Legal bases of insurance of professional risks. Occupational Safety and Health

OCCUPATIONAL SAFETY AND HEALTH
Free library / Occupational Safety and Health

Legal bases of insurance of professional risks. Occupational Safety and Health

Occupational Safety and Health

Occupational Safety and Health / Legislative basis for labor protection

Legal basis for compulsory social insurance from accidents and occupational diseases are laid down by the Constitution of the Russian Federation and the Labor Code of the Russian Federation and are also established in more detail by the Federal Law of July 24, 1998 No. 125-FZ "On Compulsory Social Insurance against Occupational Accidents and Occupational Diseases", which entered into force January 6, 2000

This law establishes in the Russian Federation the legal, economic and organizational foundations for compulsory social insurance against industrial accidents and occupational diseases and determines the procedure for compensation for harm caused to the life and health of an employee in the performance of duties under an employment contract (contract) and in other cases established by law .

insured - is, on the one hand, an individual subject to compulsory social insurance against industrial accidents and occupational diseases in accordance with the provisions of paragraph 1 of Art. 5 of Federal Law No. 125-FZ, and on the other hand, an individual who has received damage to health due to an accident at work or an occupational disease, duly confirmed and resulting in loss of professional ability to work.

According to paragraph 1 of Art. 5 "Persons subject to compulsory social insurance against industrial accidents and occupational diseases" are subject to compulsory social insurance against industrial accidents and occupational diseases, and, therefore, are insured:

individuals performing work on the basis of an employment agreement (contract) concluded with the insured;
individuals sentenced to imprisonment and employed by the insured.

Individuals performing work on the basis of a civil law contract are subject to compulsory social insurance against accidents at work and occupational diseases, if, in accordance with the said contract, the insured is obliged to pay insurance premiums to the insurer. Then they will also be called insured.

The main principles of compulsory social insurance from accidents at work and occupational diseases are:

guaranteeing the right of the insured to insurance coverage;
economic interest of subjects of insurance in improving conditions and increasing labor safety, reducing industrial injuries and occupational morbidity;
obligatory registration as insurers of all persons hiring (attracting to work) workers subject to compulsory social insurance against accidents at work and occupational diseases;
mandatory payment of insurance premiums by insurers;
differentiation of insurance rates depending on the class of occupational risk.

The insurer for compulsory social insurance against accidents at work and occupational diseases is the Social Insurance Fund of the Russian Federation, and the insured is the employer.

Since all employers are required to be insurers of the professional risks of all their "insured", in order to streamline and control the fulfillment of this obligation of the employer, mandatory registration of insurers is introduced.

Registration of policyholders is carried out in the executive bodies of the insurer:

policyholders - legal entities - within 5 days from the date of submission to the executive bodies of the insurer by the federal executive body that carries out state registration of legal entities, the information contained in the Unified State Register of Legal Entities and submitted in the manner established by the Government of the Russian Federation;
policyholders - legal entities - at the location of their separate subdivisions that have a separate balance sheet, current account and accrue payments and other remuneration in favor of individuals, on the basis of an application for registration as an insurant, submitted no later than 30 days from the date of creation of such a separate subdivision ;
policyholders - individuals who have concluded an employment contract with an employee - on the basis of an application for registration as an insurer, submitted no later than 10 days from the date of conclusion of an employment contract with the first of the hired employees;
policyholders - individuals who are obliged to pay insurance premiums in connection with the conclusion of a civil law contract - on the basis of an application for registration as an insurant submitted no later than 10 days from the date of conclusion of the said contract.

The procedure for registering policyholders, which is not regulated by the Government of the Russian Federation, is established by the insurer, i.e., the FSS of Russia.

In accordance with the law, all insured persons, when attacked by them insured event are eligible for this type of insurance.

For the purposes of social insurance of occupational risks insurance case - the fact of damage to the health of the insured as a result of an accident at work or an occupational disease, confirmed in accordance with the established procedure, which entails the insurer's obligation to provide insurance coverage.

Occupational Illness - a chronic or acute illness of the insured, which is the result of exposure to a harmful production factor or their combination and has caused temporary or permanent loss of professional capacity for work.

Professional work capacity - the ability of a person to perform work of a certain qualification, volume and quality, and degree of loss of professional ability to work - expressed as a percentage, a persistent decrease in the ability of the insured to carry out the professional activity in which he was engaged before the occurrence of the insured event.

Professional performance should not be confused with ability to work in general, i.e., with the ability of a person to perform certain labor operations, to participate in labor activity. Typically, this general working capacity (so it can be called) depends on the age and state of health of the person.

Eligibility insurance benefits in case of death of the insured as a result of the occurrence of an insured event, they have:

disabled persons who were dependents of the deceased or had the right to receive maintenance from him by the day of his death;
the child of the deceased, born after his death;
one of the parents, spouse (wife) or other family member, regardless of his ability to work, who does not work and is busy caring for the dependent children of the deceased, his grandchildren, brothers and sisters who have not reached the age of 14 years, or although they have reached the specified age, but according to the conclusion of the institution of the state service of medical and social expertise (hereinafter referred to as the institution of medical and social expertise) or medical and preventive institutions of the state healthcare system recognized as needing outside care for health reasons;
persons dependent on the deceased who became disabled within five years from the date of his death.

In the event of the death of the insured, one of the parents, spouse or other family member who is unemployed and is engaged in caring for the children, grandchildren, brothers and sisters of the deceased and who became disabled during the period of care, retains the right to receive insurance payments after the end of care for these persons . Dependency of minor children is assumed and does not require proof.

Insurance benefits in the event of the death of the insured are paid:

minors - until they reach the age of 18;
students over 18 years of age - until the end of their studies in educational institutions in full-time education, but not more than up to 23 years;
women who have reached the age of 55 and men who have reached the age of 60 - for life;
disabled people - for the period of disability;
one of the parents, spouse (wife) or other family member who is not working and is busy caring for the dependent children, grandchildren, brothers and sisters of the deceased - until they reach the age of 14 or change their state of health.

Also, the right to receive insurance payments in the event of the death of the insured as a result of an insured event may be granted by a court decision to disabled persons who had earnings during the life of the insured, in the event that part of the earnings of the insured was their permanent and main source of livelihood.

The definition of disability is associated with a medical and social examination. For this, Art. 13 of Federal Law No. 125-FZ "Examination, re-examination of the insured by an institution of medical and social examination" established that the examination of the insured by an institution of medical and social examination is carried out at the request of the insurer, the insured or the insured, or by decision of a judge (court) when submitting an accident report to production or an act on an occupational disease.

Re-examination of the insured person by an institution of medical and social expertise is carried out within the time limits established by this institution. Re-examination of the insured person may be carried out ahead of schedule at the request of the insured person or at the request of the insurer or policyholder. In case of disagreement of the insured, the insurer, the insured with the conclusion of the institution of medical and social expertise, the said conclusion may be appealed by the insured, the insurer, the insured to the court.

Evasion of the insured without a valid reason from re-examination within the time limits established by the institution of medical and social expertise entails the loss of the right to insurance coverage until he passes the specified re-examination.

In many cases, the main share of the blame for what happened lies with the victim. Therefore, Art. 14 of Federal Law No. 125-FZ "Taking into account the guilt of the insured when determining the amount of monthly insurance payments" reads as follows.

If during the investigation of the insured event by the commission for the investigation of the insured event it is established that the gross negligence of the insured contributed to the occurrence or increase of harm caused to his health, the amount of monthly insurance payments is reduced according to the degree of fault of the insured, but not more than 25%. The degree of guilt of the insured person is determined by the commission for the investigation of the insured event in percentage terms and is indicated in the accident report at work or in the report on occupational disease.

When determining the degree of guilt of the insured, the opinion of the trade union committee or other representative body authorized by the insured is considered.

The amount of monthly insurance payments provided for by Federal Law No. 125-FZ cannot be reduced in the event of the death of the insured.

In the event of insured events confirmed in accordance with the established procedure, a refusal to compensate for harm is not allowed.

Damage caused by the intent of the insured, confirmed by the conclusion of law enforcement agencies, is not subject to compensation.

Authors: Fainburg G.Z., Ovsyankin A.D., Potemkin V.I.

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