It is not uncommon for workers to suffer work-related injuries due to third-party torts, such as traffic accidents on the way to and from work or while away from work, or injuries caused by beatings by others during work. When a third-party tort and a work-related accident are competing, can the employee claim both work-related injury insurance compensation and tort damages?
Relevant adjudication cases
Case 1:
Wujiang City Textile Co., Ltd. v. Zhou Moukun, a dispute over work-related injury insurance benefits
Referee's Opinion:
If a worker suffers personal injury due to the infringement of a third party and suffers a work-related injury, he or she may be entitled to wages for the period of suspension of work with pay at the same time as compensation for lost work, which shall be paid by the employer on a monthly basis. Where an employer claims that it is not necessary to pay wages during the period of suspension of work on the grounds that the infringer has already compensated the employee for lost time wages, the people's court will not support it.
Case 2:
Xi's family sued an accessories company for a dispute over work-related injury insurance benefits
Referee's Opinion:
If a work-related injury is caused by a third party, the injured employee or the close relatives of the employee who died on the job may at the same time request the third party to bear the liability for tort damages, and the social insurance agency and the employer to pay the corresponding work-related injury insurance benefits, but the medical expenses shall not be claimed repeatedly.
Case 1:
A construction company and Zhou Moumou work-related injury insurance treatment dispute case
Referee's Opinion:
If a worker's personal injury is caused by a third party's infringement and constitutes a work-related injury, the employer and the tortfeasor shall bear their respective liability for compensation in accordance with the law. If the infringer has already paid compensation, the worker has the right to request the employer to pay the work-related injury insurance benefits other than the medical expenses, and if the employer pays the work-related injury insurance benefits in advance, it may recover the medical expenses from the third party within the scope of the compensation liability that the third party should bear.
Medical expenses should be broadly understood to include medical expenses, nursing expenses, nutrition expenses, transportation expenses, hospital meal allowances, disability assistive devices and other expenses incurred based on the treatment of work-related injuries, but do not include wages during the period of leave of absence and funeral expenses.
Can "one injury and two compensations"?
Work-related injury insurance compensation belongs to the field of public law, and the employee enjoys social insurance benefits, while tort compensation belongs to the field of civil law, which is the tort liability that the tortfeasor should bear in accordance with the law. Although there are obvious differences between the two in terms of legislative purpose, value orientation, scope of protection, applicable conditions, etc., there is no conflict in principle, and the law does not clearly stipulate that the victim can only receive one compensation.
According to the implementation of relevant laws and regulations, if an employee suffers a work-related injury due to a third party, and the social insurance agency refuses to pay work-related injury insurance benefits on the grounds that the employee or his close relatives have already filed a civil lawsuit against the third party, it will generally not be supported, except for the medical expenses already paid by the third party.
It can be seen from this that in addition to the part of the medical expenses that the injured employee cannot receive double compensation, the remaining part can be both, that is, it belongs to the principle of "limited double compensation" or "mutual complementarity", which is summarized as follows:
1. For the actual economic losses, i.e., the part of medical expenses, including medical expenses, nursing expenses, hospital meal subsidies, transportation expenses, rehabilitation expenses, assistive device expenses, funeral expenses, etc., cannot be double-compensated, and the parties may follow the "high principle" to claim.
2. If the employee is disabled or dies due to a work-related injury, in order to protect the rights and interests of the employee and his family, the compensation items involving personal attributes, including one-time disability allowance and disability compensation, one-time work-related death allowance and death compensation, can be both.
3. The parties may claim separately the parts of work-related injury insurance benefits and tort damages that do not overlap, including disability allowances, one-time work-related injury medical subsidies, and disability employment subsidies in work-related injury insurance;
Note: In practice, due to the slightly different policy provisions in different regions or the judgment tendencies of different courts, there are also differences in the specific compensation items that the parties can claim. Before asserting your rights, you can consult local judicial rulings for reference, and if necessary, consult a professional legal person.
In summary, after an employee suffers a work-related injury due to the infringement of a third party, the employer is obliged to pay work-related injury insurance benefits in accordance with the law, regardless of whether the employee receives civil compensation from the infringing party.
In order to prevent more legal risks and compensate for losses, enterprises should improve the employment management system in advance, pay social insurance for employees in accordance with the law when they join the company, submit applications for work-related injury recognition in a timely manner after work-related injuries occur, and take effective preventive measures to strengthen employees' safety awareness and ensure their safety and health.
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Note: The name of the person in the article has been changed, and the case information quoted is from the Judicial Case Study Institute of the Supreme People's Court
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