A labor-related accident is the basis for recognizing it as an insured event.
The establishment of the fact of an accident related to labor activity in accordance with Article 186 of the Labor Code is the basis for recognizing it as an insured event and entails for the insurer the obligation to pay the insured amount. As mentioned above, an insured event is an accident that occurred to an employee under the circumstances provided for in Article 16-1 of Law No. 30, according to which these circumstances are provided for in Article 186 of the Labor Code (the Law still refers to Article 322 of the expired Labor Code). Thus, the establishment of the fact of an accident related to labor activity in accordance with Article 186 of the Labor Code is the basis for recognizing it as an insured event and entails for the insurer the obligation to pay the insured sum.
However, practice shows that, despite the existence of an accident certificate at work, insurers refuse to make insurance payments. A. filed a lawsuit against JSC "B" to declare the decision to refuse insurance payments illegal, arguing that her husband died in the performance of his work duties, and minor children remained after his death. The defendant objected to the stated requirements, pointing out that the deceased carried out the work on his own initiative. By the decision of the Almaly district Court No. 2 of Almaty dated October 29, 2015, the claim was dismissed on the grounds that A., not being the policyholder, does not have the right to appeal the refusal of the insurer. The appeal board of the Almaty City Court overturned the court's decision and satisfied the claims. At the same time, the board proceeded from the fact that the employer had approved an act on an industrial accident, therefore, the accident was related to the performance of work duties. In addition, the board indicated that the beneficiary, by virtue of Article 9 of the Civil Code, has the right to appeal the insurer's refusal to make insurance payments.
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