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1. Fill in with a pen or signature pen, and the font is neat and clear.
2. If the applicant is organized by an employer or a trade union, the official seal shall be affixed to the name.
3. Employees of public institutions should fill in the occupational category, and employees of enterprises should fill in the job (or type of work) category.
4.In the Injury Location field, fill in the specific part of the injury.
5. In the column of diagnosis time, for occupational diseases, fill in according to the time of diagnosis of occupational diseases; If you are injured or killed, fill in the information according to the time of initial consultation.
6. The name of the occupational disease shall be filled in according to the certificate of diagnosis of occupational disease or the diagnosis and appraisal of occupational disease, and the time of exposure to occupational disease hazards shall be filled in according to the actual contact time. If it is not an occupational disease, do not fill in.
7. A brief description of the injury should clearly state the time and place of the accident, the work performed at that time, the cause of the injury, and the location and extent of the injury.
Patients with occupational diseases should write down what kind of hazardous work they are engaged in in in which unit, the start and end time, and the results of the diagnosis.
1) Where they are violently injured in the performance of their work duties, submit a judgment or other valid proof from the public security organ or people's court.
2) If the first accident caused by a motor vehicle accident is determined as a work-related injury, the responsibility determination letter or other valid proof of the public security traffic management department shall be submitted.
3) If you are injured due to work reasons during the period of going out for work, submit a certificate from the public security department or other certificates; In the event of an accident where the whereabouts are unknown, it shall be determined that the death was due to work and submitted to the people's court for a conclusion declaring the death.
4) During working hours and at work, if you die of sudden illness or die within 48 hours after rescue fails, submit the rescue and death certificate of the medical institution.
5) Those who have been harmed in activities to safeguard national interests or public interests, such as emergency rescue and disaster relief, shall submit valid certificates in accordance with laws and regulations.
6) Belong to the demobilized and demobilized servicemen who are disabled due to war or duty injuries, and if they are injured in the old age, they shall submit the "Revolutionary Disabled Veteran's Certificate" and the diagnosis certificate of the old injury by the medical institution.
7) If the relevant supporting materials cannot be provided due to special circumstances, the situation shall be explained in writing.
8) The opinion column of the injured employee or his relatives should indicate whether he agrees to apply for work-related injury determination, and whether the above content is true.
9) The labor and social security administrative department should fill in the supplementary materials and whether to accept the opinions in the column of reviewing the materials and accepting the opinions.
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The precautions in the process of applying for work-related injury recognition are:
1. For a limited period of time, the unit should apply within one month after the accident occurred, and the employee himself can apply within one year after the accident.
2. Pay attention to the complete materials, including the first case, diagnosis certificate, labor relationship certificate, copy of the injured person's ID card and application for work-related injury identification.
3. When writing the application for work-related injury determination, it is necessary to clearly write the time, place, person and process of the incident.
4. If there may be disputes, please keep the original and collect evidence for preservation.
The legal basis is the Measures for the Determination of Work-related Injuries
Article 17 If an employee is injured in an accident or is diagnosed or appraised as an occupational disease in accordance with the provisions of the Law on the Prevention and Treatment of Occupational Diseases, the unit to which he belongs shall, within 30 days from the date of occurrence of the accident injury or the date of diagnosis or appraisal of an occupational disease, submit an application for recognition of work-related injury to the social insurance administrative department of the coordinating region. In case of special circumstances, the time limit for application may be appropriately extended with the consent of the social insurance administrative department.
If the employer fails to submit an application for recognition of work-related injury in accordance with the provisions of the preceding paragraph, the injured employee or his close relatives or trade union organization may, within one year from the date of occurrence of the accident injury or the date of diagnosis or appraisal of an occupational disease, directly submit an application for recognition of work-related injury to the social insurance administrative department of the coordinating area where the employer is located.
Matters that shall be determined by the provincial-level social insurance administrative department in accordance with the provisions of the first paragraph of this Article shall be handled by the social insurance administrative department at the districted-city level where the employer is located in accordance with the principle of territoriality.
If an employer fails to submit an application for determination of work-related injury within the time limit specified in the first paragraph of this Article, the employer shall bear the relevant expenses such as work-related injury benefits incurred during this period that comply with the provisions of these Regulations.
Article 18 The following materials shall be submitted to submit an application for determination of work-related injury:
1) Application form for determination of work-related injury;
2) Proof of the existence of an employment relationship (including a de facto employment relationship) with the employer;
3) Medical diagnosis certificate or occupational disease diagnosis certificate (or occupational disease diagnosis and appraisal certificate).
The application form for determination of work-related injury shall include basic information such as the time, place, and cause of the accident, as well as the degree of injury of the employee.
Where the materials provided by the applicant for work-related injury determination are incomplete, the social insurance administrative department shall inform the applicant of all the materials that need to be supplemented and corrected in writing at one time. After the applicant requests to supplement and correct the materials in accordance with the written notice, the social insurance administrative department shall accept it.
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When applying for a work-related injury determination, attention should be paid to the boundaries of time, space, occupation or business, and subjective fault.
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Legal analysis: 1. There must be an employment relationship between the injured employee and the employer (signing a labor contract or the existence of a de facto labor relationship.
2. Within 30 days from the date of applying for the limitation period for work-related injury recognition and identification as an occupational disease, submit an application for work-related injury recognition to the administrative department of labor insurance and obstacle lifting in the overall region.
3. The circumstances and basis for determining the work-related injury.
Legal basis: Article 14 of the Regulations on Work-related Injury Insurance An employee shall be deemed to have suffered a work-related injury if he or she has any of the following circumstances:
1) Being injured in an accident during working hours and in the workplace due to work-related reasons;
2) Being injured in an accident while engaging in work-related preparatory or finishing work in the workplace before or after missing working hours;
3) Injured by violence or other accidents during working hours and in the workplace as a result of the performance of work duties;
4) Suffering from occupational diseases;
5) Injured or unaccounted for in an accident while away for work;
6) Injured in a traffic accident or an accident involving urban rail transit, passenger ferry, or train for which they are not primarily responsible;
7) Other circumstances that laws and administrative regulations provide shall be recognized as work-related injuries.
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The precautions for the determination of work-related injuries are: the employer shall apply within 30 days from the date of occurrence of the accident injury or the date of diagnosis and appraisal of the destroyed chain bucket as an occupational disease; The employer and the employee need to have an employment relationship; Take care to preserve relevant evidence; Submit the application form for work-related injury determination, medical diagnosis certificate and other materials; Other.
[Legal basis].Paragraph 1 of Article 17 of the Regulations on Work-related Injury Insurance.
If an employee is injured in an accident or is diagnosed or appraised as an occupational disease in accordance with the provisions of the Law on the Prevention and Control of Occupational Diseases, the unit to which he or she belongs shall, within 30 days from the date of occurrence of the accident injury or the date of diagnosis or appraisal of an occupational disease, submit an application for recognition of work-related injury to the social insurance administrative department of the coordinating area. In case of special circumstances, with the consent of the social insurance administrative department, the time limit for application may be appropriately extended.
Section 2. If the employer fails to submit an application for recognition of work-related injury in accordance with the provisions of the preceding paragraph, the injured employee or his close relatives or trade union organization may directly submit an application for recognition of work-related injury to the social insurance administrative department of the co-ordinating area where the employer is located within one year from the date of occurrence of the accident injury or the date of diagnosis or appraisal of the occupational disease.
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