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How to settle the treatment fee after the work-related injury is determined? What benefits can I claim?

author:Miss Wen's social security answer

If an accident occurs at work, how should the treatment expenses incurred in the hospital be settled after the work-related injury is identified? What benefits can I claim? Do I still need a labor force test after my condition is stabilized?

Today, we have sorted out some common doubts among the neighbors, so let's go down and see how to deal with them~

How to settle the cost of work-related injury treatment?

1. Direct Internet Billing

When seeking medical treatment at the agreement institution, the agreement institution will settle the insured employees who meet the conditions for enjoying treatment and online bookkeeping.

2. Manual reimbursement

If the conditions for online bookkeeping are not met, the employer or the injured employee may make sporadic reimbursement to the social insurance agency with medical invoices and medical records after paying the medical expenses in full in advance.

Note: In fact, the medical treatment expenses for work-related injuries are processed in sections before and after the determination of work-related injuries.

That is, the medical expenses before the work-related injury is determined, and the agreement institution will first settle it in accordance with the provisions of the medical insurance.

The medical expenses for work-related injuries incurred after the work-related injuries are determined will be settled directly online, and at the same time, the work-related injury medical expenses that have been settled by the medical insurance will be settled by the work-related injury insurance fund to the medical insurance fund.

How to settle the treatment fee after the work-related injury is determined? What benefits can I claim?

What are the benefits?

According to the relevant provisions of the Regulations of Guangdong Province on Work-related Injury Insurance, employees who are injured in accidents or suffer from occupational diseases due to work-related reasons and are recognized as work-related injuries shall enjoy work-related injury insurance benefits; Among them, those who lose their ability to work after the appraisal of their ability to work enjoy disability benefits. The details are as follows:

1. Failure to reach the disability level (including declaration of waiver of appraisal): If the injured employee does not reach the disability level, he or she shall enjoy the medical treatment of the work-related injury in accordance with the relevant regulations.

2. Grade 1 to 4 disability: one-time disability subsidy, disability allowance, living care expenses, work-related injury medical treatment, basic medical insurance, a total of 5 types.

3. Grade 5 to 6 disability: one-time disability subsidy, disability allowance, one-time medical subsidy for work-related injury, one-time disability employment subsidy, and medical treatment for work-related injury, a total of 5 types.

4. Grade 7 to 10 disability: one-time disability subsidy, one-time medical subsidy for work-related injury, one-time disability employment subsidy, and medical treatment for work-related injury, a total of 4 types.

5. Work-related death: funeral allowance, pension for dependent relatives, and one-time work-related death allowance, a total of 3 types.

If a disabled employee of the first to fourth grades dies after the expiration of the period of suspension of work with pay, his close relatives may enjoy funeral subsidies and pensions for dependent relatives.

Warm reminder: If the employer finds that the employer underreported the employee's wages and failed to pay the work-related injury insurance premiums in full, resulting in a decrease in the work-related injury insurance benefits enjoyed by the employer, it can apply to the employer to make up the difference in the work-related injury insurance benefits.

How to settle the treatment fee after the work-related injury is determined? What benefits can I claim?

Is there still a workforce test?

I heard that after the work-related injury is identified, there is also a labor force evaluation, is it necessary for everyone?

A: No, it is not. If the injury is only minor and there are no other problems after treatment, there is no need for a labor force test.

If, after treatment, the injury is relatively stable, but there is a disability that affects the ability to work, an evaluation of the ability to work shall be conducted. Generally, the employer, the injured employee or his close relatives shall submit an application to the Municipal Labor Ability Appraisal Committee.

How to settle the treatment fee after the work-related injury is determined? What benefits can I claim?

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