Industrial Accident Compensation Research Articles

The Causes of Rejection of Medical Care Benefits for Industrial Accident Compensation Insurance, A retrospective analysis

The Causes of Rejection of Medical Care Benefits for Industrial Accident Compensation Insurance, A retrospective analysis

The Causes of Rejection of Medical Care Benefits for Industrial Accident Compensation Insurance, A retrospective analysis

Objectives: The purpose of this study is to analyze the reasons of the claim rejections and denials compensated by dentalrelated the Industrial Accident Compensation Insurance (IACI) that is operated by the Korea Workers’ Compensation and Welfare Service (COMWEL).Methods: We collected 803 claims from one consultant who responded to dental-related medical inquiries commissioned by the Daegu and Gyeongbuk Workers’ COMWEL from January 2021 to May 2023. We analyzed the approval status and the reasons for non-approval, based on the reviewed response materials and dental online medical consultation data.Results: Among the initial and supplementary compensation applications, there were 79 cases with insufficient examina-tions, 72 cases with incomplete records, 19 cases with errors, 148 cases due to pre-existing conditions, and 6 cases where the applicant was ineligible for medical benefits. The reasons for re-evaluation after data supplementation included 122 cases of inadequate examinations, 76 cases of incomplete records, 24 cases with logical errors, 11 cases with insufficient photographs, and 57 cases for a combination of these reasons.Conclusions: In the context of industrial injury compensation claims, the denial of claims often arises from missing or incomplete dental records, diagnostic omissions, or logical inconsistencies between records, diagnoses, and treatment plans. Therefore, it is essential to ensure accurate medical records, appropriate examinations, and evidence-based diagnosis. Spe-cial attention should also be given to the collection of clinical data, including photographs.

Children's health affected by parent's behavioral characteristics: a review.

Exposure of an individual to occupational and environmental risk factors for a certain disease affects them and their family. Children are highly vulnerable in this setting because they are family-dependent. This review discusses diseases that occur in children according to the occupational and behavioral characteristics of their parents. Toxic agents in the home environment can affect children's health. Maternal exposure to substances during pregnancy may directly affect fetal outcomes. The Industrial Accident Compensation Insurance Act in Korea was amended in 2023 to compensate for children's adverse health effects due to their parents' occupational risks. The long working hours and smoking behaviors of parents and toxic materials in the home environment are highlighted. To control for the diverse factors affecting children's health in medical research, this review introduces directed acyclic graphs. Pediatric, occupational, and environmental medicine must collaborate to prevent childhood diseases related to environmental factors.

Blind Spots in the Industrial Accident Compensation Insurance Act and the Employment Insurance Act

Blind Spots in the Industrial Accident Compensation Insurance Act and the Employment Insurance Act

Machine Learning-Based Pain Severity Classification of Lumbosacral Radiculopathy Using Infrared Thermal Imaging

Pain is subjective and varies among individuals. Doctors determine pain severity based on a patient’s self-reported symptoms. In such situations, a language barrier may prevent patients from expressing their pain accurately, which may cause doctors to underestimate their pain degree. Moreover, patients’ subjective descriptions of pain can determine their eligibility for secondary benefits, as in the case of compensation for traffic or industrial accidents. Therefore, to perform a multiclass prediction of the severity of lumbar radiculopathy, the authors applied digital infrared thermographic imaging (DITI) to a machine-learning (ML) algorithm. The DITI dataset included data from a healthy population and patients with radiculopathy with herniated lumbar discs at the L3/4, L4/5, and L5/S1 levels. The dataset of 1000 patients was split into training and test datasets in a 7:3 ratio to evaluate the model’s performance. For the training dataset, the average accuracy, precision, recall, and F1 score were 0.82, 0.76, 0.72, and 0.74, respectively. For the test dataset, these values were 0.77, 0.71, 0.75, and 0.73, respectively. Applying the ML algorithm to a pain-severity classification using thermographic images will aid in the treatment of lumbosacral radiculopathy and allow providers to monitor the therapeutic effect of interventions through an assessment of physiological evidence.

Spinal Cord Injury Fact Sheet in Korea.

Spinal cord injury (SCI) has been recognized as a medically complex and life-disrupting condition. As the aging of the population accelerates, the trend of SCI has changed. This review aimed to provide comprehensive statistics and recent epidemiological changes in SCI and rehabilitation in Korea. All three insurance databases (National Health Insurance Service [NHIS], automobile insurance [AUI], and industrial accident compensation insurance [IACI]) were considered. These nationwide databases provide data on the current trends in term of incidence, etiology, and rehabilitation of SCI. Traumatic spinal cord injury (TSCI) was more frequent among the elderly in the NHIS compared to working age individuals in the AUI and IACI. In all three trauma-related insurance databases, male with TSCI outnumbered female. TSCI incidence per year was approximately 17 times higher among males than females, on average, in IACI. In all three insurances, the cervical level of TSCI was the most frequent. Although the ratio of SCI patients receiving rehabilitation treatment at primary and secondary hospitals increased for nine years, the increase in training on activities of daily living (ADL training) was found to be relatively small. This review provides a broader and comprehensive understanding of the incidence, etiology, and rehabilitation treatment of SCI in Korea.

Utilization of the Consultation and Support Department in Application for Industrial Accident Compensation Insurance System for Patients Who Develop Mesothelioma

目的．中皮腫に罹患した患者にとって労災保険制度の早期申請は安心した療養生活に繋がる．しかし申請における医師の負担は大きく，相談支援部門の役割が期待されていることから，労災保険制度の申請に対する相談支援部門の役割の現状と課題を明らかにすることにした．方法．患者に対してアンケート調査を行い，労災保険制度の申請（認定）を従属変数とし，「相談支援部門の対応」3項目と「労災保険制度の申請理由」5項目を独立変数としてステップワイズ法による回帰分析を行った．結果．患者は相談支援部門から石綿ばく露に関する情報提供を受けた場合，労災保険制度の申請が増加傾向を示唆する結果になった（b=0.42，t［22］=1.971，p=0.061，β=0.387）．労災保険制度を選んだ理由に関しても患者自身の石綿ばく露に関する記憶だけでなく，医療機関や患者会等の助言が大きな要因になっていた（b=－1.47，t［18］=－2.941，p=0.009，β=－0.65）．結論．石綿ばく露聴取や労災保険制度・救済制度の申請において，医師・看護師等の診療部門，相談支援部門，患者会が連携していくことが重要である．

Problems and suggested improvement plans for occupational health service in Korea.

The purpose of this paper was to review the problems relating to Korea's occupational health services and suggest ways to improve them. Korea can be classified as a welfare state type of conservative corporatism partially interwoven with liberalism. While experiencing compressed economic growth, the economic sectors of developed (excess areas) and developing (deficient areas) countries are interwoven. Therefore, it is necessary to perfect conservative corporatism along with a complementary reinforcement of liberal contents and to apply a multilayered approach focusing on complementing the deficient areas. It is essential to form a national representative indicator related to occupational health, and a strategy for selection and concentration is needed. The proposed central indicator is the occupational health coverage rate (OHCR), which is the number of workers who have applied for mandatory occupational health services under the Occupational Safety and Health Act in the numerator with the total working population in the denominator. This paper proposes ways to raise the OHCR, which is currently at the level of 25%-40%, to 70%-80%, which is the level of Japan, Germany, and France. To achieve this target, it is necessary to focus on small businesses and vulnerable workers. This is an area of market failure and requires the active input of community-oriented public resources. For access to larger workplaces, the marketability of services should be strengthened and personal intervention using digital health resources should be actively attempted. Taking a national perspective, work environment improvement committees with tripartite (labor, management, and government) participation for improvement of the working environment need to be established at the center and in the regions. Through this, prevention funds linked to industrial accident compensation and prevention could be used efficiently. A national chemical substance management system must be established to monitor the health of workers and the general public.

Comparison of Trends in the Incidence of Traumatic Spinal Cord Injury in Daily Life, Automobile Accidents, and Industrial Accidents: A National Multi-Insurance Study in Korea.

To examine the incidence of traumatic spinal cord injury (TSCI) from all etiologies, we measured and compared the incidence of TSCI from three national or quasi-national databases in South Korea, namely, the National Health Insurance Service (NHIS), automobile insurance (AUI), and Industrial Accident Compensation Insurance (IACI). We reviewed patients with TSCI reported in the NHIS database between 2009 and 2018, and in the AUI and IACI databases between 2014 and 2018. TSCI patients were defined as those first admitted to the hospital with a diagnosis of TSCI according to the International Classification of Diseases (10th revision) criteria. Age-adjusted incidence was calculated using direct standardization using the 2005 South Korean population or the 2000 US population as the standard population. The annual percentage changes (APC) of TSCI incidence were calculated. The Cochrane-Armitage trend test was performed according to the injured body region. In the NHIS database, age-adjusted TSCI incidence using the Korean standard population increased significantly from 2009 to 2018 (from 33.73 per million in 2009 to 38.14 per million in 2018, APC = 1.2%, P = 0.014). Contrarily, age-adjusted incidence in the AUI database significantly decreased from 13.88 per million in 2014 to 11.57 per million in 2018 (APC = - 5.1%, P = 0.009). In the IACI database, the age-adjusted incidence showed no significant difference, while crude incidence showed a significant increase (from 22.02 per million in 2014 to 28.92 per million in 2018, APC = 6.1%, P = 0.038). According to the age group, all the three databases showed high incidences of TSCI in those in their 60s and 70s or older. Among those in their 70s or older, the incidence of TSCI increased dramatically in the NHIS and IACI databases, while no significant trend was found in AUI database. In 2018, the number of TSCI patients was the highest among those over 70 years of age in the NHIS, whereas among those in their 50s were the highest in both AUI and IACI. The proportion of patients with cervical spinal cord injury was the most common in all these databases. The differences in trends in the incidence of TSCI may be due to the different etiologies and different characteristics of subjects depending on insurance type. These results imply the need for tailored medical strategies for the different injury mechanisms represented by three national insurance services in South Korea.

Role and Issues of Physicians in Industrial Accident Compensation Insurance System for Mesothelioma Development

目的．中皮腫患者は労災保険制度の申請ができる．しかし職業ばく露の評価は医師の負担になっており，石綿ばく露調査の体制において現場の医師の対応は明らかにされていない．方法．中皮腫患者90名に対して質問紙調査を行い，労災保険制度の申請（認定）を目的変数とし，「医師の対応」3項目と「労災保険制度の申請理由」5項目を説明変数としてステップワイズ法による回帰分析を行った．結果．患者は医師からの相談窓口への紹介が増加した場合，労災保険制度申請の増加がみいだされた（b=0.276，t［88］=2.336，p=0.021，β=0.242）．また患者会からの助言・指摘が増加した場合も労災保険制度申請の増加がみいだされた（b=0.569，t［88］=5.373，p＜0.05，β=0.497）．結論．労災保険制度の申請には医師が患者に対して相談窓口に紹介することが重要であり，医療機関における相談支援体制を整え，患者会と連携を深めることが課題である．

Estimation of the mortality rate of workers in Japan

BackgroundRisk-based decision-making is used to identify risk factors for which threshold points have not been identified. The occupational mortality rate was referred to as a reference risk. This study aimed to analyze recent trends in worker mortality using three data sources.MethodsThe Reports of Worker Casualties (RWC), the Annual Statistics Report of the Industrial Accident Compensation Insurance Council (ASR), and the Annual Business Report of the Industrial Accident Compensation Insurance Council (ABR) were used. Mortality rates were estimated by age group and industry category (overall, and manufacturing and construction industries) from 1991 to 2019. The mortality rates were compared with those estimated in Western countries.ResultsThe mortality rates for the three industry categories in the RWC and ASR decreased, whereas those for the manufacturing and construction industries in the ABR did not. In 2019, the mortality rates in the ABR were 3.1, 4.8, and 3.1 times higher than those in the RWC overall and in the manufacturing and construction industries, respectively. The differences decreased when deaths after long-term medical treatment were considered. The mortality rate trends in Japan were similar to those in Western countries. The upper mortality rate among Japan and Western countries was at least five to 15 times higher than the lowest.ConclusionWhen occupational mortality rates are used as a reference risk, it is important to consider any changes with time, the data sources used, and the differences between countries.

Roles and Issues of the Physicians' Practice System in the Application of Industrial Accident Compensation Insurance Program Applications for Asbestos Lung Cancer

Roles and Issues of the Physicians' Practice System in the Application of Industrial Accident Compensation Insurance Program Applications for Asbestos Lung Cancer

업무상 재해의 요건과 인과관계의 증명책임

The recent Supreme Court en banc decision (2017du45933) maintained the legal principle of the existing precedents of the Supreme Court as they were. That is, the legal principle that workers must prove a proximate causal relation between their duty and the accident in order for an accident to be recognized as an accident on duty in cases related to industrial accident compensation insurance was reconfirmed. However, it is difficult to agree with the conclusion as such. As mentioned by the majority opinion in the judgment above, the main purpose of the enactment of the proviso to Article 37 Paragraph 1 of the Industrial Accident Compensation Insurance Act was to make it clear that a proximate causal relation between the duty and accident is necessary for all types of accidents but since the reason for the revision in the report on the review of the system and wordings of the National Assembly Legislation and Judiciary Committee at the time had the explicit written intent that, in cases where the Corporation proves that there is no proximate causal relation between the duty and the accident, the accident cannot be regarded as an accident on duty in the criteria for recognition of accident on duty, it is clear that the intention of the legislator is to have the Korea Workers' Compensation & welfare Service, not the employee, prove that there is no proximate causal relation between the duty and the accident. This is also the case even when the proviso is analyzed from the position of the legal requirement classification theory for the distribution of burden of proof. In addition, when the purpose of the Industrial Accident Compensation Insurance Act is examined, it can be seen that it is a law to protect people who are engaged in work at the industrial site. Therefore, unilaterally imposing the burden of proof, which is a core requirement for the recognition of accident on duty, does not fit the intent of the industrial accident compensation insurance as a social security system and the purpose of granting the authority to investigate accidents to the Corporation. Therefore, as the four Supreme Court judges argued in this judgment, it is reasonable to have the Korea Workers' Compensation & welfare Service prove the proximate causal relation between the duty and the accident, not the workers.

A Comparative Study on Seafarers' Industrial Accident Compensation System

A Comparative Study on Seafarers' Industrial Accident Compensation System

Comparison of Work-Related Stress in Cluster of Workers' Suicides in Korea: Analysis of Industrial Accident Compensation Insurance, 2010-2017.

Background: There is limited research on the heterogeneity of worker suicides. We compared differences in workers’ suicides by clustering suicide deaths. Methods: From 2010 to 2017, 353 suicide deaths were claimed in the Industrial Accident Compensation Insurance; variables were coded using a standardized methodology. A two-step cluster analysis classified the clusters based on demographic and employment conditions. Details of the suicide, clinical variables, personal stresses, and work-related stresses were compared using the chi-square test and one-way analysis of variance. Results: We identified five clusters and they differed particularly in work-related stress. “Responsibility-burdened type” experienced excessive responsibility as managers; “role-changed type” experienced a sudden and unpredictable role change as clerks or sales workers; “risk-exposed type” experienced physical risk factors at work (working alone, outdoors, and in shifts) as machine operating and assembling workers, or craft and related trades workers; “job-insecurity type” experienced unstable employment (irregular, nonpermanent) as elementary or service workers; “workplace-violence type” was mainly unmarried women who lived alone, and experienced interpersonal conflict and violence as professionals and related workers. There were no differences between clusters in clinical variables (except problem drinking) and personal stresses. Conclusion: Interventions to alleviate work-related stress in worker clusters are needed to prevent suicide in workers.

산업재해보상보험법상 유족보상연금의 헌법적 원리에 관한 고찰

Since the enactment of the Industrial Accident Compensation Insurance Act in 1963, industrial accident compensation insurance has continuously developed in the direction of strengthening the level of coverage for compensation benefits. However, as industrial accident insurance has continued to develop over the past 50 years, the benefit system is under pressure from fundamental system changes since the 2000s. Matters that require fundamental system change are being raised not only in benefit, but in all areas such as the scope of application, standards for recognition of work-related accidents, and finance.<BR> The purpose of this paper is to review the normative principles of the survivor

Use of a transradial myoelectric prosthesis by a unilateral trans radial amputee under the industrial accident compensation insurance system: a case report

Use of a transradial myoelectric prosthesis by a unilateral trans radial amputee under the industrial accident compensation insurance system: a case report

코로나 팬데믹 시대의 외국인근로자의 건강권 보호

Health is the most fundamental condition for human survival. For human dignity, the right to health should be guaranteed at least in the national dimension for all the people staying in a country regardless of their nationalities. In Korea, foreign workers are highly likely to be exposed to the risk of diseases and disasters in poor working conditions. In this aspect, it is more required to apply a health security system to such foreign workers during their stay. In the COVID-19 pandemic situation, foreign workers’ right to health is put in danger. Although the government’s policy is fulfilled to protect their right to health, it has some issues like violation of human rights. In this circumstance, this study tried to look into the legal system for guaranteeing the right to health of foreign workers with simple skills, who account for the largest percentage in Korea but have their right to health put in danger relatively, and to find the problems of the system and any improvement plan in terms of legal policy.<BR> The right to health is recognized according to international rules, including Constitution of the World Health Organization (WHO), the Universal Declaration of Human Rights, and the International Covenant on Economic, Social and Cultural Rights. It means the right to enjoy health in the most reachable level and the right of all human beings regardless of nationalities. Accordingly, in the Constitution and domestic rules, National Health Insurance Act was established to prevent all the people’s diseases and injuries, and is applied to foreign workers. Industrial Accident Compensation Insurance Act is a system for protecting workers or their families by guaranteeing the employer

A Study on the limit of the administrative rule-making in Industrial Accident Compensation Insurance Act

행정부가 행정입법을 남용하게 되면 국민의 권리가 침해되고 법치주의(의회입법주의)가 훼손될 우려 역시 공존한다. 이에 따라 행정입법에 대한 통제의 문제는 중요한 과제로서 다루어지고 있다. 그러므로 모법의 근거가 없거나 모법에 규정된 실체적 사항을 변동시키는 규정, 위임범위를 벗어난 규정, 모법의 취지에 맞지 않거나 상위법령의 내용과 충돌하는 규정은 개정되어야 한다. 본고에서는 산업재해보상보험법 시행령 제61조는 모법(산업재해보상보험법)에 규정된 실체적 사항을 변동시키는 규정, 위임범위를 벗어난 규정, 모법의 취지에 맞지 않거나 상위법령의 내용과 충돌하는 규정이라는 점에 대하여 검토하고자 한다. 본고에서 논의하는 순서는 다음과 같다. 먼저 행정입법의 개념, 필요성, 한계의 일반론을 개관한다(Ⅱ). 또한 법률 제63조 제1항에 규정된 “생계를 같이 하고 있던 유족”과 시행령 제61조에 규정된 “생계를 유지하고 있던 유족”의 차이점에 대해 살펴본다. 이를 통해 법률 제63조 제1항에 규정된 유족보상연금 수급자격자의 범위가 행정부에 의해 제한되었다는 것을 쉽게 추론할 수 있을 것이다(Ⅲ.2). 시행령은 유족보상연금 수급자격이 인정되려면 근로자의 소득으로 생계의 전부 또는 상당 부분을 유지하고 있던 유족(제61조 제1호, 제2호) 또는 근로자의 소득으로 생계의 전부 또는 대부분을 유지하고 있던 유족이어야 한다고 규정하고 있다(제61조 제3호). 이에 따라 시행령 제61조는 유족보상연금 수급자격자의 범위에 대해 법률 제63조 제1항 보다 가혹하고 훨씬 과도하게 제한하고 있다는 점을 알 수 있을 것이다(Ⅲ.3). 그리고 시행령의 개선방안을 검토한다(Ⅲ.4). 마지막으로 결론에서는 논의를 요약ㆍ정리한다(Ⅳ).

법정 병가제도 도입의 정책적 쟁점

Since COVID-19, there have been increasing social needs for the right to rest when sick. Accordingly, Korean government has announced a comprehensive policy plan for the Korean New Deal to introduce Medical Care and Sickness Benefits on 14th July 2020. Apart from the introduction of medical care and sickness benefits, however, statutory sick leave is required for workers to take a leave in practice while it is not recognized under current labor law system. In this regard, imperatives of the introduction of sick leave system as statutory minimum standards need to be reviewed.<BR> The current sick leave system is stipulated in collective agreements and rules of employment. On this, it is possible to consider extending the regulations which have been previously applied to major companies and public sector companies to private sector companies (by way of regulations under 〈Labor Standards Act〉) similar to the extended application of public holidays for private sector companies in 2018. And it is also possible to have 〈Equal Employment Opportunity and Work-Family Balance Assistance Act〉, which has recently introduced various systems for work and life balance, regulate sick leave in a way similar to regulations on family care leave/time off.<BR> The important point is that sick leave system shall have mutual consistency with judicial order in general. After the payment plans of medical care and sickness benefit is concretely specified, structure and contents of the legal system, term and payment methods of statutory sick leave shall be determined in accordance with it. It seems that detailed discussions on term, payment methods and legal basis of statutory sick leave and medical leave can be progressed only after discussions regarding matters on waiting period and protection of medical care and sickness benefits under labor laws become activated.<BR> When statutory sick leave is implemented, plans to embrace special types of worker between self-employed and employee shall be considered as well. Under industrial accident compensation insurance and employment insurance, special types of worker between self-employed and employee is similarly regarded with employees. Issues including the methods of identifying income and application standards discussed under the above systems may as well be applied to discussions regarding medical care and sickness benefits.<BR> Considering that sick leave and time off systems regulated under collective agreements and rules of employment are structured around the systemized companies like public sector companies and major companies, consideration shall also be given on how the existing regulations on collective determination of working conditions would be changed after the introduction of medical care and sickness benefits and statutory sick leave. If sick leave or time off has already been under protection by collective agreements, rules of employment and other regulations, it is also necessary to consider how to design the method of merge between the new benefit system and the existing one.