Insurance provision. Occupational Safety and Health

OCCUPATIONAL SAFETY AND HEALTH
Free library / Occupational Safety and Health

Insurance provision. Occupational Safety and Health

Occupational Safety and Health

Occupational Safety and Health / Legislative basis for labor protection

Insurance provision - insurance compensation for damage caused as a result of an insured event to the life and health of the insured, in the form of monetary amounts paid or compensated by the insurer to the insured or persons entitled to it in accordance with Federal Law No. 125-FZ.

Types of insurance coverage are established in Art. 8 of Federal Law No. 125-FZ.

Insurance provision carried out:

1) in the form temporary disability benefitsappointed in connection with an insured event and paid at the expense of funds for compulsory social insurance against accidents at work and occupational diseases;

2) in the form insurance payments:

a one-time insurance payment to the insured person or persons entitled to receive such payment in the event of his death;
monthly insurance payments to the insured or persons entitled to receive such payments in the event of his death;

3) in the form payment of additional expensesassociated with the medical, social and professional rehabilitation of the insured in the presence of direct consequences of the insured event, on:

treatment of the insured carried out on the territory of the Russian Federation immediately after a serious accident at work has occurred until the restoration of working capacity or the establishment of a permanent loss of professional ability to work;
purchase of medicines, medical devices and personal care;
extraneous (special medical and domestic) care for the insured, including those carried out by members of his family;
the travel of the insured, and, if necessary, the travel of the person accompanying him to receive certain types of medical and social rehabilitation (treatment immediately after a serious accident at work, medical rehabilitation in organizations providing sanatorium and resort services, obtaining a special vehicle, ordering, fitting, receiving, repairing, replacing prostheses, prosthetic and orthopedic products, orthoses, technical means of rehabilitation) and when sent by the insurer to the institution of medical and social expertise and to the institution that examines the connection of the disease with the profession;
medical rehabilitation in organizations providing sanatorium and resort services, including on a voucher, including payment for treatment, accommodation and meals for the insured, and, if necessary, payment for travel, accommodation and meals for the person accompanying him, payment for the insured’s vacation (in excess of the annual paid leave established by legislation of the Russian Federation) for the entire period of his treatment and travel to the place of treatment and back;
production and repair of prostheses, prosthetic and orthopedic products and orthoses;
providing technical means of rehabilitation and their repair;
provision of vehicles in the presence of relevant medical indications and the absence of contraindications to driving, their current and major repairs and payment of expenses for fuels and lubricants;
vocational training (retraining).

At the same time, payment of additional expenses, with the exception of payment of expenses for the treatment of the insured immediately after a severe accident at work, is made by the insurer, if the institution of medical and social expertise establishes that the insured is in need - in accordance with the rehabilitation program for the victim of an accident at work and occupational disease - in the specified types of assistance, provision or care. The conditions, amounts and procedure for payment of such expenses are determined by the Decree of the Government of the Russian Federation dated May 15, 2006 No. 286 "On approval of the Regulations on the payment of additional expenses for medical, social and professional rehabilitation of insured persons who have received damage to their health due to industrial accidents and occupational diseases ".

One-time insurance payments and monthly insurance payments appointed and paid:

to the insured - if, according to the conclusion of the institution of medical and social expertise, the result of the occurrence of the insured event was the loss of his professional ability to work;
persons entitled to receive them - if the result of the insured event was the death of the insured.

The amount of a one-time insurance payment established in Art. 11 of Federal Law No. 125-FZ and is determined in accordance with the degree of loss of professional disability by the insured based on the maximum amount established by the federal law on the budget of the Social Insurance Fund of the Russian Federation for the next financial year. In the event of the death of the insured, the lump-sum insurance payment is set in the amount equal to the specified maximum amount. The amount of the monthly insurance payment determined by Art. 12 of Federal Law No. 125-FZ. In areas where district coefficients are established, percentage bonuses to wages, the amount of the monthly insurance payment is determined taking into account these coefficients and bonuses.

The amount of the monthly insurance payment is indexed taking into account the level of inflation within the funds provided for these purposes in the budget of the Social Insurance Fund of the Russian Federation for the corresponding financial year.

The indexation coefficient and its frequency are determined by the Government of the Russian Federation.

The procedure for the appointment and payment of security for insurance defined in Art. 15 of Federal Law No. 125-FZ.

Appointment and payment of temporary disability benefits to the insured in connection with an accident at work or an occupational disease are carried out in the manner established by the legislation of the Russian Federation for the appointment and payment of temporary disability benefits under state social insurance.

The day of application for insurance security shall be the day when the insured person, his authorized representative or a person entitled to receive insurance payments submits an application to the insurer for receipt of insurance security. When the said application is sent by post, the date of application for insurance security shall be the date of its dispatch.

The insured person, his/her authorized representative or a person entitled to receive insurance payments has the right to apply to the insurer with an application for receiving insurance security, regardless of the limitation period of the insured event.

Monthly insurance payments are assigned and paid to the insured for the entire period of loss of his professional ability to work from the day from which the institution of medical and social expertise established the fact that the insured person lost his professional ability to work, excluding the period for which the insured was assigned temporary disability benefits specified in paragraph 1 Art. 15. Federal Law No. 125-FZ.

Persons entitled to receive insurance payments in connection with the death of the insured, a one-time insurance payment and monthly insurance payments are assigned from the date of his death, but not earlier than the acquisition of the right to receive insurance payments.

Upon the occurrence of circumstances entailing the recalculation of the amount of insurance payment, in accordance with paragraph 9 of Art. 12 of Federal Law No. 125-FZ, such a recalculation is made from the month following the month in which the specified circumstances occurred.

Claims for the appointment and payment of insurance security, presented after 3 years from the moment the right to receive these payments arises, are satisfied for the past time no more than 3 years preceding the application for insurance security.

Assignment of insurance security is carried out by the insurer on the basis of the application of the insured, his authorized person or a person entitled to receive insurance payments, to receive insurance security, and submitted by the insured (insured person) following documents (their certified copies):

an act on an accident at work or an act on an occupational disease;
certificates of the average monthly earnings of the insured for the period chosen by him for the calculation of monthly insurance payments in accordance with Federal Law No. 125-FZ;
conclusions of the institution of medical and social expertise on the degree of loss of professional capacity for work of the insured;
conclusions of the institution of medical and social expertise on the necessary types of social, medical and professional rehabilitation of the insured;
a civil law contract providing for the payment of insurance premiums in favor of the insured, as well as copies of a work book or other document confirming that the victim is in an employment relationship with the insured;
death certificate of the insured;
certificates of the housing maintenance authority, and in its absence, the local government authority on the composition of the family of the deceased insured person;
notification of a medical institution about the establishment of the final diagnosis of an acute or chronic occupational disease (poisoning);
conclusions of the center of occupational pathology on the presence of an occupational disease;
a document confirming that one of the parents, spouse (wife) or other family member of the deceased, is engaged in caring for the children, grandchildren, brothers and sisters of the insured, who have not reached the age of 14 years or have reached the specified age, but according to the conclusion of the institution of medical and social expertise or medical institution recognized as needing outside care for health reasons, does not work;
certificates from an educational institution stating that a family member of the deceased insured person who is entitled to receive insurance benefits is studying at this educational institution full-time;
documents confirming the expenses for the implementation, according to the conclusion of the institution of medical and social expertise, of the social, medical and vocational rehabilitation of the insured, provided for in sub. 3 p. 1 art. 8 of Federal Law No. 125-FZ;
conclusions of the institution of medical and social expertise on the connection of the death of the victim with an accident at work or an occupational disease;
a document confirming the fact of being dependent or establishing the right to receive maintenance;
victim rehabilitation programs.

The list of documents (certified copies thereof) required for assigning insurance security is determined by the insurer for each insured event.

In the event of the death of the insured, a lump sum insurance payment is made in equal shares to the spouse of the deceased (deceased), as well as to other persons specified in paragraph 2 of Art. 7 of Federal Law No. 125-FZ, who had the right to receive a lump sum insurance payment on the day of death of the insured.

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

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