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1. The applicant is the employer.
2. The applicant is the applicant's own fill-in: me.
3. If the applicant is a relative, fill in: close relative.
4. If the applicant is a trade union organization, fill in: trade union.
Note: If the employer fails to submit an application for work-related injury recognition in accordance with the provisions of Paragraph 1 of Article 17 of the Regulations on Work-related Injury Insurance, the injured employee or his immediate family members or trade union organizations may directly submit the application materials for work-related injury recognition to the Municipal Labor and Social Security Bureau within one year from the date of the accident injury or the date of diagnosis or appraisal of the occupational disease.
1. Instructions for filling in the form.
1. Fill in with a pen or signature pen, and the font is neat and clear without alteration.
2. If the applicant is an employer or a trade union organization, the official seal shall be affixed to the name.
3. Employees of public institutions fill in the occupational category, and employees of enterprises fill in the job position (or type of work) category.
4. Fill in the specific part of the injury in the column of the injured part.
5. In the column of diagnosis time, for occupational diseases, fill in according to the time of diagnosis of occupational diseases; If you are injured or killed, fill in the information according to the time of initial consultation.
6. The name of the occupational disease shall be filled in according to the occupational disease diagnosis certificate or the occupational disease diagnosis and appraisal certificate, and the time of exposure to occupational disease hazards shall be filled in according to the actual contact time. If it is not an occupational disease, do not fill in.
7. After a brief description of the injury, the time and place of the accident, the work performed at that time, the cause of the injury, and the location and extent of the injury should be clearly stated.
2. In any of the following circumstances, it shall not be recognized as a work-related injury or treated as a work-related injury:
1. Intentionally committing a crime.
2. Drunk or drug-addicted.
3. Self-harm or suicide.
3. Employees who are identified as having a disability of grade 7 to 10 due to work-related disability shall enjoy the following benefits:
1. A one-time disability subsidy shall be paid according to the level of disability from work-related injury insurance, and the standard is: 13 months' salary for grade 7 disability, 11 months' salary for grade 8 disability, 9 months' salary for grade 9 disability, and 7 months' salary for grade 10 disability.
2. If the labor or employment contract is terminated upon expiration, or the employee himself proposes to terminate the labor or employment contract, the work-related injury insurance shall pay a one-time medical subsidy for work-related injury, and the employer shall pay a one-time disability employment subsidy. The specific standards for one-time medical subsidies for work-related injuries and one-time employment subsidies for disability shall be prescribed by the people of provinces, autonomous regions and municipalities directly under the Central Government.
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Where a close relative applies for a work-related injury determination, the relationship with the injured person shall be filled in truthfully.
If an injured employee is injured in an accident and the close relatives of the injured employee apply for a work-related injury determination, the relationship between the applicant and the injured person refers to the relationship between the applicant and the injured employee, and if the wife applies for it, the spouse shall be filled; If the younger brother applies for recognition, fill in the younger brother. Fill in the information according to the actual relationship with the injured employee.
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For example, if you are the father of the injured person, fill in "father and daughter" or "father and son", if you are the mother of the injured person, fill in "mother and son" and "mother and daughter", and if you are a company, fill in "employment".
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Fill in according to the actual situation, and if the applicant is determined to be injured by the injured employee, fill in the party. If it is an employee who is in a position, fill in the employer. If it is a close relative of the injured employee, fill in the relationship between the two parties, such as father and son, father and daughter, mother and son, etc.
Legal basis: Article 70 of the Labor Law of the People's Republic of China The State develops social insurance, establishes a social insurance system, and establishes social insurance**, so that workers can receive help and compensation in the event of old age, illness, work-related injury, unemployment, childbirth, etc. Article 45 of the Labor Contract Law of the People's Republic of China stipulates that if a labor contract expires and falls under any of the circumstances specified in Article 42 of this Law, the labor contract shall be renewed until the corresponding circumstances disappear and terminated.
However, Paragraph 2 of Article 42 of this Law stipulates that the termination of the labor contract of a worker who has lost or partially lost the ability to work shall be executed in accordance with the provisions of the State on work-related injury insurance.
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Analysis of the law of hailstorms: If the applicant for work-related injury determination is an employer, the relationship between the applicant and the injured employee in the source rubber file of the work-related injury determination application form is filled in with the labor relationship. If the applicant for work-related injury determination is an individual, the relationship between the applicant and the injured employee in the work-related injury determination application form shall be filled in with the applicant.
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 and individual industrial and commercial households with employees (hereinafter referred to as "employers") shall participate in work-related injury insurance in accordance with the provisions of these Regulations and pay work-related injury insurance premiums for all employees or employees (hereinafter referred to as "employees") of the unit. 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.
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After an employee suffers a work-related injury in the course of work, the level of disability shall be determined through the work-related injury determination. To apply for work-related injury identification, it is necessary to submit the application form for work-related injury identification and related materials, and the content of the application form should be filled in truthfully, including a column for the relationship between the applicant and the injured employee, which should be filled in according to the actual situation. If it is an employer, fill in the employer.
If the injury history is a close relative of the employee, fill in the relationship between the two parties, such as father and son, father and daughter, mother and son, etc.
Legal basis: Article 14 of the Regulations on Work-related Injury Insurance An employee shall be deemed to have suffered a work-related injury under any of the following circumstances: (1) he or she is 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 work-related preparatory or finishing work in the workplace before or after working hours; (3) Suffering violence or other accidental injuries during working hours and in the workplace as a result of performing work duties; (4) Suffering from an occupational disease; (5) During the period when they are away for work, they are injured due to work reasons or their whereabouts are unknown in an accident; (6) Being injured in a traffic accident or an urban rail transit, passenger ferry, or train accident for which they are not primarily responsible while commuting to or from work; (7) Other circumstances that laws and administrative regulations provide shall be recognized as work-related injuries.
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According to the actual situation, fill in the party, if the applicant is determined to be the injured employee. If it is an employer, fill in the employer. If it is a close relative of the injured employee in Lu Jula, fill in the relationship between the two parties, such as father and son, father and daughter, mother and son, etc.
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Legal round-by-round analysis: fill in according to the actual situation, if the applicant is determined to be injured by the injured employee, fill in the party. If it is an employer, fill in the employer.
If it is a close relative of the injured employee, fill in the relationship between the two parties, such as father and son, father and daughter, mother and child, etc.
Legal basis: Article 18 of the Regulations on Work-related Injury Insurance The following materials shall be submitted to apply for work-related injury identification: (1) Application form for work-related injury identification; (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 the time, place, and cause of the accident, as well as the degree of injury of the employee, and other basic information. If the materials provided by the applicant for work-related injury determination are incomplete, the social insurance administrative department shall inform the applicant in writing of all the materials that need to be supplemented and corrected 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.
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