How to Prevent Work related Injury Insurance Fraud? Business personal aspect

An individual's insurance fraud (including work-related injury insurance) with an amount of more than 10,000 yuan constitutes the crime of insurance fraud and must be investigated for criminal responsibility in accordance with law.

Legal provisions: 1. Interpretation of the Supreme People's Court on the Specific Application of Law in the Trial of Fraud Cases (Fa Fa [1996] No. 32) 1. An attempt to defraud is an attempt to defraud a person who has already started to commit fraud, but has not obtained property for reasons other than the will of the perpetrator. Where fraud is attempted and the circumstances are serious, it shall also be convicted and punished in accordance with law.

8. In accordance with the provisions of Article 16 of the "Decision", if an insurance fraud activity is carried out and the amount is relatively large, it constitutes the crime of insurance fraud. Where an individual commits insurance fraud of more than 10,000 yuan, it is a "relatively large amount"; Where an individual commits insurance fraud in an amount of 50,000 yuan or more, it is a "huge amount"; Where an individual commits insurance fraud of more than 200,000 yuan, it is considered a "particularly huge amount". Where the amount of insurance fraud carried out by a unit is more than 50,000 yuan, it is a "relatively large amount"; Where the amount of insurance fraud carried out by the unit is more than 250,000 yuan, it is a "huge amount"; Where the amount of insurance fraud committed by a unit is more than 1 million yuan, it is a "particularly huge amount".

II. Article 198 of the Criminal Law [Crime of Insurance Fraud]In any of the following circumstances, where insurance fraud is carried out, and the amount is relatively large, a sentence of up to five years imprisonment or short-term detention is to be given, and a concurrent fine of between 10,000 and 100,000 RMB is to be given; where the amount is huge or there are other serious circumstances, a sentence of between 5 and 10 years imprisonment and a concurrent fine of between 20,000 and 200,000 RMB is to be given; where the amount is especially huge or there are other especially serious circumstances, the sentence is to be 10 or more years imprisonment and a concurrent fine of between 20,000 and 200,000 RMB or confiscation of property

1) The policyholder deliberately fabricates the subject matter of insurance and defrauds the insurance money;

2) The policyholder, the insured or the beneficiary fabricates false reasons for the occurrence of the insured accident or exaggerates the extent of the loss, and defrauds the insurance money;

3) The policyholder, the insured or the beneficiary fabricates an insurance accident that has not occurred and defrauds the insurance money;

4) The insured or the insured intentionally causes an insured accident of property damage and defrauds the insurance money;

5) The policyholder or beneficiary intentionally causes the death, disability or illness of the insured and defrauds the insurance money.

Where the conduct listed in items (4) and (5) of the preceding paragraph concurrently constitutes other crimes, punishment is to be given in accordance with the provisions on combined punishment for multiple crimes.

Where a unit commits the crime in the first paragraph, the unit is to be fined, and the directly responsible managers and other directly responsible personnel are to be sentenced to up to five years imprisonment or short-term detention; where the amount is huge or there are other serious circumstances, a sentence of between 5 and 10 years imprisonment is to be given; where the amount is especially huge or there are other especially serious circumstances, a sentence of 10 or more years imprisonment is to be given.

Where an appraiser, certifier, or property appraiser of an insured accident intentionally provides false supporting documents to provide conditions for others to defraud, it is to be punished as an accomplice to insurance fraud.

Work-related injury publicity. Strictly check the information when receiving treatment.

Legal analysis: The consequences of fraudulently obtaining work-related injury insurance benefits are: ordering them to return them, imposing fines, and investigating their criminal responsibility if the circumstances are serious and constitute a crime.

Legal basis: Article 58 of the Regulations on Work-related Injury Insurance stipulates that if an employer conceals the total amount of wages or the number of employees, the labor and social security administrative department shall order it to make corrections and impose a fine of not less than 1 time but not more than 3 times the amount of the concealed wages. Where an employer, a work-related injured worker or his or her immediate family member fraudulently obtains work-related injury insurance benefits, or a medical institution or assistive device allocation agency fraudulently obtains work-related injury insurance expenditures, the labor and social security administrative department shall order a refund and impose a fine of between 1 and 3 times the amount of the fraud; where the circumstances are serious and constitute a crime, criminal responsibility is pursued in accordance with law.

Where work-related injury insurance is obtained by fraud, the social insurance administrative department shall order it to be refunded and impose a fine of not less than 2 times but not more than 5 times the amount of the fraud; Where an organization or individual engaged in the appraisal of labor ability participates in insurance fraud, the social insurance administrative department shall order corrections and impose a fine of not less than 2,000 yuan but not more than 10,000 yuan. where the circumstances are serious and constitute a crime, criminal responsibility is pursued in accordance with law.

1. Who is punished for fictitious labor relations.

1. Where a person applies for social insurance benefits by means of fictitious labor relations, the social insurance administrative department shall impose a fine of not less than one time but not more than three times the amount involved in the case. 2. If the social insurance benefits have been obtained by fraud by means of fictitious labor relations, the social insurance administrative department shall order them to return them and impose a fine of not less than two times but not more than five times the amount obtained by fraud.

2. How many fines will the company face for making up social security?

If an employer fails to register for social insurance, the social insurance administrative department shall order it to rectify the situation within a specified period of time, and impose a fine of not less than one time but not more than three times the amount of social insurance premiums payable on the employer, and a fine of not less than 500 yuan but not more than 3,000 yuan on the person in charge and other persons directly responsible for it. If an employer fails to pay social insurance premiums in full and on time, the social insurance premium collection agency shall order it to pay or make up the amount within a time limit, and if it fails to pay a late fee of 5/10,000 per day from the date of non-payment, the relevant administrative department shall impose a fine of not less than one time but not more than three times the amount of the outstanding payment.

3. Can the hospitalization expenses for work-related injuries be reimbursed by medical insurance?

No, if you have been reimbursed by medical insurance, in principle, you cannot apply for work-related injury reimbursement. Otherwise, if the reimbursement is made in violation of the medical insurance measures, the social insurance administrative department shall order the return of the basic medical security ** expenditure obtained by fraud, and impose a fine of not less than two times but not more than five times the amount obtained by fraud, and the medical expenses shall be borne by the third party in accordance with the law, and the third party shall not pay or the third party cannot be determined, and the basic medical insurance ** shall be paid in advance. After the basic medical insurance** is paid in advance, it has the right to recover from a third party.

Article 60 of the Regulations on Work-related Injury Insurance: If an employee or his close relatives defraud work-related injury insurance benefits, or medical institutions or assistive device allocation institutions defraud work-related injury insurance expenditures, the social insurance administrative department shall order them to return them and impose a fine of not less than 2 times but not more than 5 times the amount fraudulently obtained; where the circumstances are serious and constitute a crime, criminal responsibility is pursued in accordance with law. Article 61: In any of the following circumstances, an organization or individual engaged in labor ability appraisal shall be ordered to make corrections by the social insurance administrative department and shall be fined not less than 2,000 yuan but not more than 10,000 yuan; where the circumstances are serious and constitute a crime, criminal responsibility is pursued in accordance with law: (1) providing false appraisal opinions; (2) Providing false diagnosis certificates; (3) Accepting property from a party.

Legal analysis: If the employer, the injured employee or his close relatives fraudulently obtain work-related injury insurance benefits, or the medical machine structure or assistive device configuration institution fraudulently obtains the work-related injury insurance expenditure, the social insurance administrative department shall order the employee to return it and impose a fine of not less than 2 times but not more than 5 times the amount of the fraud; where the circumstances are serious and constitute a crime, criminal responsibility is pursued in accordance with law. Therefore, if the work-related injury insurance is fraudulently obtained, the benefits received need to be refunded and a fine will be imposed, and the circumstances are serious and may constitute the crime of fraud.

Legal basis: Article 60 of the Regulations on Work-related Injury Insurance Article 60 Where an employer, an injured employee or his close relatives fraudulently obtains work-related injury insurance benefits, or a medical institution or an assistive device allocation institution fraudulently obtains work-related injury insurance expenditures, the social insurance administrative department shall order the refund and impose a fine of not less than 2 times but not more than 5 times the amount obtained by fraud; where the circumstances are serious and constitute a crime, criminal responsibility is pursued in accordance with law. Therefore, if the work-related injury insurance is fraudulently obtained, the benefits received need to be refunded and a fine will be imposed, and the circumstances are serious and may constitute the crime of fraud.