The work related injury was not reported, and the medical insurance was gone! But if something goes

If the company does not report the work-related injury, you can apply for it yourself and request the employer to pay the work-related injury compensation directly according to the identification result

1. To apply to the Human Resources and Social Security Bureau (formerly the Labor Bureau) for work-related injury identification, the company needs to report within one month of the accident, if the company does not apply, the injured employee or his close relatives shall apply for recognition within one year. Materials to be submitted: application form for work-related injury determination (**generally ** from the Labor Bureau), proof of labor relationship with the employer, medical diagnosis certificate, etc.;

2. If there is a disability that affects the ability to work after the injury is relatively stable, the applicant shall apply for labor ability appraisal and submit an application to the labor ability appraisal committee of the city divided into districts (generally established in the human resources and social security bureau at the same level);

3. According to different disability levels, the compensation obtained is different. The main compensation is: medical expenses, one-time disability allowance, one-time employment allowance, one-time medical allowance, salary during the period of leave of absence, food allowance, nursing expenses, etc.

4. If you do not have a labor contract or other evidence to prove the existence of an employment relationship, and cannot apply for a work-related injury determination, you can first apply for labor arbitration to confirm the existence of an employment relationship between you and the employer. After the existence of an employment relationship is confirmed by labor arbitration, an application for work-related injury determination is made.

You can call 12333 for more information.

Legal analysis: If the determination of work-related injury is unsuccessful, it can be reimbursed by medical insurance, in fact, China has clear provisions on the identification of work-related injury, and whether the worker can be recognized as a work-related injury after injury depends on whether he meets the conditions for work-related injury, and if he does not meet the conditions, then he must not be recognized as a work-related injury. If the work-related injury is determined not to be recognized as a work-related injury, medical insurance can be used for reimbursement in the absence of a third-party responsible party.

Legal basis: Social Insurance Law of the People's Republic of China Article 26 The treatment standards of basic medical insurance for employees, new rural cooperative medical care and basic medical insurance for urban residents shall be implemented in accordance with national regulations.

Medical insurance and work-related injuries can only be reimbursed in one way.

In the event of a work-related injury, it is necessary to go to the labor department for a work-related injury determination. According to the results of the work-related injury determination, the employer is required to compensate for the loss in accordance with the work-related injury regulations. If the employer does not recognize the work-related injury, it is recommended to directly apply for labor arbitration to protect its rights, and the specific compensation standard can be calculated by a lawyer.

If the medical expenses in the work-related injury insurance have been paid in full and the receipts for the medical expenses have been collected, they cannot be reported again. Otherwise, a copy can be used to make up the difference.

1. How to reimburse work-related injury medical insurance.

Reimbursement process for work-related injury medical expensesAfter the work-related injury is identified, the work-related injury medical expenses incurred by the employee shall be presented with the work-related injury determination conclusion and a copy of the discharge summary (including: the date of admission and discharge, the chief complaint of admission, the history of present illness, examination, diagnosis, **, the surgical process, the outcome of the post-hospitalization, and the precautions for discharge. stamped with the seal of the hospital where the patient was treated), a detailed list of medical expenses (including:

The name, dosage, frequency, unit price, total price of each item, such as drugs, examinations, **, surgeries, laboratory tests, etc.), valid reimbursement documents (with the supervision seal of the financial department or the supervision seal of the tax department and the special seal of the hospital charges), the unit shall apply for reimbursement to the medical insurance agency (review department). The scope of reimbursement of personal medical expenses for injured employees: the expenses of work-related injuries incurred by employees stationed abroad and work-related injuries who have settled in other places in the agreed medical institutions that they choose to record; Approved transfer to a medical facility other than the agreed medical institution; Expenses for injured workers to visit relatives in China or transport silver to other places (only in non-profit medical institutions); Emergency and first aid expenses incurred due to work-related injuries during business trips.

2. How to reimburse work-related injuries by social security.

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 accommodation 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 case of a death due to work, the funeral subsidy, the pension for supporting relatives and the subsidy for the death of the person due to work received by the surviving family members;

9) Labor ability appraisal fee.

In fact, China has clear provisions on the identification of work-related injuries, and whether a worker can be recognized as a work-related injury after being injured depends on whether he meets the conditions for work-related injury, and if he does not meet the conditions, then he must not be recognized as a work-related injury. If the result of the work-related injury is not recognized as a work-related injury, medical insurance can be used to reimburse the work-related injury without a third-party responsible party.

Legal basis: Social Insurance Law of the People's Republic of China Article 26 The treatment standards of basic medical insurance for employees, new rural cooperative medical care and basic medical insurance for urban residents shall be implemented in accordance with national regulations.

No, can you report a work-related injury if you use medical insurance to see a doctor for work-related injury?

1. If a work-related injury cannot be reported for medical treatment with medical insurance, and medical insurance reimbursement is made, in principle, it 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 Tongkuan fraud, and impose a fine of not less than two times but not more than five times the amount obtained by fraud.

2. Employees' work-related injuries should be identified as work-related injuries, and after the identification of work-related injuries, all medical expenses are paid by work-related injury insurance, and medical insurance cannot be used, and medical insurance is used for employees' illness or non-work-related injuries, if there is no work-related injury identification, or if it is not a work-related injury, it can only be reimbursed by medical insurance.

3. Legal provisions: Social Insurance Law

Article 30 The following medical expenses are not included in the scope of payment of basic medical insurance**

1) It should be paid out of work-related injury insurance**;

2) It shall be borne by a third party;

3) It should be borne by public health;

4) Seeking medical treatment outside the country.

Medical expenses shall be borne by the third party in accordance with the law, and if the third party does not pay or the third party cannot be determined, the basic medical insurance shall pay in advance. After the basic medical insurance** is paid in advance, it has the right to recover from a third party.

2. What are the procedures for handling work-related injuries?

1. After the conclusion of the employee's disability appraisal or the approval of the work-related death is issued, the employer shall promptly appoint a special person to contact the work-related injury insurance agency to handle the procedures for the declaration and allocation of benefits;

2. When making the declaration, the employer shall fill in the "Approval Form for the Declaration of Work-related Injury (Death) Insurance Benefits for Employees" and the "Acceptance Form for Verification and Cancellation of Work-related Injury Medical Expenses", together with the original invoice for medical expenses, the "Work-related Injury Recognition Certificate" or "Occupational Disease Diagnosis Certificate", the "Work-related Disability Certificate", the approval of the labor administrative department for the work-related death of the injured employee, the wage payment form for the 12 months before the work-related injury (death), the certificate of supporting the immediate family, the employee's ID card and payment certificate, etc.;

3. If it is a traffic accident, it must be reported to the traffic police department for the analysis and handling of the responsibility of the accident;

If a hail is missing while away on business, it must be reported to the local public security department with a certificate of disappearance and a written verdict from the people's court declaring him dead;

If there is both civil compensation for work-related injury (death), civil compensation should be actively sought, and after the civil compensation is completed, fill in the "Civil Compensation Form for Work-related Injury (Death) of Employees" together with the civil compensation mediation letter and other relevant documents.