Critical analysis of attempts to recognize an occupational disease as a non-insured event on the basis of the peculiarities of the disease investigation procedure
Authors: Boiko I. V. , Andreenko O. N. 
Published: December 2019

The current legislation clearly declares the guarantee of insurance compensation to the employee in connection with the diagnosis of occupational disease. Meanwhile, in recent years there have been precedents of recognition by the Social Insurance Fund of established cases of occupational diseases not insured in connection with claims to the correctness of the procedure of their investigation.

The article analyzes court cases in which patients with an established diagnosis of occupational disease challenged the refusal of the insurer (Social Insurance Fund) in the appointment of insurance payments, motivated by a reference to violations of the established procedure for the investigation of occupational diseases.

The insurer motivated its refusal to assign insurance payments to patients with the following arguments:

— appeals of the patient to doctors at the time of establishment of the preliminary diagnosis of occupational disease were not entered in registers of rendering medical services;

— sanitary and hygienic characteristics of working conditions of the patient was not based on proper documents;

— examination of the connection of the disease with the profession was carried out on the personal application of the patient without registration of the direction from the medical organization;

— examination of the connection of the disease with the profession was carried out in the Department of professional pathology of a medical organization that is not a vocational center;

— the staff of the Department of professional pathology did not meet the requirements of normative documents;

— violation of rules of registration of the notice on establishment of the fi nal diagnosis of chronic occupational disease is allowed;

— the representative of the Social Insurance Fund was not included in the commission that drew up the act on the case of occupational disease.

In the vast majority of cases, the violations, if any, were of the nature of technical errors and did not affect the essence of the expert opinion on the existence of a connection between the disease and the profession. In such a situation, the categorical refusal to appoint insurance payments to the patient seems unreasonable. Th e claims of the Social Insurance Fund, with a constructive approach, could be settled without a court by contacting the insurer to medical organizations and health authorities. It is necessary to correct the regulations on compulsory insurance against accidents at work and occupational diseases. Th e rules of law should not allow categorical refusal in the appointment of insurance payments to the patient, whose diagnosis of occupational disease, which led to a decrease in working capacity, is established on the merits correctly. Claims of the insurer to the procedure of investigation of a case of occupational disease are most rationally considered in the pre-trial procedure within the framework of the dialogue of the Social Insurance Fund with local health authorities.