After the work related injury and disability appraisal is down, why is it so difficult to compensate

The work-related injury insurance benefits paid by the work-related injury insurance**, the parties submit the information, the business department reviews it, and submits it to the financial department, which is allocated on a monthly basis, and is generally paid within 60 days from the date of submission of the information.

If the employer fails to pay the benefits in accordance with the law, it shall apply for labor dispute arbitration, and if the award takes legal effect, the employer shall apply to the people's court for enforcement.

Regulations on Work-related Injury Insurance

Article 54 Any dispute between an employee and an employer concerning the treatment of work-related injuries shall be handled in accordance with the relevant provisions on the handling of labor disputes.

Labor Dispute Mediation and Arbitration Law

Article 5 In the event of a labor dispute, if the parties are unwilling to negotiate, fail to negotiate or fail to perform after reaching a settlement agreement, they may apply to the mediation organization for mediation; If the applicant is unwilling to mediate, fails to mediate, or fails to perform after reaching a mediation agreement, he or she may apply to the Labor Dispute Arbitration Commission for arbitration; If a person is dissatisfied with an arbitral award, he or she may file a lawsuit in the people's court, except as otherwise provided by this Law.

Article 51: The parties shall perform on legally effective mediation documents or rulings within the prescribed time limit. If one party fails to perform within the time limit, the other party may apply to the people's court for enforcement in accordance with the relevant provisions of the Civil Procedure Law. The people's court accepting the application shall enforce it in accordance with law.

Ministry of Human Resources and Social Security.

Notice on Printing and Distributing the Regulations for Handling Work-related Injury Insurance

Ministry of Human Resources and Social Security issued No. 11, 2012.

Article 79 The business department shall notify the employer applying for work-related injury benefits, the injured employee and the dependent relatives of the results of the verification of work-related injury benefits, and perform the obligation to inform.

Article 80 The business department shall establish a payment account for the treatment of work-related injured employees in the current month according to relevant information such as work-related injury benefits, treatment adjustments, and treatment re-verification, and generate a summary table of work-related injury insurance expenditures (Table 6-1) and transfer it to the financial department.

Disability allowance and living care expenses shall be calculated and paid from the month following the conclusion of the labor ability appraisal; The pension for dependent relatives is payable from the month following the death and from the fourth month after the accident if the whereabouts are unknown.

The medical expenses for work-related injuries paid in advance by the employer or the injured employee can be paid through the commercial bank that has signed the issuance agreement; Expenses incurred by the work-related injury insurance agreement institution can be directly settled and paid through online review with the work-related injury insurance agreement institution.

When the appraisal comes out, bring all the information to the Social Security Bureau to apply. If there is a problem with the application, it means that you do not have all the information. As long as you have all the information, the work-related injury insurance** will directly pay you the benefits you are entitled to, and the dispute with the employer has nothing to do with the work-related injury insurance**.

Legal analysis: An application for recognition of work-related injury cannot be revoked if the materials are submitted. If the materials are incomplete, the labor department has no basis for making a judgment that can be revoked.

After accepting an application for recognition of work-related injury, the social insurance administrative department may, as necessary for review, conduct an investigation and verification of the accident injury, and the employer, employee, trade union organization, medical institution and relevant departments shall provide assistance. The diagnosis of occupational diseases and the appraisal of diagnostic disputes shall be carried out in accordance with the relevant provisions of the Law on the Prevention and Treatment of Occupational Diseases. The social insurance administrative department will no longer conduct investigation and verification of those who have obtained a certificate of diagnosis of an occupational disease or an appraisal of an occupational disease in accordance with the law.

Legal basis: Article 19 of the Regulations on Work-related Injury Insurance After accepting the application for work-related injury recognition, the social insurance administrative department may, according to the needs of the review, investigate and verify the accident injury, and the employer, employees, trade union organizations, medical institutions and relevant departments shall provide assistance. The diagnosis of occupational diseases and the appraisal of diagnostic disputes shall be carried out in accordance with the relevant provisions of the Law on the Prevention and Treatment of Occupational Diseases.

The social insurance administrative department will no longer conduct investigation and verification of those who have obtained a certificate of diagnosis of an occupational disease or an appraisal of an occupational disease in accordance with the law.

If the employee or his close relatives believe that it is a work-related injury, but the employer does not consider it to be a work-related injury, the employer shall bear the burden of proof.

Legal Analysis: Appraisal of injury and disability refers to the appraisal of the degree of disability after injury. The scope of injury and disability appraisal includes traffic accident disability, work-related accident disability, accidental injury disability, and fight and brawl disability.

Generally, the judicial department (such as the traffic police force, police station, and court) destroys the relevant admission records provided by the hospital or entrusts a disability appraisal agency to do the corresponding disability evaluation.

Legal basis: According to Article 36 of the Social Insurance Law of the People's Republic of China, if an employee is injured in an accident or suffers from an occupational disease due to work-related reasons, and the state bureau determines that the work-related injury is determined, he or she shall enjoy work-related injury insurance benefits; Among them, those who lose their ability to work after the appraisal of their ability to work enjoy disability benefits.

The determination of work-related injuries and the evaluation of labor ability shall be simple and convenient.

Work-related injury appraisal refers to the act of appraising the work-related injury of an employee who applies for work-related injury appraisal on the basis of the completion of his or her medical treatment or the expiration of his or her medical treatment period, and the labor ability appraisal committee at or above the districted city shall conduct an appraisal of his or her work-related injury-related matters. The scope of work-related injury appraisal includes: appraisal of working ability, appraisal and confirmation of the period of suspension of work, appraisal of nursing level, appraisal of the configuration of assistive devices for injury and disability, etc.

Legal analysis: work-related injury appraisal is the act of appraisal of work-related injuries by the labor ability appraisal committee at or above the districted city level on the basis of the work-related injury appraisal of the employee who applies for work-related injury appraisal after the completion of his or her medical treatment or the expiration of the medical treatment period. The scope of work-related injury appraisal includes:

Labor ability appraisal, suspension of pay period appraisal and confirmation, nursing level appraisal, disability assistive device configuration appraisal, etc. The appraisal of work-related injuries in a broad sense includes the appraisal of working ability and the appraisal of the disability level, and the appraisal of work-related injury in the narrow sense refers to the appraisal of the disability grade. 1. The prerequisites for the identification of work-related injuries and the appraisal of the working ability of the injured employees are that those who have been identified for work-related injuries may apply for the appraisal of their working ability.

2. If the work-related injury has not been recognized, it shall not exceed one year from the date of the accident, or although it has exceeded one year, but the statutory statute of limitations has been suspended, and it is less than one year after the deduction, the applicant may apply for the determination of work-related injury and then apply for labor ability appraisal.

Routine materials and requirements required for the declaration of the appraisal:

1) Fill in the "Application Form for Labor Ability Appraisal", and affix my recent one-inch bareheaded ** on **, and if the unit is responsible, stamp the official seal of the unit on **; Individual applications should provide the name, full address, name, and ** of the contact person and notify the contact person on the spot.

2) The original and copy of the work-related injury determination decision.

3) Bring a copy of the original ID card of the person being appraised.

4) Provide complete and continuous medical records, of which the original medical records should be provided for hospitalization (the original medical records should be copied in the hospital medical record room with the patient's ID card, and stamped with the special seal of the hospital medical record management).

Legal basis: According to 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 Treatment of Occupational Diseases, the employer shall submit an application for work-related injury recognition to the social insurance administrative department of the coordinating area within 30 days from the date of the accident injury or the date of diagnosis or appraisal of the occupational disease. 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.

Legal analysis: If a work-related injury regrets signing the draft and agreement in private, it can still apply for work-related injury recognition and disability appraisal. If the compensation is then recalculated according to the regulations of the Work-related Injury Insurance, the compensation already paid shall be deducted from the compensation.

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.

Legal basis: Regulations on Work-related Injury Insurance Article 18 The following materials shall be submitted to apply for work-related injury determination:

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 for work-related injury determination in writing at one time of the materials that need to be supplemented and corrected. After the applicant requests to supplement and correct the materials in accordance with the written notice, the labor and social security administrative department shall accept the application.