Can I be fully reimbursed for medical expenses related to work related injuries?

Business Week will reply to you in detail:

The medical expenses of the injured employee ** who are injured at work meet the standard for full reimbursement.

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 are entitled to work-related injury medical treatment. **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**. **Diseases not caused by work-related injuries are not entitled to work-related injury medical treatment, and shall be handled in accordance with the basic medical insurance measures.

Expenses in excess of the prescribed standard are at your own expense.

If the answer is helpful to you!

The medical expenses for work-related injuries can only be reimbursed if they meet the standards, and they are also based on your work-related injury appraisal level and other circumstances.

As long as the regulations are met, they can be reimbursed in full.

According to Article 29 of the Regulations on Work-related Injury Insurance, the medical treatment for work-related injuries includes: medical expenses of 100 are paid by work-related injury insurance**.

However, the medical expenses required for work-related injuries and the expenses of the work-related injuries to the medical institutions that have signed the service agreement must meet the national requirements of the work-related injury insurance medical project catalog, work-related injury insurance drug catalog, and work-related injury insurance hospitalization service standards, which can only be paid by the work-related injury insurance.

Generally speaking, the expenses that are not reimbursed are as follows.

Self-financed drugs, imported drugs, self-paid materials, imported materials, repeated unnecessary examinations, diseases unrelated to work-related injuries**, excessive**, and the use of a medical insurance card at the time of admission caused the medical insurance co-ordination to pay the expenses.

If it is a work-related injury caused by a traffic accident for which the other party is fully responsible, the cost shall be borne by the third-party responsible person. If the employer does not insure the injured employee, the employer shall bear the costs.

All those within the scope of reimbursement stipulated by the state can be reimbursed.

Work-related injury insurance also has a drug list, and work-related injury insurance that is not in the list does not pay.

In the actual process, the expenses that are not reimbursed by the work-related injury insurance shall be borne by the unit. Employees do not have to bear it.

Legal analysis: The Social Insurance Law stipulates that work-related injuries cannot be reported for medical insurance, and the expenses arising from work-related injuries are paid by work-related injury insurance. If the worker is injured because of work, the medical expenses will be paid in advance by the injured employee, or the unit can be paid in advance, and after the work-related injury is identified, the medical expenses will be reimbursed by the work-related injury insurance, and the part that cannot be reimbursed shall be borne by the unit.

Legal basis: "Social Insurance Law of the People's Republic of China".

Article 30 The following medical expenses are not included in the scope of payment of basic medical insurance**: (A) shall be paid from work-related injury insurance**; (2) It shall be borne by a third party; (3) It shall 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.

Article 38 The following expenses incurred as a result of 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) Subsidies for in-hospital meals; (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 subsidy and a monthly disability allowance for disabled employees 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 work-related death, the funeral allowance, pension for dependent relatives and work-related death allowance received by the surviving family members; (9) Labor ability appraisal fee.

In principle, it is fully reimbursed.

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.

Social Insurance Law of the People's Republic of China

Article 38 The following expenses incurred as a result of work-related injuries shall be paid from work-related injury insurance in accordance with the provisions of the state:

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

(2) Subsidies for in-hospital meals;

(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 subsidy and a monthly disability allowance for disabled employees 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 work-related death, the funeral allowance, pension for dependent relatives and work-related death allowance received by the surviving family members;

(9) Labor ability appraisal fee.

Legal analysis: Work-related injury medical expenses can only be reimbursed for expenses that meet the requirements of work-related injury insurance diagnosis and treatment items, work-related injury insurance drug Layeqin, and work-related injury insurance hospitalization service standards, so they cannot be fully reimbursed. According to the regulations on work-related injury insurance, the unit shall, within 30 days from the date of injury in the accident, apply to the department coordinating the regional social insurance administration for work-related injury determination; If the employer misses the time to apply for a work-related injury determination, the injured employee and his or her close relatives can also apply for a work-related injury determination within one year of the injury.

Legal basis: Article 30 of the Regulations on Work-related Injury Insurance stipulates that employees who are injured in accidents or suffer from occupational diseases due to work shall enjoy medical treatment for work-related injuries. Employees who are injured at work shall seek medical treatment in a medical institution that has signed a service agreement, and in case of emergency, they can first go to the nearest medical institution for first aid.

**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**. The catalogue of work-related injury insurance diagnosis and treatment items, the catalogue of work-related injury insurance drugs, and the hospitalization service standards of work-related injury insurance shall be prescribed by the social insurance administrative department in conjunction with the health administrative department, the food and drug supervision and administration department and other departments. The food subsidy for the hospitalization of the employee and the work-related injury, as well as the transportation, accommodation and transportation expenses required for the work-related injury employee to seek medical treatment outside the overall planning area shall be paid from the work-related injury insurance, and the specific standard of payment shall be stipulated by the people of the overall planning area.

Injured employees are not entitled to medical treatment for work-related injuries and shall be dealt with in accordance with the basic medical insurance measures. 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**.

Work-related injury medical expenses can only be reimbursed for expenses that 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, so they cannot be fully reimbursed.

1. What should I do if the work-related injury unit does not pay the medical expenses for the work-related injury?

1. Complain to the labor administrative department for payment. The purpose of formulating the Regulations on Work-related Injury Insurance is to ensure that employees who are injured in accidents or suffer from occupational diseases due to work receive medical treatment and economic compensation, promote work-related injury prevention and occupational health, and disperse the work-related injury risk of employers. Work-related injury insurance is a compulsory insurance that employers must pay for their employees.

According to Article 60 of the Regulations on Work-related Injury Insurance, if an employer fails to participate in work-related injury insurance in accordance with these Regulations, the labor and social security administrative department shall order it to make corrections; If an employee of an employer suffers a work-related injury during the period when he has not participated in work-related injury insurance, the employer shall pay the expenses in accordance with the work-related injury insurance benefits and standards stipulated in these Regulations. It can be seen that there is a legal basis for requiring employers to pay medical expenses for work-related injuries.

2. You can first apply to the court for a payment order. If the employer refuses to pay the medical expenses after reaching an agreement with the employee, it can request the court to issue a payment order in accordance with the law, which is also relatively fast.

3. Request for labor arbitration.

4. Dissatisfied with arbitration and file a lawsuit. This is the ultimate relief for the laborer. In accordance with Article 48 of the Law of the People's Republic of China on Mediation and Arbitration of Labor Disputes:

If the worker is not satisfied with the arbitral award provided for in Article 47 of this issue, he may file a lawsuit with the people's court within 15 days from the date of receipt of the arbitral award.

2. What are the materials required for reimbursement of medical expenses for work-related injuries?

1. Notice of work-related injury identification and diagnosis certificate;

2. A copy of the injured person's ID card;

3. Copies of outpatient medical records, invoices, prescriptions and related examination and laboratory documents;

4. Copy of inpatient medical record, hospitalization certificate and discharge certificate;

5. List of discharge expenses, daily list, and invoice of hospitalization charges;

6. Other relevant materials deemed necessary by the handling agency.

1. Reimbursement of work-related injury medical expensesAfter the work-related injury is identified, the work-related injury medical expenses incurred by the employee shall be based on 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 current medical history, the examination, the diagnosis, the operation process, the outcome of the post-work, and the difference in the discharge note. 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). 2. The problem of reimbursement of personal medical expenses: the expenses of work-related injuries of employees who have been registered abroad and work-related injuries who have settled in other places in the agreement medical institutions that they choose to record; Approved transfer to a medical facility other than the agreed medical institution; Expenses for the injured employee to visit relatives in China or to have an old injury in a foreign country (only in a non-profit medical institution); Emergency and first aid expenses incurred due to work-related injuries during business trips.

The following information must be submitted for reimbursement of personal medical expenses: approval procedures for referral and transfer, certificate of family visit or business trip of the insured unit or certificate from the relevant hospital, discharge summary (including: date of admission and discharge, admission complaint, present medical history, examination, diagnosis, **, surgical process, ** post-prognosis, and precautions for discharge.)

Stamped with the seal of the hospital), a detailed list of medical expenses (including: the name, dosage, number of times, unit price, and 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).

Article 38 of the Social Insurance Law of the People's Republic of China 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) Subsidies for in-hospital meals; (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 subsidy and a monthly disability allowance for disabled employees 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 work-related death, the funeral allowance, pension for dependent relatives and work-related death allowance received by the surviving family members; (9) Labor ability appraisal fee.