Article 19. The procedure for determining the amount of harm. Insurance payments under the contract of compulsory insurance of an employee against accidents of the Law on Compulsory Insurance of an employee against accidents in the Performance of his labor (official) Duties

Home / RLA / Article 19. The procedure for determining the amount of harm. Insurance payments under the contract of compulsory insurance of an employee against accidents of the Law on Compulsory Insurance of an employee against accidents in the Performance of his labor (official) Duties

Article 19. The procedure for determining the amount of harm. Insurance payments under the contract of compulsory insurance of an employee against accidents of the Law on Compulsory Insurance of an employee against accidents in the Performance of his labor (official) Duties

1. The amount of damage related to the loss of earnings (income) due to the death of an employee or the establishment of his degree of loss of professional ability to work is determined in accordance with the requirements of the Civil Code of the Republic of Kazakhstan.

Compensation for damage related to the loss of earnings (income) by an employee in connection with the establishment of the degree of professional disability from five to twenty-nine percent inclusive, is carried out by the policyholder in accordance with the labor legislation of the Republic of Kazakhstan.

The monthly insurance payment due to the employee as compensation for damage related to the loss of earnings (income) by the employee in connection with the establishment of the degree of professional disability from thirty to one hundred percent inclusive, is carried out by the insurer.

The amount of the average monthly earnings (income) taken into account for calculating the lost earnings (income) to be reimbursed does not exceed ten times the minimum wage established for the relevant financial year by the law on the republican budget, as of the date of conclusion of the employee's compulsory accident insurance contract.

The amount of the insurance payment is carried out minus the social disability payment from the State Social Insurance Fund.

The insurance payment due as compensation for damage related to the loss of earnings (income) by an employee in connection with the establishment of the degree of professional disability for a period of less than one year is carried out by the insurer on a monthly basis on the basis of an annuity agreement. In this case, the first insurance payment is made by the insurer within seven working days from the date of submission of the documents provided for in paragraph 2 of Article 20 of this Law.

The insurance payment due as compensation for damage related to the loss of earnings (income) by an employee in connection with the establishment of the degree of professional disability for a period of one year or more is made in the form of annuity payments in favor of the employee for a period equal to the period of establishment or extension (re-examination) of the degree of professional disability of the employee in accordance with with the annuity agreement concluded with the policyholder in accordance with Article 23 of this Law, but not more than the time when the employee reaches the retirement age established by the legislation of the Republic of Kazakhstan on social protection.

Mandatory pension contributions to the unified accumulative pension fund are deducted and transferred from insurance payments made by the insurer as compensation for damage related to the loss of earnings (income).

Insurance payment for compensation of damage related to the death of an employee in the event of an accident, as well as due to deterioration of his health as a result of an accident, is made in the form of annuity payments in favor of persons who, according to the laws of the Republic of Kazakhstan, are entitled to compensation for damage, within the period established by the Civil Code of the Republic of Kazakhstan.

In the cases provided for by this Law, other persons who are beneficiaries have the right to receive insurance benefits.

The procedure for calculating annuity payments under an annuity agreement is determined by a regulatory legal act of the authorized body for regulation, control and supervision of the financial market and financial organizations.

In case of liquidation of a legal entity recognized in accordance with the established procedure as responsible for harm caused to life and health, an annuity agreement is concluded with the injured employee or a person who, according to the legislative acts of the Republic of Kazakhstan, has the right to compensation for harm in connection with the death of an employee, in accordance with the procedure provided for by this Law.

2. Reimbursement of additional expenses caused by damage to the employee's health in the event that the degree of professional disability is established, with the exception of expenses for one sanatorium treatment in accordance with paragraph 2-1 of this article, shall be carried out by the insurer on the basis of documents confirming these expenses submitted by the employee or the person who incurred these expenses. At the same time, expenses for medical care provided within the guaranteed volume of free medical care and in the compulsory social health insurance system are not subject to reimbursement.

The total amount of insurance payments for reimbursement of additional expenses caused by damage to health may not exceed the following amounts (in monthly calculation indices established for the relevant financial year by the law on the republican budget):

1) when determining the degree of professional disability from thirty to fifty–nine percent inclusive - 500;

2) when determining the degree of professional disability from sixty to eighty–nine percent inclusive - 750;

3) when determining the degree of professional disability from ninety to one hundred percent inclusive – 1,000.

Insurance payments for reimbursement of additional expenses caused by damage to health shall be made by the insurer within the limits of the amounts established by this paragraph, within seven working days from the date of submission by the employee or the person who incurred these expenses, documents confirming these expenses.

Cumulative insurance payments for compensation of additional expenses caused by damage to health shall be carried out by the insurer according to the corresponding initially established degree of loss of professional disability within the limits of the amounts determined by part two of this paragraph.

2-1. After the initial degree of professional disability has been established, the injured employee has the right to receive reimbursement for expenses incurred to pay for one sanatorium treatment, regardless of the individual rehabilitation program of the injured employee.

Reimbursement of expenses incurred is carried out up to one hundred times the monthly calculation index established for the relevant financial year by the law on the republican budget, on the basis of documents confirming these expenses.

2-2. Employees for whom the degree of professional disability in the amount of thirty to one hundred percent inclusive was initially established before May 10, 2015 and extended (re-certified) without an examination period in the period from May 10, 2015 to January 1, 2024, are entitled to receive insurance payments for a period equal to the period of extension (re-certification) of the degree of professional disability. the employee's ability to work.

The insurance payments specified in this paragraph are appointed from the date of the policyholder's (beneficiary's) request with the submission of the documents provided for in paragraph 2 of Article 20 of this Law.

3. In the event of the death of an injured employee, the person who carried out his burial is reimbursed by the insurer for burial expenses in one hundred times the monthly calculation index established for the relevant financial year by the law on the republican budget.

4. If the amount of the insurance payment (insurance payments) and (or) funeral expenses provided for in this article exceeds the amount of the insured sum established by the employee's compulsory accident insurance contract, the difference shall be paid to the insurer at the expense of the policyholder.

If the costs of carrying out preventive measures, taking into account the amount (amounts) of the insurance payment (insurance payments) and the costs of burial, the costs of rehabilitation measures, sanatorium treatment, exceed the amount of the insured sum established by the contract of compulsory insurance of the employee against accidents, the costs of preventive measures are not carried out.

5. The expenses related to the transfer of the insurance payment are made at the expense of the insurer.

6. The insurer shall reimburse the policyholder for the costs actually incurred by him for carrying out preventive measures in the amount of no more than six percent of the insurance premium in accordance with the procedure determined by the authorized body, provided that the insurance premium is paid in full and only after the expiration of the insurance contract.

The Law of the Republic of Kazakhstan dated February 7, 2005 No. 30.

This Law regulates public relations arising in the field of compulsory employee accident insurance and establishes the legal, economic and organizational basis for its implementation.

President

Republic of Kazakhstan

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