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.

Compensation for Occupational Cancer

The legal scope and criteria for occupational cancer in Korea was out of date. The aim of this study was to review the current criteria for occupational cancer and amend the existent criteria on the basis of recent scientific evidence. The scientific evidence and the legal list of occupational cancer were analyzed to identify the causes of occupational cancer on a global scale. The relationship between compensated occupational cancer cases and carcinogen exposure in Korea was examined. The factors associated with specific causes and target cancers were determined to produce additional criteria. Five-hundred and nineteen cases of 2,468 were awarded compensation for occupational cancer including lung, malignant mesothelioma, lymphohematopoietic, and liver cancers from January 2000 to October 2012. Between 1996 and 2005, benzene accounted for 84.4% of cases, and between 1999 and 2005, asbestos was associated with 62.3% of cases. Fourteen novel causative agents and 12 additional target cancers were identified and the final guidelines were amended to include 23 causative agents and 21 target cancers. This amendment of the criteria for occupational cancer represents the widest change in Korean history and is expected to improve the understanding of occupational cancer by providing an up-to-date and accurate reference guide.

Workers' Compensation for Occupational Respiratory Diseases

The respiratory system is one of the most important body systems particularly from the viewpoint of occupational medicine because it is the major route of occupational exposure. In 2013, there were significant changes in the specific criteria for the recognition of occupational diseases, which were established by the Enforcement Decree of the Industrial Accident Compensation Insurance Act (IACIA). In this article, the authors deal with the former criteria, implications of the revision, and changes in the specific criteria in Korea by focusing on the 2013 amendment to the IACIA. Before the 2013 amendment to the IACIA, occupational respiratory disease was not a category because the previous criteria were based on specific hazardous agents and their health effects. Workers as well as clinicians were not familiar with the agent-based criteria. To improve these criteria, a system-based structure was added. Through these changes, in the current criteria, 33 types of agents and 11 types of respiratory diseases are listed under diseases of the respiratory system. In the current criteria, there are no concrete guidelines for evaluating work-relatedness, such as estimating the exposure level, latent period, and detailed examination methods. The results of further studies can support the formulation of detailed criteria.

Compensation for Occupational Skin Diseases

The Korean list of occupational skin diseases was amended in July 2013. The past list was constructed according to the causative agent and the target organ, and the items of that list had not been reviewed for a long period. The revised list was reconstructed to include diseases classified by the International Classification of Diseases (10th version). Therefore, the items of compensable occupational skin diseases in the amended list in Korea comprise contact dermatitis; chemical burns; Stevens-Johnson syndrome; tar-related skin diseases; infectious skin diseases; skin injury-induced cellulitis; and skin conditions resulting from physical factors such as heat, cold, sun exposure, and ionized radiation. This list will be more practical and convenient for physicians and workers because it follows a disease-based approach. The revised list is in accordance with the International Labor Organization list and is refined according to Korean worker's compensation and the actual occurrence of occupational skin diseases. However, this revised list does not perfectly reflect the actual status of skin diseases because of the few cases of occupational skin diseases, incomplete statistics of skin diseases, and insufficient scientific evidence. Thus, the list of occupational diseases should be modified periodically on the basis of recent evidence and statistics.

Compensation for Occupational Neurological and Mental Disorders

Standards for the recognition of occupational diseases (ODs) in Korea were established in 1954 and have been amended several times. In 2013, there was a significant change in these standards. On the basis of scientific evidence and causality, the International Labour Organization list, European Commission schedule, and compensated cases in Korea were reviewed to revise the previous standards for the recognition of ODs in Korea. A disease-based approach using the International Classification of Diseases (10th version) was added on the previous standards, which were agent-specific approaches. The amended compensable occupational neurological disorders and occupational mental disorders (OMDs) in Korea are acute and chronic central nervous system (CNS) disorders, toxic neuropathy, peripheral neuropathy, manganese-related disorders, and post-traumatic stress disorder. Several agents including trichloroethylene (TCE), benzene, vinyl chloride, organotin, methyl bromide, and carbon monoxide (CO) were newly included as acute CNS disorders. TCE, lead, and mercury were newly included as chronic CNS disorders. Mercury, TCE, methyl n-butyl ketone, acrylamide, and arsenic were newly included in peripheral neuropathy. Post-traumatic stress disorders were newly included as the first OMD. This amendment makes the standard more comprehensive and practical. However, this amendment does not perfectly reflect the recent scientific progress and social concerns. Ongoing effort, research, and expert consensus are needed to improve the standard.

Compensation for Work-Related Hematologic, Liver, and Infectious Diseases

Occupational diseases may be defined only medically or scientifically, and even then, their definition is not simple. However, compensable occupational diseases involve the additional layer of legal systems and social welfare policies as well. Their multifaceted nature makes determining the work-relatedness of these diseases more complex. Korea has established standards for the recognition of occupational diseases in Schedule 5 of the Enforcement Decree of the Labor Standards Act, and specific criteria for the recognition of occupational diseases are listed in Schedule 3 of the Enforcement Decree of the Industrial Accident Compensation Insurance Act. The new list of compensable occupational diseases comprises 13 articles as an open-ended system. The newly added articles pertain to lymphohematopoietic (Article 5) and infectious diseases (Article 9), as well as diseases of other target organs. Furthermore, the article on liver diseases (Article 8) has been partially revised. The new act has been changed to clarify the meaning as it has been presented in recent research. It is necessary to achieve agreement among concerned parties, including experts from the legal, medical, and social domains to resolve the issues of work-relatedness, causation, notion of aggravation, and so on for preparing a list and a process that are more reasonable.

Physical Agents and Occupational Disease Compensation: Noise, Vibration, Radiation, and Other Physical Agents

The context of specific criteria for the recognition of occupational diseases (ODs) due to physical agents in the Enforcement Decree of the Industrial Accident Compensation Insurance Act (ED-IACIA) and the Labor Standard Act (LSA) does not describe definite disease along with the agents but listed symptoms or obscure clinical conditions. Moreover, the needs for an amendment of these Acts have recently attracted renewed interest. To establish agreed criteria for compensable ODs due to physical agents, we reviewed the criteria for recognizing ODs on the basis of International Labor Organization (ILO) documents and European Union (EU) guideline. After providing a brief review of the history of OD outbreaks due to physical exposure in South Korea and the responses to them, we describe the basis for the recent amendments to the IACI Act and LSA and assess their appropriateness. On the basis of these findings, this study could be helpful for determining and compensating process of ODs. However, further work is required to ascertain the scientific relationship between diseases caused by physical agents and the exposure criteria.

Compensation for Occupational Diseases by Chemical Agents in Korea

Investigation into the frequency of compensation for occupational diseases (ODs) caused by hazardous chemicals revealed an important opportunity for the improvement and further development of occupational health and safety systems in Korea. In response to concerns after outbreaks of disease due to chemical exposure, specific criteria for recognition of ODs were established and included in the Enforcement Decree of the Labor Standard Act (LSA) and the Industrial Accident Compensation Insurance Act (IACIA) on June 28, 2013. However, the original versions of the LSA and IACIA contain several limitations. First, the criteria was listed inconsistently according to the symptoms or signs of acute poisoning. Second, all newly recognized hazardous chemicals and chemicals recognized as hazardous by the International Labor Organization (ILO) were not included in the LSA and IACIA. Although recent amendments have addressed these shortcomings, future amendments should strive to include all chemicals listed by the ILO and continuously add newly discovered hazardous chemicals as they are introduced into the workplace.

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.

Compensation for Work-Related Cerebrocardiovascular Diseases

The purpose of this study was to discuss the history of, and concerns regarding, the newly amended criteria of occupational cerebrovascular or cardiovascular diseases (CCVDs). Since the early 1990s, CCVDs have been the second most common occupational disease, despite fluctuations in their criteria. The first issue was the deletion of cerebral hemorrhage on duty as a recognized occupational disease in 2008. The second issue was the obscurity regarding definitions of an acute stressful event (within 24 hr before disease occurrence), short-term overwork (within 1 week), and chronic overwork (for 3 or more months). In this amendment, chronic overwork was defined as work exceeding 60 hr per week. If the average number of weekly working hours does not exceed 60 hr, night work, physical or psychological workload, or other risk factors should be considered for the recognition of occupational CCVDs. However, these newly amended criteria still have a few limitations, considering that there is research evidence for the occurrence of disease in those working fewer than 60 hr per week, and other risk factors, particularly night work, are underestimated in these criteria. Thus, we suggest that these concerns be actively considered during future amendment and approval processes.

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.

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.

Incidência cumulativa anual de doenças musculoesqueléticas incapacitantes relacionadas ao trabalho em uma área urbana do Brasil / Cumulative annual incidence of disabling work-related musculoskeletal disorders in an urban area of Brazil

Estimou-se a incidência cumulativa anual (ICA) das doenças musculoesqueléticas incapacitantes que acometem a região cervical e/ou membros superiores (DMEMS) relacionadas ao trabalho, entre trabalhadores do Regime Geral da Previdência Social (RGPS) de Salvador, Bahia, Brasil. Trabalhadores que receberam benefícios por incapacidade temporária por DMEMS relacionadas ao trabalho foram considerados casos, em 2008. Os dados provêm dos sistemas administrativos do Instituto Nacional do Seguro Social (INSS) e do Ministério do Trabalho e Emprego (MTE). A ICA foi de 15 por dez mil trabalhadores. Mulheres, os de menor renda e aqueles que trabalhavam no ramo de atividades financeiras e indústria de transformação tinham maior ICA-DMEMS do que os seus referentes. Mulheres com o menor rendimento (um salário mínimo: R$ 415,00) tiveram a maior ICA-DMEMS, de 123 casos por dez mil. Isso sugere desigualdade na ocorrência dessas enfermidades, indicando a necessidade de priorizar não só ações de prevenção, com foco na ergonomia e organização do trabalho, como também o diagnóstico precoce, tratamento e reabilitação profissional.

This study focused on the annual cumulative incidence (ACI) of disabling work-related musculoskeletal disorders affecting the neck and/or upper limbs (ULMSD) among workers covered by the National Social Insurance System in the city of Salvador, Bahia State, Brazil. Cases were workers who received disability compensation benefits when unable to work due to ULMSD, during the year 2008. The data were obtained from the administrative systems of the National Social Insurance Institute and Ministry of Labor and Employment. ACI was 15 per 10,000 workers. Increased ACI of ULMSD was associated with female gender, lower income, and work in financial activities or manufacturing. Women earning the minimum wage (US$ 64.00 per month) or less had the highest ACI of ULMSD (123 per 10,000), suggesting inequalities in the occurrence of these disorders. The study indicates the need to prioritize preventive actions focusing on ergonomics and work organization, early diagnosis, treatment, and rehabilitation.

Work-related Cerebro-Cardiovascular Diseases in Korea

Cerebro-cardiovascular disease (CVD) is one of compensable occupational diseases in Korea as in Japan or Taiwan. However, most countries accept only cardiovascular diseases (ischemic heart diseases) as compensable occupational diseases if any, but not cerebrovascular diseases. Korea has a prescribed list of compensable occupational diseases. CVD was not included in the list until 1993. In the early 1990s, a case of cerebral infarction was accepted as occupational disease by the Supreme Court. The decision was based on the concept that workers' compensation system is one of the social security systems. In 1994, the government has established a diagnostic criterion of CVD. The crude rate of compensated cerebrovascular disease decreased by 60.0% from 18.5 in 2003 to 7.4 in 2008 per 100,000 workers, and that of compensated coronary heart disease decreased by 60.5% from 3.8 in 2003 to 1.5 in 2008 per 100,000 workers. The compensated cases of CVD dramatically increased and reached its peak in 2003. Since many preventive activities were performed by the government and employers, the compensated cases have slowly decreased since 2003 and sharply decreased after 2008 when the diagnostic criterion was amended. The strategic approach is needed essentially because CVDs are common, serious and preventable diseases which lead to economic burden.

Characteristics of Work-related Musculoskeletal Disorders in Korea and Their Work-relatedness Evaluation

Work-related musculoskeletal disorders (WMSDs) can be compensated through the Industrial Accident Compensation Insurance Act. We looked at the characteristics of WMSDs in worker's compensation records and the epidemiological investigation reports from the Occupational Safety and Health Research Institute (OSHRI). Based on the records of compensation, the number of cases for WMSDs decreased from 4,532 in 2003 to 1,954 in 2007. However the proportion of WMSDs among the total approved occupational diseases increased from 49.6% in 2003 to 76.5% in 2007, and the total cost of WMSDs increased from 105.3 billion won in 2004 to 163.3 billion won in 2007. The approval rate of WMSDs by the OSHRI accounted for 65.6%. Ergonomic and clinical characteristics were associated with the approval rate; however, the degenerative changes had a minimal affect. This result was in discordance between OSHRI and the Korea Workers' Compensation & Welfare Service. We presumed that there were perceptional gaps in work-relatedness interpretation that resulted from the inequality of information in ergonomic analyses. We propose to introduce ergonomic analysis to unapproved WMSDs cases and discuss those results among experts that will be helpful to form a consensus among diverse groups.

Occupational Psychiatric Disorders in Korea

We searched databases and used various online resources to identify and systematically review all articles on occupational psychiatric disorders among Korean workers published in English and Korean before 2009. Three kinds of occupational psychiatric disorders were studied: disorders related to job stress and mental illness, psychiatric symptoms emerging in victims of industrial injuries, and occupational psychiatric disorders compensated by Industrial Accident Compensation Insurance (IACI). Korea does not maintain official statistical records for occupational psychiatric disorders, but several studies have estimated the number of occupational psychiatric disorders using the Korea Workers' Compensation and Welfare Service (COMWEL, formerly KLWC) database. The major compensated occupational psychiatric disorders in Korea were "personality and behavioral disorders due to brain disease, damage, and dysfunction", "other mental disorders due to brain damage and dysfunction and to physical diseases", "reactions to severe stress and adjustment disorders", and "depressive episodes". The most common work-related psychiatric disorders, excluding accidents, were "neurotic, stress-related, and somatoform disorders" followed by "mood disorders".

Doenças do trabalho e benefícios previdenciários relacionados à saúde, Bahia, 2000 / Work-related diseases and health-related compensation claims, Northeastern Brazil, 2000 / Enfermedades del trabajo y beneficios de la previsión relacionados a la salud, Bahia (Brasil), 2000

OBJETIVO: Estimar a contribuição das doenças relacionadas ao trabalho nos afastamentos por problemas de saúde em geral e ocupacionais. MÉTODOS: Foram analisados dados sociodemográficos, ocupacionais e de saúde referentes a 29.658 registros dos benefícios por incapacidade temporária concedidos por agravos à saúde pelo Instituto Nacional do Seguro Social, no Estado da Bahia, em 2000. Foram considerados casos todos os diagnósticos clínicos constantes da CID-10, com exceção das causas externas e fatores que influenciam o contato com os serviços de saúde. A vinculação do diagnóstico com a ocupação baseou-se no código CID-10 e se a espécie do benefício era "acidentária". RESULTADOS: Dentre os benefícios, 3,1 por cento foram concedidos para doenças do trabalho: 70 por cento eram doenças do sistema osteomuscular e do tecido conjuntivo e 14,5 por cento do sistema nervoso. No geral, benefícios concedidos numa freqüência maior que o dobro da esperada foram: para tenossinovites na indústria da transformação (Razão de Proporção-RP=2,70), síndrome do túnel do carpo na intermediação financeira (RP=2,43) e transtornos do disco lombar no ramo de transporte, correio e telecomunicações (RP=2,17). Entretanto, não foi estabelecido nexo causal para estas doenças, nesses ramos de atividade, em percentual significativo de benefícios. CONCLUSÕES: Os resultados sugerem a existência de possíveis fatores de risco ocupacionais para enfermidades nesses ramos de atividade, como também o sub-registro da vinculação das patologias com o trabalho, camuflando a responsabilidade das empresas e a perspectiva de prevenção pela reorganização do trabalho.

OBJECTIVE: To estimate the contribution of work-related diseases to sick leaves due to general and occupational health problems. METHODS: Sociodemographic, occupational and health data from 29,658 records of temporary disability benefits, granted on account of health problems by the Instituto Nacional do Seguro Social (National Institute of Social Security) in the state of Bahia (Northeastern Brazil), were analyzed. All constant ICD-10 clinical diagnoses were taken into consideration, except for those referring to external causes and factors that influence contact with health services. The link between diagnosis and occupation was based on the ICD-10 code and whether the type of compensation was due to a "work-related accident/disease" or not. RESULTS: From all the benefits, 3.1 percent were granted due to work-related diseases: 70 percent were musculoskeletal system and connective tissue diseases, while 14.5 percent were related to the nervous system. In general, benefits granted at more than two times the expected frequency were as follows: tenosynovitis in the manufacturing sector (Proportion Ratio-PR=2.70), carpal tunnel syndrome in the financial intermediation sector (PR=2.43), and lumbar disc degeneration in the transportation, postal service and telecommunications sectors (PR=2.17). However, no causal connection could be established for these diseases, in these activity sectors, in a significant percentage of benefits. CONCLUSIONS: Results suggest the existence of possible occupational risk factors for diseases in these fields of activity, as well as the underreporting of the link between diseases and work, thus disguising the responsibility of companies and the perspective of prevention through work reorganization.

OBJETIVO: Estimar la contribución de las enfermedades relacionadas al trabajo en las licencias por problemas de salud en general y ocupacionales. MÉTODOS: Fueron analizados datos sociodemográficos, ocupacionales y de salud referentes a 29.658 registros de los beneficios por incapacidad temporal concedidos por agravamientos a la salud por el Instituto Nacional do Seguro Social, en el estado de Bahia (Nordeste de Brasil), en 2000. Fueron considerados como casos todos los diagnósticos clínicos constantes de CID-10, con excepción de las causas externas y factores que influencian el contacto con los servicios de salud. La vinculación del diagnóstico con la ocupación se baso en el código CID-10 y si la especie de beneficio era "accidentaria". RESULTADOS: De los beneficios, 3,1 por ciento fueron concedidos para enfermedades de trabajo: 70 por ciento eran enfermedades del sistema osteomuscular y del tejido conjuntivo y 14,5 por ciento del sistema nervioso. En general, beneficios concedidos en una frecuencia mas grande que el doble de lo esperado fueron: para tenossinovites en la industria de transformación (Razón de Proporción-RP=2,70), síndrome del túnel del carpo en la intermediación financiera (RP=2,43) y trastornos del disco lumbar en el ramo del transporte, correo y telecomunicaciones (RP=2,17). Sin embargo, no fue establecido nexo causal para estas enfermedades, en estos ramos de actividad, en porcentual significativo de beneficios. CONCLUSÕES: Los resultados sugieren la existencia de posibles factores de riesgo ocupacionales para enfermedades en estos ramos de actividad, como también el sub-registro de la vinculación de las patologías con el trabajo, camuflando la responsabilidad de las empresas y la perspectiva de premención por la reorganización del trabajo.

Acidentes de trabalho: custos previdenciários e dias de trabalho perdidos / Occupational accidents: social insurance costs and work days lost

OBJETIVO: Estimar a contribuição de benefícios concedidos por acidentes de trabalho dentre o total de benefícios relacionados com a saúde da Previdência Social, focalizando os custos conforme o tipo de benefício, e o impacto sobre a produtividade relativa a dias perdidos de trabalho. MÉTODOS: Utilizam-se registros dos despachos de benefícios do Sistema Unico de Benefícios do Instituto Nacional de Seguridade Social da Bahia, em 2000. Acidentes de trabalho foram definidos com o diagnóstico clínico para Causas Externas, Lesões e Envenenamentos (SS-00 a T99) da Classificação Internacional de Doenças 10ª Revisão, e o tipo de benefício que distingue problemas de saúde ocupacionais e não ocupacionais. RESULTADOS: Foram estudados 31.096 benefícios concedidos por doenças ou agravos à saúde, dos quais 2.857 (7,3 por cento) eram devidos a acidentes de trabalho. Maiores proporções foram estimadas entre os trabalhadores da indústria da transformação e construção/eletricidade/gás, 18 por cento do total dos benefícios. Os custos com os benefícios para acidentes de trabalho foram estimados em R$8,5 milhões, com aproximadamente meio milhão de dias perdidos de trabalho no ano. CONCLUSÕES: Apesar do conhecimento de que esses dados são sub-enumerados, e restritos aos trabalhadores que conseguiram receber benefícios relacionados com a saúde, os achados revelam o grande impacto sobre a produtividade e o orçamento do Instituto Nacional de Previdência Social de agravos reconhecidos como evitáveis, reforçando a necessidade de sua prevenção.

OBJECTIVE: To estimate the proportion of occupational accident benefits granted within the total for health-related social security benefits, viewing the costs according to benefit type and the impact on productivity according to work days lost. METHODS: Records of benefit decisions from the National Benefits System of the National Social Security Institute for the State of Bahia in 2000 were utilized. Occupational accidents were defined in accordance with the clinical diagnoses of External Causes, Injuries and Poisoning (SS-00 to T99) of the International Classification of Diseases, 10th Revision, and with the benefit type, which distinguishes between occupational and non-occupational health problems. RESULTS: A total of 31,096 benefits granted due to illnesses or health problems were studied. Of these, 2,857 (7.3 percent) were caused by work accidents. Greater proportions were found among workers in the manufacturing, construction, electricity and gas industries, accounting for 18 percent of the total benefits. The costs of occupational accident benefits were estimated to be R$8.5 million, with around half a million work days lost during the year studied. CONCLUSIONS: Despite the fact that these data are under-reported and are restricted to workers who were able to receive health-related benefits, the findings reveal that avoidable health problems have a major impact on productivity and on the budget of the National Social Security Institute, thereby reinforcing the need for their prevention.