The Industrial Accident Compensation Insurance System is a social insurance system in which the government assumes the compensation responsibility that the employer should bear under the Labor Standards Act when a worker is injured or falls ill due to work-related reasons. Therefore, employers subject to occupational injury insurance are exempt from individual compensation responsibility for workers by paying a certain insurance premium, and the government compensates workers directly with the insurance premiums paid by employers as funding.
■ Processing Procedures for Industrial Accidents
The industrial accident compensation business is handled by the Korea Workers' Welfare & Safety Corporation, which has been delegated from the Ministry of Employment and Labor. In the event of an accident, the injured worker must complete a "care application form" and apply to the relevant Korea Workers' Welfare & Safety Corporation office. In the case of a major accident, the company must report to the Ministry of Employment and Labor without delay, but in the case of a general work-related accident, the employer must prepare and submit an industrial accident investigation form to the relevant labor office within one month of the accident occurrence date. When the facts of the accident are clear, compensation related to the accident is paid along with approval for industrial accident compensation within 2-3 weeks. However, in the case of work-related illnesses, it takes at least two months to process industrial accident compensation. The process consists of the following steps: receipt of the care application form, confirmation of medical status, confirmation of the relationship between the accident situation and the medical status, confirmation of medical expert opinion, and final approval or denial decision by the Disease Diagnosis Committee.
■ Recognition Criteria for Industrial Accidents
❍ General Criteria
① Compensation for industrial accidents is paid only when an injury, illness, disability, or death occurs due to a "work-related" reason. Work-related accidents refer to injuries, illnesses, physical disabilities, or deaths of workers caused by work-related reasons.
② Article 37 of the Industrial Accident Compensation Insurance Act, which provides evidence for determining whether an accident is a work-related accident, regards the relationship between work and the accident as having a significant causal relationship when there is a causal relationship between work and the accident and between the accident and the worker.
③ It must not be caused by the intentional or criminal acts of the worker, or those that are the cause. However, if a worker who is receiving medical treatment due to work-related stress or is receiving medical treatment due to an industrial accident commits suicide due to a significant decrease in their normal cognitive or behavioral selection abilities or mental inhibitory power, it is recognized (with medical opinion).
❍ Criteria for Determining Work-related Accidents
The criteria for determining work-related accidents generally include work-related factors and work performance. There has been much controversy regarding the relationship between work-related factors and work performance, but it is difficult to distinguish between them in practice, and it is not valid to give importance to one side or exclude the other, so if there is a significant causal relationship in the work-related context, the accident is recognized as a work-related accident.
(1) Work Performance
An accident related to work that occurs during work preparation, work, or before and after work under the control and management of the employer is recognized as a work-related accident.
(2) Work-related Factors
If there is a significant causal relationship between the work performed by the worker and the occurrence of the accident, it is recognized as a work-related accident. The causal relationship must be proven by the party making the claim. The causal relationship is judged by considering the worker's health status at the time of employment, whether there are any causative substances at the workplace, the working hours at such a workplace, and whether other workers have contracted the same disease, etc. If it is recognized that the accident would not have occurred if the worker had not been engaged in that particular work or that such an accident could occur in that particular work, it is considered to be work-related.
❍ Work-related accidents
① An accident that occurred while the worker was performing work under the control and management of the employer according to the employment contract, or an accident that occurred due to defects or management-related defects of facilities managed by the employer that caused injuries.
② An accident that occurred while using a transportation means provided by the employer or a similar means of transportation during commuting under the control and management of the employer.
③ An accident that occurred during an event or event preparation hosted by the employer or participated in according to the employer's instructions.
④ An accident that occurred during break time and can be deemed to be under the control and management of the employer.
⑤ Other accidents related to work.
❍ Occupational Disease
① Refers to diseases that can cause harm to the health of workers due to physical factors, chemicals, dust, pathogens, and work that imposes a burden on the body during the process of performing work, or exposure to such factors.
② Refers to diseases that occur as a result of occupational injuries.
③ Refers to diseases that occur in relation to work.
Under Article 5, Paragraph 1 of the Industrial Accident Compensation Insurance Act, an "occupational accident" refers to a disease that occurs during the performance of a worker's duties, which means that there must be a causal relationship between the disease and the cause of death related to work. However, even if the main cause of the disease is not directly related to the work performed, if work-related fatigue or stress overlaps with the main cause of the disease, it must be considered that there is a causal relationship between them. This causal relationship does not necessarily have to be clearly proven through medical or natural scientific evidence, but if there is considerable evidence of a causal relationship between work and the disease, it must be considered to exist. Moreover, when a basic disease that allows normal work performance suddenly worsens due to the heavy burden of work or other causes, it may be included if there is evidence to prove it. The presence or absence of a causal relationship between work and death is usually judged based on the worker's health and physical condition, rather than the average person. Supreme Court 2006. 3. 9., Sentence 2005du13841 Decision
■ Workers' Compensation Benefits
Workers' compensation benefits are paid to employees of workplaces covered by workers' compensation insurance who require medical treatment for injuries or illnesses that occur in the course of their work or to their survivors in case of death. Workers' compensation benefits include medical benefits, temporary disability benefits, permanent disability benefits, death benefits, caregiving benefits, funeral expenses, and vocational rehabilitation benefits. When an employee receives workers' compensation benefits for a work-related injury or illness, the employer is exempt from the liability of compensation under the Labor Standards Act, and any related damages are also exempt within the scope of workers' compensation benefits.
① Medical Care Benefits
Under the Industrial Accident Compensation Insurance Act, medical benefits cover all medical expenses incurred, and treatment must be provided by an insurance facility established by the Korea Workers' Welfare & Safety Corporation or a designated medical institution. However, in unavoidable circumstances, medical expenses can be paid in lieu of treatment.
② Temporary Disability Benefits
Temporary disability benefits are paid during the period when an employee cannot work due to medical treatment. The amount of temporary disability benefits is 70% of the average wage for one day. However, if the employee cannot work for less than three days, temporary disability benefits are not paid.
③ Disability Benefits
When an employee has a physical disability after recovering from a work-related injury or illness, the employer must pay permanent disability benefits, which are calculated by multiplying the number of days specified in the disability rating table by the average wage according to the degree of disability.
④ Survivor’s Benefits
If a worker dies on the job, the Korea Workers' Compensation and Welfare Corporation provides survivors' benefits equivalent to 1,300 days of average wages to the survivors by choosing between ①1/2 lump sum, 1/2 pension, and ②full pension.
⑤ Funeral Expenses
If an employee dies as a result of a work-related injury or illness, the employer must pay funeral expenses equal to 120 days of the average wage.
⑥ Nursing Benefits
Nursing benefits are paid according to Article 61 of the Industrial Accident Act to severely disabled persons with disabilities of the 1st and 2nd degree who actually receive care because they need medical care at all times or frequently even after the end of treatment.
⑦ Temporary Compensation
According to Article 80 Paragraph 4 of the Industrial Accident Act, if a worker receiving medical care benefits is receiving an injury-disease compensation annuity after three years have elapsed since the start of medical care, dismissal is allowed under the proviso of Article 23 Paragraph 2 of the Labor Standards Act.
⑧ Injury and Disease Compensation Pension
If a worker who receives medical care benefits continues to meet all of the following conditions after two years have passed since the start of medical care, an injury-disease compensation annuity is paid to the worker instead of work suspension benefits (Article 66 of the Industrial Accident Act). ①The injury or disease must not be cured, ②The degree of disability caused by the injury or disease must meet the criteria for the disability grade prescribed by Presidential Decree, ③The person cannot work due to recuperation
⑨ Vocational Rehabilitation Allowance
Vocational rehabilitation allowance is provided to those who have received disability benefits and require job training for employment. This allowance covers the costs of vocational training and provides a vocational training allowance.
■ Compensation Procedures under the Industrial Accident Compensation Law and Relationship with Other Types of Compensation
❍ Compensation Procedures under the Industrial Accident Compensation Law
As with the application for remedy for unfair dismissal, if sub-payment is decided by the branch of the Korea Workers’ Compensation & Welfare Service due to the revision of the Administrative Litigation Act, an administrative lawsuit is immediately filed with the administrative court without going through a request for examination (Korea Labor Welfare Corporation headquarters)or a request for reexamination (Industrial Accident Compensation Insurance Review Committee). can be submitted (select one). Requests for examination and reexamination are quick and cost-effective, but the cancellation rate is high.
❍ Relationship with Labor Standards Act
When a worker who has suffered an injury can receive insurance benefits under the Industrial Accident Compensation Insurance, they are exempted from liability under the Labor Standards Act. Therefore, except for "injuries that require medical care for less than 4 days" that are not eligible for compensation under the Industrial Accident Compensation Insurance Law, employers cannot directly hold liability for injury compensation under the Labor Standards Act until the non-payment of insurance benefits is confirmed. If a worker is receiving medical care due to work-related injuries, the company cannot unilaterally terminate the employment relationship during the medical care period and the 30 days after that.
However, if a worker receiving medical care benefits has been receiving disability pension benefits for more than 3 years after the start of medical care, the employer can terminate the employment relationship after 3 years have passed, as it is considered that they have already received temporary compensation under Article 84 of the Labor Standards Act (Article 80(4) of the Industrial Accident Compensation Law). In this case, the period of service to calculate the retirement allowance must include up to 3 years after the start of medical care.
❍ Civil Liability for Damages
If an injured worker receives compensation under the Labor Standards Act or the Industrial Accident Compensation Insurance Act, the employer is relieved of liability for civil damages related to the same reasons for compensation paid within the limit of the insurance benefit amount. However, if the injured worker receives compensation for damages under the Civil Code or other laws for the same reasons, the worker cannot receive insurance benefits under the Industrial Accident Compensation Insurance Act within the limit of that amount (Article 80, Paragraph 3 of the Industrial Accident Compensation Insurance Act).
The scope of civil damages refers to all damages suffered by the injured party attributable to the company's fault and causal relationship. In legal precedents, damages for civil liability are categorized into active damages, passive damages, and mental damages. Generally, in the case of a worker's death, the scope of damages includes passive damages such as lost income (income lost from the time of death until the retirement age) and lost severance pay (loss of severance pay due to early retirement), active damages such as funeral expenses, and mental damages such as bereavement compensation. In cases where the worker is young or has little fault in the accident, the amount of civil damages for compensation is much higher than the amount of compensation for industrial accidents.
❍ Industrial Accident Compensation and Criminal Liability
If there is a direct relationship between the perpetrator and the victim in an industrial accident resulting in death, the victim's family can file a criminal complaint for negligent homicide against the individual perpetrator. If there is a violation of industrial safety standards during the inspection conducted by a labor inspector regarding compliance with the Industrial Safety and Health Act at a workplace where a major disaster occurs, the employer can face criminal punishment. According to Article 167 (Penalties) of the Industrial Safety and Health Act, a person who causes a worker to die by violating Article 38 (Safety Measures) Paragraphs 1 to 3 or Article 39 (Health Measures) Paragraph 1 shall be punished with imprisonment for up to seven years or a fine of up to 100 million won.
❍ National Pension
Even if an employee has received compensation for workplace injuries through industrial accident compensation or compensation under the Labor Standards Act, they can also apply for disability pension or survivor's pension under the National Pension Act. According to Article 63 of the National Pension Act, if the recipient of disability pension or survivor's pension receives a salary under another law for the same reason, the disability pension amount under Article 68 or the survivor's pension amount under Article 74 shall be paid at 50% of the original amount.
❍ Car Insurance
If an employee is injured in a traffic accident while performing work, he/she can be compensated under the Industrial Accident Compensation Insurance Act or automobile insurance. Therefore, the type of insurance to be compensated should be selected according to the worker's free will in consideration of the circumstances of the accident. In general, if the worker who has suffered an accident is old or has a lot of negligence, it is better to claim industrial accident compensation insurance because auto insurance offsets the negligence.
❍ General Insurance
Benefits such as life insurance, property insurance, fire insurance, survivor's pension under the Deduction Cooperative Act, and unemployment benefits received by an injured employee who has taken out insurance already have the nature of a consideration for premiums paid, and any benefit derived from an insurance contract is separate from compensation under the Industrial Accident Compensation Insurance Act, and thus not subject to deduction.
