First, the scope of insurance:
The administrative region of the autonomous region of enterprises, institutions, social organizations, private non-enterprise units, foundations, law firms, accounting firms and other organizations and individual businesses with employees should be required to participate in work-related injury insurance, pay work-related injury insurance premiums for the unit of all employees (including employees). The scope of work-related injury insurance is now extended to all employers. (Measures for the Implementation of the Regulations on Work-Related Injury Insurance in the Xinjiang Uygur Autonomous Region)
Second, the contribution standard: (Measures for the Payment of Work-Related Injury Insurance Premiums for Enterprises in Selected Industries, Dec. 31, 2010)
The rate of work-related injury insurance premiums, based on the difference in industries and the degree of risk, is determined as five: i.e., 0.5 percent; 0.8 percent; 1 percent; 1.5 percent; and 2 percent. The contribution base is the same as pension insurance.
1. For the financial industry, trade and retail, broadcasting, television, culture, education and health, a variety of service industries, such as the implementation of 0.5% of the workers' compensation insurance levy rate;
2. For the telecommunications and postal services, press and publication of scientific and technological exchanges and promotion, the transportation industry to implement the 0.8% of the workers' compensation insurance levy rate;
3. For the real estate and entertainment, the management of public *** facilities, agriculture, forestry, animal husbandry and fisheries, textile and garment manufacturing industry to implement the 1% of the workers' compensation insurance;
3. Fisheries, textile and garment manufacturing industry to implement 1% of the workers' compensation insurance levy rate;
4. Agricultural and sideline products, food processing industry, textile, leather and fur products, wood and furniture processing and manufacturing industry, pharmaceuticals, paper, printing, chemical fibers, plastics, rubber and metal products, construction, transportation, logistics, loading and unloading of machinery and equipment manufacturing industry, electricity, heat, gas and water production and supply industry to implement a 1.5% of the workers' compensation insurance levy rate;
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5. The petroleum coking chemical raw materials and chemical products manufacturing, non-ferrous metal ore ferrous metal ore non-metallic ore smelting and mining, cement manufacturing coal mining and other mining industries, etc. The implementation of the 2% of the workers' compensation insurance levy rate.
Third, to enjoy the provisions of work-related injury insurance treatment
(a) the employee has one of the following circumstances, shall be recognized as work-related injuries:
1, in the work time and workplace, due to work-related injuries; (i.e.? Three work principle?)
2, before and after working hours in the workplace, engaged in work-related preparatory or finishing work by accidental injury;
3, in the working time and workplace, due to the performance of work duties by violence and other accidental injuries;
4, suffering from occupational diseases;
5, out of work during the workplace, due to work-related injuries or Accident whereabouts unknown;
6, on the way to and from work, by the main responsibility of the traffic accident or urban rail transit, passenger ferries, train accidents;
7, laws and administrative regulations should be recognized as work-related injuries in other cases.
(b) the employee has one of the following circumstances, deemed to be work-related injuries:
1, in the working time and at work, sudden death of disease or death within 48 hours after the failure of rescue;
2, in the rescue and relief of disasters, and other activities to safeguard the interests of the state, the interests of the public ****** injury;
3, the employee formerly in the military service, due to the war, Disabled due to service-related injuries, has obtained the revolutionary disabled soldier's certificate, to the employer after the recurrence of old injuries.
Employees with the former Article 1, Article 2 of the situation, in accordance with the provisions of the enjoyment of work-related injury insurance treatment; employees with the former Article 3 of the situation, in accordance with the provisions of the enjoyment of work-related injury insurance treatment in addition to the one-time disability benefit.
Fourth, the treatment of work-related injuries insurance (the State Council Regulations on Work-related Injuries Insurance and the Measures for the Implementation of the Regulations on Work-related Injuries Insurance in the Xinjiang Uygur Autonomous Region)
(a) Medical and rehabilitation costs
The medical and rehabilitation costs of treating work-related injuries are dealt with in accordance with the relevant provisions of the basic medical insurance. The medical expenses are paid by the Work Injury Insurance Fund on the basis of the conclusion of the work injury determination.
(2) Meal allowance
The meal allowance during the period of hospitalization and medical treatment outside the coordinated area is paid by the Work Injury Insurance Fund according to the actual number of days of hospitalization, and the allowance is 25 yuan per day.
(3) Transportation and accommodation expenses for medical treatment outside the state (Yizhou Human and Social Development (2014) No. 38).
1, transportation costs: the coordinated area outside the medical treatment of transportation costs paid by the workers' compensation insurance fund, according to the train hard sleeper, ship third class, bus ticket reimbursement according to the facts;
2, accommodation costs: by the workers' compensation insurance fund limit of vouchers to pay for, according to the provincial capital (including the plan to list cities) location of 100 yuan, the seat of the prefecture city of 80 yuan, the county seat of the standard of 60 yuan to be reimbursed.
(D) Configuration of auxiliary aids
The costs required for the installation and configuration of disability aids shall be paid by the Workers' Compensation Insurance Fund in accordance with the standards of the Configuration Catalog of the New People's Republic of China Social Security Development Document 2013139.
(E) living care expenses
If the employee who has suffered a work injury has been assessed as having a disability grade and the Labor Capacity Appraisal Committee confirms that he needs living care, the living care expenses will be paid by the Work Injury Insurance Fund on a monthly basis.
The living care expenses are paid according to three different grades: totally unable to take care of oneself, mostly unable to take care of oneself, or partially unable to take care of oneself, and the standard is 50%, 40%, and 30% of the average monthly salary of the workers of the previous year in the coordinated area respectively.
(F) the first to fourth level of disability injury treatment
Retain the labor relationship, withdraw from the workplace, the following treatment can be paid from the Work Injury Insurance Fund:
1, the monthly payment of disability allowance: first-degree disability of 90% of the salary, second-degree disability of 85% of the salary, third-degree disability of 80% of the salary, fourth-degree disability of 75% of the salary.
If the actual amount of the disability allowance is lower than the local minimum wage standard, the Work Injury Insurance Fund will make up the difference.
2. Lump-sum disability benefit: the lump-sum disability benefit is paid on the basis of one's contributory salary: 27 months for first-degree disability, 25 months for second-degree disability, 23 months for third-degree disability, and 21 months for fourth-degree disability.
3. When the injured worker reaches the retirement age: after going through the retirement procedure, the disability allowance will be stopped, and the worker will enjoy the basic pension insurance treatment in accordance with the relevant provisions of the state. If the basic pension insurance treatment is lower than the disability allowance, the difference will be made up by the Industrial Injury Insurance Fund.
4. Basic medical insurance treatment: the employer and the individual employee pay the basic medical insurance premiums based on the disability allowance.
(7) Grade 5 to Grade 6 disability treatment
1. The one-time disability benefit is paid from the Work Injury Insurance Fund, and the standard is based on the person's contributory salary: 18 months for Grade 5 disability, and 16 months for Grade 6 disability.
2. Retaining the labor relationship with the employer and arranging appropriate work by the employer, it is difficult to arrange work, and the employer will pay the monthly disability allowance based on the standard of one's salary: 70% of the salary for Grade 5 disability, and 60% of the salary for Grade 6 disability.
If the actual amount of the disability allowance is lower than the local minimum wage, the employer shall make up the difference.
3. The employer shall pay the social insurance premiums for the employee in accordance with the regulations.
4. Upon the voluntary proposal of the injured worker, the worker can terminate or break the labor relationship with the employer, and enjoy the treatment based on the average monthly salary of the workers of the previous year at the time of the termination or breakup of the labor relationship:
(1) Payment of lump-sum medical benefits for work-related injuries, which will be paid by the Workers' Compensation Insurance Fund: 11 months for fifth-degree invalidity, and 10 months for sixth-degree invalidity.
(2) Payment of one-time disability employment benefit, paid by the employer: 27 months for Grade 5 disability, 24 months for Grade 4 disability.
If you suffer from occupational disease, the one-time medical benefit for work injury will be increased by 30% on the basis of this standard.
(H) seventh to tenth grade disability injury treatment
1, the payment of a one-time disability benefit: from the Work Injury Insurance Fund to my salary as the standard: 13 months for seventh-degree disability, eighth-degree disability for 11 months, ninth-degree disability for 9 months, tenth-degree disability for 7 months.
2, the termination of labor and employment contracts, or the termination of labor and employment contracts proposed by the employees themselves, the termination or termination of the labor (employment) relationship based on the average monthly salary of the previous year's employees, entitlement:
(1) payment of a one-time medical benefits for work-related injuries: from the Workers' Compensation Insurance Fund, the seventh-degree disability of 9 months, eighth-degree disability of 8 months, the ninth-degree disability of 7 months, 10th-degree disability of 6 months, and the third-degree disability of 6 months, the third-degree disability of 6 months. months, grade 10 disability 6 months.
If you suffer from occupational disease, the one-time medical benefit for work injury will be increased by 20% on the basis of this standard.
(2) Payment of one-time disability employment benefits: paid by the employer, 21 months for Grade 7 disability, 18 months for Grade 8 disability, 15 months for Grade 9 disability, and 12 months for Grade 10 disability.
(IX) Treatment of work-related death
1. If an employee dies at work, his/her next of kin will receive a funeral grant, a dependent's pension and a lump-sum work-related death benefit from the Work Injury Insurance Fund in accordance with the following provisions:
(1) Funeral grant: 6 months of the average monthly salary of the employees of the previous year in the co-ordinated area.
(2) Dependent Relatives Pension: according to a certain percentage of the employee's own wages paid by the employee who died in the workplace to provide the main source of living, unable to work relatives.
The standard is 40% per month for spouses, 30% per month for each of the other relatives, and 10% per month for widows and orphans on top of the above standard. The sum of the approved pensions for each dependent relative should not be higher than the lifetime salary of the employee who died at work.
(3) Lump-sum compensation for work-related deaths: the standard is 20 times the per capita disposable income of urban residents nationwide in the previous year.
2. If a disabled employee dies as a result of a work-related injury during the period of time off work with pay, his close relatives are entitled to a funeral grant.
3. If a Grade 1 to Grade 4 disabled employee dies after the period of work stoppage without pay, his next of kin shall be entitled to the funeral subsidy and the pension for dependent relatives.
(J), Labor Capacity Appraisal Fee
Autonomous Region Pricing Bureau set 300 yuan
V. Not recognized as or deemed to be work-related injuries
1, intentional crimes;
2, drunkenness or xx;
3, xx or suicide;
4, laws, administrative regulations and other circumstances
.Six, other provisions
(a) referral of work injuries (IZHIS [2015] No. 25)
Work injuries must be in the social security work injuries designated medical institutions, level by level referrals, the medical expenses incurred to be reimbursed.
Fixed-point hospitals, county-level: Yining County People's Hospital; state-level: Yining City People's Hospital, the People's Liberation Army Eleventh Hospital, Yili Prefecture Xinhua Hospital, Yili Prefecture Friendship Hospital; autonomous region level: Xinjiang Medical College, the autonomous region of the People's Hospital, the autonomous region of Chinese medicine hospitals, the People's Liberation Army Four Seventy-four hospitals, hospitals for occupational diseases.
(B) work-related injury reimbursement (handling procedures)
Employees who have work-related injuries can be treated by the employer or the employee's personal advances, advances by the employer to the Social Security Bureau to declare the costs, the declaration must be submitted in the online handling system to apply for. The Social Security Administration will close and submit for payment within 10 working days for expenses that meet the scope. After the employing unit provides a receipt of payment to the Bureau, the work injury expenses will be allocated to the unit, which will then pay the individual. (Note: In case of policy changes, the latest policy shall prevail, for details, please consult the Medical Insurance Center of the Social Security Bureau at 4026090)
Expanded Knowledge
Under what circumstances does an injured worker stop enjoying the benefits of work injury insurance?
A: Article 42 of the Regulations on Work-Related Injury Insurance stipulates that an injured employee shall cease to enjoy work-related injury insurance benefits under any of the following circumstances:
(a) loss of conditions for entitlement to benefits;
(b) refusal to accept the evaluation of labor capacity;
(c) refusal of medical treatment.
If an employer splits, merges, or transfers, what is the responsibility for work injury insurance?
Answer: Article 43 of the Regulations on Work-Related Injury Insurance stipulates that if an employer splits, merges or transfers, the successor unit shall assume the responsibility of the original employer's work-related injury insurance; if the original employer has already taken part in the work-related injury insurance, the successor unit shall apply for the change of the registration of work-related injury insurance in the local organization.
If the employer carries out contracting, the responsibility of work injury insurance shall be borne by the unit in which the employee's labor relationship is located.
Who will bear the responsibility of work injury insurance if an employee is injured during the secondment period?
A: Article 43 of the Regulations on Work-Related Injury Insurance stipulates that if an employee suffers a work-related injury during the period of secondment, the original employer shall bear the responsibility of work-related injury insurance, but the original employer and the seconded unit can agree on the compensation method.
How to pay the work injury insurance treatment when the enterprise goes bankrupt?
A: Article 43 of the Regulations on Work-Related Injury Insurance stipulates that in case of bankruptcy of an enterprise, the costs of work-related injury insurance treatment payable by the unit shall be allocated according to the law at the time of bankruptcy and liquidation.
How can employees enjoy the treatment of work injury insurance when they are injured at work again?
A: Article 45 of the Regulations on Work-Related Injury Insurance stipulates that if an employee is injured at work again and should be entitled to disability allowance according to the regulations, he or she should be entitled to disability allowance according to the newly recognized disability level.
Extended reading
First, the scope and object of enjoyment
With all kinds of enterprises in the administrative area of Anhui Province, individual industrial and commercial households with employees (hereinafter referred to as the employer) to establish a labor relationship (including de facto labor relationship) of the employees or employees (hereinafter referred to as employees), where the employer in accordance with the State Council "Regulations on Work-Related Injury Insurance" (hereinafter referred to as the "Regulations") and the present approach (hereinafter referred to as employees), all employers in accordance with the State Council's "Regulations on Work-Related Injury Insurance" (hereinafter referred to as the "Regulations") and these Measures to participate in work-related injury insurance, and in accordance with the provisions of the payment of work-related injury insurance premiums, are entitled to enjoy work-related injury insurance benefits.
II. Medical treatment for work-related injuries
(1) Employees who are injured at work (including occupational diseases, hereinafter referred to as the same) and undergo treatment shall enjoy medical treatment for work-related injuries.
(2) Treatment of work-related injuries should be provided at medical institutions that have signed service agreements. In case of emergency, first aid can be provided at the nearest medical institution.
(c) After being recognized as injured at work, the medical expenses that are in line with the scope of payment by the Workmen's Compensation Insurance Fund shall be paid by the Workmen's Compensation Insurance Fund.
In case of hospitalization for treatment of work injury, the hospital meal allowance shall be paid by the unit in accordance with 70% of the standard meal allowance for the unit on business trip; if nursing care is required, the unit shall pay monthly nursing care fee, which is 80% of the average monthly salary of the workers of the previous year in the co-ordinated area. Approved by the coordinated area outside the transfer of medical treatment, the required transportation, food and lodging expenses, the unit in accordance with the standard reimbursement of the unit on business trips.
(d) the injured employee suspended from work to receive treatment, the period of suspension of pay generally does not exceed 12 months. The seriousness of the injury or special circumstances, confirmed by the Appraisal Committee may be appropriately extended, but the extension shall not exceed 12 months.
(e) injured workers in the period of suspended pay, the employer shall not terminate or terminate its labor relations, the original wages and benefits remain unchanged, issued by the employer on a monthly basis.
Third, the treatment of work-related injuries after the assessment of disability
(a) was identified as a first to fourth-degree disability, retaining the labor relationship, withdrawal from work (production), enjoy the following treatment:
Anhui Workers' Compensation Insurance Treatment
Note: ① in the period of disability allowance, the employer and the individual employee to the disability allowance as the basis for the payment of basic medical insurance premiums in accordance with the provisions of the law.
② After deducting the basic medical insurance premiums paid by the individual, the actual amount of disability allowance is less than the local minimum wage, the workers' compensation insurance fund to make up the difference.
③ After the injured worker reaches the retirement age and retirement procedures, the disability allowance is discontinued, enjoy the basic pension insurance benefits. If the pension insurance treatment is lower than the disability allowance, the difference will be made up by the Industrial Injury Insurance Fund.