Article 1 These Measures are formulated in accordance with the Regulations on Industrial Injury Insurance and Several Provisions for the Implementation of Jiangxi Province, combined with the actual situation of this Municipality, in order to ensure that employees receive medical treatment and economic compensation after suffering from accidents or occupational diseases at work, to promote industrial injury prevention and vocational rehabilitation, and to spread the industrial injury risks of employers.
Article 2 All kinds of enterprises and individual industrial and commercial households with employees within the administrative area of this Municipality (hereinafter referred to as employers) shall participate in work-related injury insurance in accordance with the provisions of these Measures and pay work-related injury insurance premiums for all employees or employees (including migrant workers, hereinafter referred to as employees) of their own units.
The employees of the employing unit have the right to enjoy work-related injury insurance benefits in accordance with the provisions of these measures.
Article 3 The municipal labor security administrative department shall be responsible for the work-related injury insurance in the whole city, and the labor security administrative department of the county (city, district) shall be responsible for the work-related injury insurance within its administrative area.
City medical insurance agencies specifically undertake work-related injury insurance affairs within the scope of zhanggong district and Economic and Technological Development Zone; County (city) medical insurance agencies specifically undertake work-related injury insurance affairs within the administrative area of the county (city) (medical insurance agencies hereinafter referred to as agencies).
Article 4 An agency undertaking work-related injury insurance shall perform the following duties:
(1) Collecting work-related injury insurance premiums;
(two) to verify the total wages of the employer and the number of employees, handle the registration of work-related injury insurance, and be responsible for keeping the records of the employer's payment and the employees' enjoyment of work-related injury insurance benefits;
(three) to carry out the investigation and statistics of industrial injury insurance, and to prepare the accounting statistics of industrial injury insurance funds;
(four) in accordance with the provisions of the management of industrial injury insurance fund expenditure, audit and payment of industrial injury insurance benefits;
(five) to provide free consulting services for employers, workers and their immediate family members;
(six) regularly publish the income and expenditure of the industrial injury insurance fund;
(seven) according to the use of work-related injury insurance premiums, the incidence of work-related injuries, the degree of occupational hazards, etc. , put forward suggestions to adjust the industry benchmark rate;
(eight) other duties as prescribed by laws, regulations and rules.
Fifth financial departments and audit institutions shall supervise the income and expenditure and management of work-related injury insurance funds according to law; The trade union shall safeguard the legitimate rights and interests of workers with work-related injuries according to law and supervise the work-related injury insurance of employers; Health and safety production supervision and management departments shall, within the scope of their respective duties, assist the administrative departments of labor and social security to do a good job in work-related injury insurance.
Article 6 The work-related injury insurance fund consists of the work-related injury insurance premium paid by the employer, the interest of the work-related injury insurance fund and other funds incorporated into the work-related injury insurance fund according to law.
The work-related injury insurance fund shall be co-ordinated and adjusted throughout the city.
Article 7 The industrial injury insurance fund shall be raised according to the principle that employers pay and employees do not pay.
The amount of work-related injury insurance premium paid by the employer is the product of the total wages of employees multiplied by the unit payment rate.
Article 8 The rate of work-related injury insurance shall be determined according to the principle of fixed income by expenditure and balance of payments. The benchmark rate for employers to participate in the initial payment of work-related injury insurance is 0.5% for the first-class industry, 1.2% for the second-class industry and 2.0% for the third-class industry. The specific standard of the benchmark rate can be adjusted regularly after being approved by the Municipal People's Government. After the employer of the second and third industries pays the initial fee, the agency can implement the floating rate of the upper and lower files on the basis of the industry benchmark rate according to the changes in the use of work-related injury insurance premiums, the incidence of work-related injuries, the degree of occupational hazards and other factors. The specific floating measures shall be formulated by the municipal labor and social security administrative department in conjunction with the municipal administrative departments of finance, health and safety production supervision and management.
Article 9 The industrial injury insurance fund shall be deposited in the financial special account of the social security fund, and the management of two lines of revenue and expenditure shall be implemented to pay the following expenses:
(a) medical expenses for work-related injuries, rehabilitation treatment fees, assistive devices fees, one-time disability subsidies, disability allowances for first-to fourth-grade disabled people and life care fees for people who cannot take care of themselves;
(two) medical expenses, funeral subsidies, and pensions for supporting relatives of employees who died at work.
Gold, one-time work-related death subsidy;
(three) the labor ability appraisal fee;
(four) work injury prevention fees;
(5) Investigation fee for ascertainment of work-related injuries;
(6) Vocational rehabilitation fees;
(seven) other work-related injury insurance fees stipulated by laws and regulations.
Tenth industrial injury insurance fund set aside a certain proportion to pay for major accidents of industrial injury insurance benefits. The reserve fund is drawn from 20% of the sum of the industrial injury insurance fund in that year and accumulated year by year. When it reaches 50% of the total accumulated balance of the industrial injury insurance fund at the end of the year, it will not be withdrawn. 50% of the county (city, district) reserve fund is left in the county (city, district) to pay the insurance benefits for major accidents in the county (city, district); The remaining 5O% will be turned over to the municipal industrial injury insurance financial account before the end of the following year 1 for adjusting the payment of industrial injury insurance benefits for major accidents in this city.
When a major accident occurs in the insured unit, when the expenses paid by the industrial injury insurance fund exceed 50% of the accumulated balance of the industrial injury insurance fund at the corresponding level, the excess shall be paid by the reserve at the corresponding level; If the reserve at the corresponding level is insufficient to pay, it may apply for adjusting the municipal reserve; If the city's reserve fund is insufficient for adjustment, it shall be advanced by the people's government at the county level where the incident occurred, and the funds advanced shall be gradually returned by the reserve fund extracted later.
Article 11 Units that did not participate in industrial injury insurance before the promulgation of these Measures shall, within 30 days from the date of promulgation of these Measures, and units established after the promulgation of these Measures shall, within 30 days from the date of establishment, register industrial injury insurance with local agencies with business licenses or registration certificates and other relevant documents.
The employer must declare the amount of work-related injury insurance premium payable to the agency on a monthly basis, and pay the work-related injury insurance premium within the prescribed time limit after being approved by the agency.
Article 12 After the employer pays the insurance premium, it shall publicize the relevant information such as the time to participate in work-related injury insurance, the payment situation, and the scope of personnel who enjoy the treatment of work-related injury insurance within 30 days or 15 days after the insurance premium is changed.
Article 13 When an employee suffers from accidental injury or occupational disease due to work, the employer shall actively take measures to make the injured employee receive timely treatment, and the required medical expenses shall be paid in full by the employer according to the medical expenses estimated by the medical institution.
The insured employer shall report to the local labor security administrative department and the agency within 24 hours after the accident. The medical expenses paid by the employer for the insured employees shall be settled with the agency after being confirmed as work-related injuries according to law. The medical expenses incurred after settlement shall be paid by the industrial injury insurance fund.
If the uninsured employer or uninsured employee of the insured unit is confirmed as a work-related injury according to law, the employer must pay all the medical expenses of the injured employee and other expenses not lower than the treatment of work-related injury insurance.
Article 14 Laborers shall seek medical treatment in medical institutions that have signed service agreements with agencies. In case of emergency, you can go to the nearest medical institution for first aid. After the injured employee's injury is relatively stable, the agency will determine whether to transfer to the agreed medical institution for further treatment according to the injury.
Article 15 The expenses for treatment of work-related injuries must meet the standards stipulated in the Catalogue of Drugs for Basic Medical Insurance and Work-related Injury Insurance in Jiangxi Province, Measures for the Management of Medical Treatment Projects for Urban Workers in Ganzhou City and Interim Measures for the Management and Payment Standards of Medical Service Facilities for Basic Medical Insurance for Urban Workers in Ganzhou City, and be paid by the work-related injury insurance fund. The national standards shall be implemented after the state announces the catalogue of industrial injury insurance drugs, the diagnosis and treatment items of industrial injury insurance and the hospitalization service standards of industrial injury insurance.
Sixteenth injured workers need to be transferred to hospital for treatment or to seek medical treatment in other places, which shall be certified by the agreed medical institution and approved by the agency. Without the approval of the unauthorized transfer, the industrial injury insurance fund will not pay the medical expenses after the transfer.
Workers with work-related injuries who meet the discharge conditions after being treated by the agreed medical institutions and still do not leave the hospital after issuing the discharge notice, the medical expenses incurred shall be borne by the individual workers with work-related injuries.
The work-related injury insurance fund will not pay the expenses incurred by the workers in the treatment of non-work-related diseases. Those who have participated in medical insurance shall be handled in accordance with the relevant provisions of medical insurance; Did not participate in medical insurance, by the employer according to the original channel to solve.
Article 17 If an employee suffers from an accident or occupational disease at work and needs to be suspended from work to receive work-related injury medical treatment, the original salary and welfare benefits will remain unchanged during the paid suspension, and the unit where he works will pay him monthly.
The paid shutdown period generally does not exceed 12 months. Serious injury or special circumstances, confirmed by the Municipal Labor Ability Appraisal Committee, can be appropriately extended, but the extension time shall not exceed 12 months. Workers with work-related injuries shall stop the original treatment and enjoy the disability treatment according to the regulations after the assessment of disability level. Workers with work-related injuries who still need treatment after the expiration of paid shutdown shall continue to enjoy medical treatment for work-related injuries.
Workers with work-related injuries who can't take care of themselves need care during the paid shutdown period, and their units are responsible for it.
Article 18 If an employee is injured by an accident or is diagnosed and identified as an occupational disease according to the provisions of the Law on the Prevention and Control of Occupational Diseases, the unit to which he belongs shall apply to the municipal labor and social security administrative department for work-related injury identification within 30 days from the date of the accident injury or the date of diagnosis and identification as an occupational disease. In case of special circumstances, with the consent of the municipal labor and social security administrative department, the application time limit may be appropriately extended.
If the employing unit fails to apply for work-related injury identification in accordance with the provisions of the preceding paragraph, the workers with work-related injuries or their immediate family members and trade unions may directly apply to the municipal labor and social security administrative department for work-related injury identification within 1 year from the date of accident injury or occupational disease diagnosis and identification. Unless otherwise stipulated by laws, regulations and rules, the municipal labor security administrative department will not accept the case if it exceeds 1 year.
If the employer fails to apply for work-related injury identification within the time limit specified in the first paragraph of this article, the employer shall bear the related expenses that meet the requirements of work-related injury insurance benefits from the date of accident injury or occupational disease diagnosis to the date of acceptance of work-related injury identification by the municipal labor and social security administrative department.
Nineteenth employees to apply for work-related injury identification shall submit the following materials:
(a) the application form for work-related injury identification;
(2) identification;
(3) Proof of labor relationship with the employer;
(4) The diagnosis certificate of the medical institution or the occupational disease diagnosis certificate.
If an employee's immediate family members apply for work-related injury identification, in addition to the above-mentioned materials, they shall also submit their identity certificates and certificates of kinship with the employees who have suffered work-related injuries.
Twentieth workers who are injured at work belong to one of the following circumstances, they shall submit the corresponding certification materials:
(a) due to the performance of duties by violence and other accidental injuries, submitted to the people's court verdict or the public security department certificate or other certificates;
(two) during the period of going out to work, if you are injured due to work reasons, submit the certificate of the public security department or other certificates; If the whereabouts of the accident are unknown and an application for ascertainment of work-related injury death is made, a written document from the accident handling organ proving that the employee cannot survive or a conclusion that the people's court declared him dead shall be submitted;
(three) on the way to work, injured by a motor vehicle accident, submit the certificate of the public security traffic management department and traffic accident responsibility confirmation;
(4) In case of sudden death due to various diseases or death within 48 hours after initial diagnosis during working hours and posts, submit the rescue and death certificates of medical institutions:
(five) to safeguard national interests and public interests in emergency rescue and disaster relief activities, and to submit certification materials to the civil affairs department or other relevant departments.
Twenty-first city and county (city, district) administrative department of labor and social security shall conduct a preliminary examination after receiving the application for work-related injury identification. If the materials provided by the applicant are incomplete, the applicant shall be informed in writing of all the materials that need to be corrected on the spot or within 15 working days; After the applicant has informed the corrected materials in writing, the municipal labor security administrative department shall accept it.
Article 22 After accepting the application for work-related injury identification, the municipal labor and social security administrative department shall examine and investigate the accepted application materials for work-related injury identification, and the employing units, employees, trade unions, medical institutions and relevant departments shall provide assistance.
The diagnosis of occupational diseases and the identification of diagnostic disputes shall be carried out in accordance with the relevant provisions of the Law on the Prevention and Control of Occupational Diseases. The administrative department of labor security will no longer investigate and verify the personnel who have obtained the occupational disease diagnosis certificate or occupational disease diagnosis and appraisal certificate according to law.
If the employee or his immediate family members think it is a work-related injury and the employer does not think it is a work-related injury, the employer shall bear the burden of proof.
Twenty-third employees in any of the following circumstances, should be identified as work-related injuries:
(1) Being injured by an accident during working hours and in the workplace;
(two) before and after working hours, in the workplace, engaged in preparatory or finishing work related to the work and was injured by an accident;
(three) during working hours and workplaces, due to the performance of duties by violence and other accidental injuries;
(4) Suffering from occupational diseases;
(five) during the business trip, injured or missing due to work reasons;
(6) Being injured by a motor vehicle accident on the way to work;
(seven) other circumstances that should be recognized as work-related injuries as stipulated by laws and administrative regulations.
Twenty-fourth employees in any of the following circumstances, as a work-related injury:
(a) died of sudden illness during working hours and jobs, or died after being rescued within 48 hours after the initial diagnosis;
(2) safeguarding national interests and public interests in emergency rescue and disaster relief activities;
(3) An employee who was formerly in the army and was disabled due to war or business has obtained a revolutionary disabled soldier's certificate, and the old injury recurs after going to the employer.
Employees who are in the situations mentioned in Items (1) and (2) of the preceding paragraph shall enjoy the treatment of work-related injury insurance in accordance with the relevant provisions of these Measures; In case of item (3) of the preceding paragraph, employees shall enjoy the treatment of work-related injury insurance except one-time disability allowance in accordance with the relevant provisions of these Measures.
Twenty-fifth employees in any of the following circumstances, shall not be identified as work-related injuries or as work-related injuries:
(a) casualties caused by crime or violation of public security management:
(2) Drunkenness causes casualties;
(3) Self-mutilation or suicide.
Article 26 The municipal labor and social security administrative department shall make a decision on work-related injury identification within 60 days from the date of accepting the application for work-related injury identification, and deliver it to the employees who apply for work-related injury identification or their immediate family members, employers, trade union organizations and agencies within 20 working days from the date of making the decision. If it is recognized as a work-related injury or regarded as a work-related injury, a certificate of work-related injury identification shall be issued.
During the work-related injury identification period, if the safety production supervision, public security, traffic police, health, food and drug supervision, civil affairs and other departments have not yet reached a conclusion on the corresponding accident, and the conclusion may affect the work-related injury identification, the work-related injury identification procedure may be suspended. After the conclusion of the corresponding accident is determined, the work-related injury identification procedure will be resumed.
Twenty-seventh workers injured at work and disabled by treatment, affecting the ability to work, should be identified.
Employers, employees with work-related injuries or their immediate family members shall submit the following materials to the Municipal Labor Ability Appraisal Committee for labor ability appraisal:
(a) the application form for labor ability appraisal;
(2) Notice of conclusion of work-related injury identification or work-related injury identification certificate:
(3) Discharge summary, medical diagnosis certificate or occupational disease diagnosis certificate (occupational disease diagnosis certificate), work-related injury medical records and medical imaging examination materials issued by medical institutions;
(4) Other relevant certification materials.
Twenty-eighth city labor ability appraisal committee is composed of representatives of municipal labor and social security, personnel, health, trade union organizations, agencies and employers, and undertakes the appraisal of workers injured in the city. Counties (cities, districts) do not set up labor ability appraisal committees. Employers, employees with work-related injuries or their immediate family members directly submit application materials for labor ability appraisal to the administrative departments of labor security of counties (cities, districts). After receiving all the materials, the administrative departments of labor security of counties (cities, districts) will transfer the materials to the municipal labor ability appraisal committee.
Twenty-ninth city labor ability appraisal committee shall make a conclusion of labor ability appraisal within 60 days from the date of accepting the application for labor ability appraisal. Due to the complicated situation, it cannot be made within 60 days, and it can be extended for 30 days with the approval of the labor ability appraisal Committee.
After accepting the application for labor ability appraisal, the Municipal Labor Ability Appraisal Committee randomly selects 3 to 5 relevant experts from its medical and health expert database to form an expert group, and puts forward appraisal opinions. When necessary, a qualified medical institution may be entrusted to assist in the relevant diagnosis. According to the expert group's appraisal opinions, the labor ability appraisal committee makes a conclusion on the labor ability appraisal of the injured workers. To reach the level of disability, it shall be issued to the injured workers "work-related disability certificate".
After the conclusion of labor ability appraisal is made, it shall be delivered to the injured workers or their immediate family members and employers in a timely manner.
Thirtieth the employer or individual who applies for appraisal refuses to accept the appraisal conclusion made by the Municipal Labor Ability Appraisal Committee, and may apply to the Provincial Labor Ability Appraisal Committee for re-appraisal within 05 days from the date of receiving the appraisal conclusion. The conclusion of labor ability appraisal made by the provincial labor ability appraisal Committee is final.
Thirty-first 1 year after the conclusion of labor ability appraisal is made, if the injured workers or their immediate family members, their units or agencies think that the disability of the workers has changed, they may apply to the Municipal Labor Ability Appraisal Committee for re-appraisal.
Article 32 Workers with work-related injuries may install artificial limbs, orthotics, artificial eyes, dentures and wheelchairs and other auxiliary devices due to their daily life or employment needs, and the required expenses shall be paid from the work-related injury insurance fund according to the prescribed general standards. Failing to install rehabilitation equipment as required, or replacing cosmetic or decorative prostheses by themselves, or intentionally damaging rehabilitation equipment, the industrial injury insurance fund will not pay related expenses.
Thirty-third employees who are disabled due to work-related injuries shall provide the following materials to the agency where they are insured when applying for work-related injury insurance benefits:
(1) An application form for treatment;
(two) the conclusion of labor ability appraisal and the certificate of work-related injury and disability;
(3) Relevant materials on the employer's participation in industrial injury insurance;
(four) other materials required by the agency.
Thirty-fourth workers died at work, their immediate family members to apply for work-related injury insurance benefits, should be based on different circumstances, to the insured local agencies to provide the following relevant materials:
(1) An application form for treatment;
(2) Confirmation of employee's death at work;
(3) Relevant materials on the employer's participation in industrial injury insurance;
(4) Household registration book, ID card or household registration certificate issued by the local police station;
(five) a certificate issued by the neighborhood office and the township (town) people's government to support relatives who have no source of income;
(six) the certificate issued by the civil affairs department of the elderly or orphans;
(seven) if the dependent relatives are students at school, provide the proof of studying issued by the school;
(eight) if the dependent relatives adopt children, they shall provide the adoption registration certificate issued by the civil affairs department;
(nine) other materials required by the agency.
Article 35 The industrial injury insurance benefits such as life care fee, disability allowance or one-time disability allowance that employees with work-related injuries should enjoy according to law, and the industrial injury insurance benefits such as funeral allowance, dependent relatives pension and one-time work-related death allowance that the immediate family members of employees who died at work should receive according to law shall be paid from the insurance fund in a timely manner according to the regulations after examination and confirmation by the agency.
If an employee dies at work, the work-related injury insurance fund will give his immediate family a one-time work-related death subsidy according to the following standards: the average monthly salary of employees in this city last year was 48 months; The death due to work is 54 months, and the average monthly salary of employees in this city last year; Awarded the title of revolutionary martyr for 60 months, which is the average monthly salary of employees in this city last year.
Article 36 If an employee goes out on business or his whereabouts are unknown during emergency rescue and disaster relief, he shall be paid wages within 3 months from the month of the accident, and wages shall be suspended from the fourth month. The industrial injury insurance fund shall pay pensions to its dependent relatives on a monthly basis. Life is difficult, you can advance 50% of the one-time work death subsidy. If the accident handling organ proves that the employee cannot survive or is declared dead by the people's court, it shall be handled in accordance with the provisions of Article 35 of these Measures on the death of the employee due to work.
After the missing person appears, the industrial injury insurance benefits received shall be returned to the agency in full.
Article 37 If accidents such as water traffic, shipping, air traffic, railway traffic, subway traffic and road traffic caused by other people's non-work behaviors cause work-related injuries, the insured employees shall receive compensation in advance in accordance with the regulations on handling such accidents, and the difference between the total amount of compensation and the treatment of work-related injuries shall be made up by the work-related injury insurance fund. If the two sides of the accident settle compensation privately, the industrial injury insurance fund will not pay the industrial injury treatment. If the industrial injury is caused by civil infringement, the insured employees shall first obtain civil injury compensation in accordance with the relevant provisions, and the difference between the total amount of civil injury compensation and the industrial injury insurance treatment shall be made up by the industrial injury insurance fund.
Accident-hit-and-run resulted in the insured workers being unable to obtain traffic accident compensation. If life is difficult, the employer and the agency shall pay 50% of the medical expenses and other work-related injury insurance benefits according to the standards stipulated in these Measures (except for the pension for dependent relatives). After the compensation, the handling agency may claim compensation for traffic accident injuries in accordance with relevant regulations, and the immediate family members of the employees who are injured or died at work and the employer shall cooperate.
If there is civil compensation for the same industrial accident, it shall be handled in the order of civil compensation and industrial injury insurance compensation.
Article 38 Before terminating or dissolving the labor relationship or going through the retirement formalities, the employing unit shall organize the employees to carry out occupational health examination, establish occupational health files, and inform the employees themselves in writing of the examination results. Those who are diagnosed with occupational diseases shall go through the procedures of work-related injury identification, labor ability appraisal and treatment approval, and pay treatment in accordance with the provisions of these measures. Employees who are diagnosed as suspected occupational diseases and are diagnosed as occupational diseases after retirement shall apply for work-related injury identification and enjoy work-related injury insurance benefits.
If the employing unit fails to carry out occupational health examination or establish occupational health records for the employees before retirement, and the employees are diagnosed with occupational diseases after leaving their jobs or after retirement, the employing unit shall bear the responsibility and pay work-related injury benefits before terminating or dissolving the labor relationship or going through retirement procedures.
Article 39 If an employer fails to pay or stop paying work-related injury insurance premiums for its employees according to law, the agency shall recover them according to law. During the period when the industrial injury insurance premium is unpaid or stopped, the treatment of industrial injury insurance shall be paid by the employer, and the industrial injury insurance fund shall not be replenished. For employers who refuse to pay work-related injury insurance premiums for employees, the administrative department of labor security may apply to the people's court for compulsory collection according to law.
If the employer is really unable to pay the fees on time, it may postpone the payment with the approval of the agency, but the extension period shall not exceed 3 months. During the extension period, the agency shall continue to pay work-related injury insurance benefits to the workers with work-related injuries.
Fortieth agencies shall, on the principle of equal consultation, select medical institutions and auxiliary equipment allocation institutions, sign service agreements, and announce the list of service institutions to the public. If the service agency fails to provide services in accordance with the service agreement, the agency may terminate the service agreement.
Article 41 The annual inspection system of industrial injury insurance shall be established and included in the annual inspection of labor and employment of the administrative department of labor security.
The administrative department of labor and social security shall strengthen the supervision and inspection of the collection of work-related injury insurance premiums and the payment of work-related injury insurance funds according to law. The administrative department of labor and social security, agencies and their staff in violation of these regulations and the circumstances are relatively minor, shall be given administrative sanctions by the administrative department of labor and social security; If the employer conceals the total wages or the number of employees, and the institution or individual engaged in labor ability appraisal violates the law, the administrative department of labor security shall punish it according to law. If the circumstances are serious enough to constitute a crime, criminal responsibility shall be investigated according to law.
Forty-second staff of state organs, institutions and social organizations engaged in personnel management with reference to the national civil service system shall be paid by their units for accidents or occupational diseases.
Other institutions and non-profit organizations other than those specified in the preceding two paragraphs may choose one of the above two ways to implement before the provincial government makes specific provisions.
Article 43 These Measures shall come into force on October 20, 2006. Before the implementation of these measures, it has been recognized as a work-related injury, and the one-time work-related injury insurance benefits shall be implemented according to the original provisions, and the regular work-related injury insurance benefits shall be implemented according to these measures.