The establishment by the medical and social expert commission of the degree of loss of professional disability at the end of employment and upon expiration of the insurance contract is not a reason for refusal of insurance payment.
In the civil case of the claim of Ya. and JSC "A" against JSC "C" and JSC "K" for recognition of actions as illegal and for insurance payments, the defendants motivated the refusal to pay insurance for the second occupational disease by the fact that the plaintiff Ya. loss of professional disability in the amount of 9% was established during the period when he was not an employee JSC "A", in addition, the insured event occurred during the expiration of the insurance contract between the employer and the insurance company "E". The Cassation Judicial Board, changing the decision of the court of first instance and the decision of the court of appeal, and deciding to impose on JSC "S" the obligation to make insurance payments in the amount of 175,831 tenge in compensation for damage related to the loss of earnings and in connection with the establishment of Ya. She pointed out that the occupational disease was acquired by the employee in the performance of his work duties and developed over a long period of time during his work.
The establishment by the medical and social expert commission of the degree of loss of professional disability at the end of employment and upon expiration of the insurance contract is not a reason for refusal of insurance payment.
The Supervisory Judicial Board of the Supreme Court recognized the above conclusions of the cassation judicial Board as justified. As follows from the accident Act dated December 03, 2010, the accident was caused by work related to industrial noise at the mines of JSC "A" in the period from March 18, 1996 to June 29, 2010, and the main cause was an increased noise level. In accordance with paragraph 2 of Article 13 of the Law "On Compulsory Insurance of an Employee against Accidents in the Performance of his labor (official) duties", termination of the employee's compulsory accident insurance contract does not release the insurer from the obligation to make insurance payments to the beneficiary for insured events that occurred during the period of validity of the compulsory insurance contract. Based on this provision of the law and taking into account the case materials, which established that Ya had a second occupational disease. it developed for a long time during the period of his work as an underground miner of a sewage treatment plant, the supervisory judicial board found justified the conclusions of the cassation judicial board on assigning JSC "S" the responsibility to carry out Ya. By its decision of April 24, 2012, it upheld the decision of the Karaganda Regional Court of November 29, 2011 in this case.
When considering cases on claims of beneficiaries (insured) to insurers for the recovery of a lump sum insurance payment, the courts made mistakes in determining its amount. N. appealed to the court with a claim to JSC "S" for the recovery of insurance payments, stating that on October 07, 2010, he, working as a herder in the KH "Bagration-2", fell from a horse and suffered an industrial injury. On October 22, 2010, the employer drew up an act on an industrial accident. By the conclusion of the medical and social expertise dated February 15, 2011, the third disability group was established for him with the establishment of the degree of professional disability in the amount of 59% for a period of 1 year. Subsequently, the conclusion of the ITU (medical and social expertise) On February 13, 2012, the period of loss of professional disability was extended for another 1 year.
In accordance with article 19 of the Law "On Compulsory Insurance of an employee against accidents in the performance of his labor (official) duties", the amount of insurance payment for reimbursement of expenses caused by damage to the employee's health in the event of a degree of disability from 30 to 59 percent is established inclusive – 1,000 monthly calculation indices. For the period from July 12, 2010 to July 11, 2011, the liability of KH "B" to the employee is insured in JSC "A". The insured event occurred during the period of validity of the compulsory insurance contract. Due to the fact that the specified payment was not received, the plaintiff asked the court to collect from the defendant a one-time insurance payment in connection with the received labor injury in the amount of 1,618,000 tenge. By the decision of the Ust-Kamenogorsk City Court of July 18, 2012, which was left unchanged by the decision of the appellate judicial board of the East Kazakhstan Regional Court of September 19, 2012, N.'s claims against JSC "A" for the recovery of insurance payments were satisfied in full. By the decision of the Cassation Judicial Board of the East Kazakhstan Regional Court dated December 6, 2012, the decision of the court of first instance and the decision of the court of appeal were changed. The amount of the collected lump sum insurance payment has been reduced to the amount of 1,512,000 tenge. By changing judicial acts, the court of cassation indicated that, according to paragraph 1 of Article 6 of the Civil Code, the norms of civil legislation should be interpreted in accordance with the literal meaning of their verbal expression. Paragraph 2 of Article 19 of the Law "On Compulsory Insurance of an employee against accidents in the performance of his labor (official) duties" states that the amount of insurance payment for reimbursement of expenses caused by damage to the employee's health in the event of a degree of loss of professional disability is established in monthly calculation indices for the relevant financial year, established by the law on the republican the budget. That is, the amount of the insurance payment is determined using the MCI defined by the law on the republican budget at the time of determining the degree of professional disability for the employee. The degree of loss of professional ability to work was first established by the ITU Executive opinion dated February 15, 2011. Consequently, when determining the amount of the one-time insurance payment to be recovered from the defendant in favor of N., the MCI established by the law on the Republican budget for 2011 was subject to application. According to paragraph 4 of Article 8 of the Law "On the Republican Budget for 2011 - 2013", the MCI for 2011 was 1,512 tenge. Accordingly, the amount of the one-time insurance payment to be recovered from the defendant in favor of N. should be 1,512,000 tenge.
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