Reimbursement of self paid drugs for medical expenses related to work related injuries

According to the regulations, the medical expenses for work-related injuries shall be paid from the work-related injury insurance**; If the employer does not pay social insurance, the employer shall bear all the responsibilities.

Social Insurance Law of the People's Republic of China

Article 38 The following expenses incurred due to 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) 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 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.

1. If the factory has self-financed drugs, this cannot be reimbursed, so be sure to make it clear to the doctor.

2. Self-financed drugs are not reimbursed by the Social Security Bureau.

3.Neither pension insurance nor medical insurance will be able to reimburse the out-of-pocket drug.

If the unit is negligent, it is the unit's responsibility.

The unit shall pay it.

This law is clearly stipulated.

1. The medical expenses for work-related injuries shall be reimbursed by work-related injury insurance if there is work-related injury insurance, and shall be reimbursed by the employer if there is no work-related injury insurance.

2. Article 38 of the Social Insurance Law The following expenses incurred due to work-related injuries shall be paid from the 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 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 dissolved.

If these medical expenses are related to work-related injuries**, that is, they are rational use of drugs, then they should be borne by the unit;

If it is not related to the work-related injury**, it should be borne by the injured person.

If the hospital does not inform the patient when using the self-paid medicine for work-related injuries, then the hospital can file a complaint with the administrative authority of the work-related injury medical insurance. (such as the Municipal Industrial Injury Department, the Municipal Medical Insurance Department).

Legal analysis: After the work-related injury is identified, the 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 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), 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, **, surgery, laboratory tests, etc.), and 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 for treatment), the unit shall apply for reimbursement to the medical insurance agency (review department).

Legal basis: "Social Insurance Law of the People's Republic of China" Article 38 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) Those who are unable to take care of themselves shall be charged for living care expenses confirmed by the Labor Ability Appraisal Committee; (with a lack of Kai 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 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.

Legal analysis: The medical expenses for work-related injuries are generally paid by work-related injury insurance**, if the employer fails to pay work-related injury insurance in accordance with the regulations, it shall be paid by the employer, and if the employer does not pay, it shall be paid in advance from the work-related injury insurance** and reimbursed according to the employer. If the work-related injury is caused by a third party, and the third party does not pay the medical expenses for the work-related injury or the third party cannot be determined, the work-related injury insurance** shall pay in advance.

After the work-related injury insurance** is paid in advance, it has the right to recover from a third party. Generally, the person in charge of the unit will go to the social security institution with the required materials to go through the reimbursement procedures, or directly settle the settlement at the time of discharge. The specific handling process is implemented according to local policies.

Legal basis: Regulations on Work-related Injury Insurance

Article 2 Enterprises, public institutions, social organizations, private non-enterprise units, associations, law firms, accounting firms and other organizations within the territory of the People's Republic of China, as well as individual industrial and commercial households with employees (hereinafter referred to as "employers") shall, in accordance with the provisions of these Regulations, participate in work-related injury insurance and pay work-related injury insurance premiums for all employees or employees of their units (hereinafter referred to as "employee souyou").

Employees of enterprises, public institutions, social organizations, private non-enterprise units, associations, law firms, accounting firms and other organizations within the territory of the People's Republic of China, as well as employees of individual industrial and commercial households, shall have the right to enjoy work-related injury insurance benefits in accordance with the provisions of these Regulations.

Article 33 Where an employee is injured in an accident or suffers from an occupational disease at 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.

The period of leave without pay is generally not more than 12 months. If the injury is serious or the circumstances are special, it may be appropriately extended upon confirmation by the Labor Ability Appraisal Committee at the districted city level, but the extension must not exceed 12 months. After the work-related injury is assessed, the original benefits shall be suspended and the disability benefits shall be enjoyed in accordance with the relevant provisions of this Chapter.

If the injured employee still needs to be injured after the expiration of the suspension period, he or she shall continue to enjoy the medical treatment of the work-related injury.

If an injured employee who is unable to take care of himself needs nursing care during the period of suspension of work with pay, the unit to which he or she belongs shall be responsible.

Article 34 Where an injured worker has been assessed for disability and is confirmed by the Labor Ability Appraisal Committee to be in need of daily care, he or she shall be paid a monthly living care allowance from the work-related injury insurance.

The living care expenses are paid according to three different levels: completely unable to take care of themselves, most of them unable to take care of themselves, or part of their lives cannot take care of themselves, and the standards are respectively % or 30% of the average monthly salary of employees in the overall planning area in the previous year.

Reimbursement method for medical expenses for work-related injuries: **The expenses required for work-related injuries shall be paid in advance by the unit where the injured person belongs. After being identified by the labor and social security department as a work-related injury, the employer shall report and settle the expenses incurred that meet the requirements of the work-related injury insurance diagnosis and treatment items, the work-related injury insurance drug list, and the work-related injury insurance hospitalization service standards.

Social Insurance Law of the People's Republic of China

Article 38.

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) Food subsidy for living in a hospital with traces;

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;

9) Labor ability appraisal fee.

Social Insurance Law of the People's Republic of China

Article 39.

The following expenses incurred as a result of work-related injuries shall be paid by the employer in accordance with national regulations:

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

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

3) When the labor contract is terminated or dissolved, the one-time disability regret and return to work subsidy shall be enjoyed.

Legal Analysis: **The expenses required for work-related injuries shall be paid in advance by the injured person's employer. After being identified by the labor and social security department as a work-related injury, if the employer participates in the overall planning of work-related injury insurance, the expenses that meet the requirements of the work-related injury insurance diagnosis and treatment item catalog, the work-related injury insurance drug catalog, and the work-related injury insurance hospitalization service standards shall be reported and settled by the employer to the handling agency and the expenses that meet the payment scope of the work-related injury insurance** shall be settled by the handling agency to the cooperative medical institution of the work-related injury insurance agreement.

Legal basis: "Interim Measures for the Advance Payment of Social Insurance ** for Guides" Article 5 After receiving an application submitted by an individual in accordance with the provisions of Article 4, the social insurance agency shall review the situation of the individual's receipt of basic medical insurance** payment in advance and the payment of work-related injury insurance premiums by his or her employer, and deal with them in accordance with the following circumstances: (1) For the individual's employer has paid the work-related injury insurance premiums in accordance with the law, and the basic medical insurance** has been paid in advance before the work-related injury is determined, The social insurance agency shall, in accordance with the relevant provisions of work-related injury insurance, use work-related injury insurance to pay the medical expenses in excess of the advance payment of basic medical insurance, and refund the fees paid in advance to the basic medical insurance** 2) For the employer where the individual belongs has paid the work-related injury insurance premiums in accordance with the law, and the basic medical insurance ** has not paid in advance before the work-related injury is determined, the social insurance agency shall use the work-related injury insurance ** to pay the medical expenses for work-related injuries in advance3) If the employer's employer fails to pay the work-related injury insurance premiums in accordance with the law, and the basic medical insurance** has been paid in advance before the work-related injury is determined, the social insurance agency shall issue a written reminder notice to the employer within 3 working days, requiring the employer to pay the medical expenses in excess of the part paid in advance by the basic medical insurance** within 5 working days, and repay the medical expenses paid in advance to the basic medical insurance**.

If the employer fails to pay the remaining part of the medical expenses within the specified time, the social insurance agency shall pay the work-related injury insurance in advance.4) If the employer's employer fails to pay the work-related injury insurance premiums in accordance with the law, and the basic medical insurance** does not pay in advance before the work-related injury is determined, the social insurance agency shall issue a written reminder to the employer within 3 working days, requiring the employer to pay all the work-related injury medical expenses in accordance with the law within 5 working days, and the employer fails to pay within the specified time. The social insurance agency shall pay in advance with work-related injury insurance**.

**The cost of work-related injury shall be paid by the injured person's employer first.

After being identified by the labor and social security department as a work-related injury, the employer shall report and settle the expenses incurred that meet the requirements of the work-related injury insurance diagnosis and treatment items, the work-related injury insurance drug list, and the work-related injury insurance hospitalization service standards. Expenses that continue to be incurred within the scope of payment of work-related injury insurance** shall be settled by the handling agency to the cooperative medical institution of the work-related injury insurance agreement.

Legal basis. Article 5 of the Interim Measures for Advance Payment of Social Insurance ** After receiving the application submitted by the individual in accordance with the provisions of Article 4, the social insurance agency shall review the situation of the individual obtaining the basic medical insurance ** advance payment and the payment of work-related injury insurance premiums by the unit where he or she belongs, and deal with them in accordance with the following circumstances:

1) If the individual's employer has paid the work-related injury insurance premiums in accordance with the law, and the basic medical insurance** has been paid in advance before the work-related injury is determined, the social insurance agency shall, in accordance with the relevant provisions of the work-related injury insurance, use the work-related injury insurance** to pay the medical expenses in excess of the part paid in advance by the basic medical insurance**, and refund the expenses paid in advance to the basic medical insurance**;

2) If the individual's employer has paid work-related injury insurance premiums in accordance with the law, and the basic medical insurance** has not been paid in advance before the work-related injury is determined, the social insurance agency shall use the work-related injury insurance** to pay the work-related injury medical expenses in advance;

3) If the employer's employer fails to pay the work-related injury insurance premiums in accordance with the law, and the basic medical insurance** has been paid in advance before the work-related injury is determined, the social insurance agency shall issue a written reminder notice to the employer within 3 working days, requiring the employer to pay the medical expenses in excess of the part of the basic medical insurance** paid in advance within 5 working days, and repay the medical expenses paid in advance to the basic medical insurance**. If the employer does not pay the rest of the medical expenses within the specified time, the social insurance agency shall pay in advance with work-related injury insurance**;

4) If the individual's employer fails to pay the work-related injury insurance premiums in accordance with the law, and the basic medical insurance** is not paid in advance before the work-related injury is determined, the social insurance agency shall issue a written reminder to the employer within 3 working days, requiring the employer to pay all the work-related injury medical expenses in accordance with the law within 5 working days; If the employer fails to pay within the specified time, the social insurance agency shall pay in advance with work-related injury insurance**.