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Definition of Medical Care Benefits

Definition of medical care benefits

- "Medical care benefits" refer to industrial accident compensation insurance benefits paid to any worker who suffers from an injury or a disease caused by their duties, which cannot be cured through medical care within 3 days, so that they can receive medical care at an industrial accident insurance-related medical institution until the injury or disease is cured (Article 40 of the Industrial Accident Compensation Insurance Act).

Requirements for and Scope of Medical Care Benefits

Requirements for medical care benefits

- Medical care benefits shall be paid to any worker who suffers from an injury or a disease caused by reason of their duties (Article 40 (1) of the Industrial Accident Compensation Insurance Act).

- If an injury or a disease is to be cured through medical care within 3 days, no medical care benefits shall be paid (Article 40 (3) of the Industrial Accident Compensation Insurance Act).

Scope of medical care benefits

- Any worker suffering from an occupational accident shall receive medical care benefits such as medical examination and checkup, provision of medicines or treatment materials, artificial limbs and other prosthetic devices, treatment, operation, other medical care, rehabilitative treatment, hospitalization, nursing and patient care, and transfer, etc. (Article 40 (4) of the Industrial Accident Compensation Insurance Act)

Provision of Medical Care Benefits

In principle, any worker suffering from an occupational accident shall receive medical care at an industrial accident insurance-related medical institution.

- In principle, the Korea Workers' Compensation & Welfare Service shall have any worker suffering from an injury or disease caused by reason of their duties receive medical care at an industrial accident insurance-related medical institution (Main sentence of Article 40 (2) and Article 43 (1) of the Industrial Accident Compensation Insurance Act).

※ Industrial accident insurance-related medical institutions refer to ① medical institutions established in the Korea Workers' Compensation & Welfare Service, ② tertiary care hospitals referred to in Article 3-4 of the Medical Service Act and ③ medical institutions or public health clinics designated by the Service, from among medical institutions referred to in Article 3 of the Medical Service Act and public health clinics referred to in Article 10 of the Regional Public Health Act (including public health clinics referred to in Article 12 of the Regional Public Health Act).

Exceptional provision of medical care expenses

- The Korea Workers' Compensation & Welfare Service may pay a worker suffering from an occupational injury or disease for the medical care expenses in extenuating circumstances, in lieu of having him/her receive medical care at an industrial accident insurance-related medical institution (Proviso to Article 40 (2) of the Industrial Accident Compensation Insurance Act).

Extension, etc. of the Period of Medical Care

Extension of the period of medical care

- When it is necessary to extend the period of medical care for a worker receiving medical care benefits, the relevant industrial accident insurance-related medical institution shall submit to the Korea Workers' Compensation & Welfare Service a medical treatment plan containing the progress relating to the disease or injury of the worker, expected treatment period, treatment methods, etc. (Article 47 (1) of the Industrial Accident Compensation Insurance Act)

Changeof the medicalinstitution

- If any of the following events occurs to a workerin the course of medical care, they may file an application with the KoreaWorkers' Compensation & Welfare Service to be transferredto another medical institution (Article 48(2) of the Industrial AccidentCompensation Insurance Act):

· Where the worker needs to be transferred to another industrial accident insurance-related medical institution because the manpower, facilities, etc. of the industrial accident insurance-related medical institution currently providing medical care are unfit for the specialized treatment or rehabilitative treatment of the worker;

· Where the worker needs to be transferred to another industrial accident insurance-related medical institution to receive medical care near where they live;

· Where the worker needs to be transferred to another industrial accident insurance-related medical institution after receiving specialized treatment at a tertiary care hospital;

Medical care for additional injury or disease

- Where a worker receiving medical care due to an occupational accident falls under any of the following cases, they may apply for medical care benefits for an additional injury or disease (hereinafter referred to as "additional injury or disease") (Article 49 of the Industrial Accident Compensation Insurance Act):

· Where medical care is needed as an injury or a disease which has arisen from the occupational accident has been further diagnosed;

· Where medical care is needed as a new disease occurs as a result of an injury or a disease which has arisen from the occupational accident.

Additional medical care

- If a person who has received medical carebenefits suffers a recurrence of an occupational injury or disease that was thex-object of the medical care after the cure, or if there is a medical opinionthat active treatment of their occupational injury or disease is needed becausetheir injury or disease gets worse, they are entitled to additional medicalcare benefits (Article 51(1) of theIndustrial Accident Compensation Insurance Act).

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