How to pay work related injury insurance benefits, and how to pay work related injury insurance bene

Article 41 of the Social Insurance Law: "If an employee's employer fails to pay work-related injury insurance premiums in accordance with the law, and a work-related injury accident occurs, the employer shall pay the work-related injury insurance benefits." If the employer does not pay, it shall be paid in advance from the work-related injury insurance**.

The work-related injury insurance benefits paid in advance from the work-related injury insurance** shall be paid by the employer. If the employer fails to, the social insurance agency may recover compensation in accordance with Article 63 of this Law. The Interim Measures for Advance Payment of Social Insurance (Decree No. 15 of the Ministry of Human Resources and Social Security) further clarifies this.

According to the Measures, (1) the subject of the application for advance payment must be the injured employee himself or his close relatives. If the injured employee has the capacity to act, he or she shall apply in person; Where they are unable to apply or are unwilling to apply on their own, they may lawfully entrust their close relatives or other qualified persons to apply. In the case of the death or death of an employee, the request shall be made by his close relatives.

2) It must have been recognized as a work-related injury. Employees or their close relatives must submit a work-related injury determination decision and relevant materials to apply to the social insurance agency for payment of work-related injury insurance benefits in advance. (3) The application for advance payment of work-related injury insurance benefits must be made in writing.

4) The employer fails to pay or is unable to pay work-related injury insurance benefits, including: the employer has its business license revoked or its registration or filing revoked in accordance with the law; The employer pays all or part of the expenses; Where work-related injury insurance benefits cannot be obtained after arbitration or litigation in accordance with law, and the court issues a document suspending enforcement; Other circumstances in which the employee believes that the employer will not pay. (5) After receiving the application submitted by the employee or his close relatives in accordance with Article 6, the social insurance agency shall, within 3 working days, issue a written reminder notice to the employer, requiring it to verify and pay the work-related injury insurance benefits within 5 working days, and inform the employee that if the employee does not pay the application in full and on time within the time limit, the work-related injury insurance shall be paid in advance and obtain the request for it.

6) If an individual applies for advance payment of medical expenses, work-related injury medical expenses or work-related injury insurance benefits, he or she shall submit the original bills for all medical diagnosis, appraisal and other expenses. Shantou Recruitment Network.

According to the above, on the premise that Li does not agree to waive part of the request, whether the employer should pay all the work-related injury insurance benefits or part of the work-related injury insurance benefits, it is necessary to obtain relevant (e.g., written opinions on the payment by the unit). For the items paid by the unit that belong to the payment of work-related injury insurance, Li can apply to the social insurance agency responsible for work-related injury insurance for advance payment according to the above. After the social insurance agency pays the work-related injury insurance** in advance, it then requires the employer or the work-related injury insurance** to recover from the employer in accordance with the law.

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One, there are two payment methods:

There are two specific ways to pay benefits under the work-related injury insurance system:

1) The method of social pooling payment. This method is to pass legislation stipulating that employers must participate in work-related injury insurance, and pay work-related injury insurance premiums to the social insurance agency on time and in full, establish work-related injury insurance, and the social insurance agency is responsible for the payment of work-related injury insurance benefits. The employer shall bear all the costs of work-related injury insurance.

When the work-related injury insurance is implemented in the social pool, the method of "pay-as-you-go" is generally adopted, and the overall cost of work-related injury insurance is horizontally balanced and adjusted, withdrawn in the current year, and paid in the current year.

2) Formulate a unified work-related injury insurance treatment standard and item, and pay directly by the employer. The standards and items of work-related injury insurance benefits shall be uniformly stipulated, and the employer shall not have the right to change the treatment. The employer shall bear all the insurance expenses according to the insurance treatment standards and items specified in the **, and include them in the cost.

The method of raising work-related injury insurance premiums in this way does not belong to the category of "**", and is a lower-level protection method.

After the promulgation and implementation of the Regulations on Work-related Injury Insurance, employees of all types of enterprises within the territory of the People's Republic of China and employees of individual industrial and commercial households who suffer from accidents or occupational diseases due to work shall have the right to enjoy work-related injury insurance benefits in accordance with the provisions of these Regulations.

According to Article 38 of the Social Insurance Law, the following expenses incurred due to work-related injuries shall be paid from work-related injury insurance** in accordance with national regulations:

1) Medical expenses and expenses for work-related injuries;

2) Hospitalization meal subsidy;

3) Transportation and lodging expenses for medical treatment outside the overall planning area;

4) The cost of installing and configuring assistive devices for the disabled;

5) For those who are unable to take care of themselves, the living care expenses confirmed by the Labor Ability Appraisal Committee;

6) A one-time disability allowance and a monthly disability allowance for employees with disabilities of grades 1 to 4;

7) A one-time medical subsidy to be enjoyed when the labor contract is terminated or dissolved;

8) In the event of a work-related death, the funeral allowance, the pension for dependent relatives and the work-related death allowance received by the surviving family members;

9) Labor ability appraisal fee.

Article 39 The following expenses incurred as a result of work-related injuries shall be paid by the employer in accordance with the provisions of the state:

1) Wages and benefits during the work-related injury;

2) The monthly disability allowance received by the disabled employees of the fifth and sixth grades;

3) A one-time disability employment subsidy that shall be enjoyed when the labor contract is terminated or terminated.

Article 40 If an injured worker meets the requirements for receiving a basic old-age pension, the disability allowance shall be suspended and he shall enjoy the basic old-age insurance benefits. If the basic pension insurance benefits are lower than the disability allowance, the difference shall be made up from the work-related injury insurance**.

The payment process of work-related injury insurance benefits: the employee or the employee's employer can first apply for work-related injury recognition; Na Qi then obtained a work-related injury determination decision in accordance with the law; Then submit the hospitalization certificate, diagnosis and treatment sheet and other materials, apply for insurance expenses from the social security agency, and finally the social security agency approves the payment, you can pay the expenses that meet the items and standards of work-related injury insurance treatment for the employee.

The general treatment is issued by social security.

Conditions for the payment of benefits.

The right of an injured employee or the surviving family members who are entitled to a pension to enjoy work-related injury insurance benefits corresponds to certain conditions and obligations, and generally needs to go through work-related injury identification, labor ability appraisal and work-related injury disability assessment procedures. Those who meet the conditions and fulfill their obligations can enjoy work-related injury insurance benefits.

The type of benefit payment.

The cost of work-related injury insurance benefits can be broadly divided into two categories: medical treatment and cash compensation. Specifically, there are two types of work-related injury insurance payments: one is the payment of work-related injury medical expenses, sexual expenses, and assistive device configuration expenses; The second is the payment of disability allowance, disability allowance, pension for dependent relatives, funeral subsidy, one-time work-related death subsidy and other expenses.

These two types of expenses shall be paid from the work-related injury insurance** if the employer has participated in the work-related injury insurance; If you do not participate in work-related injury insurance, the employer will pay all of it.

The method of payment of benefits.

The above-mentioned first category of expenses shall be settled by the social insurance agency with the corresponding medical institutions and assistive device allocation institutions in accordance with the service agreements signed with medical institutions and assistive device allocation institutions and the relevant national catalogs and standards after verification. If the second type of expenses should be paid by work-related injury insurance**, they shall be directly paid to the injured employees or their relatives or entrusted by the social insurance handling agencies or entrusted banks, post offices, and communities for socialized distribution.

Adjustment of treatment.

Disability allowance, pension for dependent relatives, and living care expenses are long-term treatments, in order to ensure that work-related injury benefits are not affected by factors such as prices and other factors, and share the fruits of national economic development, Article 38 of the "Regulations" stipulates that the level of the above-mentioned long-term benefits shall be adjusted in a timely manner by the labor and social security administrative departments of the overall planning area according to the changes in the average wages and living costs of employees. The treatment is linked to the change in the average wage, which is based on the principle of fairness. After the country's economic level improves, the wages of workers will increase correspondingly, and workers who are injured at work should also enjoy higher insurance benefits than before.

In order to ensure that the long-term treatment of injured workers is not affected by price fluctuations, it must be adjusted in a timely manner according to the range of prices.

1. Social co-ordinated payment, which is a method of requiring employers to participate in work-related injury insurance through legislation, and pay work-related injury insurance premiums to social insurance agencies on time and in full;

2. Formulate a unified work-related injury insurance treatment standard and project by **, which shall be paid directly by the employer.

Legal basis] According to Article 30 of the Regulations on Work-related Injury Insurance, employees who are injured in accidents or suffer from occupational diseases due to work shall be treated with chiropractic treatment and enjoy medical treatment for work-related injuries. Employees should seek medical treatment in a medical institution that has signed a service agreement when talking about a work-related injury, and can first go to the nearest medical institution for first aid in case of emergency.

1. What is a work-related accident?

Work-related accidents, also known as labor accidents, are divided into broad and narrow senses. In a narrow sense, the Ministry of Human Resources and Social Security of the People's Republic of China states in the business guidelines on work-related injury insurance that "work-related accidents should refer to personal injuries and acute poisoning accidents that occur in the course of work for employees of all employers subject to the Regulations on Work-related Injury Insurance" and "their essential characteristics are injuries and acute poisoning accidents directly or indirectly caused by work-related reasons". In a broad sense, work-related accidents also include the suffering from occupational diseases. Legally, the relevant provisions of the Regulations on Work-related Injury Insurance can be referred to for specific work-related injuries.

2. Payment methods for work-related injury insurance benefits.

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 applying for a sensitive mask may be appropriately extended. 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.

The social insurance administrative department shall make a decision on the determination of work-related injury within the 15th of the state when the facts are clear and the rights and obligations are clear. If an employee suffers a work-related injury and has a disability that affects his or her ability to work after the injury is relatively stable, an appraisal of his or her ability to work shall be conducted.

**If the expenses required for work-related injuries meet the requirements of work-related injury insurance diagnosis and treatment items, work-related injury insurance drug lists, and work-related injury insurance hospitalization service standards, they shall be paid from work-related injury insurance**. Work-related injury insurance is paid, and the specific standard of payment is provided by the people of the co-ordination area for the food subsidy for the hospitalization of the employee for work-related injury, as well as the transportation, food and lodging expenses required for the work-related injury employee to seek medical treatment outside the co-ordination area with a certificate issued by the medical institution and approved by the handling agency. If the work-related injury employee goes to the medical institution that has signed the service agreement to carry out the work-related injury**, if it meets the requirements, it shall be paid from the work-related injury insurance**.

Due to the daily life or employment needs of the workers, the work-related injury can be fitted with prostheses, orthoses, artificial eyes, dentures, wheelchairs and other assistive devices upon confirmation by the Labor Ability Appraisal Committee, and the required expenses shall be paid from the work-related injury insurance** in accordance with the standards stipulated by the state. If an employee is injured in an accident or suffers from an occupational disease due to work and needs to suspend work to receive medical treatment for work-related injuries, the original salary and benefits shall remain unchanged during the period of suspension with pay, and shall be paid by the employer on a monthly basis. If the injured employee has been assessed for disability and confirmed by the Labor Ability Appraisal Committee to be in need of life care, the living care expenses shall be paid on a monthly basis from the work-related injury insurance**.