What are the specific conditions for reimbursement of work related injury insurance?

Work-related injuries can be reimbursed.

Employees who participate in work-related injury insurance can apply for recognition of work-related injuries through their units or individuals after a work-related accident, and can enjoy work-related injury medical treatment and disability benefits after being assessed as work-related injuries.

In addition, the following medical expenses that occur during the work-related injury medical treatment period approved by the Labor Ability Appraisal Center and during the ** period are within the scope of reimbursement of work-related injury medical expenses:

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, outpatient (emergency) consultation on the day of the work-related injury and hospitalization expenses within 7 days from the date of the work-related injury.

3. The medical expenses of outpatient (emergency) and hospitalization directly related to work-related injuries incurred by work-related injury insureds of work-related injury insurance participants on business trips, official study, and long-term work in other places due to business trips, official studies, and long-term work in other places.

The reimbursement process is more complicated, you ask the 51 social security Internet café, they can do personal social security and treatment applications.

Pure manual input, hopefully, thank you!

First of all, it is necessary to report to the company, write clearly the time and place of the work-related injury, the process of the incident and the witnesses at the scene, and apply to the labor inspection brigade for work-related injury identification. In the event of a work-related injury, the person in charge of social security shall immediately report to the person in charge of social security, and within 2 hours, the person in charge of social security shall report the case to the work-related injury insurance unit, and an application for work-related injury recognition shall be submitted within 1 month, and it generally takes 30 days for the determination to be determined. The relevant documents for reimbursement must belong to the designated hospital of medical insurance, and the drugs used are within the scope of medical insurance.

Submit the following materials:1Entity legal person license or business license (copy); 2.

The text of the labor contract or other valid proof of the establishment of the labor relationship; 3.ID card (copy); 4.Injury diagnosis certificate or occupational disease diagnosis certificate (or occupational disease diagnosis certificate) issued by a medical institution.

Legal basis

Article 6 of the Measures for the Determination of Work-related Injuries? To submit an application for work-related injury determination, the applicant shall fill in the Application Form for Work-related Injury Determination and submit the following materials: (1) a copy of the text of the employment contract or other supporting materials for the existence of labor relations (including actual labor relations) and personnel relations with the employer; (2) A post-injury diagnosis certificate or occupational disease diagnosis certificate (or occupational disease diagnosis and appraisal certificate) issued by a medical institution.

The following conditions must be met to apply for work-related injury insurance: there is an employment relationship between the employer and the employee; The work-related injury is recognized as a work-related injury or is treated as a work-related injury; The worker does not intentionally commit a crime, is drunk or takes drugs, assets, or suicide; Other. If an employee is injured in an accident or suffers from an occupational disease due to work-related reasons, and the work-related injury is recognized, he or she shall enjoy work-related injury insurance for rent; Among them, those who lose their ability to work after the appraisal of their ability to work enjoy disability benefits.

Legal basisArticle 14 of the Regulations on Work-related Injury Insurance.

In any of the following circumstances, it shall be found to be a work-related injury:

1) Being injured in an accident during working hours and in the workplace due to work-related reasons;

2) Being injured in an accident while engaging in preparatory or finishing work related to work in the workplace before or after working hours;

3) Injured by violence or other accidents during working hours and in the workplace due to the performance of work duties;

4) Suffering from occupational diseases;

5) Injured or unaccounted for in an accident while away for work;

6) Injured in a traffic accident or an accident involving urban rail transit, passenger ferry, or train for which they are not primarily responsible;

7) Other circumstances of family regret that shall be recognized as work-related injuries as provided by laws and administrative regulations.

The following conditions must be met for reimbursement of work-related injury insurance: there is an employment relationship between the employer and the employee; Identification of work-related injuries and appraisal of working ability; within the stipulated time; Other. If the work-related injury is determined to be a work-related injury, the employee shall enjoy the work-related injury insurance benefits; Those who lose their ability to work after being assessed for their ability to work shall enjoy disability benefits.

If the employer to which the employee works 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.

Legal basisArticle 30 of the Social Insurance Law of the People's Republic of China.

If an employee is injured in an accident or suffers from an occupational disease due to work-related reasons, and the work-related injury is recognized, he or she shall enjoy work-related injury insurance benefits; Among them, those who lose their ability to work after the appraisal of their ability to work enjoy disability benefits.

The determination of work-related injuries and the evaluation of labor ability shall be simple and convenient.

Information required for reimbursement of work-related injury expenses:

1. A copy of the front and back of the ID card of the injured employee;

2. The original medical receipt (with the signature of the injured employee or family member on the back), the list of total hospitalization expenses, the original and one copy of the outpatient medical record and discharge summary uniformly printed by the finance and taxation department;

3. The original and photocopy of the "Decision on Determination of Work-related Injury" or other valid work-related injury identification certificates.

Legal basisArticle 18 of the Regulations on Work-related Injury Insurance.

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 for work-related injury determination in writing at one time that all materials required to supplement and correct the work-related injury determination shall be completed.

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 of the Regulations on Work-related Injury Insurance.

After accepting an application for recognition of work-related injury, the social insurance administrative department may, as necessary for review, conduct an investigation and verification of the accident injury, and the employer, employee, trade union organization, medical institution 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. For those who have obtained a certificate of diagnosis of an occupational disease or a certificate of diagnosis and appraisal of an occupational disease in accordance with the law, the social insurance bank and the administrative department will no longer conduct investigation and verification.

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 worker'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 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 when the judicial reform 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.

1. Reimbursement of medical expenses should be accompanied by materials 1. A copy of the ID card of the injured employee; 2. Decision of the Municipal Labor and Social Security Bureau on the identification of work-related injuries; 3. "Municipal and Urban Employees' Work-related Injury Medical Termination Appraisal Form"; 4. Original expense bill; 5. If you are hospitalized, you shall provide a copy of the medical record of the hospitalization, a copy of the original invoice of the built-in fixation, a consent letter for medication and examination of non-work-related diseases, a consent letter for the bed fee or the built-in fixation exceeding the standard, and a detailed description of the hospitalization expenses, and affix the seal of the relevant department; 6. Provide diagnosis certificates, outpatient medical records, double-entry prescriptions (the double-entry prescriptions of outpatient clinics are consistent with the prescriptions of medical insurance, and are stamped with the "work-related injury insurance" stamp), checklists, etc. 2. Handle the one-time subsidy for 1---10 and injured employees, and provide the following information: 1. The conclusion of the labor ability appraisal of the Municipal Labor Ability Appraisal Committee; 2. The "Approval Form for One-time Subsidy for Work-related Disabled (Work-Dead) Employees" filled in by the employer in triplicate; 3. Handle 1---4 and disability allowance and nursing expenses for injured employees, and provide the following information: 1. The conclusion of the labor ability appraisal of the Municipal Labor Ability Appraisal Committee; 2. The Approval Form for Employees' Work-related Disability Pension and Nursing Expenses filled in by the employer in triplicate; 4. To handle the treatment of work-related deceased employees, the following information shall be provided: 1. Decision of the Municipal Labor and Social Security Bureau on the determination of work-related injuries; 2. Certificate of work-related death with legal effect; 3. The "Approval Form for One-time Subsidy for Work-related Disabled (Work-Dead) Employees" filled in by the employer in triplicate; 4. If there are dependent relatives, the valid identity documents of the dependent relatives, the original and photocopy of the household registration booklet, and the "Approval Form for Supporting Immediate Family Members of Employees Due to Work-related Death" filled in by the employer in triplicate.

The items reimbursed by work-related injury insurance** include: medical expenses and ** expenses incurred due to work-related injuries; Hospitalization meal subsidy; Transportation, accommodation and transportation expenses for medical treatment outside the co-ordination area; the cost of installing and configuring disability assistive devices; If they are unable to take care of themselves, the living care expenses confirmed by the Cong Jie Labor Ability Appraisal Committee; a one-time disability allowance and a monthly disability allowance for employees with disabilities of grades 1 to 4; A one-time medical subsidy to be enjoyed when the labor contract is terminated or dissolved; In the event of a work-related death, the survivors shall receive a funeral allowance on the basis of the funeral allowance, a pension for dependent relatives and a work-related death allowance; Labor ability appraisal fees can be paid from work-related injury insurance**.

It is also subject to local regulations.

Legal analysis: The expenses that can be reimbursed by work-related injury insurance are as follows: (1) Treatment (medical) expenses.

**The cost of a work-related injury must meet the relevant standards. (2) Hospitalization meal subsidy. (3) Transportation expenses, room and board expenses for medical treatment in other places.

4) **** fee. (5) Assistive device fees. Due to the needs of daily life or employment, the injured employee can be installed with assistive devices after confirmation by the Laohuai Destruction Ability Appraisal Committee, and the required expenses shall be paid from the work-related injury insurance ** in accordance with the standards stipulated by the state.

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 certificate issued by the medical institution and the consent of the handling agency, the transportation, accommodation and accommodation expenses required by the work-related injury lead bureau to prepare for 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 in the co-ordination area.

Diseases caused by non-work-related injuries shall not be entitled to medical treatment for work-related injuries and shall be handled 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**.