Let's take a look at the procedures and precautions for handling industrial accident compensation insurance
First of all, in the event of an industrial accident, workers apply for industrial compensation to the Korea Workers' Compensation and Welfare Service
which decides whether to pay medical care benefits
and notifies whether to approve medical care
Let's take a closer look
First of all, an industrial accident should happen to the worker
Emergency measures must be taken and if more than four days of medical care is needed for healing
after medical treatment at the hospital, you can apply for industrial accident
After that, workers submit an application for initial medical care benefits and a doctor's opinion to the Korea Workers' Compensation and Welfare Service
At this time, initial medical care benefits application and doctor's note, and if it is necessary to know the accident
in detail, a statement of reason, the worker's ID
and the supporting data must be submitted
At this time, the accident situation should be described in detail following the 5W1H rule
In general, a medical institution requires an electronic document to fill out the initial medical care benefit application
and the medical institution prepares and submits a medical care benefit application form
Next, the corporation decides whether or not to pay medical care benefits
At this time, in the case of occupational accidents, it is under the jurisdiction of the Industrial Complex Governor's Rehabilitation Insurance Department
and in the case of occupational diseases, it is under the Occupational Disease Judging Committee
Relatively, in the case of occupational diseases, it takes a long time to determine whether there is an industrial accident
Whether or not to pay medical care benefits is determined by checking whether the workplace and worker is covered for industrial accidents
and whether it is an accident due to work reasons
Let's take a closer look
Industrial accident application workplaces are all businesses or workplaces that employ workers
and here, it should be kept in mind that the Industrial Accident Act applies to illegal foreign workers as well
Businesses excluded from the application are those that are compensated for disasters under the Public Officials Accident Compensation Act
he Military Accident Compensation Act, the Seafarers Act, the Fishermen and Fishing Boat Accident Compensation Insurance Act
or the Private School Teachers Pension Act, and business of non-corporate persons with less than 5 full time workers
among employment activities within the family, agriculture, forestry, fishing and hunting
Next, we check whether they are workers or not
Here, the term "worker" means a "worker" under the Labor Standards Act
and under the Labor Standards Act, the term "worker" means a person who provides work
to a business or workplace for the purpose of wages, regardless of the type of occupation
Let's look at the requirements for recognizing worker nature
First of all, since it is not related to the type of job, contract workers, daily workers
and short-time workers are also included
And the purpose must be wages, that is, they must be paid in exchange for labor
and the person who provides work in the business/workplace
that is, they must be in a "subordinate relationship of use" under the labor contract
In sum, it refers to a person who receives a command from a business owner
and provides labor under a de facto subordinate relationship
In other words, it is protecting workers who have suffered
occupational accidents while under "business owner control"
According to precedents, the worker nature shall be determined by the employer
subject to employment rules or service regulations
and shall be determined by combining various economic and social conditions
such as whether the employer conducts considerable command and supervision in the course of performing the workers' duties
whether the employer designates the working hours and places and whether the worker is bound by it
whether the labor provider can independently conduct the business on his/her own
such as owning equipment, raw materials, work tools
or hiring a third party to act on behalf of the business
whether he/she carries risks such as generating profits and causing losses through the provision of labor themselves
whether the nature of the remuneration is subject to the work itself, whether the basic or fixed salary is set
matters concerning remuneration, such as whether earned income tax is withheld
the presence or absence and the degree of the continuity of the labor provision relationship and the exclusivity to the employer
and whether the status as a worker is recognized in the laws and regulations on the social security system
In some cases, those who cannot be viewed as workers are exceptionally covered by industrial accident insurance
It is a labor provider. The existing Industrial Accident Insurance Act had a "exclusive requirement"
that labor should be provided only to a specific company
and as a result, there were limits to protection for special types of workers and platform workers
However, due to the revision of the Industrial Accident Insurance Act
this exclusive requirement was completely abolished on July 1, 2023
Specifically, if you look at the changes in the Industrial Accident Insurance Act
the subjects covered by industrial accident insurance has been expanded
Under the Industrial Accident Insurance Act, the requirements for special exclusive use were abolished
and 'special use' and 'platform workers' were redefined as 'labor providers'
As a result, the blind spot of industrial accident insurance for
labor providers working at various companies is expected to be resolved
Here, a labor provider refers to a person who provides labor for
the business of someone other than himself or herself
that is, if requested to provide labor directly by the business owner
or through an electronic information processing system
to mediate and arrange labor for workers, and receive wages
and they are persons engaged in occupations prescribed by
Presidential Decree in consideration of the need for protection from occupational accidents, types of labor provision, etc.
The occupations of labor providers are insurance planners, construction machinery pilots, visiting instructors, golf course caddies
delivery drivers, quick service drivers, loan recruiters, credit card members recruiters, proxy drivers
visiting salespeople, rental product door-to-door inspector, home appliance installation and repair workers, construction site cargo owners
cargo owners, software technicians, after-school instructors, tour interpreters
and school bus drivers for children
In particular, in the case of cargo owners, all specific items and industries classifications will be abolished from July 2023,
and all cargo owners will be fully covered under the Trucking Transportation Business Act
In general, the employer bears the full amount of industrial accident insurance premiums
and the workers do not bear them
However, the labor provider and the business owner will
pay half of the industrial accident insurance premiums each
And we check whether there is a disaster due to business reasons
It determines whether a work-related disaster has occurred under the control of the employer
If you have confirmed the approval of medical treatment, the Corporation must notify you of the approval of medical treatment
If it is clear that there is a disaster due to business reasons
the decision to approve medical treatment will be notified within 7 days
It may take a long time to confirm if it is necessary to confirm the specific facts about the details of the work
or the circumstances of the accident, and in the case of occupational diseases
to check the causal relationship with the work
If there is an objection to the disposition of disapproval of medical treatment
you may request an examination to the industrial complex's industrial accident examination office
through a disposition order within 90 days from the date of knowing that there is a disposition
or file an administrative lawsuit with the competent administrative court
However, if the decision is disapproved after deliberation by the Occupational Disease Judgment Committee
it can be re-examined by the Industrial Accident Insurance Review Committee
of the Ministry of Employment and Labor through the disposition branch without a review request procedure
or an administrative lawsuit may be filed with the competent administrative court
Upon approval, you can receive insurance benefits by
submitting a medical care bill and a vacation benefit bill
Let me tell you the precautions related to industrial accident compensation, first of all, duplicate compensation is prohibited
Korea developed through the legislative process according to the transition process
of the general industrial accident worker protection system
There are compensation for damages under civil law, accident compensation under the Labor Standards Act, and industrial accident compensation under the Industrial Accident Insurance Act
Accordingly, in the event of an industrial accident under the current law in Korea
the workers in the accident acquire the right to claim damages under the Civil Act, the right to claim accident compensation under the Labor Standards Act
and the right to claim insurance benefits under the Industrial Accident Insurance Act, respectively
The claimant may exercise each of the three rights
Therefore, whether to claim accident compensation under the Labor Standards Act
insurance benefits under the Industrial Accident Insurance Act
or even civil damages depends on the intention of the worker is up to the workers' decision
However, no matter which one they choose
they cannot exercise more than one claim at the same time for the same reason
and they cannot claim accident compensation under the Labor Standards Act
at workplaces where industrial accident insurance is compulsory
Most workplaces are covered by industrial accident insurance
So, how is it different between industrial accident insurance and civil damages?
The civil damage compensation system refers to a system that
compensates for the damage of a person whose rights have been violated by the misconduct of another person
Article 90 of the Labor Standards Act stipulates that "If a person who will receive compensation receives
substantial money or goods for accident compensation under the Civil Act or other laws for the same reason
the employer shall be exempted from the liability for compensation within the limit of the amount,"
and Article 48 of the Industrial Accident Insurance Act also stipulates that "If the beneficiary has received or
is able to receive insurance benefits under this Act for the same reason
the insured is exempted from the liability for damages under
the Civil Act or other laws within the limit of the amount."
Therefore, from the perspective of workers, it is generally the most advantageous way to
first receive insurance benefits through industrial accident applications under the Industrial Accident Insurance Act
and to file a civil lawsuit if there is a difference from civil compensation
In the case of a serious accident that leaves death or disability, it is difficult to solve it only by compensation for industrial accidents
so it is common to claim separate civil damages
The amount of damages is as follows
Active damage is considered treatment cost, passive damage is lost income according to the labor loss rate
and solatium is mental damage, considering the labor loss rate and negligence ratio
The amount of damage is the sum of active damage, passive damage, and solatium
and industrial accident insurance benefits are deducted from the total amount of damage
In addition, when calculating the amount of damages, details on the circumstances of the accident, the victim's birth date, average wage
disability level, labor loss rate, negligence offset, and the employer's safety management responsibility
are required
Therefore, a worker who has suffered an occupational accident due to the intention or negligence of the employer, etc.
may claim compensation for the occupational accident against the employer, etc.
However, compensation for damages under the Civil Act
requires workers to prove the intention or negligence of the employer, etc.
and a relatively long period of time before a civil trial is confirmed