Issues and tasks of industrial accident insurance that change this year

▲ Donghee Kwon Certified Labor Attorney (law office person)

This year, there is a new system implemented in accordance with the revision of the Industrial Accident Compensation Insurance Act (Industrial Accident Insurance Act) last year. The enforcement of the Act on Punishment of Serious Accidents, etc. (The Punishment of Serious Accidents Act) may affect industrial accident insurance. It is also noteworthy whether the improvement of the industrial accident insurance system will become an issue in the presidential election.

◇Return to work plan=The regulation on ‘return to work support’ (Article 75-2), which was newly established on May 18 last year in the Industrial Accident Insurance Act, came into effect on the 1st of this month. The Corporation said “1. When medical care is required for more than 6 months due to an occupational injury or disease; In this case, you can ask the employer at the time of the accident to prepare and submit a plan for workers’ return to work. When the Corporation determines that the contents of the return to work plan are inappropriate, it may request the employer to change it and submit it. However, the limitation is that even if the employer does not submit a return to work plan, there is no provision for penalties such as fines for negligence. It is necessary to limit the payment of the return to work subsidy if the return to work plan is not submitted.

◇Student Researcher Special Case=According to the Industrial Accident Insurance Act newly established on April 13, last year, the provisions of ‘Special Cases for Student Researchers’ (Article 123-2 of the Act) will come into effect. The range is “1. A person who is currently enrolled in a bachelor’s, master’s, or doctoral degree program at a university or research institution pursuant to subparagraph 1 (a) of Article 2 of the Act on the Creation of Safe Laboratory Environments A person who has been confirmed for admission to a degree program and who continues to carry out R&D tasks performed in the previous bachelor’s/master’s degree program until admission to the master’s/doctoral degree program”. The direction of expanding industrial accident insurance coverage is reasonable, but it is questionable whether the expedient special subscription form is justified. It is time to consider the transition to ‘all-national industrial accident insurance’ that can be applied to all working people.

◇ Enforcement of the Severe Accident Punishment Act and Industrial Accident Insurance=The Serious Accident Punishment Act, which will be enforced for workplaces with 50 or more employees from the 27th of this month, may affect industrial accident compensation. A business owner or business manager who has caused at least one death in violation of the safety and health obligation of the business owner and the person in charge of management or the obligation to secure safety and health in a relationship such as a contract, service, entrustment, etc. be punished by a fine of

At issue are deaths from occupational diseases or deaths from self-harm. The former is mainly due to cerebrovascular diseases. Regardless of whether it is a violation of the obligation to secure safety and health under the Act on the Punishment of Serious Accidents, it will further lead to employers’ evasion or defense of industrial accident insurance. Since there is no penalty for the employer’s duty to assist under the Industrial Accident Insurance Act (Article 116), in the event of a cerebrovascular disease, the employer can take various measures to avoid being included in the industrial accident insurance from the beginning. Of course, when hiring, devices for health indicators will be installed, or when health checkups or special checkups are performed, they will actively demand (workers) daily life measures. It is highly likely that the company will take advantage of the difficulty in obtaining an industrial accident approval without assistance such as providing data from the employer. The Occupational Disease Adjudication Committee will also collect other data and testimonies to respond. In the end, the disadvantages of workers at workplaces without a union or with a small scale are bound to increase. Article 116 of the Industrial Accident Insurance Act should be amended urgently to punish employers in violation of the Act.

◇Applied fetal injury =After the Supreme Court ruling on the Jeju Medical Center case (Supreme Court sentenced on April 29, 2020, 2016du4107), on December 9, last year, the ‘Chapter 3 3 Special Cases for Insurance Benefit for Children with Impaired Health’ were made in the Industrial Accident Insurance Act. Although the law applies from December 9 of this year, Article 2, Item 1 of the Addendum is to be applied even if “a claim is made under Article 36 (2) before the enforcement date of this Act.” Article 2, Item 3 of the Addendum stipulates that “a child born before the enforcement date of this Act and makes a claim pursuant to Article 36 (2) within three years from the enforcement date of this Act”. In the end, if a child born before December 9, 2019 has a health impairment, the application must be made by December 8 of this year. Although “handling or exposure of harmful factors prescribed by Presidential Decree” has not yet been made under the legal regulations (Article 91-12), it should be possible to presume to be the cause of miscarriage or stillbirth by including “work-related overwork or mental stress” in harmful factors. .

◇ ‘Settlement after guarantee in advance’ becomes an issue=On December 29, last year, the Justice Party proposed a pre-guaranteed-post-evaluation system in which medical institutions directly claim industrial accident insurance after medical treatment in the event of an industrial accident. In addition to the establishment of sickness and sickness allowances in health insurance, they are insisting on a phased integration with maternity leave benefits. It is similar to the argument of labor unions. However, if it is not approved as a work-related accident, the specificity of the settlement method, the issue of non-benefit sharing in the Industrial Accident Insurance Act, the amendment of the National Health Insurance Act, the problem of the gap between the closure pay and the sickness and sickness allowance, and the issue of the establishment of the Industrial Accident Review and Assessment Service is lacking. It is difficult to assert that the Labor Promise of the Democratic Party of Korea has not yet been specifically presented, but it is highly likely that the direction and content will be the same.

◇Expanded reasons for omitting the policyholder’s opinion=Due to the revision of the regulations on the treatment of health care services on December 30 last year, the reasons for omitting the submission of opinions by insurance policyholders were expanded from the previous two to four. In addition, if the submitted opinion differs from the contents of the medical care benefit application, unlike the previous regulations, it is required to notify the applicant “up to a copy of the submitted data, if any,” along with the insured’s opinion.

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