1. Notification of Work Accident and Administrative Investigation Process

 Pursuant to Article 13 of the Social Insurance and General Health Insurance Law No. 5510, for an incident to be accepted as a work accident and for compensation/income to be claimed from SGK, the notification obligation must first be fulfilled. The employer is obliged to notify law enforcement authorities immediately and the Social Security Institution (SGK) within three working days at the latest after the accident. If the accident occurs in a place outside the employer’s control, this period begins from the date the accident is learned.

Upon notification, SGK initiates an investigation into whether the incident should be considered a work accident. The Institution conducts an inquiry, if necessary, through audit officers or Ministry labor inspectors, and notifies the interested parties of the outcome within three months at the latest. It is possible to object to this decision of the Institution in the competent court.

2. Determination of Work Accident and Judicial Process 

In cases where the incident is not reported to SGK or is not accepted as a work accident by the Institution, initiating a lawsuit for “determination of a work accident” is a prerequisite for beneficiaries to receive compensation. According to Court of Cassation decisions, if the incident has not yet been clarified as a work accident while the compensation lawsuit is ongoing, the court should grant the plaintiff a “preliminary period” (time limit) to apply to SGK, and if no result is obtained, to file a declaratory judgment lawsuit against the employer and SGK. This declaratory judgment lawsuit is considered a preliminary issue for the compensation lawsuit.

3. Payments and Granting of Income by SGK

 The basic rights provided to the insured person or their beneficiaries as a result of a work accident are as follows:

Temporary Incapacity Benefit: Paid for days that could not be worked during the treatment period.

Permanent Incapacity Income: Granted to the insured person whose earning capacity in the profession is determined to have decreased by at least 10% by the Institution’s Health Board. The disability rate is determined according to the provisions of the Social Insurance Health Procedures Regulation.

Death Benefit: Granted to the spouse, children, and under certain conditions (income requirement, age requirement, etc.) to the parents of the insured person vwho died as a result of a work accident. According to Articles 20 and 34 of Law No. 5510, criteria such as remaining shares from the spouse and children or the parents being over 65 years old are sought for parents to be granted income.

Other Benefits: Funeral assistance and treatment expenses are also among the items covered by the Institution.

4. Set-off in Compensation Lawsuits (Prevention of Duplicate Payment) 

Material compensation lawsuits filed due to work accidents primarily concern the remediation of damages not covered by SSI (SGK). To prevent unjust enrichment and duplicate payments, the “initial lump-sum capital value” (LSCV) of the income allocated by SSI is deducted from the total calculated compensation amount. In this calculation, the amount subject to recourse is taken into account, and data closest to the judgment date is used. If the Institution has not yet allocated an income, the income allocation process must be awaited, as this directly affects the right to compensation.

5. SSI’s Right of Recourse Against the Employer 

SSI collects, by way of recourse, the lump-sum capital value of the payments it has made and the incomes it has allocated to the insured person or beneficiaries, proportional to the fault of the employer or negligent third parties. Pursuant to Article 21 of Law No. 5510; if a work accident occurred due to the employer’s intent, an act contrary to occupational health and safety legislation, or the failure to notify the insured person within the prescribed period (Article 23), the Institution’s loss is collected from the employer. In cases of fault by third parties, a recourse procedure is applied at half the lump-sum capital value of the income.

6. Information Obtained from Secondary Sources 

The following additional points have been emphasized in judicial decisions serving as secondary sources:

Statute of Limitations: It has been stated that there is a 5-year statute of limitations for applications to SSI, but relevant procedures can be initiated if a work accident is determined by the court.

Traffic Accident-Work Accident Relationship: It has been stated that in incidents occurring as traffic accidents, employer notification and the insured person’s application are critical, and the insured person’s direct application may be necessary for the SSI to conduct an investigation.

Interpretation in Favor of the Worker: It has been reminded that in case of conflicting reports in the determination of a work accident, the principle of “interpretation in favor of the worker” should be observed and all hospital records should be examined.

Responsibility of Insurance Companies: It is observed that within the scope of workplace or liability insurance policies taken out by the employer, the amounts subrogated by the SSI can be claimed from insurance companies within policy limits. A paper suggestion.

Why is Expert Lawyer Support Necessary? | 2M Law Office – Istanbul Anatolian Side

Work accident files; SSI notification, administrative investigation, work accident determination, fault and disability reports, statute of limitations periods and compensation calculations consist of many technical stages. Any incomplete or faulty execution of these processes can lead to significant financial losses for the worker or beneficiaries.

In occupational accidents observed particularly in the Istanbul, Anatolian Side, Tuzla, Pendik, Kartal, Aydınlı, Bayramoğlu, and Gebze regions; the simultaneous and coordinated execution of SGK (Social Security Institution) procedures and lawsuits to be filed against the employer is of vital importance.

Why is Expert Lawyer Support Important?

Ensuring the correct registration of the occupational accident with the SGK,

Filing a lawsuit for the determination of the occupational accident when necessary,

Effectively objecting to disability rate and fault reports,

Accurately calculating the offset between SGK benefits and compensation,

Claiming full and complete compensation against the employer and third parties,

is only possible with the follow-up of an expert lawyer in labor and social security law.

Safe Occupational Accident Process with 2M Law Office

2M Law Firm, based in Istanbul, provides effective and professional legal support in the regions of Anatolian Side, Tuzla, Pendik, Kartal, Aydınlı, Bayramoğlu, and Gebze; for determination of work accidents, SSI procedures, material and moral compensation lawsuits, and subrogation processes. Expert lawyer support is of vital importance for the full protection of your rights after a work accident.