В статье авторами обозначены проблемы защиты прав и интересов страхователей, застрахованных лиц и выгодоприобретателей по договорам страхования, а также обеспечения правильности этого процесса. Предложены меры по упрощению процедуры страхования и, в частности, страхового законодательства.The author marked the problem of protecting the rights and interests of policyholders, insured persons and beneficiaries of insurance contracts, as well as to ensure the correctness of the process. The measures to simplify the procedure of insurance and, in particular, insurance legislation.
This article analyses the first Hungarian social insurance law, enacted in 1891, which made health insurance compulsory for all industrial employees (including commercial clerks) in Hungary. Its timing and content suggest that it was modelled on German and Austrian legislation. But, in contrast to Germany and Austria (where the implementation of the legislation was quite successful), implementation of the legislation in Hungary encountered several difficulties. This is the reason why the proportion of de facto insured individuals in Hungary was much less than in Austria and Germany. The article attempts, first, to fit Hungarian social insurance legislation into the wider context of European welfare development. It gives a precise definition of de jure insured persons with particular reference to the situation of day labourers. It then analyses some organisational issues, e.g. the funding of the 'district insurance offices', and the crucial problem of establishing an effective procedure for collecting contributions. The failure of the latter and the shortage of doctors led to failures in implementation. By the turn of the century, the majority of the de jure insured had not become de facto insured and many of those who were insured did not get sufficient health provision. The first problem was a long lasting one: if one compares the proportion of insured persons in Austria and Hungary over time, the difference actually widens in the period before World War II.
This study uses longitudinal data to examine the consequences of losing and gaining health insurance coverage for access to care and health. For both Medicaid and privately insured persons, compared with those who remained insured, persons losing coverage over a 2-year period were more likely to lack a usual source of care, encounter difficulty in obtaining medical care, be very dissatisfied with ability to obtain needed care, and report no physician visits in the previous 12 months. Uninsured people who gained coverage showed improvement across all indicators of access, in contrast to those who remained without insurance. The effects of changes in coverage on health were in the same direction as those for access, but did not reach statistical significance. This study strengthens the evidence that health insurance coverage has a substantial impact on ability to gain access to medical care and may affect health status.
Motivation: The study presents the current conditions for receiving the agricultural pension from the Agricultural Social Insurance Fund (KRUS) and the rules for calculating it. They are organised in such a way that the longer the insurance period of the insured person, the lower the so-called supplementary part of their pension than in the case of the insured person with the shorter insurance period. In addition, since 2011, persons insured in KRUS and having farms with an area of more than 50 ha of utilised agricultural area have been obliged to pay higher amounts for their pension insurance which do not have any impact on the level of benefits received. Farmers who also run business activities are treated by the insurance legislation in a similar manner. Hence, there is a need to make changes to the legal and economic regulations in KRUS, which would reflect the new conditions of management in Poland after 1989 and the solutions existing in the Social Insurance Institution (ZUS). Aim: The objective of the study is to identify the regulations related to agricultural pension insurance which are inadequate in relation to the existing conditions of management in our country and to the solutions existing in ZUS. In addition, the objective of the paper is to propose changes to the insurance regulations of KRUS concerning the rules for calculating pensions and the definition of special branches of agricultural production. Also, the effects of these changes from the viewpoint of the insured person have been presented. Results: The result of the study is a proposal for changes to the rules for calculating pensions for farmers insured in KRUS. The paper proposes to split the pension from KRUS into three parts: the contribution part, supplementary part and capital part. The proposals presented differentiate the pension amount depending on the insurance period and additionally paid contributions. The paper proposes to extend the special branches of agricultural production and to adopt income they generate at the level of 50% of the average salary in the national economy or at the level of the minimum wage as a criterion for access to insurance in KRUS.
Motivation: The study presents the current conditions for receiving the agricultural pension from the Agricultural Social Insurance Fund (KRUS) and the rules for calculating it. They are organised in such a way that the longer the insurance period of the insured person, the lower the so-called supplementary part of their pension than in the case of the insured person with the shorter insurance period. In addition, since 2011, persons insured in KRUS and having farms with an area of more than 50 ha of utilised agricultural area have been obliged to pay higher amounts for their pension insurance which do not have any impact on the level of benefits received. Farmers who also run business activities are treated by the insurance legislation in a similar manner. Hence, there is a need to make changes to the legal and economic regulations in KRUS, which would reflect the new conditions of management in Poland after 1989 and the solutions existing in the Social Insurance Institution (ZUS). Aim: The objective of the study is to identify the regulations related to agricultural pension insurance which are inadequate in relation to the existing conditions of management in our country and to the solutions existing in ZUS. In addition, the objective of the paper is to propose changes to the insurance regulations of KRUS concerning the rules for calculating pensions and the definition of special branches of agricultural production. Also, the effects of these changes from the viewpoint of the insured person have been presented. Results: The result of the study is a proposal for changes to the rules for calculating pensions for farmers insured in KRUS. The paper proposes to split the pension from KRUS into three parts: the contribution part, supplementary part and capital part. The proposals presented differentiate the pension amount depending on the insurance period and additionally paid contributions. The paper proposes to extend the special branches of agricultural production and to adopt income they generate at the level of 50% of the average salary in the national economy or at the level of the minimum wage as a criterion for access to insurance in KRUS.
The article is devoted to the study of the peculiarities of the legal consequences of violation of the contract of voluntary medical insurance under the legislation of Ukraine. Special attention is paid to the legal consequences of violation of the contract of voluntary medical insurance, such as: unilateral refusal of the contract, modification of the contract, payment of a penalty. The legal positions of the jurisprudence on the issues under consideration are given. The study of the legal consequences of breaching the health insurance contract is important in connection with the following. Such an appropriate form of mutual expression of the will of two or more persons is of scientific interest in view, firstly, of the increase in the share of the said contract in the structure of insurance and, secondly, of the direction of development of state policy in modern conditions in the field of health care. In the article there are specified the features of the medical insurance contract. There are also specified its peculiarities. Examining the legal consequence of a violation of a voluntary health insurance contract, such as a unilateral refusal, it was established that the Civil Code of Ukraine grants certain freedom to the parties in the event of termination of the contract. However, the legislation establishes certain restrictions in case of unilateral refusal of the insurer from the personal insurance contract. Cases of the insured's refusal to make insurance compensation are summarized in the category: those caused by the intentional behavior of the insured person (submission of false information about the fact of the occurrence of the insured event, as well as intentional actions of the insured person (insured person) aimed at the occurrence of an insured event, noncompliance with the prescriptions of the attending physician, which led to a complication of the disease)as well as those whose reasons do not depend on the insured's will (insured person) (receiving services that exceed the insured amount, suffering injuries or illnesses due to force majeure or receiving medical services that are not included in the insurance program). Having considered the judicial practice in cases of unilateral refusal of the contract, it was established that in case of violation of the contract of voluntary medical insurance, it is common for the insured to inattentive study the circumstances in which the insurer is obliged to make certain payments, as well as a false belief that they are not covered by the insurance case. ; Статья посвящена исследованию особенностей правовых последствий нарушения договора добровольного медицинского страхования по законодательству Украины. Особое внимание уделяется таким правовым последствиям нарушения договора добровольного медицинского страхования, как: односторонний отказ от договора, изменение договора, уплата неустойки. Приводятся правовые позиции из судебной практики по вопросам, которые рассматриваются. ; Статтю присвячено дослідженню особливостей правових наслідків порушення договору добровільного медичного страхування за законодавством України. Окрема увага приділяється таким правовим наслідкам порушення договору добровільного медичного страхування, як: одностороння відмова від договору, зміна договору, сплата неустойки. Наводяться правові позиції із судової практики з питань, що розглядаються.
The article is devoted to the study of the peculiarities of the legal consequences of violation of the contract of voluntary medical insurance under the legislation of Ukraine. Special attention is paid to the legal consequences of violation of the contract of voluntary medical insurance, such as: unilateral refusal of the contract, modification of the contract, payment of a penalty. The legal positions of the jurisprudence on the issues under consideration are given. The study of the legal consequences of breaching the health insurance contract is important in connection with the following. Such an appropriate form of mutual expression of the will of two or more persons is of scientific interest in view, firstly, of the increase in the share of the said contract in the structure of insurance and, secondly, of the direction of development of state policy in modern conditions in the field of health care. In the article there are specified the features of the medical insurance contract. There are also specified its peculiarities. Examining the legal consequence of a violation of a voluntary health insurance contract, such as a unilateral refusal, it was established that the Civil Code of Ukraine grants certain freedom to the parties in the event of termination of the contract. However, the legislation establishes certain restrictions in case of unilateral refusal of the insurer from the personal insurance contract. Cases of the insured's refusal to make insurance compensation are summarized in the category: those caused by the intentional behavior of the insured person (submission of false information about the fact of the occurrence of the insured event, as well as intentional actions of the insured person (insured person) aimed at the occurrence of an insured event, noncompliance with the prescriptions of the attending physician, which led to a complication of the disease)as well as those whose reasons do not depend on the insured's will (insured person) (receiving services that exceed the insured amount, suffering injuries or illnesses due to force majeure or receiving medical services that are not included in the insurance program). Having considered the judicial practice in cases of unilateral refusal of the contract, it was established that in case of violation of the contract of voluntary medical insurance, it is common for the insured to inattentive study the circumstances in which the insurer is obliged to make certain payments, as well as a false belief that they are not covered by the insurance case. ; Статья посвящена исследованию особенностей правовых последствий нарушения договора добровольного медицинского страхования по законодательству Украины. Особое внимание уделяется таким правовым последствиям нарушения договора добровольного медицинского страхования, как: односторонний отказ от договора, изменение договора, уплата неустойки. Приводятся правовые позиции из судебной практики по вопросам, которые рассматриваются. ; Статтю присвячено дослідженню особливостей правових наслідків порушення договору добровільного медичного страхування за законодавством України. Окрема увага приділяється таким правовим наслідкам порушення договору добровільного медичного страхування, як: одностороння відмова від договору, зміна договору, сплата неустойки. Наводяться правові позиції із судової практики з питань, що розглядаються.
The article considers the obligatory state social insurance as one of the forms of social protection of such subjects of social security as persons with family responsibilities, on the basis of which the corresponding conclusions are made. It is concluded that compulsory state social insurance as a form of social protection of persons with family responsibilities is the main material guarantee of the realization of their right to social protection in case of temporary disability. It is a system of rights, responsibilities and guarantees, which provides for the provision of social protection for persons with family responsibilities, including material support in connection with pregnancy and childbirth, as well as in case of illness, care for a child under three years or a disabled child under the age of 18 in case of illness of the mother or other person caring for this child, loss of a breadwinner and social services at the expense of funds formed by paying insurance premiums by the owner or his authorized body, citizens and budget and other sources provided by law. Its main essence and purpose are reduced to receipt by the insured person in case of an insured event from the insurer of material support and social services at the expense of the insured. It is noted that an important feature of material security and social services in the framework of compulsory state social insurance in the field of social protection of persons with family responsibilities are their sources of funding, the main of which, according to current legislation are contributions of employers and insured persons. The only criterion on which the amount of temporary disability benefits depends is recognized by law as the person's insurance record, and this amount does not depend on the duration of disability. Recognizing that everyone has the appropriate rights to social protection and health care, ensuring their proper implementation is a priority of society and the state. ; У статті розглянуто загальнообов'язкове державне соціальне страхування як одну із форм соціального захисту таких суб'єктів соціального забезпечення, як особи із сімейними обов'язками, на підставі чого зроблено відповідні висновки. Зроблено висновок, що загальнообов'язкове державне соціальне страхування як форма соціального захисту осіб із сімейними обов'язками є основною матеріальною гарантією реалізації їхнього права на соціальний захист у разі тимчасової втрати ними працездатності. Це система прав, обов'язків і гарантій, яка передбачає надання соціального захисту осіб із сімейними обов'язками, що включає матеріальне забезпечення у зв'язку з вагітністю та пологами, а також у разі хвороби дитини, догляду за дитиною віком до 3 років або дитиною-інвалідом віком до 18 років у разі хвороби матері або іншої особи, котра доглядає за цією дитиною, втратою годувальника та соціальні послуги за рахунок грошових фондів, що формуються шляхом сплати страхових внесків власником або уповноваженим ним органом, громадянами, а також бюджетних та інших джерел, передбачених законом. Його головна суть і призначення зводяться до отримання застрахованою особою в разі настання страхового випадку від страховика матеріального забезпечення і соціальних послуг за рахунок страхувальника. Зазначено, що важливою ознакою матеріального забезпечення та соціальних послуг у рамках загальнообов'язкового державного соціального страхування у сфері соціального захисту осіб із сімейними обов'язками є джерела їх фінансування, основними з яких відповідно до чинного законодавства є внески роботодавців і застрахованих осіб. Єдиним критерієм, від якого залежить розмір допомоги по тимчасовій непрацездатності, законодавство визнає страховий стаж особи, причому вказаний розмір не залежить від тривалості непрацездатності. Визнаючи, що кожна людина має відповідні права на соціальний захист і охорону здоров'я, забезпечення їх належної реалізації є пріоритетним напрямом діяльності суспільства й держави.
The paper compares the social insurance programmes of the Bahamas, Barbados and Jamaica from the standpoint of historical evolution and current administration, population coverage, financing problems, benefits available, distribution of expenditure, administrative costs, personnel, managerial problems, contributions of insured persons, employers, investment, and financial and actuarial equilibrium. Some comparisons are made between the social insurance programmes in these Caribbean countries and those in Latin America
Background: Tackling the rising trend of workers suffering from disability due to injuries and diseases, the Malaysian Social Security Organization (SOCSO) introduced the Return to Work (RTW) Program in January 2007. The Return to Work Program provides systematic disability management for Insured Persons with employment injuries and illnesses using a bio psychosocial and multidisciplinary approach to enable them to return to work in a safe and fast manner. In this process, it is the ultimate goal of the Case Manager to place the Insured Person with injuries or illnesses back to the same employer within the same, similar or a different job. Nevertheless there are a large number of Insured Persons who fail to return to their same employer and would therefore require job placement assistance to be placed within the "different employer hierarchy". Note: "Different employer hierarchy" refers to participants who failed to return to work with their previous employers requiring job placement assistance to be placed within new employers.Objective: This study explores factors predicting the likelihood of return to work among Insured Persons requiring job placement assistance. In the process of placing RTW participants among different employers, SOCSO has seen a drastic shift in the reception of employers wanting to employ persons with disabilities since the program was first implemented. While promotional measures and various interventions are carried out to increase number of participating employers, it is also essential that the readiness of the RTW participant themselves to return to work is evaluated at the beginning of the program to ensure that they will be mentally ready to return to work after being successfully rehabilitated.Methods: The logistic regression model was used to find significant variables from a sample size of 798 participants which may be used as indicators on the likelihood of RTW participants under job placement assistance in returning to work. Findings From the results, it was found that there were eight (8) significant variables which includes the clients self-perceived self-esteem, skills, health condition, pain tolerance, independence, self-confidence and career goals. It was also found that gender was a subsequent variable which could also be used as a predicting factor in predicting the likelihood of the participant returning to work.Discussion: In enhancing the quality and efficiency of providing job placement assistance for participants of SOCSO's Return to Work Program, significant indicators as found in this study can be used as a valuable tool in future where Case Managers may use this indicators to design interventions at the beginning of the programme . For instance, if the client had issues with self-esteem from the beginning of the program with low scores, this may suggest that additional counselling interventions and motivational programs may be required to improve the participant's self-esteem with the objective that he is able to return to work as soon as possible.
Systemically, the insurers decline their involvement in claims arising from the state of drunk or, in comprehensive material damage insurance, the state of alcoholic poisoning of the insured person. Although the lawfulness of such a term does not pose any difficulties, the contractual arrangement which establishes a presumption of a causal link between the failure to fulfil obligations alleged against the insured person and the occurrence of the loss is, on the other hand, both unlawful and unfair. The penalty applicable, both in the light of the relevant provisions of the Law of 4 April 2014 and in the light of the Code of Economic Law, is the nullity of the clause. By judgment of 25 January 2016, the Cour d'appel de Liège (Court of Appeal, Liège) held that 'that nullity must be applied only to the provision which places on the insured person proof of the causal relationship and not to the contractual 'ground for exclusion' in itself, the balance being remedied by the application of the abovementioned mandatory statutory provisions'. The present commentary thus raises the question of the extent of the nullity to be reserved for such a contractual provision. Must the clause be annulled in its entirety or only part thereof, namely the portion reversing the burden of proof? ; Systématiquement, les assureurs déclinent leur intervention pour les sinistres qui résultent de l'état d'ivresse ou, dans les assurances omnium dégâts matériels, de l'état d'intoxication alcoolique de l'assuré. Si la licéité d'une telle clause ne pose pas de difficultés, l'aménagement contractuel qui institue une présomption de lien causal entre le manquement reproché à l'assuré et la survenance du sinistre s'avère, en revanche, à la fois illicite et abusif. La sanction applicable, tant au regard des dispositions pertinentes de la loi du 4 avril 2014 qu'au regard du Code de droit économique, est la nullité de la clause. Par un arrêt du 25 janvier 2016, la Cour d'appel de Liège a décidé que « cette nullité ne doit être appliquée qu'à la ...
В соответствии со Стратегией долгосрочного развития пенсионной системы Российской Федерации, принятой в 2012 г. Правительством РФ, в системе обязательного пенсионного страхования кардинально изменилась роль пенсионных накоплений, которые до 2013 г. формировали все застрахованные лица 1967 года рождения и моложе. После обобщения мирового опыта по внедрению накопительного компонента в государственную пенсионную систему в странах Латинской Америки, а также анализа отечественных данных о результатах формирования и инвестирования пенсионных накоплений, реформаторы пришли к выводу, что накопительный механизм не в состоянии решить стоявшие перед пенсионной системой задачи. Поэтому с 2016 г. пенсионные накопления переводятся в разряд личных добровольных инициатив застрахованных лиц. ; In accordance with the Strategy of the Pension Systems Long-Term Development adopted by the Government of the Russian Federation in 2012, the role of pension savings in compulsory pension insurance has radically changed. However, until 2013 all the insured persons born after 1967 possessed pension savings. After summarizing the world experience on pension savings introduction in Latin American countries pension systems and the analysis of Russian findings on pension savings formation and investment, the reformers came to a conclusion that the accumulative mechanism is no longer able to solve the problems faced by the pension system. In this regard, since 2016 pension savings will be transferred into the category of private voluntary initiatives of the insured persons.
Corruption in health systems is taking place, with economically motivated industrial enterprises tending to influence scientists and health services, Most important is, among other corruptive means, influencing academic expert opinions in drug approval procedures or lawsuits for damages. In Germany, focussed in this article, these corruptive affairs are not explainable without regarding the structural intransparency of the health system, One possible solution for tackling corruption could lie in building up or strengthening governmental, centralized controls and sanctions as well as empowering patients and insured persons respectively.
Corruption in health systems is taking place, with economically motivated industrial enterprises tending to influence scientists and health services. Most important is, among other corruptive means, influencing academic expert opinions in drug approval procedures or lawsuits for damages. In Germany, focussed in this article, these corruptive affairs are not explainable without regarding the structural intransparency of the health system. One possible solution for tackling corruption could lie in building up or strengthening governmental, centralized controls and sanctions as well as empowering patients and insured persons respectively. (Prokla / FUB)
Discusses implementation of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (PDIMA), and political implications for the Democratic and Republican parties; US.
