How to declare work related injury insurance benefits in the event of a work related injury during c

According to the regulations, units or individuals can apply to the Human Resources and Social Security Bureau for work-related injury determination.

Regulations on Work-related Injury Insurance.

Article 17 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 unit to which he 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 region. 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.

Matters that shall be determined by the provincial-level social insurance administrative department in accordance with the provisions of the first paragraph of this Article shall be handled by the social insurance administrative department at the districted-city level where the employer is located in accordance with the principle of territoriality.

If an employer fails to submit an application for determination of work-related injury within the time limit specified in the first paragraph of this Article, the employer shall bear the relevant expenses such as work-related injury benefits incurred during this period that comply with the provisions of these Regulations.

Article 18 The following materials shall be submitted to submit an application for determination of work-related injury:

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 of all the materials that need to be supplemented and corrected in writing at one time. After the applicant requests to supplement and correct the materials in accordance with the written notice, the social insurance administrative department shall accept it.

Article 19 After accepting an application for recognition of work-related injury, the social insurance administrative department may, according to the needs of the examination, conduct an investigation and verification of 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.

Article 20 The social insurance administrative department shall make a decision on the determination of work-related injury within 60 days from the date of acceptance of the application for work-related injury determination, and notify the employee or his close relatives and the employee's unit in writing of the application for work-related injury determination.

The "Opinions" stipulate that all construction enterprises shall participate in work-related injury insurance according to the employer's participation in work-related injury insurance and pay work-related injury insurance premiums based on the total salary according to law; For construction workers, especially migrant workers, who cannot participate in the insurance of the employer and are used in the construction project, they can participate in the work-related injury insurance according to the construction project and pay the work-related injury insurance premium according to a certain proportion of the total project cost. In particular, the opinions point out that those who participate in work-related injury insurance on a construction project basis may have priority in going through the procedures for participating in work-related injury insurance among various social insurances. At the same time, participation in work-related injury insurance in accordance with the law will be a precondition for the issuance of construction permits.

1. How to pay work-related injury insurance.

Work-related injury insurance premiums shall be paid by the employer, but not by individual employees. The employer takes the total salary of all employees of the unit as the payment base, and the payment rate of work-related injury insurance premiums is divided into three grades: 4 according to the risk level of the industry. The payment rate is regularly adjusted according to the use of the enterprise's work-related injury insurance premiums and the incidence of work-related injuries.

The employer's contribution base is determined as follows:

The total monthly average salary of all employees in the previous year shall be the payment base of the employer, and the average monthly total amount of individual employees shall be calculated based on the average monthly salary income of the employee in the previous year.

If the total average monthly wage of units and individual employees is lower than 60 of the average monthly wage of employees in the previous year, 60 of the average monthly wage of employees in this city shall be used as the payment base; The part that is higher than the average monthly salary of employees in the city is more than 30 yuan, and is not included in the payment base.

Second, who pays for work-related injury insurance.

If the employer participates in the insurance, the work-related injury compensation expenses shall be paid separately by the work-related injury insurance** and the employer; If the employer does not participate in the insurance, the employer shall pay for it.

According to Article 41 of the Social Insurance Law of the People's Republic of China, if the employer of the employee fails to pay the work-related injury insurance premiums in accordance with the law, and a work-related 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 reimbursed by the employer. If the employer fails to repay, the social insurance and insurance agency may recover compensation in accordance with the provisions of Article 63 of this Law.

All kinds of medical expenses that occur during the medical period and ** period approved by the Labor Ability Appraisal Center (hereinafter referred to as the Municipal Labor Appraisal Center) belong to the scope of reimbursement of work-related injury insurance benefits in the construction industry

1. Medical expenses related to work-related injuries incurred by work-related injury insurance participants in work-related injury agreement medical institutions.

2. The medical expenses of outpatient (emergency) and hospitalization directly related to the work-related injury incurred by the work-related injury insured person in the non-work-related injury agreement hospital in accordance with the principle of nearby rescue after the work-related injury occurs. That is, the outpatient (emergency) consultation on the day of the work-related injury and the cost of hospitalization within 7 days from the date of the work-related injury.

3. The medical expenses of outpatient (emergency) consultation and hospitalization directly related to work-related injuries occur outside the overall planning area of the work-related injury of the work-related injury of the work-related injury insured person who is on a business trip, study assignment or long-term work in a different place due to business trips, official study, or long-term work in other places.

Work-related injury insurance benefits for construction workers.

The regulations clearly point out that construction enterprises shall participate in work-related injury insurance for their permanent employees in the manner of employers; For those who cannot participate in the insurance according to the employer, especially migrant workers, they can participate in the insurance according to the construction project, and can give priority to the procedures for participating in the work-related injury insurance in various social insurances; For projects that fail to submit proof of participation in work-related injury insurance according to the project and fail to implement safety construction measures, no construction permit will be issued. At the same time, in order to avoid the problem of non-implementation of work-related injury insurance benefits for work-related injury employees who only complete the work-related injury identification and appraisal after the completion of the project. The provisions also point out that those who have suffered work-related injuries during the construction of the insured projects and have not completed the identification and appraisal of work-related injuries when the project is completed shall enjoy various work-related injury insurance benefits in accordance with the law.

How is it reimbursed by workers' compensation insurance.

The employer shall go through the declaration and settlement procedures at the social security sub-center before the 10th of each month. The sub-center prints the relevant treatment verification form for the employer, and the employer affixes the seal of the unit manager after verifying that it is correct. Disability allowance, living care expenses, pensions for dependent relatives, disability subsidies and medical subsidies can be transferred to the social payment account of injured employees or dependent relatives on the 20th of each month through the issuing agency; Other benefits shall be paid to the employer, which shall pay them on behalf of the employer; The medical (**) fee settled by the network is paid to the medical institution; The assistive device dispensing fee is paid to the agreement dispensing agency.

What are the benefits of work-related injury insurance?

Benefits paid by work-related injury insurance** include: work-related injury medical expenses; Work-related injury ** pay; Hospitalization meal subsidy; Transportation, accommodation and expenses for medical treatment outside the co-ordinating area; Assistive device installation and configuration fee; living care expenses; a one-time disability benefit; Disability allowance for employees with disabilities of grades 1 to 4; one-time medical benefits for work-related injuries; funeral grants; Dependent family pension; One-time work-related death benefit. Benefits paid by the employer include:

wages and benefits during the period of suspension of work; Living care expenses during the period of leave of absence with pay; Disability allowance for Zaochun for grade 5 and grade 6 disabled employees; One-time Disability Employment Grant.

The work-related injury insurance of the construction enterprise shall be purchased by the enterprise for its employees within 30 days from the date of employment, and the payment shall be made in full every month. Enterprises shall pay work-related injury insurance premiums according to the total wages of all employees and according to the rate determined by the social insurance agency.

[Legal basis].

Article 33 of the Social Insurance Law of the People's Republic of China.

Employees shall participate in work-related injury insurance, and the work-related injury insurance premiums shall be paid by the employer, and the employees shall not pay the work-related injury insurance premiums.

Article 35.

The employer shall pay the work-related injury insurance fee according to the total wages of its employees and the rate determined by the social insurance agency.

Article 58.

The employer shall, within 30 days from the date of employment, apply to the social insurance agency for social insurance registration for its employees. If they fail to register for social insurance, the social insurance agency shall verify and approve the social insurance premiums they should pay.