Chapter VIII: Benefits in respect of accidents at work and occupational diseases
When are you entitled to benefits in respect of accidents at work and occupational diseases?
There is no specific social insurance scheme that covers accidents at work and occupational diseases. These risks are covered by the mandatory health insurance in case of short-term incapacity for work, and the mandatory pension and invalidity insurance in case of invalidity or death of the insured person.
Accidents at work are defined as accidents arising out of work and in the course of work, including travel between the places of residence and work. A list of occupational diseases is available, and if the disease is not on the list, it is not considered to be an occupational disease.
What is covered?
In case of an accident at work or occupational disease, all costs of acute medical treatment and medical rehabilitation are covered by the mandatory health insurance. No co-payment from the insured person is required. If short-term incapacity is caused by an accident at work or occupational disease, sickness cash benefit paid first by the employer and subsequently by the Health Insurance Institute of Slovenia will amount to 100% of the calculation basis. Additionally, the insured person will continue to receive the benefit even after the contract of employment has expired, until the ability to work is regained. In case of invalidity caused by an accident at work or occupational disease, no prior insurance is required in order to have access to an Invalidity Pension or Disability Allowance. Additionally, a lower percentage (30%) of physical impairment is accepted to enable entitlement to a Disability Allowance. It is not just the access which is more favourable, but also the scope of benefits. For instance, the Invalidity Pension is calculated as for the full working period (40 years for men
and 38 for women) and the Disability Allowance is higher. In the case of death due to accident at work or occupational disease, entitlement to survivors’ pension is not subject to a qualifying period, which otherwise would have to be completed by the deceased insured person.
How are benefits in respect of accidents at work and occupational diseases accessed?
Healthcare is provided by the chosen personal physician or any other physician if urgent medical treatment is required. Sickness cash benefit is paid by the employer (and for any necessary duration beyond 30 days it is reimbursed by the Health Insurance Institute of Slovenia).
Benefits in case of invalidity and death of the insured person have to be claimed at the branch office of the Pension and Invalidity Insurance Institute of Slovenia where the person is insured or the deceased was last insured. The degree of invalidity or impairment is assessed by the competent Invalidity Commission.
Your right to benefits in respect of accidents at work and occupational diseases when moving within Europe
The EU provisions on benefits in respect of accidents at work or occupational diseases are very similar to the provisions on sickness benefits (see sections II and III). Within the European Union, Iceland, Liechtenstein, Norway or Switzerland, if you reside or stay in a country other than in the one in which you are insured against accidents at work and occupational diseases, you are normally entitled to receive healthcare there in respect of an accident at work or an occupational disease; benefits in cash will normally be paid by the institution by which you are insured, even if you reside or stay in another country.∗
Whenever certain conditions have to be fulfilled in order to become entitled to benefits in respect of accidents at work or occupational diseases, the institution where you are insured must take account of periods of insurance, residence or employment that you have completed under the legislation of other countries of the European Union, plus Iceland, Liechtenstein, Norway or Switzerland. This guarantees that people will not lose their insurance coverage when changing employment and moving to another country.
Further information about the coordination of social security rights when moving or travelling can be found at http://ec.europa.eu/social-security-coordination.