DISABILITY BENEFIT

DISABILITY BENEFIT

Disability, which literally means "incapacity, deficiency," is the state of limitation or reduction in the physical integrity of an individual as a result of illness, accident, or natural disaster.[1] The term disability in insurance policies refers to the situation where the insured party suffers bodily harm as a result of adverse events experienced during the period of insurance coverage. According to Article 25 of the Social Insurance and General Health Insurance Law No. 5510, titled "being deemed disabled": "Upon the request of the insured person or the employer, as a result of the examination of the reports and supporting medical documents prepared in accordance with the procedure by the health boards of the health service providers authorized by the Institution, the insured person is deemed disabled if it is determined by the Institution's Health Board that the insured person has lost at least 60% of his working capacity or earning capacity in his profession as a result of a work accident or occupational disease for the insured persons within the scope of subparagraphs (a) and (b) of the first paragraph of Article 4, or that the insured person within the scope of subparagraph (c) has lost at least 60% of his working capacity or earning capacity in his profession in such a way that he cannot perform his duties."[2]

Disability takes four forms: temporary, permanent, total, and partial. [3]

• Total Disability: This occurs when an individual's physical integrity is compromised as a result of events such as illness, accident, natural disaster, or terrorist attack; their bodily functions become incapable of functioning independently, and they lose the basic functions necessary to work and maintain economic independence. [4]

• Partial Disability: This refers to dysfunction in one or more parts of the body resulting from illness, accident, assault, or other similar circumstances. Loss of limbs, bone fractures, or the loss of hands, arms, feet, or legs due to crushing injuries are all considered partial disability.

• Temporary Disability: An individual is rendered disabled in a treatable manner due to adverse circumstances. Situations such as having certain organs put in casts, undergoing surgery, or applying medical bandages can temporarily partially or completely impair the individual's physical integrity.

• Permanent Disability: This refers to a situation where an individual suffers lifelong physical damage as a result of an accident, illness, assault, or natural disaster, and it can be partial or complete.

Disability is covered under many insurance policies, and there are several basic types of insurance that include disability. Many types of insurance, including Personal Accident Insurance, Health Insurance, and Life Insurance, cover total and partial disabilities and compensate the insured for losses and medical expenses resulting from disabilities covered by the policy.

• Life Insurance: If an individual covered by life insurance experiences partial or total disability for various reasons during their insured period, their medical expenses and essential living needs are covered by the insurance package.

• Personal Accident Insurance: If an individual with this type of insurance suffers disability as a result of a traffic accident, medical expenses and basic necessities are covered under Personal Accident Insurance.

• Liability Insurance: In the event that a third party becomes disabled due to the negligence or failure to take precautions of an individual who has liability insurance, the liability insurance covers the financial compensation that the insured party would have to pay to the third party.

When the organs and systems of the human body function at full capacity, there are no problems or limitations in carrying out daily life and work; however, any limitation or deficiency in an individual's daily life resulting from disease in various organs and systems reflects a disability. The degree of disability is defined as the percentage of deficiency or limitation in an individual's fully (100%) bodily integrity. If a deficiency of at least 20% or more occurs in one or more organs and systems of an individual, it is reflected as a limitation in the individual's daily life.

DISABILITY ASSESSMENT PROCEDURES

Disability assessment procedures help determine the level of loss of working capacity for insured employees. Individuals working in any workplace as insured employees become disabled and acquire certain rights if they suffer a work-related accident or occupational disease for various reasons.[5]

The extent of an employee's ability to work and perform their job due to an accident is determined by disability assessment procedures carried out by official state institutions. For insured employees who have suffered a work-related accident to be considered disabled according to the laws of the country, these disability assessment procedures must be completed.

WHERE TO APPLY FOR DISABILITY CERTIFICATION?

To determine disability status, insured individuals who have suffered a loss of working capacity must apply to the relevant departments of their respective social security provincial directorates or centers. Insured employees wishing to obtain this document must submit a petition to the relevant authorities. The relevant state services will then approve the application and refer the individual to the hospitals authorized to obtain the necessary medical board reports. If insured employees have medical board reports issued by state-authorized hospitals within the last six months prior to the application date, the process will be completed based on these reports without the need for referral. Public sector employees must submit their medical board reports and application petitions to their respective institutions.

WHO PERFORMS DISABILITY DETERMINATION?

Disability assessment procedures are carried out by the Institution's Health Boards, composed of doctors and dentists. These doctors and dentists are authorized to determine the percentage of loss of working capacity and earning capacity in the profession, the degree of premature aging, the loss of earning capacity in the profession to the extent that the individual cannot perform their duties, and the degree of disability of the individual applying for disability. With the disability assessment process, the percentage of loss of earning capacity and working capacity in the profession of the individual applying for disability can be officially determined.

Based on assessments conducted by authorized doctors on the health board, decisions are made regarding whether an insured employee is disabled or not. In addition to these decisions, the board may also issue interim decisions depending on the circumstances.