2024: List of Workers' Compensation Expenses + Calculation Criteria

Author: Li Yingchun, Yingke Law Firm

Source: Labor Law Library

According to the provisions of the Social Insurance Law and the Regulations on Work-related Injury Insurance, part of the expenses incurred by employees for work-related injuries shall be paid by the work-related injury insurance fund and partly by the employer. In the end, many people are not too clear about which expenses are borne by the work-related injury insurance fund and which are borne by the employer, so I will classify them from the main body of the burden, combined with the latest statistical data, and summarize the details of these expenses and make a list for your reference in practice:

1. Expenses paid by the work-related injury insurance fund:

(1) Medical expenses and rehabilitation expenses for the treatment of work-related injuries

1. Medical expenses: If the expenses required for the treatment of work-related injuries meet the requirements of the work-related injury insurance diagnosis and treatment items, the work-related injury insurance drug list, and the work-related injury insurance hospitalization service standards, they shall be paid from the work-related injury insurance fund.

At present, there are different practices in different places to deal with the medical expenses that exceed the catalogue and service standards, and the practice in many regions is that the employer does not bear them.

2. Rehabilitation expenses: The expenses for work-related injury rehabilitation of injured employees to medical institutions that have signed a service agreement shall be paid from the work-related injury insurance fund if they meet the requirements.

(2) Hospitalization meal subsidy

The specific standard of food subsidy for employees hospitalized for work-related injuries shall be prescribed by the people's government of the coordinating region, and the regulations on work-related injury insurance do not make uniform provisions.

(3) Transportation, food and lodging expenses for medical treatment in other places

The specific standards for transportation, food and lodging expenses required for injured workers to seek medical treatment outside the overall planning area shall be prescribed by the people's government of the coordinating area, and the work-related injury insurance regulations do not uniformly stipulate.

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(4) The cost of installing and configuring assistive devices for the disabled

Due to the needs of daily life or employment, the injured employee may be fitted with prostheses, orthoses, artificial eyes, dentures, wheelchairs and other assistive devices upon confirmation by the Labor Ability Appraisal Committee, and the required expenses shall be paid from the work-related injury insurance fund in accordance with the standards prescribed by the state. It should be noted that assistive devices should generally be limited to those necessary to assist daily life and productive labor, and use products that are commonly used in the domestic market. Employees with work-related injuries choose other types of products, and the cost is higher than that of the common type, which is paid by the individual.

(5) For those who are unable to take care of themselves, the living care expenses confirmed by the Labor Ability Appraisal Committee

If an injured employee has been assessed for disability and has been confirmed by the Labor Ability Appraisal Committee to be in need of life care, the living care expenses shall be paid monthly from the work-related injury insurance fund.

Completely unable to take care of oneself: 50% of the average ×salary;

Most of the people can't take care of themselves: the average salary × 40%;

Unable to take care of oneself in the living part: 3×0% of the average salary.

(6) A one-time disability subsidy and a monthly disability allowance for disabled employees of grades 1 to 4

1. One-time disability subsidy: According to Articles 35, 36 and 37 of the Regulations on Work-related Injury Insurance, if an employee is identified as a first-to-tenth-grade disability due to work-related disability, the work-related injury insurance fund shall pay a one-time disability subsidy, and the standards are as follows:

First-degree disability: 27 of my salary×;

Second-degree disability: 25 × salary;

Third-degree disability: 23 of my salary×;

Fourth-degree disability: the salary of the person × 21;

五级伤残：本人工资×18；

六级伤残：本人工资×16；

七级伤残：本人工资×13；

八级伤残：本人工资×11；

Grade 9 disability: my salary × 9;

Grade 10 disability: 7 × salary.

2. Disability allowance received by disabled employees of grades 1 to 4 on a monthly basis:

According to Articles 35 and 36 of the Regulations on Work-related Injury Insurance, if an employee is identified as a first-grade to fourth-grade disability due to work-related disability, the disability allowance shall be paid on a monthly basis according to the following standards:

First-degree disability: 90% of the employee's salary×;

Second-degree disability: 85% of my salary×;

Third-degree disability: 80% of the employee's salary×;

Grade 4 disability: 75% of the employee's salary×;

If the actual amount of disability allowance is lower than the local minimum wage standard, the work-related injury insurance fund shall make up the difference;

After the injured employee reaches the retirement age and goes through the retirement procedures, the disability allowance will be suspended and the basic pension insurance benefits will be enjoyed. If the basic pension insurance benefits are lower than the disability allowance, the work-related injury insurance fund shall make up the difference.

(7) A one-time medical subsidy that shall be enjoyed when the labor contract is terminated or dissolved

The medical subsidy for work-related injuries is applicable to the disability of grade 5-10, which is determined according to the level of disability, and the regulations on work-related injury insurance do not stipulate a unified standard, and the specific standard is authorized by the people's governments of all provinces, autonomous regions and municipalities directly under the Central Government. It can be found in the provincial regulations on work-related injury insurance or in the work-related injury insurance measures.

For example, the standard of one-time medical subsidy for work-related injuries and disability employment subsidy in Guangdong Province

One-time Medical Benefit for Work Injuries:

五级伤残：本人工资×10；

Grade 6 disability: 8 of my ×salary;

Grade 7 disability: 6 of my ×salary;

Grade 8 disability: 4 of my ×salary;

Grade 9 disability: × 2 of my salary;

Grade 10 disability: 1 of the employee's salary×.

(8) In the case of work-related death, the funeral allowance, pension for dependent relatives and work-related death allowance received by the surviving family members

According to Article 39 of the Regulations on Work-related Injury Insurance, if an employee dies on the job, his close relatives shall receive a funeral subsidy, a pension for dependent relatives and a one-time work-related death subsidy from the work-related injury insurance fund in accordance with the following provisions:

1. Funeral subsidy: local average salary×6;

For example, if the current average wage standard in Shenzhen is 13,730 yuan, the funeral subsidy is 13,730 yuan× 6=82,380 yuan.

2. Pension for dependent relatives: according to a certain proportion of the employee's own salary, it will be paid to the relatives who provide the main source of livelihood and are unable to work due to the death of the employee due to work. The standard is: 40% per month for spouses, 30% per month for other relatives, and 10% per month for each elderly or orphan who is alone or orphaned. The sum of the approved pensions for dependent relatives shall not be higher than the wages of the employee who died on the job;

Formula: Spouse: 40% of the deceased's own salary× (paid monthly);

Other relatives: 30% of the deceased's salary × (per person per month);

Lonely elderly or orphans: 10% on the basis of the above criteria;

The sum of the above-mentioned pensions shall be ≤ the monthly wages of the employee (calculated on a monthly basis) at the time of approval.

3. One-time work-related death subsidy: the standard is 20 times the per capita disposable income of urban residents in the previous year.

According to the latest data released by the National Bureau of Statistics, the per capita disposable income of urban residents in 2023 will be 51,821 yuan.

The standard of one-time work-related death subsidy in 2024 is 51,821 yuan× 20=1036420 yuan.

Due to the unified implementation of the "Regulations on Work-related Injury Insurance" across the country, the national unified standard for one-time work-related death allowance in 2024 is 1036420 yuan, an increase of 50,760 yuan compared with 985,660 yuan in the previous year. This standard is not divided into regions, and it is unified across the country.

(9) Labor ability appraisal fee

Where an employee suffers a work-related injury and has a disability that affects his or her ability to work after treatment and his or her injury is relatively stable, an appraisal of his or her ability to work shall be conducted. The labor ability appraisal fee shall be paid by the work-related injury insurance fund.

2. Expenses paid by the employer:

(1) Wages and benefits during the treatment of work-related injuries

During the period of suspension of work and salary, the original salary and benefits remain unchanged and are paid by the unit on a monthly basis. The period of leave without pay is generally not more than 12 months. If the injury is serious or the circumstances are special, it may be appropriately extended upon confirmation by the labor ability appraisal committee at the districted city level, but the extension shall not exceed 12 months.

Note: In practice, the mainstream practice is to determine the average salary in the 12 months before the work-related injury.

Whether overtime pay is included in the calculation of the original salary and benefits during the suspension period varies from place to place in practice.

For example, the Guangdong High People's Court's Several Opinions on the Connection between Arbitration and Litigation of Labor and Personnel Disputes (2018) provides that during the period of suspension of work and pay for work-related injuries, the original salary and benefits of the employee shall remain unchanged and shall be paid by the employer on a monthly basis. The wages for the period of suspension of work and leave shall be paid according to the average salary (including overtime pay) of the employee in the 12 months prior to the work-related injury.

The Investigation and Reference of the First Civil Division of the Shanghai Higher People's Court ([2014] No. 15) tends to hold that the original salary during the suspension period should not include overtime pay.

(2) The monthly disability allowance received by employees with disabilities of grade 5 and grade 6

Employees who are identified as Grade 5 or Grade 6 disability due to work-related disability shall enjoy disability allowance on a monthly basis. Grade 5-6 disability allowance shall be paid by the employer when it is difficult to arrange work, and if the actual amount of disability allowance is lower than the local minimum wage standard, the employer shall make up the difference.

五级伤残：本人工资×70％；

六级伤残：本人工资×60％。

(3) A one-time disability employment subsidy that shall be enjoyed when the labor contract is terminated or dissolved

The disability employment subsidy is applicable to the disability level 5-10, which is determined according to the level of disability, and the regulations on work-related injury insurance do not stipulate a uniform standard, and the specific standard is authorized by the people's governments of all provinces, autonomous regions and municipalities directly under the Central Government. It can be found in the provincial regulations on work-related injury insurance or in the work-related injury insurance measures.

For example, the standard of one-time disability employment subsidy in Guangdong Province:

五级伤残：本人工资×50；

六级伤残：本人工资×40；

七级伤残：本人工资×25；

八级伤残：本人工资×15；

Grade 9 disability: 8 × salary;

Grade 10 disability: 4 of my ×salary.

(4) Nursing expenses during the period of suspension of work with pay

If an injured employee who is unable to take care of himself needs nursing care during the period of suspension of work with pay, the unit to which he or she belongs shall be responsible.

If the unit does not arrange care, the unit pays for the care. Generally, it can be paid according to the labor remuneration standard for local caregivers who perform the same level of care.

(5) Bear the expenses of not participating in work-related injury insurance

If an employee suffers a work-related injury during the period when the employer has not participated in the work-related injury insurance, the employer shall bear all the expenses of the work-related injury insurance benefits.

(6) Bear the costs of failing to apply for work-related injury determination in a timely manner

If the employer fails to submit an application for recognition of work-related injury within 30 days from the date of occurrence of the accident injury or the date of diagnosis or appraisal of an occupational disease, the employer shall bear the relevant expenses such as work-related injury benefits incurred during this period.

Note: The salary in the above calculation method refers to the average monthly salary of the injured employee in the 12 months before he was injured in an accident or suffered from an occupational disease due to work. If the salary is higher than 300% of the average salary of employees in the overall planning area, it shall be calculated according to 300% of the average salary of employees in the overall planning area; If the salary of the employee is lower than 60% of the average salary of employees in the overall planning area, it shall be calculated according to 60% of the average salary of employees in the overall planning area.

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