The Process of Compensation of Occupational Diseases in Special Populations: Public Officials, Private School Teachers and Staff, Soldiers, Fishing Crews, and Farmers

OBJECTIVE: The purpose of this study was to review the compensation and development direction of occupational accidents including occupational diseases of workers who do not apply industrial accident compensation insurance. METHODS: We reviewed laws and related articles about compensation for occupational accidents of public officials, private school teachers and staff, soldiers, fishermen, and farmers, and compared each system and presented problems and solutions. RESULTS: Public officials, private school teachers and staff, and soldiers were provided compensation for the occupational accidents by the state in the form of pensions. Safety accident insurance for farmers was a form of voluntary subscription, but the individual had to pay the remaining premiums even though there were over half of the national burden. Although there were differences in the degree of professionalism in approval system of occupational accidents in the fields of public officials, private school teachers and staff, and soldiers, there was a deliberative body composed of experts, but fishermen and farmers were in fact considering deliberations on the compensation of insurance companies. Like the industrial accident compensation insurance, the prevention fund was not legally enforced in all fields. CONCLUSION: Processes for compensation for occupational accidents was somewhat similar. However, scientific and rational deliberations were difficult to achieve consistently. There was a lack of systems to prevent disasters and institutionalize rehabilitation for returning to work after a disaster. It is necessary to introduce a consistent system for reasonable compensation, disaster prevention, and return to work according to the risk level of the special population.

Directiva administrativa para la atención de pacientes víctimas de accidentes de tránsito cubiertos por el Seguro Obligatorio de Accidentes de Tránsito (SOAT) o el Certificado contra Accidentes de Tránsito (CAT) en las Instituciones Prestadoras de Servicios de Salud (IPRESS) públicas del Ministerio de Salud y Gobiernos Regionales. Directiva Administrativa Nº 210-MINSA-DGSP.V.01 / Administrative Directive to for the care of patients victims of traffic covered by the Compulsory Insurance of Traffic Accidents (SOAT) or Certificate Accident Transit (CAT) in the Service Institutions of Health (IPRESS) Public Health Ministry and Regional Governments. Administrative Directive No. 210-MINSA-DGSP.V.01

La publicación describe los aspectos técnicos, operativos y financieros que regulen la atención a los pacientes víctimas de accidentes de tránsito cubiertos por el Seguro Obligatorio de Accidentes de Tránsito (SOAT) o el Certificado contra Accidentes de Tránsito (CAT), que hagan posible la interrelación de las instituciones prestadoras de Instituciones Prestadoras de Servicios de Salud (IPRESS)

The Administrative Process for Recognition and Compensation for Occupational Diseases in Korea

In the Workers' Compensation Insurance (WCI) system in Korea, occupational diseases (ODs) are approved through deliberation meetings of the Committee on Occupational Disease Judgment (CODJ) after disease investigations when workers or medical institutions requested the Korea Workers' Compensation and Welfare Service (COMWEL) for medical care benefits. Insufficient data presented by employers or workers or lack of objective evidence may increase the possibility of disapproval. The expertise of accident investigation staff members should be reinforced and employers' and related institutions' obligations to cooperate and submit data should be specified under the law. The deliberation meetings of the CODJ are held separately for musculoskeletal, cerebro-cardiovascular, and medical diseases, and the judgments of ODs are made by the chairperson of COMWEL and six committee members by majority vote by issue. To reinforce the expertise of the members of the CODJ, periodic education and a system to accredit the committee members after appropriate education should be introduced. To fairly and quickly compensate for diseases that occur in workers, the criteria for the recognition of occupational diseases should be continuously amended and the systems for disease investigations and judgments should be continuously improved.

Work-Related Musculoskeletal Diseases and the Workers' Compensation

The Industrial Accident Compensation Insurance Act (IACIA) regulates the workers' compensation insurance system and the standards for the recognition of occupational diseases (ODs). Since its establishment in 1994, the IACIA has been amended several times. Before 2008, the approval of compensation for work-related musculoskeletal diseases (WMSDs) was decided based on the recommendation of consultants of the Korea Workers' Compensation and Welfare Service (COMWEL). The IACIA was amended in 2008, and since then, the approval of compensation for occupational injuries has been decided based on the recommendation of COMWEL consultants, whereas the approval of compensation for ODs was decided based on the judgment of Committee on Occupational Diseases Judgment (CODJ) which was established in 2008. According to the 2013 amendment to the IACIA, degenerative musculoskeletal diseases among workers engaged in musculoskeletal-burdening work should be considered compensable ODs. Despite some commendable changes to the workers' compensation insurance system, other significant issues persist. To resolve these issues, related organizations including the associations of orthopedic surgery, neurosurgery, and occupational and environmental medicine; Ministry of Employment and Labor; and COMWEL need to work cooperatively.

Compensation for Occupational Injuries and Diseases in Special Populations: Farmers and Soldiers

Some types of workers such as farmers and soldiers are at a higher risk of work-related injury and illness than workers from other occupations. Despite this fact, they are not covered under the Industrial Safety Health (ISH) Act or the Industrial Accident Compensation Insurance (IACI) Act. The Safety Aid System for Farmers (SASF) is a voluntary insurance scheme, and it is the only public compensation plan for self-employed farmers. Fifty percent of SASF premiums are subsidized by the Korean government. Soldiers are compensated by the Veterans' Pension (VP) Act. The approval standard of and procedure for the VP Act are provided in the Decree of VP Act, and the Council for VP Benefits determines work-relatedness in the claimed cases. Meanwhile, SASF applies the insurance clause automatically without any expert advice or additional procedures. Furthermore, compared with IACI, these programs pay fewer benefits to workers. Thus, a stronger institutional strategy is needed to maintain a safe work environment, to protect workers' health in unavoidably hazardous environments, and to compensate for work-related injuries and diseases.

The Scope and Specific Criteria of Compensation for Occupational Diseases in Korea

The range of diseases covered by workers' compensation is constantly expanding. However, new regulations are required for the recognition of occupational diseases (ODs) because OD types evolve with changes in industrial structures and working conditions. OD criteria are usually based on medical relevance, but they vary depending on the social security system and laws of each country. In addition, the proposed range and extent of work-relatedness vary depending on the socio-economic conditions of each country. The Labor Standards Act (LSA) and the Industrial Accident Compensation Insurance Act (IACIA) of Korea employ lists based on their requirements without listing causes and diseases separately. Despite a considerable reshuffle in 2003, the basic framework has been maintained for 50 yr, and many cases do not fit into the international disease classification system. Since July 1, 2013, Korea has expanded the range of occupational accidents to include occupational cancers and has implemented revised LSA and IACIA enforcement decrees. There have been improvements to OD recognition standards with the inclusion of additional or modified criteria, a revised and improved classification scheme for risk factors and ODs, and so on.

Previdência Social e Seguro Público contra Acidentes e Doenças do Trabalho: estudo metodológico da definição das alíquotas para contribuição patronal nas dimensões coletiva e individual / Social Security and Public Insurance against accidents and diseases of work: study on methodological for definition of employer contribution aliquots on individual and collective dimensions

Este estudo faz um relato breve sobre a formação do sistema brasileiro de previdência social e sobre a evolução do seguro público de acidentes e doenças do trabalho neste sistema, contextualizando-a no âmbito das políticas públicas de atenção à saúde do trabalhador e segurança nos ambientes laborais, com enfoque especial nas ações e programas adotados pela política previdenciária. Considerando a expressiva evolução dos sistemas de informação acerca da acidentalidade, tanto no tocante aos registros de acidentes como nos respectivos desdobramentos, e a formação da agenda de Governo que conferiu relevância ao tema Saúde e Segurança no Trabalho – SST, a Previdência social promoveu a revisão do enquadramento dos graus de risco segundo as atividades econômicas, atualizando esta correlação de acordo com o cenário real dos padrões de acidentalidade. Em seguida, a implementação da individualização da tarifação para a formação do custeio para o pagamento dos benefícios de natureza acidentária e das aposentadorias especiais, para cada empresa, surge como um instrumento com forte potencial para estimular a adoção ou o aperfeiçoamento dos sistemas de gerenciamento de riscos laborais, pelos empregadores. Observando que alguns aspectos necessitam de atenção especial, tais como o estabelecimento de uma metodologia própria para os enquadramentos dos graus de risco, a definição de temporalidade e a extensão da cobertura do seguro aos trabalhadores de todas as categorias profissionais, propostas para tratamento e solução destas questões são apresentadas nesta dissertação.

This study is a brief account about the formation of the Brazilian social security system and the evolution of public insurance against accidents and occupational diseases in this system, contextualizing it within the public policy for worker health and safety, with special focus on actions and programs adopted by Social Security. Due to significant evolution of information systems about accidentality, and the relevance the topic Health and Safety at Work - OSH had achieved in the Government agenda, the Social Security had promoted the revision of degrees of risk according to economic activities using real scenarios patterns accidentality. The implementation of individual fare for contribution to financing the benefits related to workplaces risks appears as an instrument with strong potential to stimulate the adoption of better management systems workplace risks, by employers. Some aspects need special attention, such as the establishment of a proper methodology for framing degrees of risk, the definition of temporality and extent of insurance coverage to workers of all professional categories, and some proposals are presented for them in this dissertation.

Current Situation and Issue of Industrial Accident Compensation Insurance

Industrial Accident Compensation Insurance (IACI) has a history of about 50 yr, and is the oldest social insurance system in Korea. After more than 20 times of revision improvements in benefits, its contents and claim systems have been upgraded. It became the protector of injured workers and their families, and at the same time became the system which could cope with both financial burden of employers and their responsibilities. However, there are some issues to be reformed to upgrade the IACI: 1) the problems in the approval system of occupational diseases, 2) quality improvement of workers' compensation medical care, 3) vocational rehabilitation and return to work, 4) workers' compensation premiums and out-of-pocket money of injured workers, 5) issues in application of IACI. Growth of IACI cannot be achieved by an effort of an individual. Efforts by workers, owners, and government, in addition to physicians and welfare professionals toward the same goal are required for the next level improvement of IACI.

Cobertura real de la ley de atención de emergencia y del seguro obligatorio contra accidentes de tránsito (SOAT) / Coverage of the emergency health care law and the compulsory insurance against road traffic crashes (SOAT)

Objetivo. Determinar, desde la perspectiva de los pacientes, el grado de conocimiento y de cobertura real de la Ley de Atención de Emergencia y del Seguro Obligatorio Contra Accidentes de Tránsito (SOAT). Materiales y métodos. Estudio transversal de vigilancia activa en los servicios de emergencia de establecimientos de salud (EESS) de tres ciudades del país con heterogeneidad económica, social y cultural (Lima, Pucallpa y Ayacucho). Resultados. De 644 encuestados, 77% negaron conocer la Ley de Atención de Emergencia (81% en Lima, 64% en Pucallpa y 93% en Ayacucho; p < 0,001). Luego de explicarles dicha ley, 46% del total respondió que fueron atendidos bajo los preceptos de la ley. Con respecto al SOAT; en 237 personas (37,2%) los gastos de atención no fueron cubiertos por un seguro (74% Pucallpa, 34% en Ayacucho y 26% en Lima: p < 0,001). De los que contaban con un seguro (SOAT u otro), pero cuya atención no fue cubierta por éste, la mayoría estuvo en Lima (70%), seguido de Ayacucho (30%) y ninguno en Pucallpa. La mayoría (94%) procedió de establecimientos públicos. Las razones incluyeron problemas administrativos (25%), vencimiento del seguro o morosidad en el pago (21%), invalidez del seguro en el establecimiento (18%), no disponibilidad de la póliza (18%), o no cobertura de las lesiones por el seguro (9%). En estos casos, los gastos fueron asumidos por el mismo paciente, familiares o parientes, el chofer o dueño del vehículo, el servicio social del EESS, u otras personas o instituciones. Conclusiones. En este estudio se observó un gran desconocimiento de la Ley de Atención de Emergencia, y una cobertura de atención muy deficiente, pues casi la mitad de atenciones no fueron brindadas de acuerdo a uno o más puntos establecidos por dicha norma.

Objective. The aim of this study was to ascertain, from patients' perspective, the degree of knowledge and the actual coverage of the Emergency Health Care Law and the Compulsory Insurance against Road Traffic Crashes (SOAT). Material and methods. A cross-sectional, active surveillance of emergency wards of selected health facilities in three Peruvian cities (Lima, Pucallpa y Ayacucho) was conducted. Results. Out of 644 surveyed victims, 77% did not know about the law about provision of emergency health care (81% in Lima, 64% in Pucallpa y 93% in Ayacucho; p < 0,001). Following the explanation of what this law entails, 46% reported to have received care according to the law specifications. As for SOAT, the health care related costs of 237 persons (37.2%) were not covered by any insurance scheme (74% in Pucallpa, 34% in Ayacucho and 26% in Lima: p < 0,001). Conclusions. In this study, the lack of knowledge about the provision of emergency health care law was important, and the coverage of care was deficient as nearly half of participants reported not to be treated by one or more of the entitlements stated in such law. Road traffic injuriesrelated health care costs were not covered by any insurance scheme in one of three victims. Improvements on citizens' information about their rights and of effective law enforcement are badly needed to reach a universal and more equitable coverage in the health care of road traffic-related victims.

O novo seguro de acidente e o novo FAP / The new accident insurance and the new accident prevention factor

O que é o FAP – Fator Acidentário de Prevenção (tarifação individual por empresa)? O que é o RAT – Risco de Acidente de Trabalho (tarifação coletiva por setor econômico)? O que muda para as empresas e para os trabalhadores com o FAP? Como faço para calcular o FAP da empresa? Como essa política de prevenção funciona em outros países? Qual é a legislação básica do novo Seguro de Acidente e do novo FAP? Estas são algumas perguntas que clamam por respostas desde o lançamento do FAP, em setembro de 2009. Esta obra traz amplas informações sobre ambos: o FAP, que incidirá ano a ano para as empresas a partir de 2010, e o RAT, que é o ponto de partida para o FAP. Juntos, esses dois instrumentos orientarão as políticas de saúde e segurança no trabalho e, portanto, precisam ser amplamente conhecidos por empresários, trabalhadores, advogados, médicos, gestores públicos, engenheiros, pesquisadores, técnicos na área de saúde ocupacional e por todos os que atuam no campo da saúde e segurança no trabalho. Tornar conhecidos o FAP e o RAT é o objetivo deste livro. Aqui, estão descritos a metodologia do FAP e do RAT e o histórico da legislação previdenciária que deu origem a esses instrumentos e também é feita uma comparação com o que acontece em outros países, quanto à tarifação coletiva e individual para o financiamento do custo da acidentalidade no trabalho. Os resultados do RAT e do FAP também são apresentados, mostrando o impacto desses instrumentos em cada um dos grandes setores da economia: indústria, comércio, construção, saúde, transporte, bancos, serviços... Como está cada uma dessas atividades econômicas quanto aos acidentes de trabalho? Como o FAP altera as alíquotas das empresas nos diversos setores? Que impactos são esperados para o campo de saúde e segurança no trabalho a partir das mudanças efetuadas? As respostas para essas e outras perguntas podem ser obtidas pela leitura deste livro.

Accident trends in Alexandria national Iron and Steel company from 1988 to 1999

Iron and steel industry is a heavy industry and is characterized by high accidents rates than those in most industries owing to the inherent risks in the entire rough processes. The aim of the study is to demonstrate the accident trends in Alexandria National Iron and Steel Company [ANSDK] from 1988 to 1999, to identify the applied accident prevention control system at the company, and to illustrate its effectiveness. Accidents [injuries] have been investigated and analyzed in the study period. Results revealed that the age group of 25-29 years had reported the highest record of injury in the first 6 years [1988-1993] and translocated to the age group of 30-40 years in the next 6 years [1994-1999]. The main reasons of injury are lack of attention and unsafe working methods [28.4% and 16.4%, respectively]. The main cause of injury are accidental fall and caught up between things [25% and 20.5%, respectively]. Upper and lower extremities were the most affected organs. All the aforementioned categorized results were highly significant [P=0.000001]. The accident prevention control system is summarized as; i- intensive patrolling and inspection of work places, ii- continuous review of safety standards and procedures, iii- enforcement of usage of available personal protective equipment, iv- continuous safety training and education for all employees, and v- applying safety commendation system. The continuous follow up of execution of the aforementioned procedures has led to the dramatic decrease of accident incidence from 204 in 1988 to 24 in 1996. Consequently, frequency rates decreased from 49.6 to 4.6 and severity rate from 1.163 to 0.226 in the same period. Best prediction equations for accident parameters and rates were derived. The actual accident parameters and rates were much lower than predicted ones from 2000 to 2004. The present study emphasized the integrity and success of the accident prevention control system and it is highly recommended to be applied in heavy industrial sector

La seguridad social de cara al nuevo sistema de pensiones y reforma / The social security of face to the new system of pensions and it reforms

El documento da a conocer el quehacer del Instituto Nicaraguense de Seguridad Social de cara al nuevo sistema de pensiones y reforma, la misión y visión, los principios y valores, los indicadores generales del 2003, las ramas de seguro y cobertura, las etapas relevantes del seguro social y la reforma, La gestion durante el período comprendido del 2002 al 2003, los logros y resultados financieros, las reformas en seguro de pensiones y el Sistema de ahorro y pensiones (SAP) así como las estrategias institucional durante el período del 2003 al 2005

A experiencia do movimento sindical na análise da acidentes químicos ampliados

Exposición del accidente de la industria petroquímica, PQU, como instrumento de los sindicatos brasileños para exponer las diferentes posiciones de los trabajadores, gobierno, confederaciones empresariales e instituciones públicas y de investigación en el ámbito nacional e internacional

Análise e registro de acidentes: A experiencia dos países nórdicos

Análisis y registro de accidentes producto de la experiencia de los países nórdicos, además se dan los pronunciamientos del sistema nacional de control para la seguridad y la salud de los trabajadores que fue implementado por primera vez en Noruega. También se enuncian el análisis y registro de accidentes como parte del sistema gerencial donde se mencionan las especificaciones utilizadas por la industria actual como: ISO 9000 e ISO 14001. También se menciona los sistemas avanzados para investigar y registrar los accidentes estructrados de tal forma que sean de uso practico

Um novo modelo do seguro de acidentes do trabalho no Brasil: acidentes do trabalho sob a ótica da previdência social / A new model for workers' compensation in Brazil: occupational accidents from the standpoint of social security

A saúde e a segurança dos trabalhadores constituem ou deveriam constituir tema de máxima importância. O presente artigo tece considerações sobre pontos inadequados do atual modelo brasileiro, assim como itens que deveriam compor uma agenda de discussão, em uma visão muito mais de possibilidades alternativas do que soluções prontas. A ênfase situa-se: 1) na prevenção; 2) na abordagem global da prestação de benefícios e serviços aos segurados e 3) na participação de empregadores e empregados na gestão e operacionalização do sistema, sob controle do Instituto Nacional do Seguro Social (INSS), do Ministério da Previdência e Assistência Social (MPAS)

Diseño del proceso de estudio de cuentas de cobro por S.O.A.T. en Seguros del Estado S.A., 1998 / Study process design on billing to S.O.A.T. (Traffic Accidents Mandatory Insurance) in Seguros del Estado S.A. 1998

Seguros del Estado S.A. maneja en la actualidad el 30 por ciento del mercado Seguro Obligatorio de Accidente de Tránsito (SOAT), volumen que ha causado en la empresa un atraso en los pagos a los diferentes acreedores, esto hace que surja la necesidad de revisar el proceso y elaborar el rediseño del mismo para optimizarlo. Para su desarrollo se siguieron los siguientes pasos: revisión del marco teórico, análisis de la organización, levantamiento del proceso actual, rediseño del proceso, presentación de la propuesta a la gerencia y elaboración del informe final. El análisis del proceso detectó múltiples falencias tales como, falta de delegación, duplicación de actividades, manual de funciones inadecuado, subutilización del talento humano, etc. Se incluyó que se debe rediseñar el proceso y elaborar un nuevo manual de funciones.