1. The insurant (employer) is entitled to choose the insurer in order to enter into agreement of compulsory insurance of employees against accidents.
2. The compulsory insurance agreement of an employee against accidents must be entered into only with the insurer having a license for insurance activities in the class of annuity insurance and the indicated type of compulsory insurance.
3. The insurant is committed to enter into the agreement of compulsory insurance of employees against accidents with the insurer within the first ten days of the month following the month, in which the insurant has started operations.
4. The insurance agreement shall enter into force and become binding to the parties from the moment, when the insurant pays the insurance premium, and if it shall be paid in installments, the first insurance premium, and failure to pay or untimely payment of the insurance premium may lead to invalidity of the agreement.
If an insured event occurred:
1. The insurant is obliged to notify the insurer immediately, but not later than three business days, as it has become aware of the accident occurrence.
2. The insurant is obliged to enter into an annuity agreement with the insurer in favor of the employee or a person, who is entitled to compensation for damage in connection with the death of the employee in cases stipulated by the laws within the insurance coverage established by the agreement of compulsory insurance of employees against accident.
3. The insurant is obliged to ensure investigation of the circumstances of the insured event occurrence with mandatory participation of representatives of the authorized body and the Insurer, to prove occurrence of the insured event, as well as the losses caused by it.
4. The insurant is committed to take measures to reduce losses from the insured event.
5. The insurant is required to submit to the insurer, within the deadline established by the agreement, the documents necessary for calculating of the insurance benefit.
6. The insurer is committed to pay insurance benefit and reimbursement of burial expenses in accordance with the laws and the agreement of compulsory insurance of employees against accidents.
7. The insurer is obliged to send to the beneficiary, within seven business days from the date of receipt of the application and all the documents in writing, a reasoned justification for the reasons of refusal in payment of insurance benefit, if such decision has been made.
8. The claim for insurance benefits to the insurer shall be presented by the insurant or another person, who is the beneficiary, in writing, indicating the place of residence, contact phone numbers of the beneficiary, banking details (if required), the procedure for insurance benefits getting - in cash or by transfer to a bank account with attachment of documents necessary for insurance benefit payment.
Grounds for relief of the insurer from the insurance benefit payment:
1. The insurer is entitled to fully or partially refuse to the insurant in insurance benefit payment, if the insured event occurred as a result of:
• deliberate actions of the insurant, insured and (or) the beneficiary, aimed at occurrence of an insured event or contributing to its occurrence, excluding of actions committed in a state of necessary defense and emergency;
• the actions of the insurant, insured and (or) the beneficiary, recognized according to the procedure established by the regulations of the Republic of Kazakhstan, as intentional criminal or administrative offenses, which are in causal connection with the insured event.
2. The grounds for refusal by the insurer in insurance benefit payment may also be the following:
• providing the insurer by the insurant with knowingly false information about the insurance object, insurance risk, insured event and its consequences;
• failure to notify the insurer upon occurrence of the insured event;
• deliberate non-acceptance by the insurant of measures to reduce losses from the insured event;
• obstruction to the insurer by the insurant in the investigation of the circumstances of the insured event occurrence and in determining of the amount of loss caused by it;
• other cases provided for by statutes.
• List of documents for insurance benefit payment getting
|
• If any occupational disability category has been established |
• Death of an employee |
|
• a copy of the insurance agreement; • an Accident Report; • a copy of the identity document of the injured employee; • a copy of the certificate from territorial unit of the authorized body regarding establishment of any occupational disability category; • a copy of the certificate from territorial unit of the authorized body regarding the need in additional types of care and assistance; • a copy of the opinion of medical and consulting commission of the medical institution regarding the costs incurred by the employee in excess of the guaranteed volume of free of charge medical care; • a copy of the certificate from territorial unit of the authorized body regarding the amount of the assigned social benefit payment in case of loss of general working capacity or regarding refusal in its assigning; • a copy of the document proving the occupational disease; • a copy of the document proving the salary of the injured employee for the period having been worked by him, but not more than twelve months, certified by the employer. |
• a copy of insurance agreement • an Accident Report; • a notarized copy of the death certificate of the employee; • a notarized copy of the document proving the beneficiary's right for compensation for harm in the event of death of the employee; • a copy of the document certifying the identity of the beneficiary; • a copy of the document proving the amount of wages for the period having been worked by the employee, who died, but not more than twelve months, certified by the employer.
|
