Reimbursement of expenses caused by damage to the employee's health

Plaintiff T-aev B.A. appealed to the defendant's court to the Central Asian Sugar Corporation LLP, to the Taraz Sugar Factory Branch of this partnership, to third parties who do not declare independent claims on the subject of the dispute on the defendant's side - JSC Life Insurance Company State Annuity Company, JSC Life Insurance Company Grandes and Halyk - Life, a subsidiary of the People's Bank of Kazakhstan, Life Insurance Company, filed a claim for a one-time insurance payment to reimburse expenses caused by damage to the employee's health.

The claim was partially satisfied by the decision of the Taraz City Court of the Zhambyl region dated January 14, 2015. It was decided to collect from the Central Asian Sugar Corporation LLP, from the Taraz Sugar Factory branch of this partnership in favor of T-ev Bekzhan Alimbaevich a one-time insurance payment in the amount of 1,852,000 tenge, and to refuse to satisfy the rest of the claims (in terms of claims filed against Insurers).

The case materials established that the accident with the loader of the loading and unloading shop Tokbaev B.A. occurred on 06/02/2013, according to the ITU certificate dated 04/17/2014, the plaintiff was recognized as a disabled person of group 3, the loss of professional disability was 50%.

Insurers refused both to make payments due to the employee as compensation for damage related to loss of earnings, and to make a one-time insurance payment for reimbursement of expenses caused by damage to the employee's health, on the grounds that at the time of the accident that occurred with the plaintiff on 06/02/2013, the liability of Central Asian Sugar Corporation LLP was not insured. was.

The court has imposed on the employer the obligation to make a one-time insurance payment to reimburse expenses caused by damage to the employee's health.

At the same time, it was established that the employer of the Central Asian Sugar Corporation LLP concluded a contract of compulsory insurance of an employee against accidents in the performance of his work duties with Alliance - Life JSC on 14.03.2012 for a period until 13.03.2013, and in the period from 06.08.2013 to 05.08.2014, the employer concluded a Contract of compulsory insurance of an employee against accidents in the performance of his work obligations were concluded with JSC Halyk - Life, a subsidiary of the National Bank of Kazakhstan for Life Insurance.

It is worth noting the ambiguous practice of courts when considering similar disputes. In some cases, the employer is responsible for making a one–time insurance payment to reimburse expenses caused by damage to the employee's health, in other cases - the Insurer.

At the same time, the right to reimbursement of expenses caused by damage to an employee's health arises when determining the degree of loss of professional ability to work, depending on which the amount of the MCI to be reimbursed is determined. The accident with the loader of the loading and unloading shop, T-evym B.A., occurred on 06/02/2013, during a period when the employer's liability was not insured. However, when determining the degree of professional disability for the employee on 17.04.2014, the employer's liability was already insured.

In this case, it seems controversial to assign responsibility to the employer for making a one-time insurance payment to reimburse expenses caused by damage to the employee's health, if there is an insurance contract and insurance premiums are transferred.

At the same time, it should be noted that the Law of the Republic of Kazakhstan dated April 27, 2015 No. 311-V SAM amended and supplemented the legislative acts of the Republic of Kazakhstan on insurance issues. The provisions of the Law regarding compulsory insurance of an employee against accidents in the performance of his/her labor (official) duties apply to cases of establishing or extending (re-certifying) the degree of professional disability of an employee that arose after the entry into force of this Law (that is, after May 10, 2015).

At the legislative level, the date of an accident as a result of a labor injury or the detection of an occupational disease has been determined (paragraph 2 of Article 13 of the Law of the Republic of Kazakhstan "On Compulsory insurance of an employee against accidents in the performance of his labor (official) duties"):

in case of death or establishment of the degree of professional disability for an employee as a result of an occupational injury, the date of the accident specified in the accident report.;

when determining the degree of professional disability for an employee as a result of the detection of an occupational disease, the date of the conclusion of the healthcare organization providing specialized medical and expert assistance in the field of occupational pathology is indicated.

Article 19 of the Law has undergone significant changes. Compensation for damage related to the loss of earnings by an employee in connection with the establishment of the degree of professional disability from 5 to 29 percent inclusive is carried out by the policyholder (employer) in accordance with the labor legislation of the Republic of Kazakhstan, and from 30 to 100 percent inclusive is carried out by the insurer. When calculating the amount of the average monthly earnings taken into account should not exceed ten times the minimum wage, the amount of the insurance payment is carried out minus the social security payment in case of disability from the State Social Insurance Fund. The insurance payment is made for a period not exceeding the employee's retirement age. Mandatory pension contributions are deducted from insurance payments and transferred to the unified accumulative pension fund.

If additional expenses caused by damage to the employee's health are reimbursed, expenses that are included in the guaranteed amount of free medical care are not reimbursed. The total amount of insurance payments for reimbursement of additional expenses caused by damage to health may not exceed the amount of the MCI established by paragraph 2 of Article 19 of the Law. In the event of the death of the injured employee, the person who carried out his burial, the insurer reimburses the funeral expenses in the amount of one hundred monthly calculation indices.

If the amount of the insurance payment or funeral expenses exceeds the amount of the insured sum established by the employee's compulsory accident insurance contract, the difference is paid to the insurer at the expense of the policyholder.

 

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