[Summary of the trial]
If an employer fails to pay social insurance in full for its employees in accordance with relevant regulations, and after the employer pays the work-related injury insurance premiums and overdue fines to the relevant departments, the work-related injury insurance fund pays the corresponding fees to the employee in accordance with the regulations, and there is evidence to prove that the work-related injury insurance benefits are still reduced, and the employee requests the employer to bear the liability for compensation for the difference in losses, the people's court shall support it.
【Brief Facts of the Case】
The plaintiff, Feng, claimed that he joined the Beijing R&D center of a company in Dalian on July 26, 2012, and suffered a work-related injury on March 17, 2015 and was identified as a Grade 8 disability. Because the Beijing R&D center of a company in Dalian did not assist me in reimbursing medical expenses, wages for sick leave, and work-related injury insurance benefits for 16 months, Feng sued the court, and the People's Court of Chaoyang District, Beijing made a judgment (2017) Jing 0105 Min Chu No. 28978, ordering the Beijing R&D center of a company in Dalian to pay sick leave wages, economic compensation for the termination of labor relations, and a one-time disability employment subsidy. However, the following problems have not been resolved: 1. The total medical expenses incurred due to the work-related injury were 15,854.6 yuan, 3,172.94 yuan were approved and reimbursed by the medical insurance, and the remaining 12,681.7 yuan should be borne by the Beijing R&D center of a company in Dalian; 2. The above-mentioned judgment found that Feng's payment base was 12,500 yuan in the 12 months before the work-related injury, and the Beijing R&D center of a company in Dalian paid 3,878 yuan, resulting in a one-time disability subsidy of 94,842 yuan [(12,500 yuan-3,878 yuan)×11] According to Article 27 of the Detailed Rules for the Implementation of the Regulations of Beijing Municipality on Work-related Injury Insurance, the difference should be borne by the Beijing R&D Center of a company in Dalian;3. After the work-related injury, the Beijing R&D Center of a company in Dalian appointed Feng's mother to take care of her during the half-year suspension of work and salary, and promised to pay 6,000 yuan per month, totaling 36,000 yuan. Request: Order the Beijing R&D Center of a Dalian company to pay 12,681.7 yuan for medical expenses for the period from March 17, 2015 to July 11, 2016, the difference in one-time disability allowance of 94,842 yuan [(12,500-3,878 yuan)×11], and 36,000 yuan for nursing expenses for the period from March 18, 2015 to September 17, 2015.
The defendant, the Beijing R&D Center of a company in Dalian, argued that this case was a duplicate lawsuit, and that Feng's various expenses had no factual and legal basis and should not be borne by him.
After trial, the court ascertained that Feng joined the Beijing R&D Center of a company in Dalian on July 26, 2012, and the two parties signed the "Labor Contract", which stipulated that both parties participated in social insurance in accordance with the provisions of the state and Beijing Municipality, and went through the relevant social insurance procedures. On March 17, 2013, Feng was injured at work, and it was determined that he had reached the standard level of disability caused by work-related injuries and occupational diseases. Later, Feng applied for arbitration, demanding that the Beijing R&D Center of a company in Dalian pay sick leave wages, medical expenses, and the difference in one-time disability allowance. After the arbitral award was made, Feng appealed to the court. The People's Court of Chaoyang District, Beijing Municipality rendered the (2017) Jing 0105 Min Chu No. 28978 Civil Judgment after trial, finding that Feng's monthly salary standard was 12,500 yuan, and ordering the Beijing R&D Center of a Dalian company to pay Feng 21,462.99 yuan in sick leave wages from October 1, 2015 to March 24, 2016, 50,000 yuan in economic compensation for termination of labor relations, and 63,774 yuan in one-time disability employment subsidies. Neither party appealed, and the judgment has entered into force.
On March 26, 2018, the Social Insurance Fund Management Center of Chaoyang District, Beijing (hereinafter referred to as the Social Security Management Center) issued the "Beijing Approval Form for the Treatment of Employees with Work-related Injuries at Levels 1 to 10", which stated: Feng's average monthly salary in the 12 months before his injury: 3,878 yuan,... Disability degree appraisal level: disability level 8, one-time disability subsidy: 3878×11 months = 42658 yuan, one-time work-related injury medical subsidy: 7086×9 months = 63774 yuan, etc. On May 7, 2019, the Beijing R&D center of a company in Dalian and Feng jointly completed the audit of social insurance premiums and paid 372,660 yuan.
During the second-instance trial of this case, Feng requested the Social Security Management Center to reissue the difference in the one-time disability subsidy after the unit paid the social insurance. Chaoyang Social Security Management Center clearly replied that after the employer makes supplementary payments, the newly incurred expenses do not include the one-time disability subsidy.
【Judgment Result】
Beijing Chaoyang District People's Court (2018) Jing 0105 Min Chu 47689 Civil Judgment rejected all of Feng's litigation claims;
The Beijing No. 3 Intermediate People's Court (2019) Jing 03 Min Zhong No. 6229 Civil Judgment upheld the original trial court's determination to reject all of Feng's claims;
The Beijing High People's Court (2020) Jing Min Zai No. 84 Civil Judgment revoked the second-instance judgment and the first-instance judgment, and changed the judgment to pay Feng a one-time disability subsidy of 94,842 yuan.
[Reasons for the trial]
The court held that Feng asserted that the Beijing R&D Center of a Dalian company should pay the medical expenses and nursing expenses during the period of suspension of work, because the Beijing R&D Center of a Dalian company had paid work-related injury insurance for Feng, and the medical expenses and nursing expenses were items paid from the work-related injury insurance fund in accordance with national regulations, and had been approved and handled by the social security institution, so the court of first instance did not support his claim and was not improper. Regarding the difference in the one-time disability subsidy, the one-time disability subsidy paid to Feng by the Chaoyang Social Security Management Center on December 11, 2017 was 42,658 yuan, which was calculated based on the base of 3,878 yuan of social insurance premiums paid by the Beijing R&D Center of a company in Dalian every month. After the effective judgment confirmed that Feng's monthly salary standard was 12,500 yuan, Feng requested the Beijing R&D Center of a company in Dalian to make up the social insurance, and requested the Chaoyang Social Security Management Center to make up the difference in the one-time disability subsidy. Chaoyang Social Security Management Center clearly replied that after the employer makes supplementary payments, the newly incurred expenses do not include the one-time disability subsidy. Accordingly, because the Beijing R&D Center of a Dalian company failed to pay the work-related injury insurance premiums in full, which in fact led to the reduction of Feng's work-related injury insurance benefits and could not be remedied through administrative channels, the court of first instance did not support this litigation claim, and Feng's claim that the Beijing R&D Center of a Dalian company should bear the difference in his one-time disability subsidy of 94,842 yuan, which should be supported.
【Case source】
People's Court Case Database No.: 2023-16-2-490-007, "Feng v. Beijing R&D Center of a Dalian Company, Labor Dispute Case - Liability of Employer for Failure to Pay Social Insurance in Full as Required, Resulting in Reduction of Employees' Work-related Injury Insurance Benefits"
【Case Tips】
Employers are reminded that they should pay social insurance premiums in full and pay social insurance in strict accordance with the actual wage standards of employees, so as to avoid the reduction of employees' work-related injury insurance benefits due to insufficient payment, which may lead to labor disputes and compensation liabilities.
Workers are reminded to understand and grasp the relevant work-related injury insurance policies and regulations, so that they can enjoy the due treatment in a timely manner when they suffer a work-related injury, and at the same time, they should properly retain evidence related to work-related injury insurance benefits, such as invoices for medical expenses, work-related injury certificates, and labor ability appraisal conclusions, so as to provide strong evidence in the process of rights protection.
Disclaimer: The content of this article is for reference only and is not intended as legal advice for specific cases.