Applicant: XXX, gender, born on XX, XX, nationality, living atNo. XXX, XX Road, XX City, and working in XXXXXXX.
Requested items:
Request for identification of the applicant's disability due to work-related accidents.
Facts and reasons:
The applicant was injured by XXXX in XXX company on XX, and was recognized as a work-related injury by XXX Municipal Labor Bureau. The applicant was sent to XXXX hospital for treatment, and the doctor diagnosed it as XXXXXX, etc. He was hospitalized in XXXX hospital for XX days and was discharged on XX, XX, XX. The applicant has lost the ability to work due to XX physical injury, and XXXX can't take care of herself, which has caused the applicant psychological disorder. Therefore, I hereby apply for the appraisal of labor ability, requesting the appraisal of the degree of the applicant's labor dysfunction and self-care dysfunction, and hope to support it.
I am here to convey
XXXXX labor ability appraisal Committee
Applicant: XXX
XXXXX year XX month XX day
Workers who are disabled due to work-related injuries and whose ability to work is affected after treatment shall be appraised. Provisions of the Regulations on Work-related Injury Insurance on labor ability appraisal:
Twenty-first workers with work-related injuries are disabled, and their working ability is relatively stable after treatment, so they should be appraised.
Twenty-second labor ability appraisal refers to the level appraisal of the degree of labor dysfunction and self-care disorder.
Labor dysfunction is divided into ten levels of disability, the heaviest being 1 level, and the lightest being1level.
There are three levels of self-care obstacles: life can't take care of itself at all, most of life can't take care of itself, and some of life can't take care of itself.
The labor ability appraisal standard shall be formulated by the social insurance administrative department of the State Council in conjunction with the health administrative department of the State Council.
Twenty-third labor ability appraisal by the employer, workers or their close relatives to the city labor ability appraisal committee, and provide workers with work-related injury appraisal decisions and medical treatment related information.
References:
Laws and regulations database-industrial injury insurance regulations