Is direct causation the same as indirect causation for work related injuries?

There is a very important core principle of work-related injury insurance in China: the principle of no-fault liability. That is, in the event of a work-related injury, the employee shall not be investigated for subjective fault, and as long as there is a result of damage, it shall be recognized as a work-related injury.

In case of accidental negligence, even if the employee is responsible or at fault for injury, disability or death in the course of labor, even if it is caused by violating the operating procedures or code of conduct of the enterprise, as long as it is not suicide or self-injury, it should be recognized as a work-related injury and enjoy work-related injury insurance benefits.

Hello, work-related injury compensation should be based on the work-related injury appraisal report, and the appraisal report shall prevail.

Legal Analysis: 1. Handling Conditions.

The disease suffered by the injured employee is related to the site of the work-related injury (occupational disease) and has been clearly diagnosed by the hospital.

Second, the basis for handling.

1) Social Insurance Law of the People's Republic of China; (2) Regulations on Work-related Injury Insurance (Order No. 586); (3) Administrative Measures for the Appraisal of Labor Ability of Employees Injured at Work (Decree No. 21 of the Ministry of Human Resources and Social Security); (4) Notice on Printing and Distributing the Implementation Measures for the Implementation of the Regulations on Injury Insurance in Shandong Province (Lu Zhengfa [2011] No. 25); (5) Notice on Printing and Distributing the Work Regulations for the Appraisal of the Labor Ability of Employees Injured at Work in Shandong Province (Lu Ren She Gui 2017 No. 4).

3. Handling process and time limit.

1.Apply online.

1) Units or individuals can log on to the official website of "Qingdao Human Resources and Social Security Bureau";

2) Enter the "Online Service Hall" section, and click the "Social Insurance Declaration" module for unit users; Individual users click on the "Personal Inquiry" module and log in with their username and password;

3) The unit enters the "social security treatment" - "application for labor ability appraisal"; Individuals enter the "Social Insurance" - "Application for Labor Ability Appraisal" and enter the information;

4) Upload materials (including initial medical records, outpatient medical records, inpatient medical records, first admission records, surgical records, discharge summaries, relevant examination reports, laboratory results and other effective materials related to injuries and conditions);

5) Prepare to upload the original and copies of the materials, etc., and keep them for future reference during the on-site identification.

Legal basis: Article 30 of the Regulations on Work-related Injury Insurance 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 for the work-related injury, as well as the transportation, accommodation and accommodation expenses required for the work-related injury employee to seek medical treatment outside the co-ordination area shall be paid from the work-related injury insurance, and the specific standard of payment shall be stipulated by the people of the co-ordination 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**.

Legal Analysis: Appraisal of Diseases Caused by Work-related InjuriesThe appraisal of work-related injuries is based on the identification of work-related injuries by the employees who apply for work-related injury appraisal, and after the end of their medical treatment or the expiration of the medical treatment period, they shall be appraised by the labor ability appraisal committee at or above the level of districted cities.

Legal basis: Regulations on Work-related Injury Insurance 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 social insurance administrative department shall make a decision on the determination of work-related injury within 15 days of accepting an application for work-related injury determination where the facts are clear and the rights and obligations are clear.

Where it is necessary to base a decision on the determination of work-related injuries on the basis of the conclusion of the judicial organ or the relevant administrative department, the time limit for making a determination of work-related injury is suspended during the period that the judicial organ or the relevant administrative department has not yet made a conclusion.

Where the staff of the social insurance administrative department has an interest in the applicant for work-related injury determination, they shall recuse themselves.

Your question is not clear.

If the appraisal of the work-related injury has already been made, then you can only submit a re-appraisal to the superior within the specified period, and if the appraisal has been made, then the procedure of the appraisal has ended.

The causal relationship you are talking about may refer to the causal relationship between the current injury and the work-related injury, which should actually be determined by the labor administrative department in the process of determining the work-related injury, and if it is necessary in the process, the labor administrative department may entrust a judicial appraisal to conduct an appraisal, and if it is not satisfied with the location or scope of the work-related injury determination obtained by doing or not doing this causal relationship appraisal, it can file an administrative reconsideration or lawsuit, and then the reconsideration department or the court will conduct a review.

As for whether there is a causal relationship due to various reasons in the work-related injury determination procedure, the general labor ability appraisal committee will consider it when organizing the appraisal, but it will not entrust a judicial appraisal. The conclusion of the labor ability appraisal is not actionable, and only an application for re-appraisal can be made.

Legal analysis: To apply to the Human Resources and Social Security Bureau (formerly the Labor Bureau) for recognition of work-related injury, the company needs to report within one month of the accident, and if the company does not apply, the injured employee or his close relatives shall submit an application for recognition within one year.

Legal basis: 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 Control 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 on which the source of the employee is diagnosed or appraised as an occupational disease, submit an application for recognition of work-related injury to the social insurance administrative department of the coordinating area. 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: When a people's court hears an administrative case for the determination of work-related injury, it shall rely on the legal documents such as the determination of accident responsibility, the conclusive opinion, and the effective judgment of the people's court issued by the competent authority when determining whether there are circumstances such as "the person's primary responsibility" in Article 14 (6), "drunkenness or drug abuse" in Article 16 (2) of the "Regulations on Work-related Injury Insurance", and "self-harm or suicide" in Article 16 (3).

Legal basis: The determination of "intentional crime" in item (1) of article 16 of the "Regulations of the People's Republic of China on Work-related Injury Insurance" shall be based on the effective legal documents or concluding opinions of the criminal investigation organs, procuratorial organs and adjudication organs.

Article 2: Where, after accepting an administrative case for the determination of work-related injuries, the people's court discovers that the plaintiff or a third party has applied for labor arbitration or filed a civil lawsuit on the existence of a labor relationship before initiating the administrative lawsuit, it shall suspend the trial of the administrative case.

Article 3: Where the social insurance administrative departments designate the following units as units that bear responsibility for work-related injury insurance, the people's courts shall support them:

1) The employee establishes labor relations with two or more units, and when a work-related accident occurs, the unit for which the employee works is the unit that bears the work-related injury insurance liability; (2) If an employee dispatched by a labor dispatch unit is injured due to work during the period of work in the employing unit, the dispatching unit shall be the unit that bears the liability for work-related injury insurance; (3) If the employee assigned by the unit to work in another unit is due to work, the designated unit shall be the unit that bears the responsibility for work-related injury insurance;

4) Where an employing unit violates laws or regulations by subcontracting business to an organization or natural person that does not have the qualifications of an employing entity, and the employees hired by the organization or natural person are engaged in the contracting business due to work, the employing unit shall be the unit that bears the liability for work-related injury insurance;

5) If an individual is affiliated with another unit for external business, and the personnel employed by it are due to work, the affiliated unit shall be the unit that bears the responsibility of work-related injury insurance.