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Public Service

15. What is the qualification and benefit standard for claiming injury and sickness benefits?

  1. Qualification:
    (1) In case an insured person is not receiving salary payment on account of an ordinary injury or sickness for which he/she is hospitalized and under medical treatment, he/she shall be paid ordinary injury or sickness benefits beginning from the fourth day on which he/she is incapacitated for work.
    (2) In case an insured person is not receiving salary payment on due to an injury or occupational disease incurred while on duty for which he/she is receiving medical treatment, he shall be paid occupational injury or disease compensation beginning from the fourth day on which he is incapacitated for work.
     
  2. Benefit Standard:
    (1) Ordinary injury or sickness benefits shall be payable at the rate of 50% of the average monthly insured salary over the six-month period prior to the occurrence of the injury or sickness, starting from the 4th day of hospitalization until discharge (benefits apply to hospitalization only; multiple hospital stays for the same injury or sickness shall be considered a single instance of hospitalization with the provision that the period for outpatient treatment and recovery at home is not covered), subject to a maximum of 6 months of benefits. However, if the insured person has at least one full year of insurance coverage prior to the occurrence of the injury or sickness, then an additional 6 months of benefits are payable; for people who are insured such , the maximum benefits are payable up to 1 year.
    (2) Occupational injury and disease compensation shall be payable at the rate of 70% of the insurant’s average monthly salary over the six-month period prior to the occurrence of an occupational injury and/or disease, starting from the 4th day of treatment (including both hospitalization and outpatient treatment; benefits do not apply if no treatment is received). If the insured person has not recovered after 1 year of treatment, the rate of compensation is reduced to 50% and benefits are payable up to one additional year. The combined total benefits are payable up to 2 years.
     

 

Last Update:2019-08-20
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