Detailed rules for the implementation of Jiangxi industrial injury insurance regulations

first

In order to ensure that employees receive medical treatment and economic compensation after suffering from accidents or occupational diseases at work, promote work-related injury prevention and vocational rehabilitation, and disperse the risk of work-related injuries of employers, these measures are formulated in accordance with the relevant provisions of the Social Insurance Law of People's Republic of China (PRC) and the Regulations on Work-related Injury Insurance of the State Council (hereinafter referred to as the Regulations) and other laws and regulations, combined with the actual situation of this province.

second

Enterprises, institutions, social organizations, private non-enterprise units, foundations, law firms, accounting firms and other organizations within the administrative region of this province and individual industrial and commercial households with employees (hereinafter referred to as employers) shall participate in work-related injury insurance according to law and pay work-related injury insurance premiums for all employees or employees of this unit (hereinafter referred to as employees). The employees of the employing unit have the right to enjoy the treatment of work-related injury insurance according to law.

essay

The provincial social insurance administrative department is responsible for the work of industrial injury insurance in the province. The social insurance administrative departments of cities and counties (cities, districts) with districts shall be responsible for the work-related injury insurance within their respective administrative areas. Social insurance agencies established by social insurance administrative departments at all levels (hereinafter referred to as agencies) specifically undertake work-related injury insurance affairs.

The financial department and the auditing organ shall supervise the income and expenditure and management of the industrial injury insurance fund according to law.

Safety production supervision and management, health, civil affairs, public security, transportation, industry and commerce, housing and urban and rural construction departments shall, within the scope of their respective duties, assist the social insurance administrative departments to do a good job in work-related injury insurance.

Article 4

Industrial injury insurance should be combined with accident prevention and vocational rehabilitation.

Employers and workers shall abide by the laws and regulations on production safety and occupational disease prevention and control, implement safety and health regulations and standards, prevent work-related accidents, and avoid and reduce occupational hazards.

The administrative department of social insurance and the agency shall establish and improve the work-related injury prevention system, and encourage the insured units to do a good job in work-related injury prevention by evaluating the work-related injury risk of the insured units and taking measures such as adjusting the rates, so as to reduce the incidence of work-related accidents and occupational diseases.

Article 5

The employer shall, within 30 days after the insured payment is made or within 15 days after the insured payment is changed, publicize the relevant information about participating in work-related injury insurance in the unit. The publicity content shall include the scope of personnel who enjoy the treatment of work-related injury insurance, the time of participation and the payment.

Workers have the right to urge employers to participate in work-related injury insurance and publicize their participation, and the trade union organizations of employers have the obligation to urge employers to participate in work-related injury insurance and publicize their participation.

Workers' work-related injuries occurred before and on the day when the employer paid the insurance premium, and their work-related injury insurance benefits were paid by the employer; Work-related injuries occurred the next day when the insurance premium was paid, and the work-related injury insurance benefits were paid by the work-related injury insurance fund in accordance with the Regulations and these Measures.

Article 6

The employer shall pay the work-related injury insurance premium on time. Individual employees do not pay work-related injury insurance premiums.

The amount of work-related injury insurance premium paid by the employer is the product of the total wages of employees multiplied by the unit payment rate.

The employer's payment rate is determined by the overall regional agency according to the employer's use of work-related injury insurance premiums, the incidence of work-related injuries, the degree of occupational hazards and other factors. , and according to the industry differential rates and industry rate grades stipulated by the state.

For construction enterprises, small service enterprises and small mining enterprises that have difficulties in paying work-related injury insurance premiums according to the total wages of employers, the measures for paying work-related injury insurance premiums shall be implemented in accordance with the relevant provisions of the social insurance administrative department of the State Council.

Article 7

The industrial injury insurance fund shall be co-ordinated by the cities divided into districts and gradually implemented at the provincial level.

Before the industrial injury insurance fund is coordinated by the whole province, the provincial industrial injury insurance adjustment fund is established. The provincial-level industrial injury insurance adjustment fund is paid to the provincial-level agencies by the agencies of each district and city according to 3% of the industrial injury insurance premium actually collected in that year, and the provincial-level agencies deposit the above-mentioned funds and 3% of the industrial injury insurance premium actually collected in that year into the financial special account for management, so as to adjust and solve the gap expenditure of the industrial injury insurance fund for major accidents in the province and improve the level of protection of the industrial injury insurance fund. The specific measures for raising, managing and using the provincial industrial injury insurance transfers shall be formulated by the provincial social insurance administrative department jointly with the provincial finance department, and implemented after being submitted to the provincial people's government for approval.

The industrial injury insurance fund shall strictly implement the provisions of the financial system of the social insurance fund, and implement the management of the budget at the beginning of the year and the final accounts at the end of the year. On a monthly basis, the agency will pay the fund income into the financial account of the social security fund of the financial department at the same level, ensure that the income households have no balance at the end of the month, and apply for disbursement of funds according to regulations.

When the agency collects work-related injury insurance premiums, it shall issue a special receipt for the payment of social insurance premiums in Jiangxi Province uniformly printed by the Provincial Department of Finance.

Article 8

The industrial injury insurance fund is used to pay for the following items:

(a) medical expenses and rehabilitation expenses for the treatment of work-related injuries;

(2) Hospitalization food subsidies;

(three) transportation and accommodation expenses for medical treatment outside the overall planning area;

(four) the cost of installing and configuring auxiliary devices confirmed by the labor ability appraisal committee;

(five) life can not take care of themselves, confirmed by the labor ability appraisal committee of life care costs;

(6) One-time disability allowance and monthly disability allowance for employees with one to four industrial injuries;

(seven) a one-time medical subsidy for work-related injuries that should be enjoyed when the labor contract is terminated or dissolved;

(eight) medical expenses, funeral subsidies, pensions for dependent relatives and one-time subsidies for work-related deaths;

(nine) labor ability appraisal fee;

(10) Investigation fee for ascertainment of work-related injuries;

(eleven) industrial injury prevention fees;

(12) Vocational rehabilitation fee.

No unit or individual may use the industrial injury insurance fund for investment, operation, construction or decoration of office space, bonus payment or other purposes.

Article 9

Each city divided into districts shall establish a reserve fund for industrial injury insurance (hereinafter referred to as the reserve fund). The reserve fund shall be withdrawn according to 10% of the total amount of industrial injury insurance fund collected in the year of the city divided into districts, and accumulated year by year, and will not be withdrawn when it reaches 20% of the total amount of industrial injury insurance fund in the year of the overall planning area.

The reserve is used for the payment of work-related injury insurance benefits for major accidents in cities divided into districts. The use of work-related injury insurance reserve is proposed by the overall regional agency, audited by the municipal social insurance administrative department and the financial department with districts, and reported to the municipal people's government with districts for approval. If the reserve fund is insufficient to pay, it shall be paid by the municipal people's government with districts.

Article 10

If an employee suffers from an accident injury or is diagnosed or identified as an occupational disease, the employer shall, within 30 days from the date of the accident injury or the date of diagnosis and identification as an occupational disease, apply to the social insurance administrative department of the overall planning area in a timely manner in accordance with the provisions of the Regulations. 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 close relatives and trade unions may directly apply for work-related injury identification to the social insurance administrative department where the employing unit is located within one year from the date of accident injury or diagnosis and identification as a profession.

Article 11

Where an employee whose registered place of the employing unit is not in the same overall planning area has a work-related injury and has participated in work-related injury insurance, he shall apply to the social insurance administrative department of the insured place for work-related injury identification; Those who have not participated in work-related injury insurance shall apply to the social insurance administrative department of the employer's production and business premises for work-related injury identification.

If an employee is sent to work abroad and his domestic industrial injury insurance relationship has not been suspended, he shall apply for industrial injury identification in accordance with the Regulations and these Measures after the industrial injury occurs.

Article 12

When applying for work-related injury identification, the following materials shall be submitted:

(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).

To apply for work-related injury identification, in addition to the materials specified in the preceding paragraph of this article, you can also submit the existing certification materials of the employer, the relevant administrative organ or the people's court.

Article 13

If the applicant for work-related injury identification applies for work-related injury identification within the time limit stipulated in these Measures, and the application materials provided are complete, the social insurance administrative department shall issue a notice of acceptance within five working days from the date of receiving the application for work-related injury identification. Do not meet the acceptance conditions, the administrative department of social insurance will not accept, and inform the applicant in writing.

If the applicant for ascertainment of a work-related injury submits an application for ascertainment of a work-related injury within the time limit prescribed in the present Measures, but the materials provided are incomplete, the social insurance administrative department shall inform the applicant in writing of all the materials that need to be supplemented within five working days from the date of receiving the application for ascertainment of a work-related injury. If the applicant makes corrections as required within 30 days, the social insurance administrative department shall accept the application for work-related injury identification.

Article 14

After accepting the application for work-related injury identification, the social insurance administrative department may investigate and verify the accident injury according to the needs of examination, and the employer, employees, trade unions, medical institutions and relevant departments shall provide assistance. 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.

When the administrative department of social insurance recognizes a work-related injury, the employee or his immediate family members consider it a work-related injury, and the employer does not consider it a work-related injury, and the employer shall bear the burden of proof.

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 immediate family members and the unit where the employees work. If it is recognized as a work-related injury or regarded as a work-related injury, a certificate of work-related injury identification shall be issued.

The administrative department of social insurance shall make a decision on the determination of work-related injuries within fifteen days for an application with clear facts and clear rights and obligations.

Article 15

Workers who are disabled due to work-related injuries and whose ability to work is affected after treatment shall be appraised.

Employers, employees with work-related injuries or their immediate family members applying for labor ability appraisal shall provide the following materials to the municipal labor ability appraisal committee with districts:

(a) the application form for labor ability appraisal;

(two) the decision on the determination of work-related injuries;

(3) Discharge summary, medical diagnosis certificate or occupational disease diagnosis certificate (occupational disease diagnosis certificate), work-related injury medical records and medical imaging examination materials issued by medical institutions;

(4) Other relevant certification materials.

If the materials provided by the applicant for labor ability appraisal are incomplete, the labor ability appraisal committee shall inform the applicant in writing of all the materials that need to be supplemented at one time. After the applicant has corrected the materials in accordance with the written notice, the labor ability appraisal committee shall accept it.

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. To reach the level of disability, it shall also issue a "work-related disability certificate" to the injured workers.

Article 16

If the employing units and workers with work-related injuries who apply for labor ability appraisal or their close relatives are dissatisfied with the appraisal conclusion, they shall, within 15 days from the date of receiving the appraisal conclusion, put forward an application for re-appraisal to the provincial labor ability appraisal committee, and submit the initial appraisal conclusion.

The labor ability appraisal committee that made the preliminary appraisal shall hand over the relevant materials to the provincial labor ability appraisal committee.

The conclusion of labor ability appraisal made by the provincial labor ability appraisal Committee is final.

Article 17

Provincial and municipal social insurance administrative departments shall plan, select, demonstrate and publish designated medical institutions, rehabilitation institutions and assistive devices for work-related injuries.

Overall regional agencies are responsible for signing written agreements with designated medical institutions, rehabilitation institutions and assistive devices.

Article 18

Workers with work-related injuries should seek medical treatment in designated medical institutions for work-related injuries that have signed service agreements. In case of emergency, you can go to the nearest medical institution for first aid, and the employer shall report to the social insurance agency within two working days. After the injured worker's injury is relatively stable, the agency shall determine whether to transfer to the designated medical institution for work-related injuries that has signed the service agreement for further treatment.

Workers with work-related injuries who treat non-work-related diseases do not enjoy medical treatment for work-related injuries, and shall be treated according to the basic medical insurance method.

Article 19

Workers with work-related injuries need to install and configure assistive devices due to their daily life or employment. After being identified by the labor ability appraisal committee, the equipment shall be installed and configured in the auxiliary equipment configuration institution that signed the service agreement, and the required expenses shall be paid from the industrial injury insurance fund according to the standards stipulated by the state.

Article 20

Workers with work-related injuries who can't take care of themselves need care during paid shutdown, and the medical institution that admitted them shall issue a certificate, and the unit where they work is responsible for sending people to take care of them. If the unit does not send people to care, the unit shall pay the nursing fee to the injured workers according to the standard of 70% of the average monthly salary of the employees in the last year.

Article 21

If an employee is identified as one to four disabled due to work-related disability, the employer and the injured employee shall pay the basic old-age insurance premium and basic medical insurance premium to the statutory retirement age on the basis of disability allowance.

If the work-related injury and disability allowance is lower than the payment base of the basic old-age insurance and basic medical insurance for employees, the payment base shall be implemented in accordance with the relevant provisions of the basic old-age insurance and basic medical insurance for employees.

After deducting the payment of my basic old-age insurance and basic medical insurance, if the actual amount of disability allowance for injured workers is lower than the minimum wage standard in the overall planning area, the industrial injury insurance fund will make up the difference.

Article 22

Five to six injured workers propose to terminate or terminate the labor relationship with the employer. If the labor contract of seven to ten disabled workers expires or the employee proposes to terminate the labor contract, the industrial injury insurance fund will pay a one-time work-related injury medical subsidy, and the employer will pay a one-time disability employment subsidy.

One-time work-related injury medical subsidy and one-time disability employment subsidy are based on my salary when the labor relationship is dissolved or terminated, in which the standard of one-time work-related injury medical subsidy is: my salary is 20 months in grade five, 6 months in grade six 17 months, 7 months in grade seven 13 months, 8 months in grade eight 10 months, 7 months in grade nine and 4 months in grade ten. The one-time disability employment subsidy standard is: my salary is 32 months in Grade 5, 28 months in Grade 6, 25 months in Grade 7, 2 1 month in Grade 8, 0/7 months in Grade 9 and 0/3 months in Grade 10.

For employees suffering from occupational diseases, the one-time medical subsidy for work-related injuries will be increased by 30% on the basis of the above standards.

Workers with work-related injuries of Grade 5-10 who are less than five years away from the statutory retirement age will be deducted one-time disability employment subsidy10% every year; Less than one year counts as one year.

Article 23

Employers, employees with work-related injuries or their immediate family members shall fill in the application form for work-related injury insurance benefits and submit the following materials to the agency:

(a) the decision on the determination of work-related injuries;

(two) the conclusion of labor ability appraisal;

(three) other materials required by the agency.

To apply for work-related injury insurance benefits for the immediate family members of employees who have died at work, the materials specified in Items (1) and (3) of the preceding paragraph, as well as the relevant certification materials for supporting relatives, shall be provided.

If the application materials are incomplete, the agency shall inform the applicant to supplement the relevant application materials at one time; If the materials are complete and meet the conditions for issuance, the industrial injury insurance benefits will be issued within ten working days from the date of acceptance.

Article 24 Disability allowance, dependent relatives' pension and living care fee shall be put forward by the provincial social insurance administrative department jointly with the provincial finance department according to the changes of the average wage and living expenses of employees in the province, and shall be implemented after being approved by the provincial people's government.

Article 25

Where the employing unit is dissolved, bankrupt, closed down or restructured, priority shall be given to solving the social insurance premium including the expenses required for work-related injury insurance. The payment of work-related injury insurance benefits shall be handled in accordance with the following provisions:

(a) one to four levels of work-related injuries, the employer has participated in work-related injury insurance, work-related injury insurance benefits continue to be paid by the agency; Did not participate in work-related injury insurance, by the employer in accordance with the overall planning area last year's actual per capita expenditure standards calculated to 75 years of age, in the liquidation of assets, a one-time payment to the agency; After one-time payment, the treatment of work-related injury insurance shall be paid by the agency.

(II) For employees with work-related injuries of Grade 5 to Grade 10, if the employer has participated in work-related injury insurance, the work-related injury insurance fund shall pay the one-time work-related injury medical subsidy in accordance with these measures, and the employer shall pay the one-time disability employment subsidy in accordance with these measures and terminate the work-related injury insurance relationship at the same time; Did not participate in work-related injury insurance, the employer shall pay a one-time work-related injury medical subsidy and a one-time disability employment subsidy in accordance with these measures, and terminate the work-related injury insurance relationship.

(3) If an employee dies at work and the employer has participated in work-related injury insurance, the pension for his dependent relatives shall continue to be paid by the agency; Did not participate in work-related injury insurance, by the employer in accordance with the "Regulations" provisions of the standard, a one-time payment to dependent relatives, or a one-time payment to the agency, the agency will continue to pay regularly. The calculation time is: the spouse and parents supported by the employee who died at work are calculated to be 75 years old; Minors are 18 years old.

Article 26

The employing unit shall, before establishing, terminating or dissolving the labor relationship or going through the retirement formalities, conduct occupational health examination on the employees exposed to occupational hazards. Employees who are diagnosed with occupational diseases in the employing unit shall go through the work-related injury identification in accordance with the procedures stipulated in the Regulations.

If an employee is diagnosed as an occupational disease after leaving his post, the employee or his close relatives shall file an application for work-related injury identification within one year from the date of being diagnosed as an occupational disease, and the social insurance administrative department shall accept it.

Article 27

Workers with work-related injuries who are diagnosed as occupational diseases and identified as work-related injuries after going through retirement procedures shall enjoy the relevant treatment of work-related injury insurance according to law, but shall not enjoy the one-time disability employment subsidy and one-time work-related injury medical subsidy. The relevant benefits of work-related injury insurance shall be borne by the employer before the termination or dissolution of labor relations or before going through retirement procedures. If an injured employee works in multiple employers before terminating or dissolving the labor relationship or going through retirement procedures, the employer who caused the employee to suffer from occupational diseases will pay the relevant treatment of industrial injury insurance.

Article 28

Civil servants, institutions managed with reference to the Civil Service Law and social group work personnel who suffer from accidents or occupational diseases due to their work can be identified as work-related injuries in accordance with the provisions of the Regulations and these Measures, and their ability to work can be appraised, and they can enjoy relevant work-related injury insurance benefits. The required expenses shall be paid by their units in accordance with the standards stipulated in the Regulations and these Measures. Those who have been injured or sacrificed in the line of duty have received government pensions, which are no longer recognized as work-related injuries and enjoy work-related injury insurance benefits. Where laws, regulations or the competent department of the State Council have other provisions, those provisions shall prevail.

Article 29

The work-related injury insurance of the central, provincial and military units stationed in Jiangxi shall be coordinated at the provincial level according to law, and the work-related injury insurance shall be implemented in accordance with the relevant provisions of the state and the province.

Article 30

These Measures shall come into force on July 65438, 20 1 year. "Regulations on Industrial Injury Insurance in Jiangxi Province > Several Provisions" (Order of the Provincial People's Government 132) shall be abolished at the same time.