Interpretation of Taiyuan Workers' Compensation Insurance Regulations

Workers' Compensation Insurance, also known as Occupational Injury Insurance, is a social insurance system whereby the state or the society provides necessary material assistance to the injured, disabled, and dependent family members of the deceased due to accidental injuries sustained by the workers due to work-related reasons and in the course of their work, or due to occupational illnesses caused by exposure to occupational hazards, such as dust, radiation, and poisonous and hazardous substances. Social insurance system. Workplace accidents are a labor risk that is difficult to avoid in the process of industrialization, and the establishment of a workplace accident insurance system, in the event of workplace injuries, employees can receive timely treatment, medical rehabilitation and the necessary financial compensation.

Payment benchmark

The city's three types of industrial injury insurance industry benchmark rates were determined as follows: a class of industry (banking, securities, insurance, residential services, catering and retail industry, etc.) for the employer to the total wages of the employees of the unit of 0.6%; the second type of industry (real estate industry, sports, entertainment, food manufacturing, etc.) 1.2% of the total wages of employees in the employing unit; three types of industries (petroleum processing industry, non-ferrous metal ore mining, ferrous metal ore mining, other mining, etc.) is 2.4% of the total wages of employees in the employing unit. On the basis of the benchmark rate, the agency according to the various types of enterprises industrial injury insurance premiums, the incidence of work-related injuries, the degree of occupational disease hazards and other factors, one to three years to fluctuate the contribution rate.

All kinds of enterprises should participate in the work injury insurance but did not participate; underreporting the number of employees, not to part of the employees to pay the work injury insurance premiums; not on time to pay the work injury insurance premiums, should be paid back to the work injury insurance premiums.

Industrial injury insurance fund to implement the city's co-ordination, all included in the financial account of the social security fund. Workers' compensation insurance reserve for the integrated area of the major accidents in the payment of workers' compensation insurance. Workers' compensation insurance reserve according to the year 20% of the total fund collection.

Recognition of work-related injuries

Within 30 days from the date of the employee's accidental injury or diagnosis or identification of occupational disease, the enterprise shall submit an application for the recognition of work-related injuries to the municipal labor insurance department of the city or three counties and one city with jurisdiction. In the event of special circumstances, the deadline can not be submitted to the application for recognition of work injuries, reported to the Department of Labor and Social Security may be appropriately extended, but the maximum time shall not exceed 150 days. The employer did not submit an application for recognition of work injuries within the specified time limit, the costs incurred during this period of treatment of work injuries, etc., by the employer.

If an enterprise fails to submit an application for recognition of work-related injuries, the injured employee or his/her immediate family members, or the trade union organization can apply for recognition of work-related injuries within one year from the date of occurrence of the accidental injury or the date of diagnosis or assessment of occupational disease, directly to the municipal or three-county municipal labor security department with jurisdiction.

The agency received the application for recognition of work-related injuries, review within 15 days, eligible for acceptance; application materials are incomplete, a one-time written notice to the applicant needs to make up all the materials. The applicant within 30 days to make up all the materials, shall be accepted. The agency shall make a decision on the determination of work injury within 60 days from the date of acceptance of the application for the determination of work injury, and within 20 working days from the date of the decision on the determination of work injury, the decision on the determination of work injury shall be sent to the applicant, as well as to the injured employee (or his/her immediate family members) and the employer. If the enterprise does not participate in work injury insurance or does not pay work injury insurance premiums to the injured employee, the cost of investigation and verification of work injury determination shall be paid by the enterprise.

Employees or their immediate family members that the work injury, the enterprise holds the opposite view `, the employer shall bear the burden of proof, and within 15 days after receiving the notice of proof of the labor security department to submit evidence. If the evidence is not submitted within the prescribed time limit, the labor security department may make a conclusion on the work injury according to the evidence provided by the injured employee in accordance with the law.

Determination Procedures

Enterprises of all kinds, injured workers or their immediate family members, and trade unions should fill out the application form for the determination of work-related injuries when applying for the determination of work-related injuries and attach a copy of the employee's resident identity card; submit a copy of the labor contract or valid proof of the establishment of the labor relationship between the employee and the employer at the time of injury or occupational disease; and a copy of the medical certificate issued by the medical institution, and a copy of the labor contract or valid proof of the establishment of the labor relationship. The validity of the certificate, as well as the medical institutions issued by the employee injury diagnosis certificate, or occupational disease diagnosis certificate (or occupational disease diagnosis certificate).

In addition, one of the following nine circumstances, should also be submitted to the appropriate evidence:

(a) the employer did not participate in work-related injury insurance, submit a copy of the employer's business license or business administration department issued a certificate of inquiry;

(b) the death of the employee, submit a death certificate;

(c) in the working hours and workplace due to accidental injury at work, the working hours and workplace due to accidental injury at work, the working hours and workplace due to accidental injury at work. (c) Accidental injuries during working hours and in the workplace due to work-related reasons, and accidental injuries in the workplace before or after working hours while engaged in preparatory or finishing work related to work, submit the relevant evidence of the accident;

(d) Accidental injuries due to violence and other injuries in the performance of work-related duties during working hours and in the workplace, submit the certificate of the public security organs or the judgment of the people's court or other effective proof;

(e) work out of the period, due to work-related injuries, submitted to the public security organs or other proof; accidents occurring whereabouts unknown recognized as work-related deaths, submitted to the People's Court to declare the conclusion of death.

(F) on the way to and from work (or not on the way to and from work but in line with the third case), was injured in a motor vehicle accident, submit the certificate of responsibility of the public security traffic management department or other effective proof;

(G) in the work time and work, sudden death or death within 48 hours of the failure to rescue, submit the witnesses to a sudden illness of the witnesses and the medical institution's rescue certificate;

(H) in the working hours and work, sudden death or death within 48 hours after the failure to save, submit sudden illness witnesses and witnesses. Medical institutions of the rescue certificate;

(h) in disaster relief and other activities to safeguard national interests, public **** interests of the injury, in accordance with laws and regulations, submitted to the civil affairs department or other relevant departments of the certificate;

(ix) employees originally served in the military, due to war, service-related injuries resulting in disability, has obtained the Revolutionary Soldier's Certificate of Invalidity, to the enterprise after the recurrence of the old injuries, submit the "Revolutionary Soldier's Certificate of Invalidity" and the "Revolutionary Soldier's Certificate of Invalidity". Revolutionary Military Disabled Soldier's Certificate" and the medical institutions on the recurrence of old injuries diagnostic certificate.

Appraisal of ability

If an injured worker is cured at the end of the period or during the period with pay, the enterprise, the injured worker, or his/her immediate family members should apply to the Municipal Labor Ability Appraisal Commission for the appraisal of labor ability, fill in the Application for the Appraisal of Labor Ability and submit the decision of the determination of the work injury, the Certificate of the Work Injury of the employee, the diagnostic certificate and examination results of the medical treatment of the employee's injury, and the certificate of the work injury. The worker shall fill in the application for appraisal of labor capacity and submit the decision on the determination of work injury, the certificate of work injury of the worker, the certificate of diagnosis of work injury of the worker, the results of examination, medical records of diagnosis and treatment and other materials. Injured workers believe that the work injury directly caused by other diseases, should also be submitted to the work injury medical institutions issued by the relevant certificate.

The Municipal Labor Capacity Appraisal Committee shall, within 60 days from the date of receipt of the application for appraisal of labor capacity, make a conclusion. Appraisal involves more medical and health professionals, the complexity of the situation, the appraisal period can be appropriately extended, but shall not exceed 30 days. During the appraisal process, if the expert group considers that further examination is necessary, it may request the injured worker to go to a designated medical institution for medical examination. The examination time is not counted in the period of labor capacity appraisal.

Enterprises, injured workers or their immediate family members who are not satisfied with the conclusion of the labor capacity appraisal shall apply for re-appraisal to the Provincial Labor Capacity Appraisal Committee within 15 days from the date of receipt of the conclusion, with a written explanation of the reasons; the appraisal conclusion of the Provincial Labor Capacity Appraisal Committee shall be final. Apply for re-assessment of labor capacity or review of the appraisal of the appraisal conclusion and the original appraisal conclusion, the appraisal costs borne by the applicant.

Application for treatment

Enterprises, injured workers or their immediate family members to the agency to apply for treatment of work-related injuries, should fill out the application form for treatment of work-related injuries and submit the following materials:

(a) the conclusion of the determination of work-related injuries;

(b) the conclusion of the evaluation of labor capacity;

(c) the conclusion of the evaluation of labor capacity. ) Proof of wages paid for the 12 months prior to the work injury or occupational disease suffered by the injured worker.

If you apply for the pension treatment for dependent relatives who died at work, you should provide the materials stipulated in items (a) and (c), as well as the dependent's household registration book, resident's identity card, and proof of the dependent's economic status issued by the street office or township (township) people's government.

In addition, there are the following three cases, should also be submitted to the appropriate materials: dependents belonging to widows and orphans, submitted to the street office, the township (town) people's government issued a certificate; dependents belonging to adoptive parents, adoptive children, the submission of notary certificates; dependents belonging to the total loss of working capacity, the submission of the Labor Appraisal Commission's Labor Appraisal Conclusion.

If an injured worker needs to install or configure auxiliary aids for daily life or employment, the medical institution shall make a recommendation and the Labor Capacity Appraisal Committee shall confirm the recommendation.

The Labor Capacity Appraisal Committee will review and determine that if the disability grade of the injured worker or the grade of the impairment of self-care has changed, the disability allowance and the cost of nursing care will be adjusted accordingly from the month after the appraisal conclusion is made.

In the event of an accidental injury or occupational disease sustained by an illegal employer, or if the employer uses child labor and causes disability and refuses to pay a lump-sum compensation, the immediate family members of the injured or deceased employee, or the immediate family members of the injured or deceased child laborer, may report the incident to the Labor Security Supervision Department. After investigation, the labor security supervision department in accordance with the law.

Treatment

The treatment to be enjoyed by those who participate in work injury insurance includes medical treatment for work injury, disability treatment and death treatment. The medical treatment for work-related injuries includes medical expenses for work-related injuries, rehabilitation treatment expenses, and expenses for installation and configuration of auxiliary aids. Disability treatment includes one-time disability benefit, disability allowance and living care expenses.

The treatment for work-related deaths includes one-off work-related death benefits, funeral grants, and pensions for dependent relatives. If an employee who has not participated in work-related injury insurance suffers a work-related injury or if an employee suffers a work-related injury during the period in which the enterprise owes work-related injury insurance premiums, the employer will pay the costs to the injured employee in accordance with the items and standards of work-related injury insurance treatment stipulated in the Regulations on Work-related Injury Insurance, the Measures for the Implementation of the Regulations on Work-related Injury Insurance for Experimental Implementation in Shanxi Province, and the Rules for the Implementation of the Regulations on Work-related Injury Insurance in Taiyuan City, and the fund of the Work-related Injury Insurance Fund will not be reimbursed.

Enterprises do not pay work-related injury insurance premiums on time, and if the work-related injury insurance treatment has been paid by the Work Injury Insurance Fund before the non-payment, the work-related injury insurance treatment during the non-payment period shall be paid by the employer; the Work Injury Insurance Fund shall pay back the expenses after the non-payment.

Enterprises underreporting the wages of employees, not paying the full amount of work-related injury insurance premiums, resulting in the reduction of work-related injury insurance benefits to which injured employees are entitled, the difference will be made up by the employer. After the employer pays the full amount of work-related injury insurance premiums, the work-related injury insurance treatment will be re-approved. The difference of the work injury insurance treatment before re-authorization, the work injury insurance fund will not make up the difference.