Announcement of Interim Results of Special Audit on Industrial Accident Insurance System
A case was uncovered by the Ministry of Employment and Labor where a hospital worker, after falling and injuring themselves at home, asked hospital officials to process the industrial accident claim as if the fall had occurred in the office, and received about 50 million KRW in benefits. There was also a case of fraudulent receipt of 10 million KRW by claiming an accident caused by driving a motorcycle after drinking occurred during a delivery.
On the 20th, the Ministry of Employment and Labor announced the "Interim Results of the Special Audit on the Industrial Accident Insurance System."
The Ministry originally planned to conduct a special audit on the industrial accident insurance system and its overall operation for one month from the 1st to the 30th of last month. However, due to the emergence of various fraudulent benefit cases and structural problems in the system, the audit period was extended by one month until the end of this month to conduct a more intensive audit of the entire system.
The Ministry is investigating 320 cases received through various reporting systems or identified internally related to fraudulent benefit claims. Among the 178 cases (55.6%) that have been completed so far, 117 cases of fraudulent claims were detected. The amount of fraudulent claims identified amounts to approximately 6.031 billion KRW.
According to the interim results, at the application and approval stages of industrial accident claims, there were cases where accidents that occurred privately, either solely by the injured worker or in collusion with the employer, were fabricated as work-related injuries to apply for and receive approval for industrial accident claims. During the treatment stage, cases were confirmed where the disability condition was exaggerated or falsified to increase the disability rating and fraudulently receive industrial accident insurance benefits. Cases of fraudulent receipt of temporary disability benefits were also detected, such as receiving benefits while working another job or having the benefits paid under another person's name. The Ministry plans to take measures such as recovering undue profits at double the amount, re-determining disability ratings, and criminal prosecution for the detected fraudulent cases.
The Ministry is also closely examining long-term care patients, who account for the majority of the detected fraudulent amounts. As of last year, patients receiving care for more than six months accounted for 47.6% of the total, and those receiving care for more than one year accounted for 29.5%, indicating a very high proportion of long-term care patients. Accordingly, during the audit process, the Ministry instructed the Korea Workers' Compensation and Welfare Service to re-examine treatment plans for long-term care patients. So far, treatment termination decisions have been made without extending care for 419 long-term care patients.
Minister of Employment and Labor Lee Jeong-sik stated, "Various fraudulent benefit cases and system deficiencies cause unnecessary expenditures of the industrial accident fund, leading to deterioration of the fund’s financial soundness, which will ultimately become a burden for future generations. We will thoroughly investigate to identify additional fraudulent cases and system improvement points and eradicate corruption related to industrial accident compensation, including fraudulent claims."
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