Industrial Accident Compensation Insurance Act, what are the criteria for occupational accidents?

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Medical specialist attorney, while running the hospital, I'm suddenly facing hospital suspension because I allegedly billed false medical fees. Even one day of suspension would be a big hit for our business... and most importantly, I feel wronged because I don't think I did anything wrong. I'm asking if business resumption is possible if I prepare a lawsuit through objection or administrative appeal with a medical specialist attorney. The hospital's losses are significant. Medical specialist attorney, please reply.

industrial accident compensation insurance act

industrial accident insurance

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作者: 고병준

Hello. You asked about the criteria for occupational accidents under the Industrial Accident Compensation Insurance Act.

The criteria for occupational accidents can be broadly classified into three categories.

First, cases where an accident causes injury during work.

Such occupational accidents include not only accidents that occur during work, but also accidents that occur while using facilities provided by the employer or during break times under the employer's control and supervision.

The second is when there is a causal relationship between the work and the injury.

If there is no significant causal relationship between the work and the injury caused by the work-related accident, even if it falls under the above cases, it cannot be regarded as an occupational accident.

Finally, the injury must not result from the worker's intentional or criminal acts.

If the injury occurs as a result of the worker's intentional or criminal acts, it is not recognized as an occupational accident.

In addition, if additional diseases occur during recovery from an occupational accident, whether such diseases can also be recognized as occupational accidents is often an issue.

The Supreme Court ruled, "When a worker is injured in an occupational accident and a new disease occurs during recovery, a causal relationship between the additional disease and the original injury or disease must be proven."

(Supreme Court Decision 91Nu5624 dated November 12, 1991)

As you mentioned, if you suffer an occupational accident due to the employer's intent or negligence, the worker can claim damages against the employer.

However, the worker must directly prove the employer's intent or negligence, and if damages have been received, the worker cannot receive insurance benefits in the amount equal to the damages received.

Please note that the Industrial Accident Compensation Insurance Act is an insurance operated by the Korea Workers' Compensation and Welfare Service, and if a worker can receive insurance benefits, the policyholder is exempted from compensation liability for the same reason.

If legal measures are needed, we recommend responding to the case with the help of an industrial accident attorney.