• Title/Summary/Keyword: Industrial Accident Compensation Insurance

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Development of a Work-Related Injury and Illness Monitoring Geographic Information System using Workers' Compensation Insurance Big Data (산재보험 빅데이터를 활용한 산재 모니터링 지리정보시스템 개발)

  • Yoo, Dong Hee;Chung, Suk Hoon;Lee, Jeong Hwa;Choi, Keun Ho
    • The Journal of Information Systems
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    • v.31 no.2
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    • pp.217-238
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    • 2022
  • Purpose This study aims to develop a work-related injury and illness monitoring geographic information system that analyzes and visualizes the types of work-related injury and illness based on workers' compensation insurance big data. Design/methodology/approach Using the developed system, we explained the process of monitoring the areas of the applied workplace, medical care application, index, and medical care institution. We also showed examples of analyzing the index and medical care institution area. By applying the system, we can intuitively recognize the current status of workers' compensation insurance and confirm the basic information necessary for managing the current status of workers' compensation insurance. Findings We generated more helpful information by combining workers' compensation insurance data and designated medical care institution data. We were able to apply the severity score and the vulnerability index of work-related injury and illness to the system as a demonstration. To efficiently manage workers' compensation insurance, it was necessary to integrate workers' compensation insurance and designated medical care institution data, as well as the data from various sources.

Changes and Challenges in the Concept of Industrial Accident Insurance in Korea (산업재해 인정 형태 변화와 보상체계 합리화 연구)

  • Kim, Jin-Soo;Ra, Ji-Hun;Lee, Seong-Young
    • Korean Journal of Social Welfare
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    • v.59 no.3
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    • pp.59-73
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    • 2007
  • The compensation system in industrial accident insurance is systemized with "either receiving all or no benefits at all" according to "admited or denied as an industrial accident". Therefore, they are centered on the decision as "industrial accident" or "non-industrial accident", but judging between the two is very complicated, and has inherent conflicting factors. In the early stage of industrialization, industrial accident compensation was based on the indemnity liability for employer's faults. In order to be compensated any damage, the injured worker should prove that the accident was not due to his or her faults. However it was very difficult for injured worker or his or her family to prove the employer's faults, so it was almost impossible to get compensation. Thereafter industrialization progress and improvement of workers' political status lead to conversion from principle of liability with employer's faults to principle of liability without employer's faults. In addition to that, coverage of industrial accident compensation was also expanded. This improvement strengthened the benefit payment principle of "All or Nothing". Even though the "All or Nothing" principle provokes tremendous criticism, the reason why it's difficult for industrialized countries to adopt partial compensation system, is that partial compensation system worsens the administrative hardship, therefore industrialized countries overcome the restrictions of the "All or Nothing" principle with making balance in provisions for any risk to some extent. However, in Korea because the general compensation system for covering medical cost and income loss from accidents, is not equipped, it could be possible to cause acute conflicts with regard to coverage of industrial accidents. Therefore it is required to improve the industrial accident insurance with the acceptance of the significance and logic of discriminated compensation, and create the integrated compensation system in the long run.

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Compensation for Personal Injury and the Insurer's Claim for Indemnity - Focused on the NHIC's Claim for Indemnity - (인신사고로 인한 손해배상과 보험자의 구상권 - 국민건강보험공단의 구상권을 중심으로 -)

  • Noh, Tae Heon
    • The Korean Society of Law and Medicine
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    • v.16 no.2
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    • pp.87-130
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    • 2015
  • In a case in which National Health Insurance Corporation (NHIC) pays medical care expenses to a victim of a traffic accident resulting in injury or death and asks the assailant for compensation of its share in the medical care expenses, as the precedent treats the subrogation of a claim set by National Health Insurance Act the same as that set by Industrial Accident Compensation Insurance Act, it draws the range of its compensation from the range of deduction, according to the principle of deduction after offsetting and acknowledges the compensation of all medical care expenses borne by the NHIC, within the amount of compensation claimed by the victim. However, both the National Health Insurance Act and the Industrial Accident Compensation Insurance Act are laws that regulate social insurance, but medical care expenses in the National Health Insurance Act have a character of 'an underinsurance that fixes the ratio of indemnification,' while insurance benefit on the Industrial Accident Compensation Insurance Act has a character of full insurance, or focuses on helping the insured that suffered an industrial accident lead a life, approximate to that in the past, regardless of the amount of damages according to its character of social insurance. Therefore, there is no reason to treat the subrogation of a claim on the National Health Insurance Act the same as that on the Industrial Accident Compensation Insurance Act. Since the insured loses the right of claim acquired by the insurer by subrogation in return for receiving a receipt, there is no benefit from receiving insurance in the range. Thus, in a suit in which the insured seeks compensation for damages from the assailant, there is no room for the application of the legal principle of offset of profits and losses, and the range of subrogation of a claim or the amount of deduction from compensation should be decided by the contract between the persons directly involved or a related law. Therefore, it is not reasonable that the precedent draws the range of the NHIC's compensation from the principle of deduction after offsetting. To interpret Clause 1, Article 58 of the National Health Insurance Act that sets the range of the NHIC's compensation uniformly and systematically in combination with Clause 2 of the same article that sets the range of exemption, if the compensation is made first, it is reasonable to fix the range of the NHIC's compensation by multiplying the medical care expenses paid by the ratio of the assailant's liability. This is contrasted with the range of the Korea Labor Welfare Corporation's compensation which covers the total amount of the claim of the insured within the insurance benefit paid in the interpretation of Clauses 1 and 2, Article 87 of the Industrial Accident Compensation Insurance Act. In the meantime, there are doubts about why the profit should be deducted from the amount of compensation claimed, though it is enough for the principle of deduction after offsetting that the precedent took as the premise in judging the range of the NHIC's compensation to deduct the profit made by the victim from the amount of damages, so as to achieve the goal of not attributing profit more than the amount of damage to a victim; whether it is reasonable to attribute all the profit made by the victim to the assailant, while the damages suffered by the victim are distributed fairly; and whether there is concrete validity in actual cases. Therefore, the legal principle of the precedent concerning the range of the NHIC's compensation and the legal principle of the precedent following the principle of deduction after offsetting should be reconsidered.

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Current Situation and Reform Scheme for Personal Care Attendants(PCAs) in Workers' Accident Medical Corporation (산재의료원 간병인 관리현황 및 개선방안)

  • Oh, Jin Joo;Lee, Hyun Joo;Choi, Jeong Myung;Kim, Chun Mi
    • Korean Journal of Occupational Health Nursing
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    • v.16 no.2
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    • pp.222-231
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    • 2007
  • Purpose: This study aims to suggest political alternatives for nursing care costs for PCAs to provide qualitative medical benefit for patients with occupational disease by investigating present situation and problems of the nursing care cost system of Korea's Industrial Accident Compensation Insurance. Methods: Data was collected from 6 workers' accident medical corporation and 275 nurses affiliated with Korea labor welfare corporation using self reported questionnaire. Result: Research results were as follows; Character of nursing care cost of the Korea's Industrial accident Compensation Insurance changed as if it aims to support for living expenses for the family; As possible problems which could be caused under current system, administrative problems, decrease of service quality were made as objects of criticism. Some patients did not make every effort in rehabilitation to be beneficiaries continuously. Some patients were supplied with whole one PCA or all-night PCA even though they did not need as much caring as such. Conclusion: The research suggested that PCAs payment system improvement is necessary, and the presented nurses' opinion for the improvement method could be applied for policy making.

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A Comparative Study on Seafarers' Industrial Accident Compensation System - Focusing on the German Legislation - (선원재해보상에 관한 비교법적 연구 - 독일의 법제를 중심으로 -)

  • Park, Jun-Mo;Park, Sung-Ho
    • Journal of the Korean Society of Marine Environment & Safety
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    • v.28 no.4
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    • pp.567-576
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    • 2022
  • Seafarers are exposed to various unpredictable maritime risks due to the spatial specificity of the working environment of the sea; thus, sufficient compensation for injured crewmembers is needed. However, Korea does not provide such compensation. Therefore, this study attempted to examine the Maritime Labor Act and the Industrial Accident Insurance Act of Germany, an advanced European social insurance country, and derive implications compared to Korea. First, we investigated how compensations are managed by a public institution in Germany and by shipowners in Korea. Second, regarding the contents of accident compensation, Germany does not only provide continuous treatment and care through various support systems, but also operates various programs to enable a return to ship work. In contrast, Korea has a temporary compensation system that allows shipowners to avoid liability for accident compensation, which is disadvantageous to shipwrecked seafarers. Finally, in Germany, workers' compensation insurance is public, judged considering the origin of work, whereas in Korea, it is determined by shipowners or insurance companies. Therefore, it is necessary to establish a public institution in charge of crew accident compensation to ensure proper compensation for crewmembers in Korea and to improve the Seafarers Act or system to provide compensation for additional medical care, disability pension, and rehabilitation benefits.

Perception and Need for Industrial Accident Compensation Insurance in Industries which have less than 5 Employees (5인 미만 사업장의 산재보험에 대한 사업주와 근로자의 인식도 및 요구도 조사)

  • Yun, Soon-Nyung;Jung, Hye-Sun;Lee, Bok-Im;Lee, Hyun-Joo;Lee, Hyun-Jeong;Kim, Hwa-Joong
    • Korean Journal of Occupational Health Nursing
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    • v.9 no.2
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    • pp.121-131
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    • 2000
  • This study was conducted to acquire data in order to institute an effective industrial accident compensation insurance(IACI) system. The subjects were employers and employees in small scale industries which have less than 5 employees. The questionnaires consisted of questions on perception and need for IACI. A total of cases were 181 employers and 105 employees participated in the study. Perception and need of employers and employees were assessed using the ANOVA, t-test. The results were as follows ; 1. Workplaces examined mostly in manufacturing(78.9%), industries with one employee(44.1%). Beneficiary rate of IACI 4.4%. 2. 60.0% of employees had experienced an industrial accident and in most cases employers paid the cost of medical treatment. 45.0% of employers nd 50.0% of employees were not aware that IACI had been put into effect starting July, 1, 2000. 52.0% of employers had no type of industrial accident compensation. 3. The need of outcome measures, especially of employers and employees who had an IACE, were higher than those without an IACI. Employers and employees who had experienced an industrial accident outnumbered those who hadn't. The results of this study reveal that there is a great need for the institution of an IACI and health promotion policy in small scale industries.

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Relationship between Medical Service Experience and Subjective Health Awareness of Patents with Industrial Accident (산업재해 환자의 의료서비스 경험과 주관적 건강 인식과의 관계)

  • Choi, Ryoung;Hwang, Byung Deog
    • The Korean Journal of Health Service Management
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    • v.14 no.2
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    • pp.55-65
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    • 2020
  • Objectives: This study intends to analyze the relationship between medical service experience and subjective health awareness by using data from Panel Study of Worker's Compensation Insurance(PSWCI). Methods: Tte χ2-test was performed to investigate subjective health awareness and medical service experience relevance. Logistic analysis was performed to analyze the influencinge factors. Results: The subjective health awareness scored "bad" in"'lack treatment period" compared to "adequate treatment period" in medical service experience (OR = 2.603 [95% CI = 1.666-2.555]). Conclusions: To improve the subjective health awareness of patients with industrial accidents, the industrial accident compensation and medical care approval system should be improved, and long-term industrial accident insurance policies should be developed to accommodate direct and indirect medical services.

Medical Expenses for Trauma According to the Type of Medical Insurance (외상환자의 보험체계에 따른 진료비 분석)

  • Park, Heeseung;Jung, Yooun Joong;Kim, Young-Hwan;Kim, Tae-Hyun;Km, Min Ae;Kyoung, Kyu Hyouck;Kim, Jung Jae;Hong, Suk-Kyung
    • Journal of Trauma and Injury
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    • v.25 no.4
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    • pp.178-187
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    • 2012
  • Purpose: In Korea, the nation's medical expenses were 12 billion won in 2010. The medical costs for individuals can also be overwhelming. If a patient has sustained severe trauma, his/her insurance company responsible may pay only part of the medical bills. In Korean, there are diverse types of medical insurance, such as health insurance, automobile insurance, and industrial accident compensation insurance. And each insurance system has a different type of payment system. Our study will be essential for establishing the optimal medical expense payment system. Methods: From January to December 2011, we retrospectively reviewed the medical charts of 161 patients who were admitted to our hospital's emergency room after having undergone severe trauma. Of those 161 patients, 125 were retrospectively reviewed. Written permission was obtained from all of the patients. We analysed the demographic characteristics, clinical outcomes, data of the trauma, type of the patient's insurance, and the entire bill when the patient was discharged. Results: Seventy-one patients had health insurance, 48 automobile insurance, and six industrial accident compensation insurance. High-deductible insurance included health insurance and industrial accident compensation insurance, with the deductibles up to 20.6% and 19.1%, respectively. We attempted to analyze the cause of the high deductible rate. In patients with health insurance, medicines, primarily sedatives, pain killers, antibiotics, and fluids. comprised a large proportion. On the other hand, industrial accident compensation insurance deducted for a high-grade hospital room charge. Conclusion: We found that medical expenses were diverse according to the type of insurance. In particular, health insurance forced patients to pay too much of the medical expenses. Therefore, in Korea we should try to identify the insurance problems and improve the wage system.

A Scheme of Compensation System for Farmers' Accidents through the Example of Germany (독일의 사례를 통해 본 농업인재해 보장체계 구축 방안)

  • Min, Byeong-Wook;Kim, Hyo-Chel;Lee, Kyung-Suk
    • Journal of Agricultural Extension & Community Development
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    • v.18 no.3
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    • pp.351-384
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    • 2011
  • The purpose of this study is to look at the case of the German compensation system for farmers' accidents and to build a basic scheme in our country's compensation system for farmers' accidents. When you view examples of Germany, the social insurance scheme for farmers accidents in korea should be design as an independent institution from the existing industrial accident insurance, and it comes to relationships with other social insurance system, preferably with complementary personalities. A general rule of the compensation system applies to all farmers in principle but the coverage limits part-time farmers. Financial burden consists of the mix of insurance premium and state aid. The type and level of benefits is similar to the current industrial accident insurance, which give priority to places on economic security for keeping farmworks, such as cost for using temporary farmers, rather than income loss. In terms of financial system, pay-as-you-go system would be better because of immediate payment with the introduction of the compensation system. The compensation system might be managed and administrated by the existing nationwide organization. Of course, for operating of system review and further research on the technical details such as premium issues and funding problems of government support, the exact classification of the target coverage, premiums based on estimated income for the farmers' estimation, the exact statistical data on the accumulation of agricultural disaster is needed.

Relationship between Occupational Accident Service, Pain, and Life Satisfaction of Industrial Accident Compensation Insurance Beneficiaries (산업재해보험 급여수급자의 통증과 산업재해서비스 및 생활만족간의 관계)

  • Jang, Yu Mi
    • The Journal of the Convergence on Culture Technology
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    • v.8 no.4
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    • pp.45-51
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    • 2022
  • This study aims to provide basic data on socioeconomic and social activities from the point of view that disability or disease accompanying the suffering of industrial accident subjects is directly related to individual socioeconomic activity and is a major variable affecting current health and daily life satisfaction. The purpose of this study is to investigate the relationship between pain and life satisfaction and to suggest basic data for economic and psychological rehabilitation of industrial accident insurance beneficiaries by linking factors affecting life satisfaction with industrial accident services. As a result of the study, it was found that workers' compensation insurance benefit recipients had an effect on their daily life satisfaction after becoming an industrial accident patient due to industrial accident pain. There was a positive(+) relationship between rehabilitation services and medical counseling services. Occupational accident pain lowers self-esteem, which is a characteristic of an individual, and even if current health improves, satisfaction with daily life decreases. The importance of industrial accident-related services can be seen in that the satisfaction of daily life is increased through rehabilitation services and medical consultation services. In addition, it was indirectly confirmed that satisfaction with rehabilitation services and health can be improved as a result of continuing attempts to improve self-esteem suitable for patients in various problems and situations after an industrial accident.