The Regulations on Work-related Injury Insurance clearly stipulates that lawyers are specifically entrusted to apply for work-related injury identification, disability assessment and calculation of work-related injury compensation.
Regulations on industrial injury insurance
Work injury identification
Fourteenth 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;
(six) on the way to work, I was injured by a traffic accident or an urban rail transit, passenger ferry or train accident for which I was not primarily responsible;
(seven) other circumstances that should be recognized as work-related injuries as stipulated by laws and administrative regulations.
Fifteenth employees in any of the following circumstances, as a work-related injury:
(a) died of sudden illness during working hours and at work, or died within 48 hours after being rescued;
(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 fall under the circumstances 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 Regulations; In case of item (3) of the preceding paragraph, the employees shall enjoy the treatment of work-related injury insurance in addition to the one-time disability allowance in accordance with the relevant provisions of these regulations.
Article 16 An employee meets the provisions of Articles 14 and 15 of these Regulations, but under any of the following circumstances, it shall not be deemed as a work-related injury or regarded as a work-related injury:
(a) Intentional crime;
(2) Being drunk or taking drugs;
(3) Self-mutilation or suicide.
Article 17 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, within 30 days from the date of the accident injury or the date of the diagnosis and identification as an occupational disease, apply to the social insurance administrative department in the overall planning area for work-related injury identification. Under special circumstances, with the consent of the administrative department of social insurance, 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 employees with work-related injuries or their immediate family members and trade unions may apply for work-related injury identification directly to the administrative department of labor and social security in the area where the employing unit is located within 1 year from the date of accident injury or occupational disease diagnosis and identification.
In accordance with the provisions of the first paragraph of this article, matters that should be identified by the provincial social insurance administrative department shall be handled by the municipal social insurance administrative department located in the district where the employer is located in accordance with the principle of territoriality.
If the employer fails to file an application for work-related injury identification within the time limit specified in the first paragraph of this article, the employer shall bear the relevant expenses such as work-related injury treatment in accordance with the provisions of these regulations during this period.
Eighteenth applications for work-related injury identification shall submit the following materials:
(a) the application form for work-related injury identification;
(two) the existence of labor relations with the employer (including factual labor relations);
(3) Medical diagnosis certificate or occupational disease diagnosis certificate (or occupational disease diagnosis certificate).
The application form for ascertainment of a work-related injury shall include basic information such as the time, place and cause of the accident and the degree of injury of the employees.
If the materials provided by the applicant for work-related injury identification are incomplete, the social insurance administrative department shall inform the applicant in writing of all the materials that need to be supplemented at one time. The administrative department of social insurance shall accept the corrected materials after the applicant has been informed in writing.
Article 19 After accepting the application for ascertainment of work-related injuries, the social insurance administrative department may investigate and verify the accident injuries according to the needs of examination, 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 social insurance administrative department 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 close relatives 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.
Twentieth "the administrative department of social insurance shall, within 60 days from the date of accepting the application for work-related injury identification, make a decision on work-related injury identification, and notify the employees who apply for work-related injury identification or their close relatives and their units in writing.
"The administrative department of social insurance shall make a decision on the determination of work-related injuries within 15 days for the application with clear facts and clear rights and obligations.
"If it is necessary to take the conclusion of the judicial organ or the relevant administrative department as the basis for making a decision on ascertainment of a work-related injury, the time limit for making a decision on ascertainment of a work-related injury shall be suspended while the judicial organ or the relevant administrative department has not yet made a conclusion.
"If the staff of the social insurance administrative department has an interest in the applicant for work-related injury identification, they should withdraw."
Prison labor ability
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.
Article 24 The labor ability appraisal committees of provinces, autonomous regions and municipalities directly under the Central Government and the labor ability appraisal committees of cities divided into districts are composed of representatives of social insurance administrative departments, health administrative departments, trade union organizations, handling agencies and employing units of provinces, autonomous regions, municipalities directly under the Central Government and cities divided into districts respectively.
The labor ability appraisal Committee establishes a medical and health expert database. Medical and health professional and technical personnel included in the expert database shall meet the following conditions:
(1) Having senior professional and technical positions in medicine and health.
(two) to master the relevant knowledge of labor ability appraisal
(3) Having good professional ethics.
Twenty-fifth districts of the city labor ability appraisal committee after receiving the application for labor ability appraisal, it shall randomly select 3 or 5 relevant experts from the medical and health expert database established by it to form an expert group, and the expert group shall put forward the appraisal opinions. According to the expert group's appraisal opinions, the municipal labor ability appraisal committee with districts makes a conclusion on the labor ability appraisal of workers with work-related injuries; When necessary, a qualified medical institution may be entrusted to assist in the relevant diagnosis.
The municipal labor ability appraisal committee with districts shall make a conclusion of labor ability appraisal within 60 days from the date of receiving the application for labor ability appraisal. When necessary, the time limit for making the conclusion of labor ability appraisal may be extended by 30 days. The conclusion of labor ability appraisal shall be delivered to the units and individuals applying for appraisal in time.
Article 26 If an entity or individual applying for appraisal refuses to accept the appraisal conclusion made by the municipal labor ability appraisal committee with districts, it may, within 5 days from the date of receiving the appraisal conclusion, apply to the labor ability appraisal committee of a province, autonomous region or municipality directly under the Central Government for re-appraisal. The conclusion of labor ability appraisal made by the labor ability appraisal committees of provinces, autonomous regions and municipalities directly under the Central Government is final.
Twenty-seventh labor ability appraisal work should be objective and fair. If a member of the labor ability appraisal committee or an expert participating in the appraisal has an interest with the party concerned, he shall withdraw.
Twenty-eighth from the date of the conclusion of the labor ability appraisal 1 year later, if the injured workers or their close relatives, their units or agencies think that the disability situation has changed, they can apply for the re-examination and appraisal of the labor ability.
Article 29 The time limit for the labor ability appraisal committee to apply for re-appraisal and re-appraisal in accordance with the provisions of Articles 26 and 28 of these regulations shall be implemented in accordance with the provisions of Paragraph 2 of Article 25 of these regulations.
industrial injury insurance treatment
Thirtieth employees who suffer from accidents or occupational diseases at work shall enjoy medical treatment for work-related injuries.
Workers with work-related injuries should seek medical treatment in medical institutions that have signed service agreements. In case of emergency, they can go to the nearest medical institution for first aid.
If the expenses required for work-related injury treatment meet the catalogue of work-related injury insurance diagnosis and treatment items, the catalogue of work-related injury insurance drugs and the hospitalization service standard of work-related injury insurance, they shall be paid from the work-related injury insurance fund. The catalogue of work-related injury insurance diagnosis and treatment items, the catalogue of work-related injury insurance drugs and the hospitalization service standard of work-related injury insurance shall be stipulated by the social insurance administrative department of the State Council in conjunction with the health administrative department of the State Council, the food and drug supervision and management department and other departments.
Food subsidies for hospitalization of workers with work-related injuries, and certificates issued by medical institutions and approved by agencies. The transportation and accommodation expenses required for workers with work-related injuries to seek medical treatment outside the overall planning area shall be paid by the work-related injury insurance fund, and the specific standards for fund payment shall be stipulated by the people's government of the overall planning area.
Workers with work-related injuries who treat diseases caused by non-work-related injuries do not enjoy medical treatment for work-related injuries, and are treated according to the basic medical insurance method.
The expenses for work-related injury rehabilitation treatment for workers with work-related injuries to medical institutions that have signed service agreements shall be paid by the work-related injury insurance fund if they meet the requirements.
Thirty-first administrative reconsideration or administrative litigation occurs after the social insurance administrative department makes a decision to identify work-related injuries, and during the administrative reconsideration and administrative litigation, the medical expenses for treating work-related injuries will not stop paying.
Article 32 Workers with work-related injuries may install artificial limbs, orthotics, artificial eyes, dentures, wheelchairs and other assistive 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 standards stipulated by the state.
Article 33 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. If the injury is serious or the situation is special, it may be appropriately extended upon confirmation by the Municipal Labor Ability Appraisal Committee with districts, but the extension time shall not exceed 12 months. After assessing the disability level, the injured workers shall stop the original treatment and enjoy the disability treatment in accordance with the relevant provisions of this chapter. 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.
Thirty-fourth workers with work-related injuries who have been assessed as disabled and confirmed by the labor ability appraisal committee need life care, the work-related injury insurance fund will pay the life care fee on a monthly basis.
Life care fees are paid according to three different levels: completely unable to take care of themselves, mostly unable to take care of themselves or partially unable to take care of themselves, and their standards are 50%, 40% or 30% of the average monthly salary of employees in the overall planning area respectively.
Thirty-fifth workers who are disabled due to work are identified as first-class to fourth-class disabilities, retain their labor relations, quit their jobs, and enjoy the following benefits:
(a) according to the level of disability from the industrial injury insurance fund to pay a one-time disability allowance. The standard is: 27 months' salary for first-degree disability, 25 months' salary for second-degree disability, 23 months' salary for third-degree disability and 2 1 month salary for fourth-degree disability.
(2) Pay the disability allowance from the industrial injury insurance fund on a monthly basis. The standard is: 90% of my salary for first-degree disability, 85% for second-degree disability, 80% for third-degree disability and 75% for fourth-degree disability. If the actual amount of disability allowance is lower than the local minimum wage, the difference will be made up by the industrial injury insurance fund.
(3) After the workers with work-related injuries reach retirement age and go through retirement formalities, they will stop paying disability benefits and enjoy basic old-age insurance benefits in accordance with state regulations. If the basic old-age insurance benefits are lower than the disability benefits, the industrial injury insurance fund will make up the difference.
If an employee is identified as one to four disabled due to work-related disability, the basic medical insurance premium shall be paid by the employer and individual employees on the basis of disability allowance.
Thirty-sixth workers who are disabled due to work are identified as five or six disabled, and enjoy the following benefits:
(a) according to the level of disability from the industrial injury insurance fund to pay a one-time disability allowance. The standard is: my salary is level 5 disability 18 months, level 6 disability 16 months;
(two) to retain the labor relationship with the employer, and the employer shall arrange appropriate work. If it is difficult to arrange a job, the employer will pay a monthly disability allowance. The standard is: level 5 disability is 70% of my salary, level 6 disability is 60% of my salary, and the employer shall pay the social insurance premium that should be paid according to the regulations. If the actual amount of disability allowance is lower than the local minimum wage, the employer shall make up the difference.
Upon the employee's own proposal, the employee may terminate or terminate the labor relationship with the employer, and the work-related injury insurance fund shall pay the one-time medical subsidy for work-related injuries, and the employer shall pay the one-time disability employment subsidy. Specific standards for one-time medical subsidies for work-related injuries and one-time disability employment subsidies shall be formulated by the people's governments of provinces, autonomous regions and municipalities directly under the Central Government.
Thirty-seventh workers who are disabled due to work are identified as seven to ten disabled, and enjoy the following benefits:
(a) according to the level of disability from the industrial injury insurance fund to pay a one-time disability allowance. The criteria are: level 7 disability 13 months, level 8 disability 1 1 month, level 9 disability for 9 months and level 10 disability for 7 months;
(two) the expiration of the labor employment contract, or the employee himself proposes to terminate the labor employment contract, the industrial injury insurance fund pays a one-time medical subsidy for work-related injuries, and the employer pays a one-time disability employment subsidy. Specific standards for one-time medical subsidies for work-related injuries and one-time disability employment subsidies shall be formulated by the people's governments of provinces, autonomous regions and municipalities directly under the Central Government.
Thirty-eighth workers who need treatment for the recurrence of work-related injuries shall enjoy the treatment of work-related injuries stipulated in Articles 30, 32 and 33 of these Regulations.
Article 39 If an employee dies at work, his close relatives shall receive funeral subsidies, pension for supporting relatives and one-time work-related death subsidies from the industrial injury insurance fund in accordance with the following provisions:
(a) the funeral subsidy is the average monthly salary of employees in the overall planning area for 6 months.
(2) The pension for supporting relatives shall be paid to the relatives who provided the main source of livelihood before the death of the employee and were unable to work because of work according to a certain proportion of the employee's salary. The standard is: spouse 40%, other relatives 30%, widowed elderly or orphans 10%. The total approved pension of dependent relatives should not be higher than the salary of employees who died at work. The specific scope of supporting relatives shall be stipulated by the administrative department of social insurance of the State Council.
(three) the standard of one-time work death allowance is 20 times of the per capita disposable income of urban residents in the previous year.
If a disabled employee dies at work during the period of paid suspension, his close relatives shall enjoy the treatment stipulated in the first paragraph of this article.
If a disabled worker of Grade 1 to Grade 4 dies after the expiration of his unpaid leave, his close relatives may enjoy the treatment specified in Items (1) and (2) of the first paragraph of this article.
Fortieth disability allowance, pension for dependent relatives, and living nursing expenses shall be adjusted by the administrative department of social insurance in the overall planning area according to the changes in the average salary and living expenses of employees. Measures for adjustment shall be formulated by the people's governments of provinces, autonomous regions and municipalities directly under the Central Government.
Forty-first employees who go out for work or whose whereabouts are unknown during emergency rescue and disaster relief shall be paid wages within 3 months from the month of the accident, and wages shall be stopped 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 an employee is declared dead by the people's court, it shall be handled in accordance with the provisions of Article 39 of this Ordinance on the death of an employee due to work.
Forty-second injured workers in any of the following circumstances, stop enjoying the benefits of work-related injury insurance:
(a) the loss of the conditions for enjoying the treatment
(2) refusing to accept the appraisal of labor ability.
(3) refusing treatment.
Article 43 Where the employing unit is divided, merged or transferred, the successor unit shall bear the industrial injury insurance liability of the original employing unit; If the original employer has participated in work-related injury insurance, the successor unit shall go to the local agency to register the change of work-related injury insurance.
Where the employing unit conducts contracted operation, the responsibility for work-related injury insurance shall be borne by the unit where the employee's labor relations are located.
If an employee is injured by an industrial accident during the secondment period, the original employer shall bear the responsibility of industrial injury insurance, but the original employer and the secondment unit may agree on compensation measures.
If an enterprise goes bankrupt, the industrial injury insurance benefits that should be paid by the unit shall be distributed according to law at the time of bankruptcy liquidation.
Article 44 If an employee is sent to work abroad and should take part in local industrial injury insurance according to the laws of the country or region where he goes, he should take part in local industrial injury insurance, and his domestic industrial injury insurance relationship is terminated; Can not participate in local industrial injury insurance, its domestic industrial injury insurance relationship is not suspended.
Forty-fifth employees who suffer work-related injuries again and should enjoy disability allowance according to the regulations shall enjoy disability allowance according to the newly recognized disability grade.