Contents of employeesû and employersû appeals with the Compensation Fund and against the decisions given by the Compensation Appeal Committee

Authors

  • Vachara Onoparatwibul Department of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok 10330

Keywords:

The content of appeals, Compensation Fund, the Compensation Fund Committee, Decisions, ข้อยื่นอุทธรณ์, กองทุนเงินทดแทน, คณะกรรมการกองทุนเงินทดแทน, ผลคำวินิจฉัย

Abstract

Rationale : At present it has been a large number of appeals filed with the Compensation Fund Committee. No studies have yet clearly indicated medical cases about the content of their lodging appeals and reversal of decisions by this committee.

Methodology : Descriptive study was done to explain about content of employeesû and employersû appeals with Compensation Appeal Committee related to medical cases and the result of decisions. There were 377 cases were collected data from reports on the resolutions of the minutes of the Compensation Fund Committee, Social Security Office from 1 January to 31 December 2006. Total 232 cases concerning medicine appeals were filed in 2006 and decisions were finished in the same year. After that, there were a study of appeals and decisions.

Results : It was found that the major appeals involved medical expenses calling for higher payments which are more than 35,000 baht (43%), followed by cases of work-related illness or injury. Besides, there were the appeals related to illness or accident from work (23%) and loss of the ability to work. Moreover, an increase of the compensation for the loss of ability to work (9.5%) and the increase of loss of ability to work (9.5%) were demanded respectively.

According to the decisions carried out by the Compensation Consideration Subcommittee regarding medical cases, the reversals of preliminary decisions were given by officials at 59.9% (decisions confirmed at 40.1%). Cases of losing the ability to work, there were 88.2 percent reversals of decision with the assessment of the loss of ability to work largely increased. With regard to work-related illness or injury, there were 76.4 percent reversals of decisions. It was found that illness or injury was originated by work, rationale and medical evidence. As for medical expenses, there were 42.6 percent reversals of decisions in order to have higher compensation for medical expenses paid.

Discussion : The Sub-committee on Considering Compensation Appeals with regard to medical case decides a large number of appeals and many preliminary decisions given by officials were reversed. It was found that the problems came from legal misinterpretations to medical expenses, diagnosis for work-related illness or injury and incorrect assessment of compensation for loss ability to work.

Key words : The content of appeals; Compensation Fund; the Compensation Fund Committee, Decisions

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