Insurance Indemnity Related to Accident at Work or Occupational Disease
A socially insured person is entitled to receive an insurance compensation if he/she due to an accident at work or an occupational disease
- has temporarily lost the ability to work;
- has completely lost the ability to work; or
- has died.
In case of death of an insured person, family members, who have lost the ability to work and who were provided for by the deceased, are entitled to receive the insurance compensation.
A person, who after 1 January 1997 was insured against risks of accident at work and occupational diseases for at least 3 years, is entitled to insurance compensation for an occupational disease.
From 1 January 2020
Indemnity for loss of capacity for work or indemnity for loss of supporter and disability pension cannot be received at the same time.
A person who, at the same time, has rights to both disability pension and indemnity for loss of the capacity for work or for loss of supporter shall get payment for one service – either pension or indemnity, whichever the person chooses.
Anna receives indemnity for loss of the capacity for work due to diagnosed occupational disease in the amount of EUR 175 per month. From 15.03.2020, Anna has group III disability determined additionally with the cause being “general illness” and has rights to disability pension in the amount of EUR 80 per month.
Since she only has rights to receive one service, Anna must make a choice, which service she wants to receive further on.
For persons with pension and indemnity being granted until 31 December 2019, the mentioned services shall be paid simultaneously for the time period stated in the ruling on granting, recalculating the service, or prolonging the payment period. After that, the receiver needs to make a choice as to which of the services they want to receive further on.
Types of insurance compensation:
- sickness benefit;
- compensation for the incapacity for work;
- compensation for additional expenses due to medical treatment and rehabilitation, care of a person, purchase and repair of special equipment, transportation costs for the visitation of a doctor.
If a person has died due to an accident at work or an occupational disease, his or her family members are entitled to receive:
- a survivor’s benefit;
- a funeral allowance.
Insurance compensation is paid according to the Law On Compulsory Social Insurance in respect of Accidents at Work and Occupational Diseases.
Procedure on the calculation of insurance compensation is stipulated by Cabinet Regulation No. 50 of 16 February 1999 Procedures for the Granting and Calculation of Insurance Compensation of Compulsory Social Insurance against Accidents at Work and Occupational Diseases.
The benefits’ claiming rules
The following documents shall be submitted if insurance compensation is requested:
- application on the request for compensation;
- statement on the occupational disease, which shall be issued according to the respective laws on investigation and registration procedures of occupational diseases.
Additional documents for receiving particular benefits and indemnities:
- Compensation for additional expenses — documents approving the necessity and amount of additional expenses;
- Survivor’s benefit:
- report from hospital stating the relation of the cause of death with the accident at work or occupational disease;
- documents certifying the kinship or marriage to the insured person – birth certificate and/or marriage certificate (must be presented, if such information is not available to the SSIA);
- court judgement on the fact of maintenance, in case it is impossible to establish the fact of full or partial maintenance based on the aforementioned documents.
Information regarding the level of loss of capacity to work and disability is sent by the State Medical Commission for the Assessment of Health Condition and Working Ability to State Social Insurance Agency in electronic format.
A deed regarding the accident at work is sent by the State Labour Inspectorate to State Social Insurance Agency in electronic format.
An application you can submit in one of the divisions of the State Social Insurance Agency (SSIA):
- sent by post or submit by a notary authorized person’s intermediation.
By signing the application, the person requesting the benefit confirms that the information provided in the application is accurate.
The allowance may be requested through an authorised person, provided that the representation rights have been granted in accordance with Article 38 Paragraph one of the Administrative Procedure Law. Representation of a natural person shall be drawn up as a notarised power of attorney, or a natural person may authorise his or her representative at the VSAA office, if both the representative and the authorising person are present.
The rates of the benefits
Any insurance compensation amount depends on the average contribution wage, considering the last 12 months (except two months before the month, when the accident at work happened or the occupational disease was diagnosed, the person had temporarily lost the ability to work or died due to an accident at work or an occupational disease).
Sickness benefit is granted in the amount of 80% of the average contribution wage and is paid in the following cases:
- in case of an accident at work — starting from the 11th day the person has lost the ability to work;
- in case of an occupational disease — starting from the 1st day the person has lost the ability to work.
The compensation for the loss of capacity for work is calculated depending on the degree of incapacity determined by VDEĀVK and the average contribution wage.
The amount of the survivor’s benefit depends on the number of persons that were provided for and the average contribution wage.
Time for claiming
Application for granting the benefit must be submitted no later than 12 months from the occurrence of such rights.
Time for decision
The decision by VSAA on the granting or rejection of an insurance compensation (including sickness benefit, compensation for incapability to work, survivor’s benefit and compensation of additional costs) is made within one month after the receipt of the application.
Receipt of the benefit
Insurance compensation for an accident at work or an occupational disease is received:
- via wire-transfer on a bank account or an account of the Postal Accounting System (PAS);
- via direct payment at the residence of the beneficiary.
A beneficiary leaving Latvia for permanent residence abroad shall continue receiving the compensation subject to the following provisions:
- before leaving the person submits a written application to VSAA indicating a Latvian bank account, where the compensation shall be transferred;
- If person lives abroad, annual written request for continuation of indemnity payment must be submitted to SSIA within the period from October 1 till December 15 (must be submitted personally, via authorized person or sent by post; request must contain the account of credit institution of the Republic of Latvia).
Upon sending the request by post, notarial confirmation on the fact that the receiver of indemnity is alive, issued not later that in one month before the date of request, must be attached (data of person’s passport must be specified).
When submitting documents issued in foreign countries, they have to be formatted accordingly to the rules of document validation. If the document has been issued in a foreign language, a translation of the document might be necessary.
Request for the further indemnity payment can be also submitted to SSIA division personally by the receiver of indemnity and work disabled members of family upon presenting person attestant document. In that case life attestation issued by the notary is not necessary.
A person granted a service or old-age pension shall receive the compensation for loss of capacity for work in the following order:
- if the amount of the granted pension does not exceed the benefit for loss of capacity for work, the person shall receive the difference of the latter and service or old-age pension;
- if the amount of the granted service or old-age pension equals to or exceeds the benefit for loss of capacity for work, the payment of the benefit for loss of capacity for work is terminated.
If old-age pension has been granted to the person prematurely and particular person does not work, until reaching of definite pensioning age, the pension is paid in the amount of 50% from granted old-age pension.
Persons to whom indemnity on work disability and premature old-age pension have been paid by comparing the amount indemnity for work disability and the amount of payable premature pension. If population income tax has been withheld from premature old-pension (50%), indemnity for work disability is compared with the amount of pension before taxes.
If premature old-age pension or long-service pension has been granted to person, but those pensions are not paid to particular person because the person continues to work, insurance indemnity must be paid in granted amount without decreasing it by the amount of long-service pension or old-age pension or without stopping payment of pension if it exceeds the amount of indemnity.
Compensation of damages shall not be paid to persons whose loss of working ability is determined from 10% to 24%.
Receipt of for loss of capacity for work and survivor’s benefit shall be suspended for as long as the person receives the unemployment benefit.