Regulations on Work-related Injury Insurance
Chapter I: General Provisions
Article 1 These Regulations are formulated in order to ensure that employees who are injured in accidents or suffer from occupational diseases as a result of their work receive medical treatment and economic compensation, to promote the prevention and rehabilitation of work-related injuries, and to disperse the risk of work-related injuries of employers.
Article 2 Enterprises, public institutions, social organizations, private non-enterprise units, foundations, law firms, accounting firms and other organizations within the territory of the People's Republic of China, as well as individual industrial and commercial households with employees (hereinafter referred to as "employers") shall, in accordance with the provisions of these Regulations, participate in work-related injury insurance and pay work-related injury insurance premiums for all employees or employees (hereinafter referred to as "employees") of their units.
Employees of enterprises, public institutions, social organizations, private non-enterprise units, foundations, law firms, accounting firms, and other organizations within the territory of the People's Republic of China, as well as employees of individual industrial and commercial households, shall have the right to enjoy work-related injury insurance benefits in accordance with the provisions of these Regulations.
Article 3 The collection and payment of work-related injury insurance premiums shall be carried out in accordance with the provisions of the Interim Regulations on the Collection and Payment of Social Insurance Premiums on the collection and payment of basic old-age insurance premiums, basic medical insurance premiums and unemployment insurance premiums.
Article 4 The employer shall publicize the relevant information on the participation in work-related injury insurance in the employer.
Employers and employees shall abide by the laws and regulations on work safety and the prevention and treatment of occupational diseases, implement safety and health regulations and standards, prevent the occurrence of work-related accidents, and avoid and reduce the hazards of occupational diseases.
In the event of a work-related injury, the employer shall take measures to ensure that the injured employee receives timely treatment.
Article 5 The social insurance administrative department under the State Council shall be responsible for work-related injury insurance nationwide.
The social insurance administrative departments of local people's governments at or above the county level shall be responsible for work-related injury insurance within their respective administrative areas.
The social insurance handling agency (hereinafter referred to as the handling agency) established by the social insurance administrative department in accordance with the relevant provisions of the State Council specifically undertakes work-related injury insurance affairs.
Article 6 The social insurance administrative departments and other departments shall solicit the opinions of trade union organizations and representatives of employers in formulating policies and standards for work-related injury insurance.
Chapter II Work-related Injury Insurance Fund
Article 7 The work-related injury insurance fund shall be composed of the work-related injury insurance premiums paid by the employer, the interest of the work-related injury insurance fund and other funds included in the work-related injury insurance fund in accordance with law.
Article 8 Work-related injury insurance premiums shall be determined in accordance with the principle of fixed income and balance of income and expenditure.
The State determines the differential rates of different industries according to the degree of work-related injury risk, and determines a number of rate grades in each industry according to the use of work-related injury insurance premiums and the incidence of work-related injuries. The differential rates by industry and the rates within the industry shall be formulated by the social insurance administrative department of the State Council, and shall be promulgated and implemented after approval by the State Council.
According to the use of work-related injury insurance premiums and the incidence rate of work-related injuries of the employer, the co-ordinating regional agency shall apply the corresponding rate grade in the industry to determine the payment rate of the unit.
Article 9 The social insurance administrative department of the State Council shall periodically learn about the income and expenditure of the work-related injury insurance fund in each overall area of the country, and promptly propose a plan for adjusting the differential rates of the industry and the rate grades within the industry, and report it to the State Council for approval before promulgating it for implementation.
Article 10 The employer shall pay the work-related injury insurance premiums on time. Individual employees do not pay work-related injury insurance premiums.
The amount of work-related injury insurance premiums paid by an employer is the product of the total wages of its employees multiplied by the employer's contribution rate.
For industries that are difficult to pay work-related injury insurance premiums according to the total amount of wages, the specific methods for paying work-related injury insurance premiums shall be prescribed by the social insurance administrative department of the State Council.
Article 11 The work-related injury insurance fund shall be gradually implemented at the provincial level.
Industries that cross regions and have greater production mobility can participate in work-related injury insurance in different places in a relatively centralized manner. The specific measures shall be formulated by the social insurance administrative department of the State Council in conjunction with the competent departments of relevant industries.
Article 12 The work-related injury insurance fund shall be deposited in the special financial account of the social security fund for the payment of work-related injury insurance benefits, labor ability appraisal, publicity and training for work-related injury prevention as provided for in these Regulations, as well as other expenses for work-related injury insurance as prescribed by laws and regulations.
The specific measures for the extraction, use and management of work-related injury prevention expenses shall be formulated by the social insurance administrative department of the State Council in conjunction with the departments of finance, health administration, and production safety supervision and management of the State Council.
No unit or individual may use the work-related injury insurance fund for investment and operation, construction or renovation of office space, distribution of bonuses, or diversion for other purposes.
Article 13 The work-related injury insurance fund shall retain a certain proportion of the reserve fund for the overall planning of the payment of work-related injury insurance benefits for major accidents in the region; If the reserve fund is insufficient to pay, the people's government of the overall planning area shall pay in advance. The specific proportion of the reserve fund in the total amount of the fund and the method for using the reserve fund shall be prescribed by the people's governments of provinces, autonomous regions and municipalities directly under the Central Government.
Chapter III: Determination of Work-related Injuries
Article 14 In any of the following circumstances, an employee shall be deemed to have suffered a work-related injury:
(1) Being injured in an accident during working hours and in the workplace due to work-related reasons;
(2) Being injured in an accident while engaging in work-related preparatory or finishing work in the workplace before or after working hours;
(3) Suffering violence or other accidental injuries during working hours and in the workplace as a result of performing work duties;
(4) Suffering from an occupational disease;
(5) During the period when they are away for work, they are injured due to work reasons or their whereabouts are unknown in an accident;
(6) Being injured in a traffic accident or an urban rail transit, passenger ferry, or train accident for which they are not primarily responsible while commuting to or from work;
(7) Other circumstances that laws and administrative regulations provide shall be recognized as work-related injuries.
Article 15 An employee shall be deemed to have suffered a work-related injury under any of the following circumstances:
(1) Death from a sudden illness during working hours and at work, or death within 48 hours after rescue efforts failed;
(2) Suffering harm in emergency rescue and disaster relief or other activities to preserve the national interest or the public interest;
(3) An employee who previously served in the military and was disabled due to injuries sustained in war or in the line of duty, and has obtained a certificate for a revolutionary disabled soldier, but the old injury recurs after arriving at the employer.
Where employees have any of the circumstances in items (1) or (2) of the preceding paragraph, they shall enjoy work-related injury insurance benefits in accordance with the relevant provisions of these Regulations; Employees who have the circumstances in item (3) of the preceding paragraph shall enjoy work-related injury insurance benefits other than a one-time disability subsidy in accordance with the relevant provisions of these Regulations.
Article 16: Where employees meet the requirements of Articles 14 and 15 of these Regulations, but in any of the following circumstances, they must not be found to be a work-related injury or treated as a work-related injury:
(1) Intentionally committing a crime;
(2) Drunk or taking drugs;
(3) Self-harm or suicide.
Article 17 Where an employee is injured in an accident or is diagnosed or appraised as an occupational disease in accordance with the provisions of the Law on the Prevention and Treatment of Occupational Diseases, the unit to which he belongs shall, within 30 days from the date of occurrence of the accident injury or the date of diagnosis or appraisal of an occupational disease, submit an application for recognition of work-related injury to the social insurance administrative department of the coordinating region. In case of special circumstances, the time limit for application may be appropriately extended with the consent of the social insurance administrative department.
If the employer fails to submit an application for recognition of work-related injury in accordance with the provisions of the preceding paragraph, the injured employee, his close relatives or the trade union organization may, within one year from the date of occurrence of the accident injury or the date of diagnosis or appraisal of an occupational disease, directly submit an application for recognition of work-related injury to the social insurance administrative department of the coordinating area where the employer is located.
Matters that shall be determined by the provincial-level social insurance administrative department in accordance with the provisions of the first paragraph of this Article shall be handled by the social insurance administrative department at the districted-city level where the employer is located in accordance with the principle of territoriality.
If an employer fails to submit an application for determination of work-related injury within the time limit specified in the first paragraph of this Article, the employer shall bear the relevant expenses such as work-related injury benefits incurred during this period that comply with the provisions of these Regulations.
Article 18 The following materials shall be submitted to submit an application for determination of work-related injury:
(1) Application form for determination of work-related injury;
(2) Proof of the existence of an employment relationship (including a de facto employment relationship) with the employer;
(3) Medical diagnosis certificate or occupational disease diagnosis certificate (or occupational disease diagnosis and appraisal certificate).
The application form for determination of work-related injury shall include basic information such as the time, place, and cause of the accident, as well as the degree of injury of the employee.
Where the materials provided by the applicant for work-related injury determination are incomplete, the social insurance administrative department shall inform the applicant of all the materials that need to be supplemented and corrected in writing at one time. After the applicant requests to supplement and correct the materials in accordance with the written notice, the social insurance administrative department shall accept it.
Article 19 After accepting an application for recognition of work-related injury, the social insurance administrative department may, according to the needs of the examination, conduct an investigation and verification of the accident injury, and the employer, employees, trade union organizations, medical institutions and relevant departments shall provide assistance. The diagnosis of occupational diseases and the appraisal of diagnostic disputes shall be carried out in accordance with the relevant provisions of the Law on the Prevention and Treatment of Occupational Diseases. The social insurance administrative department will no longer conduct investigation and verification of those who have obtained a certificate of diagnosis of an occupational disease or an appraisal of an occupational disease in accordance with the law.
If the employee or his close relatives believe that it is a work-related injury, but the employer does not consider it to be a work-related injury, the employer shall bear the burden of proof.
Article 20 The social insurance administrative department shall make a decision on the determination of work-related injury within 60 days from the date of acceptance of the application for work-related injury determination, and notify the employee or his close relatives and the worker's unit in writing of the application for work-related injury determination.
The social insurance administrative department shall make a decision on the determination of work-related injury within 15 days of accepting an application for work-related injury determination where the facts are clear and the rights and obligations are clear.
Where it is necessary to base a decision on the determination of work-related injuries on the basis of the conclusion of the judicial organ or the relevant administrative department, the time limit for making a determination of work-related injury is suspended during the period that the judicial organ or the relevant administrative department has not yet made a conclusion.
Where the staff of the social insurance administrative department has an interest in the applicant for work-related injury determination, they shall recuse themselves.
Chapter IV Labor Ability Appraisal
Article 21 Where an employee suffers a work-related injury and has a disability that affects his or her ability to work after treatment and his injury is relatively stable, he or she shall conduct an appraisal of his or her ability to work.
Article 22 The appraisal of labor ability refers to the grade appraisal of the degree of labor dysfunction and the degree of self-care impairment.
There are 10 levels of disability for labor dysfunction, with the most severe being level 1 and the least being level 10.
There are three levels of self-care disorders: complete inability to take care of oneself, inability to take care of oneself most of one's life, and partial inability to take care of oneself in life.
The standards for the appraisal of labor ability shall be formulated by the social insurance administrative department of the State Council in conjunction with the health administrative department of the State Council and other departments.
Article 23 The employer, the injured employee or his close relatives shall submit an application to the labor ability appraisal committee at the districted city level for the appraisal of labor ability, and provide relevant materials on the determination of the work-related injury and the medical treatment of the work-related injury.
Article 24 The labor ability appraisal committees of provinces, autonomous regions and municipalities directly under the Central Government and the labor ability appraisal committees at the level of cities divided into districts shall be composed of representatives of the social insurance administrative departments, health administrative departments, trade union organizations, handling agencies and representatives of employers at the level of provinces, autonomous regions, municipalities directly under the Central Government and districted cities, respectively.
The Labor Ability Appraisal Committee shall establish a database of medical and health experts. Medical and health professional and technical personnel included in the expert database shall meet the following conditions:
(1) Have qualifications for senior professional and technical positions in medical and health care;
(2) Master the relevant knowledge of labor ability appraisal;
(3) Have good professional character.
Article 25 After receiving an application for labor ability appraisal, the labor ability appraisal committee at the districted city level shall randomly select 3 or 5 relevant experts from the medical and health expert database established by it to form an expert group, and the expert group shall submit an appraisal opinion. The labor ability appraisal committee of the city divided into districts shall make the conclusion of the appraisal of the labor ability of the injured employee on the basis of the appraisal opinions of the expert group; When necessary, a qualified medical institution may be entrusted to assist in the diagnosis.
The labor ability appraisal committee at the districted city level shall make a labor ability appraisal conclusion within 60 days from the date of receipt of the labor ability appraisal application, and if necessary, the time limit for making a labor ability appraisal conclusion may be extended by 30 days. The conclusion of the labor ability appraisal shall be promptly sent to the units and individuals applying for the appraisal.
Article 26 If the unit or individual applying for appraisal is dissatisfied with the appraisal conclusion made by the labor ability appraisal committee at the districted city level, it may submit an application for re-appraisal to the labor ability appraisal committee of the province, autonomous region or municipality directly under the Central Government within 15 days from the date of receipt of the appraisal conclusion. The labor ability appraisal conclusions made by the labor ability appraisal committees of provinces, autonomous regions and municipalities directly under the Central Government are the final conclusions.
Article 27 The appraisal of labor ability shall be objective and impartial. Where the members of the labor ability appraisal committee or the experts participating in the appraisal have an interest in the parties, they shall recuse themselves.
Article 28 One year after the conclusion of the appraisal of working ability, if the injured employee or his close relatives, his unit or the handling agency considers that his or her disability has changed, he or she may apply for a review and appraisal of his or her working ability.
Article 29 The time limit for re-appraisal and re-examination and appraisal conducted by the Labor Ability Appraisal Committee in accordance with the provisions of Articles 26 and 28 of these Regulations shall be implemented in accordance with the provisions of the second paragraph of Article 25 of these Regulations.
Chapter V Work-related Injury Insurance Benefits
Article 30 Employees who are injured in accidents or suffer from occupational diseases due to their work shall be treated and shall enjoy medical treatment for work-related injuries.
Employees who treat work-related injuries shall seek medical treatment at the medical institution that has signed the service agreement, and in case of emergency, they may first go to the nearest medical institution for first aid.
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. The catalogue of work-related injury insurance diagnosis and treatment items, the catalogue of work-related injury insurance drugs, and the standards for work-related injury insurance hospitalization services shall be formulated by the social insurance administrative department of the State Council in conjunction with the administrative department of health under the State Council, the food and drug supervision and administration department and other departments.
The food subsidy for the hospitalization of employees for the treatment of work-related injuries, as well as the transportation, accommodation and food expenses required for the injured employees to seek medical treatment outside the co-ordination area shall be paid from the work-related injury insurance fund upon the certificate issued by the medical institution and approved by the handling agency, and the specific standards for fund payment shall be prescribed by the people's government of the co-ordination area.
Employees injured at work are not entitled to medical treatment for work-related injuries and are treated in accordance with the basic medical insurance measures.
If the expenses for work-related injury rehabilitation of an injured employee to a medical institution that has signed a service agreement are met, it shall be paid from the work-related injury insurance fund.
Article 31 Where an administrative reconsideration or administrative lawsuit occurs after the social insurance administrative department makes a decision to determine a work-related injury, the payment of medical expenses for the treatment of the work-related injury shall not cease during the period of administrative reconsideration or administrative litigation.
Article 32 An injured worker may be fitted with prostheses, orthoses, eyes, dentures, wheelchairs and other assistive devices due to the needs of daily life or employment, and the required expenses shall be paid from the work-related injury insurance fund in accordance with the standards prescribed by the State.
Article 33 Where an employee is injured in an accident or suffers from an occupational disease at work and needs to suspend work to receive medical treatment for work-related injuries, the original wages and benefits shall remain unchanged during the period of suspension with pay, and shall be paid by the employer 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. After the work-related injury is assessed, the original benefits shall be suspended and the disability benefits shall be enjoyed in accordance with the relevant provisions of this chapter. Employees who are injured at work and still need medical treatment after the expiration of the period of suspension with pay shall continue to enjoy medical treatment for work-related injuries.
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.
Article 34 Where an injured worker has been assessed for disability and is confirmed by the Labor Ability Appraisal Committee to be in need of living care, he or she shall be paid a monthly living care allowance from the work-related injury insurance fund.
The living care allowance is paid according to three different levels: being completely unable to take care of oneself, being unable to take care of oneself for most of one's life, or being unable to take care of oneself partially, and the standard is 50%, 40% or 30% of the average monthly wage of employees in the overall planning area in the previous year.
Article 35 Where an employee is identified as having a grade 1 to 4 disability due to work-related disability, he or she shall retain the labor relationship, withdraw from the job, and enjoy the following benefits:
(1) A one-time disability subsidy shall be paid from the work-related injury insurance fund according to the level of disability, and the standard is: 27 months' salary for first-degree disability, 25 months' salary for second-degree disability, 23 months' salary for third-degree disability, and 21 months' salary for fourth-degree disability;
(2) Disability allowance shall be paid monthly from the work-related injury insurance fund, and the standard is: 90% of the salary of the first-degree disability, 85% of the salary of the second-degree disability, 80% of the salary of the third-degree disability, and 75% of the salary of the fourth-degree disability. 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;
(3) After the injured employee reaches the retirement age and goes through the retirement procedures, the disability allowance shall be suspended and the basic old-age insurance benefits shall be enjoyed in accordance with the relevant provisions of the state. If the basic pension insurance benefits are lower than the disability allowance, the work-related injury insurance fund shall make up the difference.
If an employee is identified as having a first-grade to fourth-grade disability due to work-related disability, the employer and the employee shall pay the basic medical insurance premiums based on the disability allowance.
Article 36 Where an employee is identified as having a Grade 5 or Grade 6 disability due to work-related disability, he or she shall enjoy the following benefits:
(1) A one-time disability subsidy shall be paid from the work-related injury insurance fund according to the level of disability, and the standard is: 18 months' salary for grade 5 disability and 16 months' salary for grade 6 disability;
(2) Retain the labor relationship with the employer, and the employer shall arrange appropriate work. If it is difficult to arrange work, the employer shall pay the employer a monthly disability allowance at the following rates: 70% of the employee's salary for the fifth grade disability and 60% of the salary for the sixth grade disability, and the employer shall pay all social insurance premiums payable for the employee in accordance with the regulations. If the actual amount of disability allowance is lower than the local minimum wage, the employer shall make up the difference.
At the request of the injured employee, the employee may terminate or terminate the employment relationship with the employer, and the work-related injury insurance fund shall pay a one-time medical subsidy for work-related injuries, and the employer shall pay a one-time disability employment subsidy. The specific standards for one-time medical subsidies for work-related injuries and one-time employment subsidies for disability shall be prescribed by the people's governments of provinces, autonomous regions and municipalities directly under the Central Government.
Article 37 Where an employee is assessed as having a disability of Grade 7 to Grade 10 due to work-related disability, he or she shall enjoy the following benefits:
(1) A one-time disability subsidy shall be paid from the work-related injury insurance fund according to the level of disability, and the standard is: 13 months' salary for grade 7 disability, 11 months' salary for grade 8 disability, 9 months' salary for grade 9 disability, and 7 months' salary for grade 10 disability;
(2) If the labor or employment contract is terminated upon expiration, or the employee himself or herself proposes to terminate the labor or employment contract, the work-related injury insurance fund shall pay a one-time medical subsidy for work-related injuries, and the employer shall pay a one-time employment subsidy for disability. The specific standards for one-time medical subsidies for work-related injuries and one-time employment subsidies for disability shall be prescribed by the people's governments of provinces, autonomous regions and municipalities directly under the Central Government.
Article 38 Where an injured employee suffers a recurrence of work-related injury and is confirmed to need treatment, he or she shall enjoy the work-related injury benefits provided for in Articles 30, 32 and 33 of these Regulations.
Article 39 Where 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) The funeral subsidy shall be 6 months of the average monthly wage of employees in the overall area in the previous year;
(2) The pension for dependent relatives shall be paid to the relatives who provided the main source of livelihood and are unable to work due to the death of the employee due to work according to a certain proportion of the employee's own salary. 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 in the course of work. The specific scope of support for relatives shall be prescribed by the social insurance administrative department under the State Council;
(3) The standard of one-time work-related death subsidy shall be 20 times the per capita disposable income of urban residents in the previous year.
Where a disabled employee dies as a result of a work-related injury during the period of suspension of work with pay, his close relatives shall enjoy the benefits provided for in the first paragraph of this article.
Where an employee with a disability of the first to fourth grades dies after the expiration of the period of suspension with pay, his close relatives may enjoy the benefits provided for in items (1) and (2) of the first paragraph of this article.
Article 40: Disability allowances, pensions for dependent relatives, and living care expenses are to be adjusted by the social insurance administrative department of the coordinating region in a timely manner on the basis of changes in the average wages and living expenses of employees. The adjustment measures shall be formulated by the people's governments of provinces, autonomous regions, and municipalities directly under the Central Government.
Article 41 Where an employee has an accident or is missing during the rescue and disaster relief due to work, he or she shall be paid wages within three months from the month in which the accident occurs, and wages shall be suspended from the fourth month, and the work-related injury insurance fund shall pay the pension to his dependent relatives on a monthly basis. If you have difficulties in living, you can advance 50% of the one-time work-related death allowance. Where an employee is declared dead by a people's court, it is to be handled in accordance with the provisions of Article 39 of these Regulations on the death of an employee on the job.
Article 42 In any of the following circumstances, an injured employee shall cease to enjoy work-related injury insurance benefits:
(1) Losing the conditions for enjoying benefits;
(2) Refusal to accept the appraisal of labor ability;
(3) Refusal of treatment.
Article 43 Where an employer is divided, merged or transferred, the successor unit shall bear the work-related injury insurance liability of the original employer; If the original employer has already participated in the work-related injury insurance, the successor unit shall go to the local agency to change the registration of the work-related injury insurance.
If the employer implements contracted operation, the liability for work-related injury insurance shall be borne by the unit where the employee's labor relationship is located.
If an employee is injured in a work-related accident while on secondment, the original employer shall bear the work-related injury insurance liability, but the original employer and the secondment unit may agree on compensation methods.
If an enterprise goes bankrupt, it shall pay the work-related injury insurance benefits that should be paid by the unit at the time of bankruptcy liquidation.
Article 44 Where an employee is dispatched out of the country to work and shall participate in the local work-related injury insurance in accordance with the laws of the country or region to which he is going, he or she shall participate in the local work-related injury insurance, and his domestic work-related injury insurance relationship shall be suspended; If they are unable to participate in the local work-related injury insurance, their domestic work-related injury insurance relationship shall not be suspended.
Article 45 Where an employee suffers another work-related injury and shall be entitled to disability allowance in accordance with regulations, he or she shall be entitled to disability allowance according to the newly recognized disability level.
Chapter VI: Supervision and Management
Article 46 The handling agency shall undertake work-related injury insurance affairs and perform the following duties:
(1) In accordance with the provisions of the people's governments of provinces, autonomous regions and municipalities directly under the Central Government, collect work-related injury insurance premiums;
(2) Verify the total wages and the number of employees of the employer, handle the registration of work-related injury insurance, and be responsible for keeping records of the employer's contributions and employees' enjoyment of work-related injury insurance benefits;
(3) Conducting surveys and statistics on work-related injury insurance;
(4) To manage the expenditures of the work-related injury insurance fund in accordance with regulations;
(5) Verify work-related injury insurance benefits in accordance with regulations;
(6) Provide free consulting services to injured workers or their close relatives.
Article 47: Handling agencies are to sign service agreements with medical establishments and assistive device dispensing institutions on the basis of equal consultation, and publish a list of medical establishments and assistive device dispensing institutions that have signed service agreements. The specific measures shall be formulated by the social insurance administrative department of the State Council in conjunction with the health administrative department and the civil affairs department of the State Council.
Article 48 The handling agency shall verify the use of medical expenses, rehabilitation expenses and assistive device expenses of injured employees in accordance with the agreement and relevant national catalogues and standards, and settle the expenses on time and in full.
Article 49 The handling agency shall regularly publish the income and expenditure of the work-related injury insurance fund, and promptly submit proposals to the social insurance administrative department for adjusting the rate.
Article 50 The social insurance administrative departments and handling agencies shall periodically listen to the opinions of injured workers, medical institutions, institutions for the allocation of assistive devices, and all sectors of society on improving work-related injury insurance.
Article 51 The social insurance administrative departments shall supervise and inspect the collection of work-related injury insurance premiums and the payment of work-related injury insurance funds in accordance with law.
The financial departments and auditing institutions shall supervise the income and expenditure and management of the work-related injury insurance fund in accordance with the law.
Article 52 Any organization or individual has the right to report illegal acts related to work-related injury insurance. The social insurance administrative departments shall promptly investigate the report, handle it in accordance with provisions, and keep the informant confidential.
Article 53 Trade union organizations shall safeguard the lawful rights and interests of employees injured at work in accordance with law, and shall supervise the work of employers on work-related injury insurance.
Article 54 Any dispute between an employee and an employer concerning the treatment of work-related injuries shall be handled in accordance with the relevant provisions on the handling of labor disputes.
Article 55: In any of the following circumstances, relevant units or individuals may apply for administrative reconsideration in accordance with law, and may also initiate administrative litigation in the people's courts in accordance with law:
(1) The employee applying for a work-related injury determination, his or her close relatives, or the employee's work unit, are dissatisfied with the decision not to accept the application for work-related injury determination;
(2) The employee applying for a work-related injury determination, his or her close relatives, or the employee's unit is not satisfied with the work-related injury determination conclusion;
(3) The employer is not satisfied with the unit payment rate determined by the handling agency;
(4) The medical institution or assistive device allocation institution that signed the service agreement believes that the handling agency has not performed the relevant agreement or provisions;
(5) The injured employee or his close relatives have objections to the work-related injury insurance benefits approved by the handling agency.
Chapter VII: Legal Responsibility
Article 56: Where a unit or individual misappropriates a work-related injury insurance fund in violation of the provisions of Article 12 of these Regulations, and a crime is constituted, criminal responsibility shall be pursued in accordance with law; where a crime is not constituted, sanctions or disciplinary sanctions are to be given in accordance with law. The misappropriated funds shall be recovered by the social insurance administrative department and incorporated into the work-related injury insurance fund; The confiscated illegal gains shall be turned over to the state treasury in accordance with law.
Article 57: In any of the following circumstances, the staff of the social insurance administrative departments are to be given sanctions in accordance with law; where the circumstances are serious and constitute a crime, criminal responsibility is pursued in accordance with law:
(1) Refusing to accept an application for a determination of work-related injury without a legitimate reason, or fraudulently designating a person who does not meet the requirements for work-related injury as an employee injured at work;
(2) Failing to properly keep the evidentiary materials for applying for a work-related injury determination, resulting in the loss of relevant evidence;
(3) Accepting property from a party.
Article 58: Where the handling agency commits any of the following acts, the social insurance administrative department shall order corrections and give disciplinary sanctions to the directly responsible managers and other responsible personnel in accordance with law; where the circumstances are serious and constitute a crime, criminal responsibility is pursued in accordance with law; If the economic losses of the parties are caused, the handling agency shall bear the liability for compensation in accordance with law:
(1) Failing to keep records of the employer's contributions and employees' enjoyment of work-related injury insurance benefits in accordance with regulations;
(2) Failing to verify work-related injury insurance benefits in accordance with regulations;
(3) Accepting property from a party.
Article 59: Where medical establishments or institutions dispensing assistive devices do not provide services in accordance with the service agreement, the handling agency may terminate the service agreement.
If the handling agency fails to settle the expenses on time and in full, the social insurance administrative department shall order it to make corrections; Medical institutions and assistive device dispensing institutions may terminate the service agreement.
Article 60 Where an employer, an injured employee or his close relatives fraudulently obtains work-related injury insurance benefits, or a medical institution or an institution dispensing assistive devices defrauds the work-related injury insurance fund, the social insurance administrative department shall order it to return it and impose a fine of not less than 2 times but not more than 5 times the amount fraudulently obtained; where the circumstances are serious and constitute a crime, criminal responsibility is pursued in accordance with law.
Article 61 In any of the following circumstances, an organization or individual engaged in labor ability appraisal shall be ordered to make corrections by the social insurance administrative department and imposed a fine of not less than 2,000 yuan but not more than 10,000 yuan; where the circumstances are serious and constitute a crime, criminal responsibility is pursued in accordance with law:
(1) Providing false appraisal opinions;
(2) Providing false diagnosis certificates;
(3) Accepting property from a party.
Article 62 Where an employer is required to participate in work-related injury insurance in accordance with the provisions of these Regulations but fails to do so, the social insurance administrative department shall order it to participate within a time limit, pay the work-related injury insurance premiums that should be paid, and impose a late fee of 5/10,000 per day from the date of non-payment; If the payment is still not made within the time limit, a fine of not less than 1 time but not more than 3 times the amount of the outstanding payment shall be imposed.
If an employee of an employer who is required to participate in work-related injury insurance in accordance with the provisions of these Regulations but does not participate in work-related injury insurance suffers a work-related injury, the employer shall pay the expenses in accordance with the work-related injury insurance benefits and standards stipulated in these Regulations.
After the employer participates in the work-related injury insurance and pays the work-related injury insurance premiums and late fees that should be paid, the work-related injury insurance fund and the employer shall pay the newly incurred expenses in accordance with the provisions of these Regulations.
Article 63 Where an employer violates the provisions of Article 19 of these Regulations by refusing to assist the social insurance administrative department in conducting an investigation and verification of the accident, the social insurance administrative department shall order it to make corrections and impose a fine of not less than 2,000 yuan but not more than 20,000 yuan.
Chapter VIII Supplementary Provisions
Article 64 The term "total wages" as used in these Regulations refers to the total amount of labor remuneration paid directly by an employer to all employees of that unit.
For the purposes of these Regulations, the term "personal wages" refers to the average monthly wages paid by injured employees in the 12 months prior to the injury caused by accidents or occupational diseases caused by 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.
Article 65: Where civil servants and staff of public institutions or social organizations managed with reference to the Civil Servants Law suffer from accidents or occupational diseases as a result of their work, the unit to which they belong shall pay the expenses. The specific measures shall be formulated by the social insurance administrative department of the State Council in conjunction with the financial department of the State Council.
Article 66 Where an employee of a unit that does not have a business license or has not been registered or filed in accordance with law, or an employee of a unit whose business license has been revoked or whose registration or filing has been revoked in accordance with law, is injured in an accident or suffers from an occupational disease, the unit shall give a lump sum compensation to the disabled employee or the close relatives of the deceased employee, and the compensation standard shall not be lower than the work-related injury insurance benefits provided for in these Regulations; Employers shall not use child labor, and if the employer uses child labor to cause disability or death of a child worker, the employer shall give a lump sum compensation to the child worker or the child's close relatives, and the compensation standard shall not be lower than the work-related injury insurance benefits provided for in these Regulations. The specific measures shall be formulated by the social insurance administrative department under the State Council.
Where the close relatives of the disabled or deceased employees provided for in the preceding paragraph have a dispute with the employer over the amount of compensation, or the child laborers or close relatives of the child laborers provided for in the preceding paragraph have a dispute with the employer over the amount of compensation, it shall be handled in accordance with the relevant provisions on the handling of labor disputes.
Article 67: These Regulations shall come into force on January 1, 2004. Where employees who have been injured in an accident or suffer from an occupational disease before the implementation of these Regulations have not completed the determination of work-related injuries, the provisions of these Regulations shall be followed.
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