How much do you need to know about work-related injury insurance
Work-related injuries have always been a headache for office workers. Once a work-related injury occurs, it takes a long time to identify it. So, regarding work-related injuries caused by different situations, who will pay work-related injury benefits?
1. What kind of work-related injury benefits need to be paid by the unit?
1. Wages during the suspension of work period
Article 33 of the "Regulations on Work-related Injury Insurance" stipulates: "An employee who is injured in an accident at work or suffers from an occupational disease needs to suspend work to receive medical treatment for work-related injuries. , During the suspension of work and salary period, the original wages and benefits remain unchanged and are paid by the employer on a monthly basis. "There is a transition period between the employee's work-related injury and the assessment of the disability grade - the suspension of work and salary period. During this period, the employee lay in bed unable to move and could not go to work, but the unit still had to pay him wages.
2. Nursing expenses during the suspension of work and salary period
Article 33 of the "Work-related Injury Insurance Regulations" stipulates: "If a work-injured employee who cannot take care of himself needs care during the suspension of work and salary period, The unit is responsible. "If an employee is lying in bed and unable to move, someone must take care of basic daily living. In reality, the unit usually does not send someone to do it, but spends money! Generally, the payment is based on the local nursing standards (such as 100 yuan/day) or the nursing staff's missed work fee.
(P.S. With the consent of the injured employee or his relatives, the nursing fee can also be paid according to the average monthly rate for one employee of the unit in the previous year)
3. Level 5 and Level 6 disability Subsidies
Article 36 of the "Regulations on Work-related Injury Insurance" stipulates: "Employees who are disabled due to work and are identified as grade five or grade six disabilities shall enjoy the following benefits: (2) Retention of benefits with the employer In terms of labor relations, the employer will arrange appropriate work. If it is difficult to arrange work, the employer will provide disability allowances on a monthly basis. "After the employee has been assessed the disability level, the employer will no longer have to pay wages and nursing fees during the suspension of work period. , employees will officially enjoy disability benefits from now on. The level five disability allowance is 70% of the employee's salary, and the level six disability allowance is 60%.
So how long will the unit be issued?
If the employee does not want to drag on like this and wants to make a clean break as soon as possible, the employer can pay him a one-time disability employment subsidy to terminate the labor relationship between the two parties, and the disability allowance will naturally not need to be paid later.
If the employee's injury prevents him from engaging in other work arranged by the company, it will undoubtedly be a disaster for the company, because in this case, the company will have to pay disability allowance until the employee starts to enjoy basic pension. up to insurance benefits. Regarding income insurance issues such as pension education funds, I have just compiled relevant content. I hope it will be helpful to you: List of the 8 pension and education funds with the highest yields in 2020
4. One-time disability Employment subsidy
The one-time disability employment subsidy is a one-time payment settled by the unit when the injured employee terminates the labor relationship with the unit. It is only applicable to work-related injuries of grades 5 to 10. Because disabled employees with levels 1 to 4 must retain their labor relationship, quit their jobs, and enjoy disability benefits, there is no problem of paying a one-time disability employment subsidy.
The formula is: the standard of one-time disability employment subsidy is the average monthly salary of employees in the previous year × the number of months. (P.S The specific provisions of the monthly coefficient are different in each region)
Attention! If the company fails to pay work-related injury insurance for its employees, then the company should also bear the subsequent work-related injury benefits!
2. What kind of work-related injury benefits does the unit not have to pay?
1. Post-disability assessment nursing expenses
Article 34 of the "Regulations on Work-related Injury Insurance" stipulates: "Work-injured employees have been assessed with a disability level and confirmed by the Labor Capacity Appraisal Committee that they need to live. For nursing care, daily nursing expenses will be paid monthly from the work-related injury insurance fund. ”
After the disabled employee is assessed as being in need of continued nursing care, the nursing fee will no longer be paid by the employer. Paid from the Work Injury Insurance Fund.
2. Medical expenses within the scope of medical insurance
As long as the unit pays work-related injury insurance for employees in accordance with the law, the unit does not need to bear the medical expenses within the scope of medical insurance. There are two situations. Processing:
(1) Work-related injuries not caused by a third party’s tort
If the injury is not caused by another person’s tort, the cost of employee treatment will be reimbursed by the work-related injury insurance fund, and the unit No need to pay a penny! However, the prerequisite must be in compliance with the Work Injury Insurance Diagnosis and Treatment Item Catalog, Work Injury Insurance Drug Catalog, and Work Injury Insurance Inpatient Service Standards.
(2) Work-related injuries due to third party tort
If you are hit by a third party due to work reasons, hit by others on the way to and from get off work, etc., according to tort liability, the tort liability shall be The person shall bear the medical expenses within the scope of responsibility. Within the portion borne by the infringer, as long as they are reasonable treatment expenses (not subject to medical insurance coverage), they will be paid by the infringer; however, if the third party does not pay for work-related injury medical expenses or the third party cannot be identified, the infringer may file a claim with the work-related injury insurance fund. Apply for advance payment. When employees who are injured at work bear part of the responsibility, the treatment expenses covered by medical insurance are reimbursed by the work-related injury fund.
3. Food subsidy during hospitalization
Usually when an employee is hospitalized, the food expenses in the hospital will definitely be more expensive than the food expenses at home. Therefore, the regulations stipulate that reasonable food expenses are The excess is paid by the fund.
Calculation formula: Compensation amount for hospitalization food subsidy = standard of food subsidy for general staff of state agencies on business trips (yuan/day) × number of days of hospitalization
4. Transportation required for medical treatment abroad , food and accommodation expenses
Many times, the hospital to which workers injured at work are sent in an emergency is often unable to meet adequate medical equipment requirements, and they need to be transferred to hospitals outside the city for treatment. The transportation costs and food expenses incurred during this process Accommodation fees are also paid by the fund.
5. Work-related injury rehabilitation fees and assistive device fees
Work-injured employees should go to the medical institution that has signed a service agreement (i.e. the designated hospital for work-related injury insurance). They can go to the local social insurance center to check the designated work-related injury insurance agreement agency. List) The expenses for work-related injury rehabilitation shall be paid from the work-related injury insurance fund if they comply with the regulations.
For daily life or employment needs, workers injured at work can be equipped with prostheses, orthotics, prosthetic eyes, dentures and wheelchairs and other assistive devices after confirmation by the Labor Capacity Appraisal Committee. The required fees will be based on national standards. Payment from the Work Injury Insurance Fund.
6. One-time disability subsidy for grades 1 to 10
The one-time disability subsidy is a one-time occupational injury compensation for workers who are disabled on the job. Specifically, it is Calculated based on disability level.
7. One-time work-related injury medical subsidy for levels 5 to 10
The reason why it is called "one-time" means that it is settled in one go when the employee and the unit terminate or terminate the labor relationship. The amount is only paid by the fund, which is the medical insurance cost for future medical treatment for disabled employees.
8. Level 1~4 Disability Allowance
If an employee is assessed as having a level 1~4 disability, usually the employer cannot terminate the employment relationship with him or her because this type of employee basically loses Without the ability to take care of himself, it will be difficult to return to work in the future, so the fund will pay his monthly disability allowance to provide living security.
9. Work-related death benefits
①Funeral subsidy
Funeral subsidy = local average monthly salary of employees in the previous year × 6
② Dependent relatives pension
Spouse: the deceased’s salary × 40% (paid monthly);
Other relatives: the deceased’s salary × 30% (each person per month);< /p>
If the above-mentioned persons are elderly people or orphans - add 10% to the above standards;
Total: the sum of pensions should ≤ the employee’s monthly salary (calculated on a monthly basis)
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③One-time work-related death benefit:
One-time work-related death benefit = ×20 of the national per capita disposable income of urban residents in the previous year
2016: One-time work-related death benefit = 31,195 yuan × 20 = 623,900 yuan
3. When can we stop paying work-related injury benefits?
1. Loss of conditions for enjoying benefits
The "loss of conditions" here usually occurs when the injured employee recovers, or the injured employee dies, or the injured employee begins to enjoy pension insurance benefits. Or the minor relative who died on the job has become an adult or died, etc.
2. Refuse to accept labor ability appraisal
Work-related injury benefits are a right for disabled employees, but at the same time, employees must also fulfill corresponding obligations. If after the suspension of work and salary period, the employee neither applies for an extension of the period nor undergoes a labor ability level appraisal, the unit can stop issuing corresponding work-related injury benefits.
3. Refusing treatment
After an employee is injured on the job, he has the right to enjoy work-related injury insurance benefits and the obligation to actively cooperate with treatment. If you refuse treatment without justifiable reasons, you will not be entitled to work-related injury insurance benefits.
4. Work-related injury benefits under special circumstances that the unit may encounter
1. Medical expenses beyond the scope of work-related injury insurance
The expenses required for employee treatment are covered by work-related injury insurance. The insurance fund will provide reimbursement, but the prerequisite must be in compliance with the work-related injury insurance diagnosis and treatment item catalog, the work-related injury insurance drug list, and the work-related injury insurance hospitalization service standards. But often, the expenses reimbursed by the fund are not enough to cover the entire cost of employee treatment, so who will bear these excess expenses?
Some people think that the cost should be borne by the individual employees, on the grounds that employees should use medicines and treatments within the scope of medical insurance; others believe that as long as they are reasonable expenses should be borne by the unit, because according to the work-related injury insurance employee relief The basic spirit is that the employer should bear the excess.
In actual operation, although the industry has not yet formed a unified and clear view, one thing is certain, that is, in the case of sudden work-related injuries and first aid, the treatment expenses beyond the scope of medical insurance will be paid by the unit. This issue actually reflects the contradiction and game between medical institutions and the human and social system.
2. The social security payment base is lower than the actual salary standard
Many units pay work-related injury insurance based on the minimum payment base rather than the actual salary standard of employees, which leads to the consequences of work-related injuries. Disability allowances and one-time disability benefits for levels 1 to 6 will be significantly reduced because these two items are based on the average salary paid in the 12 months before the employee was injured. Generally, employees have two ways to protect their legitimate rights and interests:
The first is to negotiate with the unit and require the unit to make up the difference in social security contributions. After the payment is made, the injured person will not suffer any loss or discount in the one-time disability subsidy and disability allowance benefits.
The second is that after the disability appraisal, the employees' union initiated labor arbitration and requested that the difference between the one-time disability subsidy and the disability allowance be paid by the unit.