This11 kinds of casualties can not be identified as work-related injuries

According to the latest data released by the National Bureau of Statistics,

      The standard of one-time work death subsidy in 2022 is 47412 yuan × 20=948240 yuan.

However, not all casualties can be identified as work-related injuries, and some do not belong to the category of work-related injuries. The Encyclopedia of Emergency Management summarizes this topic in detail for your reference and study.

1. During working hours and in the workplace,Injuries not due to work

According to the (I) provisions of Article 14 of the Regulations on Work Injury Insurance, during working hours and workplaces, those who are injured by accidents due to work should be recognized as work-related injuries. This is the so-called"Three jobs".

      “Three workersThe most important factor is"Reason for Work", is a sufficient condition for constituting a work injury,"Workplace"and"Working time"It is more of a supporting factor that proves the cause of the work, but also a reinforcing effect on the cause of the work. According to the judicial interpretation of the Supreme Court, if the employer or the social insurance administrative department has no evidence to prove that it is not caused by work, it is presumed to be the cause of work and can also be identified as a work injury.

Of course, if the employer has evidence to prove that the employee's injury during working hours and in the workplace is not caused by work, it cannot be regarded as a work injury.

      2、During working hours and in the workplace,Not being injured by violence in the performance of his job duties.

The Regulations on Industrial Injury Insurance provide that within working hours and workplaces"Accidental injuries such as violence due to the performance of work duties" can be identified as work-related injuries, including two meanings. One layer refers to the violent personal injuries committed by employees due to the performance of their work duties, which fail to achieve the unreasonable or illegal purposes of some people. The other layer refers to the accidental injuries suffered by employees due to the performance of their work duties during working hours and in the workplace, such as earthquake, fire in the factory area, the collapse of the workshop house and the injury caused by the unsafe other facilities of the unit.

"Accidental injuries such as violence due to the performance of work duties" emphasizes that there is a causal relationship between the injury and the performance of work duties.

If an employee is violently injured due to personal interests, personal grievances and other reasons, it is obviously not recognized as a work-related injury.

      3、Engaged during work-outPersonal activities are hurt.

The period of work-related absence generally includes the following situations:1. The period during which the employee is assigned by the employer or is engaged in activities related to work duties outside the workplace due to work needs; 2. The period during which the employee is assigned by the employer to go out to study or hold a meeting; 3. Other periods during which the employee goes out for activities due to work needs.

The regulations on work-related injury insurance stipulate that if an employee is injured or his whereabouts are unknown due to work reasons during the period of going out of work, it shall be recognized as a work-related injury."Reasons for Work".

If an employee engages in personal activities while away from work, it cannot be considered as a work injury.

The Supreme People's Court also made it clear in the Provisions on Several Issues Concerning the Trial of Administrative Cases of Industrial Injury Insurance,"If an employee is injured in personal activities unrelated to work or assigned by the employer to go out to study or hold meetings during the period of work, and the social insurance administrative department does not recognize it as a work-related injury, the people's court shall support it".

      4、There was a traffic accident on the way to work,I am primarily or fully responsible.

Commuting traffic accidents are a common type of work-related injury identification, but not all traffic accidents on the way to and from get off work can be identified as work-related injuries. The responsibility of employees in traffic accidents should be considered here.

The Work Injury Insurance Regulations provide for commuting to and from work.“Traffic accidents not my primary responsibilityCan be identified as work-related injuries, "not my main responsibility" how to understand? Specifically refers to "no responsibility", "secondary responsibility", "equal responsibility".

If the accident determination conclusion issued by the traffic police department is that the employee is personally responsible for the accident."Primary responsibility" or "full responsibility" cannot be identified as a work-related injury.

      5、During working hours and at work,Emergency disease rescue is invalid inHe died 48 hours later.

Regulations on Work Injury Insurance"During working hours and at work, death from sudden illness or death within 48 hours after rescue is invalid" is regarded as work-related injury.

"Sudden illness" includes all types of illness and is not required to be associated with work. The more common diseases in practice are heart disease, cerebral hemorrhage, myocardial infarction and other sudden diseases.

The starting time of "48 hours" is based on the initial diagnosis time of the medical institution as the starting time of the sudden disease.

Although the employee suffered from sudden illness during working hours and at work, the rescue was ineffective.Death after 48 hours is not regarded as a work-related injury.

      6、Working hours and sudden illness at workLeave home and then go to the hospital for treatment or death can not be regarded as work-related injuries

The Supreme People's Court (2017) The Supreme Law Administration's ruling No. 3687 holds that item (I) of the first paragraph of Article 15 of the Regulations on Work Injury Insurance stipulates that employees who die of sudden illness or die within 48 hours after rescue within 48 hours during working hours and posts shall be regarded as work-related injuries. The above clauses are mainly set for the situation of sudden illness during working hours and at work, unable to persist in work, and need to go to the hospital for emergency rescue. If you go to the hospital for treatment or die of sudden illness after returning home, it does not fall within the scope of this provision.

In this case, Zhang Haisheng felt unwell during working hours and at work. He took leave of absence and went home to rest in bed. He was found by his family the next day and died after rescue. Although this unfortunate consequence is worthy of sympathy, it does not belong to the deemed work-related injury situation stipulated in the "Work Injury Insurance Regulations". The Provincial Human Resources and Social Security Department's decision not to recognize work-related injuries is based on law. 1. the court of second instance found that the facts were clear and the applicable laws and regulations were not improper.-- "Dai Qiuyan, Hebei Provincial Department of Human Resources and Social Security Labor and Social Security Administration (Labor, Social Security) Retrial Review and Trial Supervision Administrative Ruling" (2017) Supreme Law Xingshen No. 3687

The Department of Regulations of the Ministry of Human Resources and Social Security "On How to UnderstandThe reply to item (I) of article 15 of the regulations on industrial injury insurance holds that the understanding and application of item (I) of article 15 of the regulations as death at work should be strictly in accordance with the four elements of working hours, working post, sudden illness, and direct hospital rescue, with simultaneity and consistency. the specific circumstances mainly include: (I) employees died on the spot of sudden illness during working hours and at work; (II) employees have sudden illness during working hours and at work, and the situation is urgent, they are directly sent to the hospital or medical institution for rescue on the spot and die within 48 hours. In other cases, suchAlthough he became ill or felt unwell during working hours or at work, he did not go to the hospital for rescue but went home to rest,Death within 48 hours shall not be regarded as a work-related injury.

      7、Not due to work reasonsThe rescue of the person in distress leads to casualties and is not recognized by the relevant departments as a courageous act.

Employment Injury Insurance Ordinance No.Item (II) of Article 15 stipulates that injuries suffered in activities such as emergency rescue and disaster relief to safeguard national interests and public interests are regarded as work-related injuries. Here, attention should be paid to the practices in judicial practice.

"Reply of the Supreme People's Court on Whether Work-related Injury is Identified in Cases of Casualties Caused by Assistance to Persons in Danger Not Due to Work" ([2014] The opinions in Hang He Zi No. 2) are as follows: if the casualties caused by the rescue of the person in distress are not due to work reasons, if they are not recognized by the relevant departments as acting bravely for righteousness, they do not seem to be regarded as work-related injuries as stipulated in Item (II) of the first paragraph of Article 15 of the Regulations on Work-related Injury Insurance. Considering that Zhang Shichun's behavior of giving up his life to save lives in the case involved in the request for instructions is worth advocating, it is suggested that your court and the lower court coordinate with the relevant local departments to do a good job of pacification through other means as far as possible, so as to properly resolve the dispute.

      8、Intentional crime resulting in casualties

According to the provisions of Article 16 of the Regulations on Work Injury Insurance, employees who have one of the following circumstances shall not be deemed to be work-related injuries or regarded as work-related injuries: (1) Intentional crime; knowing that their actions will cause harm to society, and those who hope or allow such results to occur, thus constituting a crime, are intentional crimes. The social impact of intentional crime is bad, and it does great damage to the property and interests of the country, society and citizens. In the spirit of guiding citizens to abide by the law, the law sets adverse consequences for the bad situation of intentional crime, which is excluded from the industrial injury insurance system, and the industrial injury is not recognized.

The determination of "intentional crime" shall be based on the effective legal documents or concluding opinions of criminal investigation organs, procuratorial organs and judicial organs.

Special attention should be paid to the fact that the casualties caused by negligent crimes do not affect the identification of work-related injuries, such as the crime of causing traffic accidents and the crime of major liability accidents.

9, drunkenness or drug use resulting in casualties

The law excludes casualties caused by drunkenness from the scope of work-related injury identification, mainly considering that some national laws prohibit drunken work and drunk driving. Therefore, various accidents caused by loss of control caused by drunkenness cannot be treated as work-related injuries. This provision is also to control workers' drunken work to a certain extent and reduce the occurrence of work-related accidents.

For drunkenness standards, you can refer to the national standard "Threshold Value and Test of Blood and Exhaled Essence Content of Vehicle Drivers".(GB19522-2004). This standard stipulates that drivers whose blood alcohol content is greater than (equal to) 20 mg/100 ml and less than 80 mg/100 ml belong to drinking and driving, and those whose blood alcohol content is greater than (equal to) 80 mg/100 ml belong to drunk driving. The test conclusions, diagnosis certificates and other materials issued by the traffic management departments of the public security organs, medical institutions and other relevant units in accordance with the law can be used as the basis for determining drunkenness.

Drug abuse is often called drug dependence and drug abuse in medicine. Drug abuse has caused serious damage to people's health, resulting in huge losses and waste of social wealth. Drug trading activities have intensified various illegal and criminal activities, disrupted social security, and gave society Stability poses a huge threat. Compared with drunkenness, drug abuse is even worse in terms of the perpetrator's subjective fault and social harm. Drawing on the relevant provisions of international conventions, my country also excludes drug abuse from the scope of work-related injury identification.

10, self-harm or suicide

"Self-mutilation" refers to the act of harming one's own body through various means and ways, and causing injury results.

"Suicide" refers to the act of ending one's own life by various means and means. Some self-harm or suicide is caused by the mental state of employees, but others cannot be ruled out to obtain work-related injury treatment. Self-harm or suicide is not necessarily related to work, and employees should be responsible for their subjective intention. Therefore, work-related injury cannot be determined.

What is more difficult to do in practice is how to prove that the employee is self-inflicted or suicidal? After all, not everyone will leave a suicide note, and the burden of proof is on the employer.

11. Employees of enterprises not engaged in the prevention of new coronary pneumonia and related work who are infected with new coronary pneumonia during their work cannot be recognized as work-related injuries.

Ministry of Human Resources and Social Security inOn February 21, 2020, the Ministry of Human Resources and Social Security answered questions related to labor employment, labor relations, wages and benefits, and social security contributions, which are of general concern to enterprises in the resumption of work and production:

Notice on the Protection of Medical Care and Related Staff Infected with Novel Coronavirus Pneumonia Due to the Performance of Their Work Duties (Letter from the Ministry of Human Resources and Social Security 〔2020 No.11) makes it clear that in the prevention and treatment of new coronary pneumonia, medical care and related staff who are infected with new coronary pneumonia or die from new coronary pneumonia due to the performance of their duties shall be recognized as work-related injuries and shall enjoy work-related injury insurance benefits in accordance with the law. This is a special policy for health care workers and related staff engaged in prevention and treatment with a high risk of occupational exposure to the new coronavirus during the fight against the epidemic, reflecting the care of the Party and the State for health care workers and related staff.Infection with COVID-19 cannot be recognized as a work injury if it is not for COVID-19 prevention and related staff.

Attached: Work-related injury identification process:

 

At 10 a.m. on January 17, 2022, the State Council Information Office held a press conference, and the National Bureau of Statistics released the income and consumption expenditure of residents in 2021.per capita disposable income of urban residents47412 yuanAccording to the latest statistics published, the standard of one-time work-related death subsidy has changed. now, combined with judicial practice, on the basis of this article pushed last year, the Encyclopedia of Emergency Management has supplemented some problems in the treatment of work-related injuries for reference!

 

One,Within what period of time is the application required?

 

(I) time limit for application by the employer party

According to the Regulations on Work Injury Insurance and the Measures for the Identification of Work Injury, if an employee is injured by an accident or is diagnosed or identified as an occupational disease in accordance with the provisions of the Occupational Disease Prevention and Control Law, the unit to which he belongs shallFrom the date of accident injury or the date of diagnosis and identification as occupational disease.Within 30 days,Apply for work-related injury identification to the social insurance administrative department of the overall planning area. In case of special circumstances, the application time limit may be appropriately extended upon approval of the social insurance administrative department.

Special attention:Pursuant to Article 1 of the Employment Injury Insurance OrdinanceArticle 17 stipulates that if the unit does not submit an application for work-related injury identification within the 30 days, the relevant expenses such as work-related injury treatment incurred during this period shall be borne by the employer.

Time limit for application by the (II) laborer

If the employer fails to submit an application for work-related injury identification within the prescribed time limit, the injured employee or his close relatives or trade union organization shall be diagnosed or identified as an occupational disease from the date of the accident injury or the date of diagnosis or identificationWithin one year, an application for work-related injury identification may be submitted directly in accordance with the provisions of Article 4 of these Measures.

 

Special attention:Trade union organizations can also apply!

 

(III) overSpecial provisions for the 1-year application period

According to the "Provisions of the Supreme People's Court on Several Issues Concerning the Trial of Work Injury Insurance Administrative Cases", if the application period for work injury identification is exceeded due to reasons that do not belong to employees or their close relatives, the delayed time shall not be counted in the application period for work injury identification.

Any delay in the application time under any of the following circumstances shall be deemed as not attributable to the employee or his close relatives:

      （1) Force majeure;

      （2) personal freedom is restricted;

      （3) The reason belongs to the employer;

      （4) the social insurance administrative department registration system is not perfect;

      （5) The parties apply for arbitration and file a civil lawsuit on the existence of a labor relationship.

 

II,What materials need to be submitted

 

According to the provisions of the measures for the determination of work-related injuries, the application form for the determination of work-related injuries shall be filled in and the following materials shall be submitted:

A copy of the text of the (I) labor and employment contract or other supporting materials for the existence of labor relations (including de facto labor relations) and personnel relations with the employer;

Post-injury diagnosis certificate or occupational disease diagnosis certificate (or occupational disease diagnosis certificate) issued by the (II) medical institution.

 

Three,How long does the social security department take to accept

 

After the social insurance administrative department receives the application for the identification of work-related injuries,should be inReview the materials submitted by the applicant within 15 daysIf the materials are complete, a decision shall be made to accept or not to accept them.

If the materials are incomplete, the applicant shall be informed in writing of all the materials that need to be supplemented. social insurance administrative departmentAfter receiving all the supplementary materials submitted by the applicant, it shall beMake a decision of acceptance or inadmissibility within 15 days.

If the social insurance administrative department decides to accept the application, it shall issue a decision on the acceptance of the application for the determination of industrial injury; if it decides not to accept the application, it shall issue a decision on the non acceptance of the application for the determination of industrial injury.

 

Four,How long it takes to make a work injury determination

 

The social insurance administrative department shall, from the date of accepting the application for the determination of industrial injury.Make a decision on the determination of work-related injury within 60 days, and issue a "decision on the determination of work-related injury" or a "decision on the non-determination of work-related injury".

The social insurance administrative department shall, from the date of accepting the application for the identification of work-related injuries with clear facts and clear rights and obligationsMake a decision on the determination of work-related injury within 15 days.

The social insurance administrative department shall, from the date of making the decision on the determination of industrial injury.Within 20 days, the "Determination of Work Injury Decision" or "No Determination of Work Injury Decision" will be delivered to the injured employee (or his close relatives) and the employer, and a copy will be sent to the social insurance agency.

 

Five,The premise of industrial injury identification does not have to have labor relations.

 

The Supreme Court held that, under normal circumstances, the social insurance administrative department should determine the work-related injury of an employee on the premise that there is a labor relationship between the employee and the employer, but there are exceptions under special circumstances.

The Supreme Court (2018) Supreme Court Administrative Judgment No. 151think,When there is an illegal subcontracting or subcontracting situation, the employer's responsibility for the employee's work injury insurance is not based on the existence of a labor relationship.In violation of laws and regulations, the employing unit subcontracts or subcontracts the contracted business to organizations or natural persons that do not have the qualification of the main body of employment, and in the event of an industrial accident, the employing unit that illegally subcontracts or subcontracts shall bear the liability for industrial injury insurance.

 

Six,What to do if you don't accept the conclusion of work injury determination?

 

If an employee, his or her close relatives or the employing unit refuses to accept the decision on inadmissibility or refuses to accept the decision on the determination of work-related injury, he or she may apply for administrative reconsideration or bring an administrative lawsuit according to law.

Special reminder:Administrative reconsideration or administrative litigation is optional, and the administrative reconsideration here is not the pre-procedure of administrative litigation. In practice, some units usually choose to reconsider before litigation in order to delay time, and workers should not reconsider direct litigation in order to save time.

 

Seven,Calculation standard of work-related injury treatment

 

Based on the relevant provisions of the Work Injury Insurance Regulations and the latest statistical data, it is summarized for reference in practice.

 

（One）Level 1-10 Disability Grant

According to the provisions of Articles 35, 36, and 37 of the Regulations on Work Injury Insurance, if an employee is identified as a level 1 to level 10 disability due to work-related disability, the work injury insurance fund shall pay a one-time Disability subsidy, the standard is as follows:

Level I disability	My own salary* 27 months
Level II Disability	My own salary* 25 months
Level 3 disability	My own salary* 23 months
Level 4 disability	My own salary* 21 months
Level 5 disability	My own salary* 18 months
Grade Six Disability	My own salary× 16 months
Grade Seven Disability	My own salary* 13 months
Grade Eight Disability	My own salary* 11 months
Grade Nine Disability	My own salary× 9 months
Grade 10 Disability	My own salary× 7 months

My salary: refers to the injured worker who suffers from an accident injury or suffers from an occupational disease due to work.12 months average monthly contributory wage.My salary is higher than the average wage of employees in the overall planning area.300, calculated according to 300 of the average wage of employees in the overall planning area; If my salary is lower than 60% of the average wage of employees in the overall planning area, it shall be calculated according to 60% of the average wage of employees in the overall planning area (the same below).

 

（II）Level 1-6 Disability Allowance (Monthly)

According to the provisions of Articles 35 and 36 of the Regulations on Work Injury Insurance, if an employee is identified as a level 1 to level 6 disability due to work-related disability, the disability allowance shall be paid on a monthly basis. The standards are as follows:

Level I disability	My own salary× 90%
Level II Disability	My own salary× 85%
Level 3 disability	My own salary× 80%
Level 4 disability	My own salary× 75%
Level 5 disability	My own salary× 70%
Grade Six Disability	My own salary× 60%

 

Description:1）Level 1-4 disability benefits are paid from the Industrial Injury Insurance Fund,If the actual amount is lower than the local minimum wage standard, the difference shall be made up by the industrial injury insurance fund;

               2）Level 5-6 disability allowance is paid by the employer when it is difficult to arrange work,If the actual amount of disability allowance is lower than the local minimum wage standard, the employer shall make up the difference.

 

(III)Grade 5-10 One-time Work Injury Medicaid and Disability Employment Grant

1) One-time work injury medical subsidy: paid by the work injury insurance fund;

2) One-time disability employment subsidy: paid by the employer;

The above two gold standards are determined according to the level of disability. The work injury insurance regulations do not provide for a unified standard. The specific standards authorize the people's governments of provinces, autonomous regions, and municipalities directly under the Central Government to stipulate,Generally, it is calculated according to a certain multiple of my salary.Can be found in the provincial work injury insurance regulations or work injury insurance measures (the regulations in jiangsu province are rather special,adopt a quota standard, see below).

 

For example:Guangdong Province, one-time work injury medical subsidy and disability employment subsidy standard.

One-time work-related injury medical subsidy:

Level 5 disability	My own salary× 10 months
Grade Six Disability	My own salary× 8 months
Grade Seven Disability	My own salary× 6 months
Grade Eight Disability	My own salary× 4 months
Grade Nine Disability	My own salary× 2 months
Grade 10 Disability	My own salary× 1 month

 

One-time disability employment benefit:

Level 5 disability	My own salary× 50 months
Grade Six Disability	My own salary× 40 months
Grade Seven Disability	My own salary* 25 months
Grade Eight Disability	My own salary× 15 months
Grade Nine Disability	My own salary× 8 months
Grade 10 Disability	My own salary× 4 months

 

Jiangsu's regulations are quite special. According to the "Measures for the Implementation of the" Work Injury Insurance Regulations "in Jiangsu Province, the quota standard is adopted:

One-time work-related injury medical subsidy:

Level 5 disability	200000 yuan
Grade Six Disability	160000 yuan
Grade Seven Disability	120000 yuan
Grade Eight Disability	80000 yuan
Grade Nine Disability	50000 yuan
Grade 10 Disability	30000 yuan

 

Work-injured workers suffering from occupational diseasesThe one-time medical subsidy for work-related injuries will be increased by 40% on the basis of the above-mentioned standards.

One-time disability employment benefit:

Level 5 disability	95000 yuan
Grade Six Disability	85000 yuan
Grade Seven Disability	45000 yuan
Grade Eight Disability	35000 yuan
Grade Nine Disability	25000 yuan
Grade 10 Disability	15000 yuan

 

Jiangsu also specifically stipulates that the injured worker himself proposes to terminate the labor relationship with the employer., and the termination of labor relations from the legal retirement age is less than 5 years, one-time work-related injury medical subsidy and one-time disability employment subsidy shall be implemented according to the following standards: less than 5 years, according to 80% of the full payment; Less than 4 years, according to 60% of the full payment; Less than 3 years, according to 40% of the full payment; Less than 2 years, according to 20% of the full payment; if it is less than one year, it shall be paid at 10% of the full amount, except for the circumstances stipulated in Article 38 of the the People's Republic of China Labor Contract Law. Those who reach the legal retirement age or go through the retirement procedures in accordance with the regulations shall not pay a one-time work-related injury medical subsidy and a one-time disability employment subsidy.

 

（Four）Wages during the shutdown period

During the period of suspension of work, the original wages and benefits will remain unchanged and will be paid by the unit on a monthly basis. The period of suspension of pay is generally not more12 months. If the injury is serious or the situation is special, it may be appropriately extended after confirmation by the labor ability appraisal committee of the city divided into districts, but the extension shall not exceed 12 months.

Note: In practice, the mainstream practice is based on the work-related injury before.12 months average wage is determined.

Whether overtime is included in the calculation of the original wages and benefits for the shutdown period varies from place to place in practice.

For example, Guangdong High Court's "Several Opinions on the Connection between Labor and Personnel Dispute Arbitration and Litigation" (2018) During the period of work-related injury work stoppage and salary retention, the original wages and benefits of the 7. shall remain unchanged and shall be paid by the unit on a monthly basis. Wages for work-related injuries shall be paid on the basis of the average wage (including overtime pay) of the worker for the twelve months prior to the work-related injury.

"Investigation and Reference of the First Civil Court of Shanghai High Court" ((2014] No. 15) tends to believe that the original salary during the shutdown period should not include overtime pay.

 

（Five）Pay off period care

If an injured worker who cannot take care of himself needs care during the period of suspension of work and pay, the unit to which he belongs shall be responsible.

If the unit does not arrange care, the unit will pay for the care. How to determine the standard of nursing fee? There is no uniform practice everywhere.

For example, the "Guangdong Province Work Injury Insurance Regulations" stipulates that if a work-injured employee cannot take care of himself during the period of suspension of work and salary, the unit to which he belongs shall be responsible. If the unit does not send people to care, it shall pay the nursing fee to the injured worker with reference to the labor remuneration standard of the local nursing worker engaged in the same level of nursing.

 

（Six）Nursing expenses after disability assessment

If the injured worker has assessed the disability level and confirmed by the labor ability appraisal committee that he needs life care, he shall pay the life care fee from the work injury insurance fund on a monthly basis.

Life is completely unable to take care of themselves	social wage× 50%
Most of life can not take care of themselves	social wage× 40%
Part of life can not take care of themselves	social wage× 30%

 

（Seven）Hospitalization food subsidies, transportation expenses, board and lodging expenses

The food subsidy for the hospitalization of employees for work-related injuries, as well as the certificate issued by the medical institution and reported to the handling agency for approval, the transportation, board and lodging expenses required for the injured employees to seek medical treatment outside the overall planning area shall be paid from the work-related injury insurance fund, and the specific standards for fund payment shall be determined by the overall planning area. People's government regulations.

 

（Eight）Medical expenses

If the expenses required for the treatment of work-related injuries meet the catalogue of work-related injury insurance diagnosis and treatment items, the catalogue of work-related injury insurance drugs, and the standards for hospitalization services of work-related injury insurance, they shall be paid from the work-related injury insurance fund.

Medical expenses exceeding the catalogue and service standards should be borne by the injured workers or the employing units. At present, there are different practices in different places, and the practice in most areas is that the employing units do not bear them. For example:

Answers to Several Questions on the Trial of Labor Dispute Cases by Zhejiang High Court(II)

16. The employer has paid work-related injury insurance for the worker in accordance with the law, and the worker's work-related injury medical expenses exceed the scope of the social security fund reimbursement catalog.?

Answer: The employer has paid work-related injury insurance for the laborer in accordance with the law. In principle, the expenses of the laborer's work-related injury medical expenses that exceed the scope of the social security fund reimbursement catalog should not be borne by the employer, but the expenses that exceed the scope of the catalog are approved or approved by the employer.

Shenzhen 《Summary of 2016 Symposium on Difficult Issues of Social Insurance Disputes in the City

3. the employer has paid work-related injury insurance for the laborer, if the laborer requests the employer to make up for the work-related injury medical expenses on the grounds that the actual expenditure is higher than the medical expenses paid by the social security department, it will not be supported. Except as otherwise provided by laws and regulations.

 

（Nine）Work injury rehabilitation fee

If the expenses of the injured worker to the medical institution where the service agreement is signed for the work injury rehabilitation are in accordance with the provisions, they shall be paid from the work injury insurance fund.

 

（Ten）Auxiliary equipment cost

Due to the needs of daily life or employment, workers with work-related injuries can be equipped with artificial limbs, orthoses, artificial eyes, artificial teeth, wheelchairs and other assistive devices after confirmation by the labor ability appraisal committee, and the expenses required shall be paid from the work-related injury insurance fund in accordance with the standards set by the state.

It should be noted that assistive devices should generally be limited to assisting daily life and production and labor, and use popular products in the domestic market. Workers with work-related injuries choose other types of products, and the cost is higher than the popular part, which is paid by the individual.

 

（XI）Recurrence of work injury treatment

If a worker with a work-related injury recurs and confirms the need for treatment, he or she shall enjoy the medical expenses for the work-related injury, the expenses for auxiliary equipment, and the salary for the period of work stoppage.

 

（XII）Treatment standard for work-related death

At 10 a.m. on January 17, 2022, the State Council Information Office held a press conference, and the National Bureau of Statistics released the income and consumption expenditure of residents in 2021. In terms of residents' income, the whole of 2021per capita disposable income of urban residents47412 yuan, up 8.2 percent in nominal terms over the previous year, real growth net of price factors7.1%。

This statistic has a direct impact on the one-time death benefit for workers injured at work.

According to Article 39 of the "Work Injury Insurance Regulations", if an employee dies due to work, his close relatives receive funeral subsidies, dependent relatives pensions and one-time work death subsidies from the work injury insurance fund in accordance with the following provisions.

 

Description:

According to the second paragraph of Article 62 of the Regulations on Work Injury Insurance, if an employee of an employer who should participate in work injury insurance but does not participate in work injury insurance has a work injury, the employer shall follow the work injury insurance benefits specified in the Work Injury Insurance Regulations. And standard payment.

Therefore, if an employee dies due to work, close relatives can receive three expenses, funeral grant, dependent relatives pension and one-time work death grant. The three cost standards are as follows:

1, a one-time death grant:The standard is the per capita disposable income of urban residents in the previous year.20 times. This standard changes every year, and generally increases by at least tens of thousands of yuan per year.

Formula: National per capita disposable income of urban residents× 20

According to the latest data released by the National Bureau of Statistics,In 2021, the per capita disposable income of urban residents nationwide was 47412 yuan.

ThereforeThe standard of one-time work death subsidy in 2022 is 47412 yuan × 20=948240 yuan.

Because the Regulations on Work Injury Insurance are uniformly implemented throughout the country, it is.In 2022, the national unified standard of one-off work death subsidy is 948240 yuan, an increase of 71560 yuan compared with 876680 yuan in the previous year. This standard has no geographical distinction and is unified throughout the country.

2. Funeral grants:Funeral grants areThe average monthly salary of employees in the six-month co-ordination area in the previous year. This standard will also change every year, and the standard is different in each region. For example, Shenzhen's social average salary last year was 11620 yuan/month, while the funeral subsidy was 69720 yuan.

Formula: Local Social Flat Wages× 6;

3. Pension for dependent relatives:According to a certain percentage of the employee's own salary, it will be paid to the relatives who provided the main source of income and were unable to work. Criteria: Spouse per month40%, other relatives 30% per month, lonely elderly or orphans per month on the basis of the above-mentioned standards increased by 10%. The sum of the approved pensions of the dependent relatives shall not be higher than the wages of the worker who died as a result of work;

Formula: spouse: the deceased's own salary* 40% (paid monthly);

Other relatives: salary of the deceased* 30% (per person per month);

Older persons or orphans: added to the above criteria10％；

The sum of the above benefits at the time of initial approval shall be≤ Monthly wages of employees (calculated on a monthly basis).