Provision of Medical Care Expenses
Provision of Medical Care Expenses
- The Korea Workers' Compensation & Welfare Service may directly pay a worker suffering from an accident caused by an occupational reason (hereinafter referred to as "worker suffering from an occupational accident") for the following medical care expenses, 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, Article 38 (1) of the Enforcement Decree of the Industrial Accident Compensation Insurance Act and Article 21 (3) and (4) of the Regulations of Medical Care Affairs):
- Medical care expenses incurred in cases where the beneficiary receives urgent medical care, such as emergency treatment, at a medical institution other than the industrial accident insurance-related medical institutions, falling under any of the following cases:
1. Medical care expenses incurred in cases where the worker suffering from an occupational accident receives medical care at a medical institution other than the industrial accident insurance-related medical institutions unavoidably because there is no industrial accident insurance-related medical institution near the place where the accident occurs;
2. Where the state of injury or disease of the worker suffering from an occupational accident requires special medical facilities or technology and such worker pays medical care expenses after receiving urgent medical care, such as emergency treatment, at a medical institution other than the industrial accident insurance-related medical institutions because nearby industrial accident insurance-related medical institutions do not have the necessary facilities or technology;
3. Medical care expenses incurred in cases where the worker suffering from an occupational accident has undergone an operation at a medical institution other than the industrial accident insurance-related medical institutions pursuant to 1. or 2. and receives outpatient treatment at the medical institution in order to check the state of injury or disease;
4. Cases equivalent to 1. or 2. where the worker suffering from an occupational accident pays medical care expenses at a medical institution or a pharmacy after receiving urgent medical care at a medical institution other than the industrial accident insurance-related medical institutions.
- Expenses incurred in relation to any of the following medical care benefits (limited to cases where such medical care benefits are not provided by industrial accident insurance-related medical institutions):
· Provision of artificial limbs and other prosthetic devices;
· Patient care;
· Transfer.
- Other medical care expenses falling under any of the following:
· Medical care expenses incurred in cases where the worker suffering from an occupational accident receives medical care due to the accident before the 1st medical care benefits are determined;
· Medical care expenses incurred in cases where the worker suffering from an occupational accident receives medical care due to the accident that happens between the next day of the statutory due date of reporting of insurance contractual relationship establishment and the day when insurance contractual relationship establishment is reported;
· Medical care expenses incurred in cases where the worker suffering from an occupational accident receives medical care unavoidably due to an additional injury or disease, or additional medical care before an additional injury or disease, or additional medical care is determined;
· Medical care expenses incurred in cases where the worker suffering from an occupational accident receives urgent medical care at a medical institution other than the industrial accident insurance-related medical institution providing medical care at the time of determination of provision of medical care benefits.
Claims for Medical Care Expenses
Claims for medical care expenses
- Where a worker suffering from an occupational accident has paid medical care expenses unavoidably and intends to claim the expenses, they shall file a written claim for medical care expenses and a statement of expenses with the Korea Workers' Compensation & Welfare Service (Article 38 (2) of the Enforcement Decree of the Industrial Accident Compensation Insurance Act, Article 21 (1) and Form 10 of the Regulations of Medical Care Affairs).
※ Any worker suffering from an occupational accident may claim medical care expenses offline at the Korea Workers' Compensation & Welfare Service or online via the Employment/Industrial Accident Insurance Total Service of the Korea Workers' Compensation & Welfare Service.
Claims for medical care expenses and extinctive prescription of right to claim medical care benefits
- Period of extinctive prescription
· If the right to claim medical care benefits is not exercised for 3 years after the next day of medical care, it shall become extinctive by prescription (Subparagraph 1 of Article 112 (1) of the Industrial Accident Compensation Insurance Act).
- Interruption of extinctive prescription
· Extinctive prescription of the right to claim medical care benefits shall be interrupted by a request for medical care benefits (including a claim for medical care expenses) filed by the beneficiary (The former part of Article 113 of the Industrial Accident Compensation Insurance Act).
· The right to claim medical care benefits which is not exercised for over 3 years before the day the medical care expenses are claimed shall become extinctive. However, extinctive prescription of the right to claim medical care benefits for the past 3 years and of the future shall be interrupted by a request for medical care expenses (The former part of Article 113 of the Industrial Accident Compensation Insurance Act and Supreme Court's Decision dated November 14, 1989, Case No. 89Nu 2318).
· Where the request for medical care expenses that has interrupted extinctive prescription of the right to claim medical care benefits is the 1st request requiring a judgment on whether the case concerns an occupational accident, the interruption of prescription resulting from the request for medical care expenses shall affect the other insurance benefits (The latter part of Article 113 of the Industrial Accident Compensation Insurance Act).
Payment of Medical Care Expenses
Payment of medical care expenses
- Medical care expenses shall be paid within 14 days after the decision for payment thereof (Article 82 (1) of the Industrial Accident Compensation Insurance Act).
- No public charges of the State or local governments shall be imposed on any money or valuables offered as medical care expenses (Article 91 of the Industrial Accident Compensation Insurance Act).
Claims for and payment of unpaid medical care expenses
- Decision on beneficiaries of unpaid medical care expenses
· The order of priority for entitlement to unpaid medical care expenses among survivors shall be in accordance with the following order, but the order of priority for the said entitlement among persons under the same subparagraph shall follow the order in which they are listed in the subparagraph. In such cases, where at least 2 beneficiaries are in the same priority status, the unpaid medical care expenses shall be divided and paid equally among them (Article 65 (1) of the Industrial Accident Compensation Insurance Act and Article 77 of the Enforcement Decree of the Industrial Accident Compensation Insurance Act):
√ The spouse, children, parents, grandchildren, and grandparents whose livelihood had been supported by the worker as at the time of their death;
√ The spouse, children, parents, grandchildren, and grandparents whose livelihood had not been supported by the worker as at the time of their death, and siblings whose livelihood had been supported by the worker as at the time of their death;
√ Siblings.
· An adoptive parent has priority over a biological parent, a parent of an adoptive parent over a parent of a biological parent, and an adoptive parent of any parent over a biological parent of any such parent (Article 65 (2) of the Industrial Accident Compensation Insurance Act and Article 77 of the Enforcement Decree of the Industrial Accident Compensation Insurance Act).
· Notwithstanding the order of priority of survivors who are beneficiaries, if a worker designates a survivor to receive unpaid medical care expenses in their will, such designation shall be honored in the payment of such insurance benefits (Article 65 (4) of the Industrial Accident Compensation Insurance Act and Article 77 of the Enforcement Decree of the Industrial Accident Compensation Insurance Act).
- Claims for unpaid medical care expenses
· If a beneficiary of medical care expenses dies, their survivor shall file a written claim for unpaid medical care expenses with the Korea Workers' Compensation & Welfare Service in order to receive such expenses instead of the deceased beneficiary (Article 81 of the Industrial Accident Compensation Insurance Act and Article 49 and Form 29 of the Regulations of Compensation Affairs).
- Payment of unpaid medical care expenses
· Unpaid medical care expenses shall be paid within 14 days after the decision for payment thereof (Article 82 (1) of the Industrial Accident Compensation Insurance Act).
Prohibition, etc. of transfer and seizing of entitlement to medical care expenses
- Each worker’s entitlement to medical care expenses shall not be extinguished by their retirement (Article 88 (1) of the Industrial Accident Compensation Insurance Act).
- Entitlement to medical care expenses may not be transferred, seized or offered as collateral (Article 88 (2) of the Industrial Accident Compensation Insurance Act).
Collection of unjust gains
- Where any person receives medical care expenses by fraud or other improper means, an amount equivalent to double the medical care expenses shall be collected from him/her (The former part of Article 84 (1) of the Industrial Accident Compensation Insurance Act).