, as it is the only published literature and research available in the world that provides guidance on these levels. In NSW, a transitional threshold for IMD has been implement whilst further research is undertaken by a world-leading expert.  The Mine Safety Advisory Council Steering Committee has endorsed this research and the transitional thresholds.

CS Health will pay for any respiratory physician appointments for existing NSW coal mine workers. Any workers who are new to industry and require investigations will need to pay for these at their own expense.

Yes. Appointments and investigations with any specialists and GPs needs to also be completed by the worker in order for an appropriate diagnosis to be confirmed. Smoking is a personal choice. However, CS Health recommends ceasing smoking as it is known to cause conditions like emphysema and chronic obstructive pulmonary disease.

The authorised Order 43 doctor is responsible for certifying the medical suitability of a worker and any restrictions that should be applied to manage identified health conditions.  It is the employer’s responsibility to determine whether they are able to accommodate any recommended medical restrictions.  

Unfortunately the timing of these appointments is determined by the Respiratory Physician and not CS Health. CS Health can request that coal mine workers are added to a cancellation list when waiting to see a Respiratory Physician, if there are lengthy delays.

Coal mine workers are encouraged to speak with their employer about the potential for suitable duties or access to leave whilst investigations are being undertaken

CS Health has developed internal processes to help manage workers who require further investigations or have dust restrictions applied. A Clinical Investigations Team (CIT) now case manages workers through this process and CS Health works with employers to ensure a thorough understanding of the individual’s needs.  Employers and union representatives also have a responsibility to support workers to ensure the best possible outcome.

The cost of testing and seeing a respiratory physician is covered by CS Health until a diagnosis is established. Any costs for work time sits at the discrepancy of the worker/employer.  The cost of any ongoing treatment or medical follow up outside normal Order 43 review is not covered by CS Health.  If the condition is identified as being related to their employment as a coal worker they may be able to lodge a claim to cover related expenses. If a site does not accommodate a worker with suitable duties, it is more likely to result in a claim.

CS Health complies with the Australian Privacy Principles (APP) under the Privacy Act 1988 (Cth) as well as the Health Privacy Principles (HPP) under the Health Records and Information Privacy Act 2002 (NSW). 

 Order 43 contains detailed information regarding the content and release of medical information to employers and will be followed when applying these guidelines. 

As is currently the case under Order 43 reporting, the worker will have access to all medical reports relating to his/her health. 

If a coal mine worker is found temporarily unfit for their current role: 

Any exposure restriction recommendations to fitness for work are discussed with the coal mine worker first. 

• Consent is sought from the coal mine worker to discuss the health condition with their employer. 
• If consent is not provided, CS Health will not release the health information. However, CS Health is required to provide a copy of the completed health assessment certificate, which will necessarily note the exposure restrictions, for the employer to manage. 
• Some respiratory conditions are notifiable to the NSW Resources Regulator and employer under statutory requirements. In these cases, consent is not required from the coal mine worker.  

As is currently the case under Order 43 reporting, the employer will receive the completed Order 43 health assessment report. This will include: 

• Whether a health review is required 
• Any exposure restrictions and health assessment review requirements 
• In the case of NSW Resources Regulator notifiable conditions, the actual diagnosis is provided.

• An impact analysis report confirmed that adoption of Inhalable Mine Dust (IMD) thresholds currently recommended in the QLD guidelines for workers with occupational lung disease is expected to severely impact a workers’ ability to return-to-work.   
• It was proposed that a revised IMD limit of 5mg/m3 (which is a 50% reduction in the current workplace exposure standards), in place of the 2.5mg/m³ and 1.25mg/m³ thresholds recommended in the QLD guidelines would reduce the impact on workers.   
• The University of Illinois have been engaged to undertake a formal assessment of the IMD exposure thresholds in the NSW mining sector, to determine if the transitional IMD limits should be maintained, or if the QLD proposed levels should be adopted.   
• The transitional arrangement for IMD exposure thresholds, supported by the Mine Safety Advisory Council (MSAC), will remain in place until at least the end of 2024, pending the formal assessment of NSW IMD thresholds.   

This approach is not recommended. SEG dust exposure profiles can vary significantly between mines, and using industry data would not provide the necessary confidence that a worker’s exposure is below the restriction levels. If the mine lacks sufficient data, the employer should consider collecting additional monitoring data to accurately determine workplace exposure for the SEG. 

If exposure data exceeds the restriction levels, the employer should consider reviewing and implementing additional control measures in line with the hierarchy of control. Additional controls should be implemented, followed by reassessment of exposure profiles after further monitoring. The employer might also consider assigning alternative work areas or tasks for the worker. 

It is recommended that workers with dust restrictions are periodically monitored as part of an ongoing enhanced exposure monitoring strategy. This ensures that any potential individual worker variations are assessed and understood.  

Workers with dust restrictions should not need to wear a dust monitor every day. A statistically valid SEG sampling strategy combined with periodic monitoring should provide sufficient data to accurately assess the worker’s exposure level.  

Decisions on allowing work outside of the assigned SEG should be risk-based, considering the exposure profile of each SEG and the planned frequency and duration of the work. 

Enhanced dust monitoring combines a recognised occupational exposure monitoring strategy with individual assessment considerations for workers with assigned dust restrictions. The following components should be considered for inclusion in an enhanced dust monitoring program:

• Baseline followed by periodic exposure monitoring of the relevant Similar Exposure Group (SEG), in line with the NSW Resources Regulator Technical Reference Guide – Monitoring and control of worker exposure to airborne dust.
• Periodic personal exposure monitoring of restricted workers to assess variability in individual dust exposures.
• Periodic review of tasks performed by restricted workers, including workplace assessments where appropriate.

Yes, a worker can work a 12-hour shift. However, shift length and roster patterns should be considered, as they may require adjustments to the dust restriction level. It is advisable to consult an occupational hygienist to determine if adjustments are needed based on the worker’s specific roster pattern.

No, Coal Services Order 42 dust monitoring reports do not include information on individual worker dust restrictions or compliance with these restrictions. These reports focus on results and compliance with legislated workplace exposure limits. Employers and workers must review individual results separately to assess compliance with specific restrictions. 

Contract employers and workers may face challenges in such situations. Contract companies and workers may need support and access to site-specific occupational exposure data to determine whether dust exposure levels in SEGs are suitable for workers with dust restrictions. 

Personal exposure monitoring measures an individual’s unprotected exposure to dust during their usual work activities. This involves collecting a personal dust exposure sample from the breathing zone in accordance with Australian standards and WHS (MPS) Regulation requirements to assess compliance with workplace exposure limits and dust restrictions. 

Atmospheric monitoring, typically referring to static or area dust sampling, measures dust levels in specific locations to identify sources and causes of dust generation. Static monitoring results cannot be used to assess compliance with workplace exposure limits or dust restrictions. 

Real-time dust monitors should not be used for assessing compliance with dust restrictions. Personal exposure monitoring assessments must follow relevant Australian standards and WHS (MPS) Regulation requirements. However, real-time monitors are useful tools for investigating exposure sources and reviewing control effectiveness.

Respiratory Protective Equipment (RPE) can be used as part of an overall control strategy for workers with dust restrictions. In accordance with section 36 of the NSW WHS Regulations, RPE should only be used as a control after higher level engineering controls have been considered first. RPE can also be used as an interim control measure while higher-order controls are being developed and implemented. An employers RPE program should align with the applicable sections of AS/NZS 1715:2009, Selection, use and maintenance of respiratory protective equipment.

Contact CMI on (02) 4942 3150 email [email protected] 

A worker is required to complete a Worker’s Injury Claim form and provide a SIRA Certificate of Capacity from your nominated treating doctor.  

Yes, you can claim at any time.  

Yes – you can make a claim at any time. Once the claim has been received, CMI will collect information from your treating doctors, and you may need to attend an Independent Medical Examination with a Respiratory Physician. On receipt of all the information, CMI will then make a decision on your claim.

• Within 3 days of making a claim, an Injury Management Specialist and/or a Specialist Case Manager will contact you.  
• CMI will collect information from your treating doctors. 
• A CS Health Authority to Release Information Form is requested so that we can collect information specifically from CS Health. This form must be witnessed and signed by an authorised individual (details can be found on the form)  
• You will be required to attend an Independent Medical Examination with a Respiratory Physician 
• On receipt of the above information, CMI will make a decision on your claim. 

• A statement from you that details your employment history, both inside and outside the coal mining industry, names of employers, periods of employment, position/role and duties performed
• Details of doctors, scans, and current treatment 
• Original scans, x-rays and other radiological investigations must be made available to the Independent Medical Examiner  
• A Tax File Declaration Form, Bank Details Form, and Dependency Declaration Form  

A decision to commence weekly payments will be made within 21 days unless there is a reasonable excuse not to commence payment. In that case, the decision will be made within 42 days after the claim for compensation is made or when the reasonable excuse ceases (whichever is earlier).  

After careful consideration of all available information, a Specialist Case Manager will assess your claim and make a decision to either accept or decline your claim. 

A worker should notify their employer immediately (or as soon as practicable) following a workplace injury (including becoming aware of an occupational dust disease). An employer should lodge an injury notification to CMI within 48 hours of becoming aware of a workplace injury. A worker can also contact CMI directly to discuss this process if they prefer not to involve their employer, or if they are not currently employed in the NSW coal industry.

As the sole provider of workers compensation insurance to the NSW coal industry, CMI assumes liability for lung conditions caused by exposure to coal, silica or any other dust in the NSW coal mining industry.  

While lung claims do not directly impact your workers compensation policy’s premium, their costs do impact the overall scheme costs.

Liability for occupational dust diseases caused by exposure to coal, silica or any other dust in the NSW coal mining industry are not directly premium impacting. However, they affect overall scheme costs and premium rates.  

Coal Services are still working on an implementation plan which means CMI are not able to provide any analysis of future premium impacts at this stage. 

An employer should lodge an injury notification to CMI with in 48 hours of becoming aware of a workplace injury. If a worker wishes to lodge a workers compensation claim they should notify their employer immediately (or as soon as practicable). 

An IME will help to determine liability, by looking at work history and exposure, not just the disease process. In NSW, we have already seen claims by workers who are from other industries or states and who have not been exposed to coal, silica or any other dust in the NSW coal mining industry. CMI will obtain the workers consent to request their file from CS Health, obtain information from the employer(s) such as dust monitoring reports, details of employment history and dust exposure, request medical records such as scans, reports and details of current treatment from workers doctors. With this information the IME will provide an independent opinion as to whether the condition is work related.

For accepted claims, CMI encourages employers to provide suitable duties in accordance with their obligations under NSW workers compensation legislation as it applies to coal miners. 

Where a worker is unable to return to their pre-injury employment but can undertake suitable duties, CMI aims to reintegrate the worker into the workforce in the following order of priority: 

1. Return to same employer, different role
2. Return to same industry, suitable role
3. Return to alternate industry, suitable role

Where suitable duties are provided, they should facilitate a graduated return to full pre-injury duties. 

Where appropriate, a referral to an approved workplace rehabilitation provider for return to work services will occur to assist with re-deployment. 

Whilst lung claims are not directly premium impacting, they do affect the overall scheme costs, which is funded by policyholders.  Secondary psychological claims caused by lung claims will be managed with the primary lung claim i.e. not directly premium impacting. 

Workers should speak with their employer and MEU representatives to determine what leave and assistance is available to them while their claim is being assessed by CMI or if the claim is declined.