Work accident is defined in Article 13 of the Social Insurance and General Health Insurance Law No. 5510 as follows:
Work accident;
a) While the insured is at work,
b) If the insured works independently on his own behalf and account due to the work carried out by the employer,
c) The insured person working under an employer spends time without performing his/her main job due to being sent to another place outside the workplace as an employee,
d) (Amended: 17/4/2008-5754/8 art.) During the times reserved for breastfeeding the child of the breastfeeding female insured within the scope of subparagraph (a) of the first paragraph of Article 4 of this Law, in accordance with the labor legislation,
e) During the insured’s transportation to and from the place where the work is done, with a vehicle provided by the employer,
It is an event that occurs and causes physical or mental disability to the insured immediately or later.”
In terms of the application of the Social Security Law, five elements must be met for an event to be considered a work accident.
The person involved in the accident must be insured,
The insured person has an accident depending on the place and time (in the workplace or places considered as workplaces).
If the insured is working independently on his own behalf and account due to the work carried out by the employer, he suffers an accident due to the work he is carrying out,
Immediate or later physical disability (physically or spiritually) of the accident victim,
There is a causal link in the accident.
Examples of work accidents accepted by the Supreme Court decisions include: In cases where the insured is physically disabled as a result of falling while running in the courtyard while at the workplace, or is injured as a result of fighting in the cafeteria, or is shot by any person with a gun in a resting place, or dies due to “suicide at the workplace” or drowning in places such as the pool within the boundaries of the workplace, these are considered work accidents.
The death of an insured worker due to a heart attack while working at the workplace should be considered as a work accident since it has the elements listed within the scope of the Social Insurance and General Health Insurance Law No. 5510.
The Supreme Court decision on the subject is as follows;
C. Supreme Court of Appeals General Assembly 2004/21-529 E., 2004/527 K.
“At the end of the trial held due to the “determination” case between the parties; Upon the request of the plaintiff and the defendant SSK attorneys to review the decision dated 19.11.2003 and numbered 2001/515-2003/1112 given by the (Ankara Sixth Labor Court) regarding the rejection of the case, the decision of the 21st Civil Chamber of the Supreme Court of Appeals dated 12.4.2004 and numbered 2004/501-3531; {…1- According to the articles in the file, the evidence collected, and the compelling reasons on which the verdict is based, all appeal objections of the defendant Institution must be rejected. 2- The case concerns a request to determine whether a damaging insurance incident should be considered a workplace accident, and there is no dispute between the parties that the incident occurred at the workplace. The dispute centers on whether the plaintiff’s deceased’s heart attack death should be considered a workplace accident.
In this respect, the legal basis for the case is Article 11-A of Law No. 506. According to the said article, a workplace accident is an event that causes immediate or delayed physical or mental disability to the insured. In other words, according to Articles 11-A-a and b of the aforementioned Law, it is clear that if a damaging insurance incident occurs while the insured is at the workplace and under the employer’s command due to work being carried out by the employer, there is a legal obligation to consider it a workplace accident. The incident in question occurred while the plaintiff was working as an electrician and was at the workplace. The plaintiff died of a heart attack while he was on duty at the workplace, repairing an electrical fault. In this case, while there is clearly a legal obligation to consider the incident a work-related accident, the court’s dismissal of the case, citing the report obtained from Hacettepe University Faculty of Medicine, violates procedure and law and constitutes grounds for reversal.
Therefore, the plaintiff’s appeals addressing these aspects should be accepted, and the judgment should be overturned…), and the case was returned to its original location. Following the retrial, the court upheld the previous decision.
Appellant: Plaintiff’s attorney and defendant SSI attorney.
After the General Assembly of Civil Chambers reviewed the appeal decision and determined that it had been timely appealed, and the documents in the case were read, the necessary action was taken:
1. Since the defendant SSI attorney’s appeals against the initial decision were evaluated by the Special Chamber and the appeal request was rejected, there is no legal basis for appealing the appeal decision. Therefore, the appeal petition should be dismissed.
2. Regarding the plaintiff’s attorney’s appeal:
The case concerns a request to determine whether a damaging insurance incident should be considered a workplace accident.
On October 2, 2000, insured worker Yusuf suffered a heart attack while repairing electrical faults in the workers’ quarters at his workplace. Since the Institution did not recognize this incident as a workplace accident, the plaintiff, the deceased’s rightful owner, filed the lawsuit.
The defendant SSI and the employer’s attorneys argued for the dismissal of the case.
The court, based on a report appointed by a panel of experts consisting of doctors, did not recognize the incident as a workplace accident, and the case was dismissed. Upon appeal by the plaintiff and defendant SSI attorneys, the Special Chamber ruled to dismiss the SSI attorney’s appeals and to overturn the judgment, granting the plaintiff’s appeal and stating that the incident should be considered a workplace accident.
The court appealed the Miskin ruling, which was not upheld in the previous decision. The plaintiff and defendant SSI attorneys appealed.
There is no dispute that the deceased was an insured worker and that the damaging insurance event occurred at the workplace and during the performance of work assigned by the employer.
The dispute, brought before the General Assembly of Laws through resistance, centers on whether a death resulting from a heart attack occurring during work at the workplace can be considered a work-related accident.
To resolve the dispute, it is beneficial to first establish the legal basis and principles to be applied in determining which event constitutes a work-related accident.
It should be noted immediately that “work-related accident” is not defined in the law; however, the “circumstances and circumstances” under which an accident is considered a work-related accident are specified, limited to “place and time” conditions.
The relevant legal regulation is contained in Article 11 of Social Security Law No. 506, titled “Definition of Work-related Accidents and Occupational Diseases,” and paragraph (A) of this article, regarding work-related accidents, reads as follows:
“A) A work-related accident is an event that occurs under one of the following circumstances and situations and causes the insured to suffer immediate or delayed physical or mental disability.
a) While the insured is at work,
b) Due to work being carried out by the employer,
c) During periods when the insured is not performing their primary job due to the employer’s transfer to another location,
d) During periods when a nursing woman is allocated to breastfeed her child,
e) During the group transportation of insured individuals to and from the work location in a vehicle provided by the employer…”
According to the provisions of this article, a work-related accident is an event that occurs under any of the circumstances and situations listed in the article and causes the insured to suffer immediate or delayed physical or mental disability.
As is clearly accepted in both practice and scholarship, and as is evident from the text of this article, the situations listed in this article are not illustrative, but rather limiting. An insurance event that does not fall under one of these circumstances cannot be considered a work-related accident. There is no requirement for all of these listed conditions to occur simultaneously; the occurrence of any one of them is necessary and sufficient.
In other words, a workplace accident is a legal event, and it must occur when one of the circumstances specified and limited in the legal article explained above occurs.
Incidentally, the elements of a workplace accident should be briefly discussed. These can be listed as follows: The person who suffers the accident must be considered an insured within the meaning of Law No. 506; the insured must suffer an accident, and the accident must occur in one of the circumstances and conditions listed in Article 11, paragraph (A) of Law No. 506, as detailed above; the accident must occur in the form of an event that causes immediate or delayed physical or mental impairment to the insured; and there must be a causal link between this event and the damage suffered by the insured.
It should be noted immediately that the law’s definition of a workplace accident as an event that harms the insured necessitates considering causality as an element of a workplace accident. However, the requirement here is a “suitable causal link,” which should be understood as the correspondence between the occurrence of any of the circumstances and conditions required by the law and the outcome. The existence of any other restrictive condition, even if not specified in the law, should not be sought.
In short, the aforementioned legal regulation should be evaluated within the principles of social security law. If any of the circumstances stipulated in the article are met, a narrow interpretation should not be applied in assessing whether the worker was the source of the damaging insurance event or other factors contributing to its occurrence.
In the specific case, the deceased insured worker, along with another worker, was assigned to inspect and repair the installations of the workers’ quarters within the workplace. While performing the assigned task, he fainted and fell to the ground while the other worker was leaving to purchase materials. He died en route to the hospital by ambulance. The employer did not report the occupational accident, and the cause of the insured’s death was listed as myocardial infarction on the statistical form completed by the hospital. The defendant institution also rejected the beneficiaries’ claims regarding the occupational accident.
However, the fact that an incident is not considered a work-related accident by the institution or the employer, whether it is due to external factors or occurs suddenly, does not necessitate that the incident be considered a work-related accident, given the clear provisions of the law. Because, as clearly stated in the law, it is necessary and sufficient for the damaging insurance event to occur under any of the circumstances and conditions listed in the law.
More precisely, the death of an insured person from a heart attack while working at the workplace is an event that meets the condition of “occurring while the insured is at the workplace” specified in subparagraph (a) of paragraph (A) of Article 11 of Social Security Law No. 506, and it also meets the condition of “occurring due to work carried out by the employer” specified in subparagraph (b) of the same article, and should be considered a work-related accident. Since the article does not contain any other condition or restriction, it is impossible to interpret a restriction that does not exist in the law.
The court, based on the compelling reasons explained above and in the reversal decision, should have abided by the Special Chamber’s reversal decision, which was also adopted by the General Assembly of Civil Chambers, and considered the incident a work-related accident. However, the contrary view, based on the report that did not consider the incident a work-related accident, resisting the previous decision and dismissing the case, is contrary to procedure and law. Therefore, the decision to dismiss should be overturned.
Conclusion: 1. The defendant SSK attorney’s appeal petition is rejected for the reasons explained in paragraph (1) above, and no fee is due since it is exempt from the fee.
The plaintiff attorney’s appeal is accepted for the reasons explained in paragraph (2) above, and the decision to resist is overturned pursuant to Article 429 of the Civil Procedure Code (CCP). Appeals maybe filed in advance upon request.
It was unanimously decided on 13.10.2004 that the fee be refunded.