Revision background and principles
The original Regulations on the Implementation of Xiamen City (DecreeNo. 1 13 of Xiamen Government) was promulgated by the municipal government in 2004. 20 10 the State Council revised the industrial injury insurance regulations (hereinafter referred to as the regulations), and the provincial government also adjusted the industrial injury insurance policies in our province. Some contents of the regulations are inconsistent with the provisions of the superior law and need to be revised urgently. At the same time, after ten years of practice, some effective practices in the regulations need to be supplemented and improved, so it is necessary to amend the regulations. Considering the connection with the superior law, the "Regulations" and the existing provisions of the provincial government are not repeated, but only the contents that need to be operated in practice and form * * * knowledge are supplemented and refined.
Main contents of revision
1 About the scope of application
The regulations stipulate that enterprises, institutions, social organizations, private non-enterprise units, foundations, law firms, accounting firms and other organizations within the administrative area of this Municipality and individual industrial and commercial households with employees shall participate in industrial injury insurance in accordance with the regulations and these regulations, which is consistent with the regulations. But at the same time, for the central and provincial institutions in Xiamen, it is stipulated that they can choose to participate in industrial injury insurance in our city.
In view of the problem that civil servants, institutions managed according to the Civil Service Law and social group work personnel are included in the scope of industrial injury insurance. Considering that the procedures of civil servants' work-related injury identification and related dispute resolution are inconsistent with the relevant provisions of the current work-related injury insurance, this Ordinance does not explicitly include such personnel in the scope of work-related injury insurance. However, considering the necessity of protecting the rights and interests of such personnel and referring to the practices of other parts of the country, we will jointly formulate policies and establish a unified industrial injury insurance system in the near future.
2 On industry differential rates and floating rates
The "Regulations" will delete the provisions of the original "Regulations" on benchmark rates and floating rates, and authorize the social insurance administrative department to jointly formulate relevant policies with relevant departments. Mainly considering that the determination of differential rates and floating rates in related industries needs to be adjusted in time, the risk of accidents in the business activities of enterprises in the three industries is not consistent, and more specific rules should be given on the industry rate grade standard. There are three main considerations in our bureau: first, combining with the actual balance of industrial injury insurance premiums in our city, further reducing the burden on employers and appropriately reducing the contribution rate of industrial injury insurance; The second is to set a number of rates in the three types of industries to reflect the differences; The third is to formulate more reasonable floating standards and basis for floating rates and give full play to the role of economic leverage more reasonably.
3. About the insurance of construction enterprises such as construction and transportation.
In view of the industry characteristics of construction, mining and stone processing enterprises, in 2005, our city promulgated the Measures for Migrant Workers in Construction, Mining and Stone Processing Enterprises to Participate in Work-related Injury Insurance (Trial) (Xiafu (2005) No.356), which stipulated that workers in construction enterprises should participate in work-related injury insurance on a project basis, and set corresponding payment rates, which better protected the legitimate rights and interests of employees in construction enterprises. To this end, the "Regulations" further legalize it and appropriately expand its scope, stipulating that all construction enterprises such as construction and transportation should pay work-related injury insurance premiums according to a certain proportion of the total project cost, taking the construction project under construction as the unit. Specifically, in addition to construction and traffic construction enterprises, it also includes all projects under construction, such as decoration, decoration and landscaping.
In addition, the "Regulations" have been specially revised in other aspects to resolve disputes and ensure the treatment of workers injured at work.
First, in order to solve the dispute between the injured workers and the employing units during the paid suspension period, it is clear that the Municipal Labor Ability Appraisal Committee will confirm the dispute during the paid suspension period. Second, in order to further rationalize the jurisdiction of work-related injury identification, so that workers with work-related injuries can obtain compensation for work-related injuries in a timely and effective manner, it is stipulated that employees of employers who have not registered or filed in our city or participated in work-related injury insurance in our city shall apply to the social insurance administrative department where the employer is located for work-related injury identification. Three, in view of the employer underreporting the total wages of employees, employees' personal wages, resulting in a reduction in the treatment of employees with work-related injuries, it is clear that the employees' units make up the treatment. However, if the injured workers are identified as Grade I to Grade IV, after being repaid by the employer, the industrial injury insurance fund will be paid according to the standard after repayment from the next month.
Provisions of Xiamen Municipality on Implementing the Regulations on Industrial Injury Insurance
Chapter I General Provisions
Article 1 In order to implement the Regulations of the State Council Municipality on Industrial Injury Insurance (hereinafter referred to as the Regulations), these Provisions are formulated in light of the actual situation of this Municipality.
Article 2 Enterprises, institutions, social organizations, private non-enterprise units, foundations, law firms, accounting firms and other organizations within the administrative area of this Municipality and individual industrial and commercial households with employees (hereinafter referred to as employers) shall participate in work-related injury insurance in accordance with the Regulations and these Provisions and pay work-related injury insurance premiums for all employees or employees (hereinafter referred to as employees).
State organs, institutions and social organizations managed with reference to the Civil Service Law shall pay work-related injury insurance premiums for employees who have established labor relations with them.
The central and provincial institutions in Xiamen can pay work-related injury insurance premiums for all employees of the unit in accordance with these regulations.
Article 3 The municipal and district social insurance administrative departments (hereinafter referred to as social insurance administrative departments) shall be responsible for work-related injury insurance within their respective administrative areas.
The social insurance agency established by the administrative department of social insurance in accordance with the provisions (hereinafter referred to as the agency) shall specifically undertake work-related injury insurance affairs in accordance with these provisions.
Article 4 Local tax authorities shall be responsible for accepting the declaration and registration of work-related injury insurance and the collection and payment of work-related injury insurance premiums.
The financial and auditing departments shall supervise the income and expenditure and management of the industrial injury insurance fund according to law.
Health, construction, transportation, production safety supervision and other departments shall do a good job in work-related injury insurance according to their respective responsibilities.
Chapter II Industrial Injury Insurance Fund
Fifth industrial injury insurance fund in accordance with the provisions of the implementation of the city as a whole.
Article 6 The employing unit shall, within 30 days from the date of its establishment according to law, register the industrial injury insurance with the local tax authorities in accordance with regulations. Where an employer changes or terminates the registered items of work-related injury insurance according to law, it shall handle the change or cancellation of registration with the local tax authorities within 30 days from the date of change or termination according to law.
When handling the insurance registration formalities with the local tax authorities, the employing unit shall truthfully submit the total wages, individual wages and roster of employees of the unit in the previous year, and timely submit the increase and decrease of individual wages and roster of employees. The employee work-related injury insurance relationship specified in the employee roster submitted by the employer shall take effect from the day after the declaration.
The local tax authorities shall provide the agency with the registration and declaration of the employer's industrial injury insurance in a timely manner. According to the employer's declaration, the agency shall determine and record the individual wages of workers in accordance with the provisions of the second paragraph of Article 64 of the Regulations.
Article 7 The employing unit shall pay the industrial injury insurance premium to the local tax authorities in full and on time.
Construction enterprises of construction projects such as construction and transportation shall pay work-related injury insurance premiums according to a certain proportion of the total project cost. The specific measures for participating in industrial injury insurance shall be formulated separately by the municipal social insurance administrative department in conjunction with the relevant administrative departments.
Eighth industrial injury insurance according to the degree of risk in different industries, in accordance with the provisions of the state to implement industry differential rates. The specific standards shall be formulated by the municipal social insurance administrative department in conjunction with the departments of finance, health and safety production supervision according to the relevant provisions of the state, and shall be promulgated and implemented after being approved by the Municipal People's government.
According to the employer's income and expenditure of work-related injury insurance premiums in the last two years, the incidence of work-related accidents, the degree of occupational hazards and other factors, the agency shall implement a floating rate for the employer's payment rate. The specific plan is put forward by the municipal social insurance administrative department in conjunction with the departments of finance, health and safety production supervision, and promulgated and implemented after being approved by the Municipal People's government.
Article 9 The Municipal Committee of Labor Ability Appraisal shall prepare the annual expenditure plan of labor ability appraisal funds, which shall be included in the budget of the industrial injury insurance fund and implemented after the approval of the budget approval procedures of the social insurance fund.
Labor ability appraisal funds for the following expenses:
(1) Subsidies for special clinical examination fees for work ability appraisal of workers with work-related injuries;
(2) Special allowance for hiring experts;
(3) Appraisal criteria for expert argumentation and other technical consulting fees;
(four) the cost of policy training for expert appraisal;
(5) Other expenses stipulated by laws and regulations.
Tenth work-related injury insurance accident prevention fees by the municipal social insurance administrative department in conjunction with the municipal production safety supervision department to prepare the annual budget plan for work-related injury insurance accident prevention, included in the work-related injury insurance fund budget, according to the social insurance fund budget approval procedures after implementation.
Industrial accident prevention fees include:
(a) publicity and education expenses for workers to prevent work-related accidents;
(two) the cost of accident prevention and policy and regulation training for enterprise safety production management personnel;
(three) the cost of compiling the atlas of industrial accident prevention publicity materials;
(four) to carry out research on the prevention policy of industrial accidents.
Chapter III Identification of Work-related Injury
Eleventh municipal social insurance administrative department is responsible for the city's work-related injury identification.
Entrusted by the municipal social insurance administrative department, the district social insurance administrative department is specifically responsible for the work-related injury identification of the following employers:
(a) the employer in the district agencies for industrial injury insurance business;
(two) the employer who fails to go through the formalities of work-related injury insurance in accordance with the provisions and has been registered by the relevant departments at the district level;
(three) the district belongs to institutions, social organizations and other organizations.
Article 12 The administrative department of social insurance shall not accept an application for ascertainment of a work-related injury under any of the following circumstances:
(a) the application has been filed for more than one year from the date of the accident injury or the date of diagnosis and identification as an occupational disease;
(2) There is no labor relationship or employment relationship with the employer;
(three) the employer is not registered in this city, and has not participated in work-related injury insurance in this city;
(4) It is stipulated in Article 66 of the Regulations.
If it is not accepted, the administrative department of social insurance shall make a "decision of rejection" and serve it on the applicant.
Article 13 If the social insurance administrative department needs to make a work-related injury determination decision based on the conclusion of the judicial organ, arbitration institution or relevant administrative department, the time limit for making the work-related injury determination decision shall be suspended while the judicial organ, arbitration institution or relevant administrative department has not yet reached a conclusion, and the applicant shall be notified in writing.
Chapter IV Appraisal of Labor Ability
Article 14. Generally, the period of work stoppage with pay for injured workers shall not exceed 12 months. The time for rehabilitation treatment of workers with work-related injuries is included in the period of work-related injuries with pay. If there is a dispute between the employer and the injured worker due to paid shutdown, it may apply to the Municipal Labor Ability Appraisal Committee for confirmation of paid shutdown.
For medical reasons (including rehabilitation treatment), if it is necessary to stop work with pay for more than 12 months, the employer or the injured employee shall apply to the Municipal Labor Ability Appraisal Committee for confirmation 30 days in advance.
If it is necessary to continue treatment after the expiration of paid shutdown, it shall be confirmed by the Municipal Labor Ability Appraisal Committee.
Fifteenth injured workers think that rehabilitation treatment is needed or agreed medical institutions suggest rehabilitation treatment, injured workers or employers shall apply to the Municipal Labor Ability Appraisal Committee for rehabilitation treatment confirmation; The Municipal Committee of Labor Ability Appraisal, when assessing the disability level of workers with work-related injuries, confirms the need for rehabilitation, and can also be directly transferred to rehabilitation institutions for rehabilitation. The Municipal Labor Ability Appraisal Committee shall formulate standards for medical rehabilitation and vocational rehabilitation, and provide a basis for rehabilitation appraisal.
Rehabilitation institutions shall formulate rehabilitation treatment plans for workers with work-related injuries and report them to the agency for approval.
Sixteenth employees who participate in work-related injury insurance according to law shall bear the cost of labor ability appraisal by the work-related injury insurance fund; Failing to participate in work-related injury insurance according to law, the appraisal fee for workers with work-related injuries shall be borne by the employer.
If the employer or the injured employee applies for re-appraisal, re-appraisal and the appraisal conclusion changes, the required labor ability appraisal fee shall be implemented in accordance with the provisions of the preceding paragraph; If the original appraisal conclusion is maintained, the appraisal fee shall be borne by the applicant.
Chapter V Work-related Injury Insurance Benefits
Article 17 The food subsidies for hospitalization of workers with work-related injuries and the transportation and accommodation expenses required for going abroad for treatment shall be paid by the work-related injury insurance fund. The specific standards shall be formulated by the municipal social insurance administrative department and promulgated for implementation after being reported to the Municipal People's Government for approval.
Workers with work-related injuries need nursing during paid shutdown, and the number of nurses and the nursing period shall be determined by medical institutions; If there is any dispute between the employer and the injured worker, it shall be confirmed by the Municipal Labor Ability Appraisal Committee. The daily nursing expenses of each nursing staff shall be calculated by dividing by 2 1 which is not less than 50% of the average monthly salary of employees in the previous year, and the unit shall directly pay the injured employees. Unless the unit sends someone to nurse.
Article 18. Workers who have been identified as one to four disability grades and meet the conditions for receiving basic pensions and retirement fees shall go through retirement and resignation procedures, stop issuing disability allowances and enjoy basic old-age insurance benefits and retirement benefits. If the basic old-age insurance benefits and retirement benefits are lower than the disability allowance, the industrial injury insurance fund will make up the difference. Do not meet the conditions of receiving basic pension and retirement pension, the industrial injury insurance fund shall pay disability allowance according to the prescribed standards until the death of the injured worker.
Article 19 If the employees who retired or resigned in this city before the implementation of the Regulations on June 65438+1 October1June 2004 suffer from the aggravation of occupational diseases and have reached the level of life care as appraised by the Municipal Labor Ability Appraisal Committee, from the second month of appraisal, according to Article 34 of the Regulations and these Provisions, the work-related injury insurance fund will pay their living monthly according to the corresponding level of life care. In accordance with the provisions of the occupational disease treatment medical expenses, paid by the industrial injury insurance fund.
Chapter VI Supervision and Administration
Article 20 If an employee of an employer who should participate in work-related injury insurance in accordance with the Regulations suffers from work-related injuries, the work-related injury insurance fund and the employer shall pay the new expenses in accordance with the Regulations after the employer participates in the insurance and pays the work-related injury insurance premium and overdue fine that should be paid. The specific measures for the confirmation of payment qualification and treatment shall be formulated separately by the municipal social insurance administrative department in conjunction with the financial department and the local tax department.
If the employer underreports the total wages of employees and the individual wages of employees, resulting in a reduction in the treatment of industrial injury insurance for employees, the difference shall be made up by the employer. After the employer pays the overdue payment, it will receive treatment from the industrial injury insurance fund according to the standard after the overdue payment from the next month.
Article 21 Employees who regularly receive disability allowance or dependent relatives who receive dependent relatives' pensions shall continue to receive treatment in accordance with the provisions of social insurance agencies.
Chapter VII Supplementary Provisions
Article 22 If an employee suffers from accident injury or occupational disease and his work is less than 12 months, his salary shall be calculated according to the average monthly payment salary he actually takes part in; If the work is less than 1 month, the salary shall be calculated according to the monthly salary agreed in the contract. If the salary is not agreed or cannot be determined, it shall be calculated according to the average salary of employees in the whole city in the previous year.
Article 23 These Provisions shall apply to the employees who suffered accidental injuries and were confirmed as occupational diseases after 1995 1 days, and still maintained labor relations with the employer.
Article 24 These Provisions shall come into force on July 1 year, and the regulations for the implementation of industrial injury insurance in Xiamen were promulgated by DecreeNo. 1. The decree of Xiamen Municipal People's Government on July, 2005 1 day1KLOC-0/3 shall be abolished at the same time.