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    Determination And Payment Of Work-Related Injury Insurance Benefits

    2008/10/17 12:01:00 41813

    It is the central content of the industrial injury insurance system to scientifically and reasonably determine the compensation for industrial injury and protect the legitimate rights and interests of workers injured.

    The fifth chapter of the industrial injury insurance Ordinance, hereinafter referred to as the "Regulations", provides a principle stipulation for the definition of work-related injury insurance liability in respect of the items, standards, payment of work-related injury insurance, and the situation where the treatment is stopped and the employer's condition changes.

    At the same time, the sixty-third chapter of the eighth chapter of the regulations also stipulates the liability for compensation for accidents and occupational injuries caused by illegal operation and use of child labor.

    The principle of determining treatment

    It is the legislative purpose of the Ordinance to ensure that workers who are injured by work accidents or suffer from occupational diseases receive medical treatment and economic compensation, promote occupational injury prevention and occupational rehabilitation, and disperse industrial injury risks of employers.

    The fifth chapter stipulates that the treatment of work-related injury insurance can be divided into 4 categories, namely, medical treatment for work-related injuries, treatment of suspended wages, compensation for disability compensation and death compensation.

    From the perspective of pay structure and payment channels, it fully embodies the combination of treatment, economic compensation and occupational rehabilitation, and the requirement of dispersing employers' occupational injury risk.

    Guarantee the right of treatment and economic compensation for injured workers.

    The regulations stipulate that work-related injury workers should be treated in a timely and effective manner. They should fully protect the inspection, diagnosis, treatment, hospitalization, pportation, food allowance and other expenses of the injured workers. After the injury is stable, they can enjoy the corresponding one-off and long-term economic compensation according to their disability level after the injury is identified.

    Promoting occupational rehabilitation.

    The provisions of the twenty-ninth regulations and sixth regulations of the regulations on the rehabilitation treatment of work-related injury workers, thirtieth provisions on assistive devices such as artificial limbs and organs reflect the principle of improving the quality of life of work-related injury workers and restoring their body functions and working abilities through rehabilitation training.

    The risk of industrial injury is dispersed.

    According to the regulations, employers have participated in work-related injury insurance in accordance with the law. The cost of treatment and economic compensation for their employees after their work-related injuries are mostly paid by the industrial injury insurance fund, thus forming the socialization of damages and dispersing the industrial injury risk of employers.

    In addition, the principle of combination of one-time compensation and long-term compensation and the principle of determining the level of disability and occupational disease are also included.

    For workers who are partially or completely disabled, or because of the death of workers, the work-related injury insurance institutions should pay a one-time compensation, and pay long-term benefits to the dependents who have been identified as 1-4 grade disabled workers or workers who died.

    This principle of compensation has been accepted by more and more countries in the world.

    In order to distinguish the different levels of disability and occupational diseases, different standards of treatment are issued, and the degree of victimization of the injured workers is determined through specialized accreditation bodies and personnel.

    According to different grades, different standards of disability allowance are issued.

    Payment of benefits

    Payment terms.

    The rights of work-related injury workers or those who enjoy pension benefits enjoy the insurance benefits of industrial injury are corresponding to certain conditions and obligations. Generally, they need to be identified through industrial injury, labor capacity identification and injury assessment procedures.

    Those who meet the requirements and fulfill their obligations can enjoy industrial injury insurance benefits.

    Types of payment.

    The cost of work-related injury insurance can be broadly divided into two categories: medical treatment and cash compensation.

    Specifically, there are two types of payment for work-related injury insurance: the first is the payment of work-related injury medical expenses, rehabilitation treatment fees, and assistive devices allocation costs; the two is disability payment, disability allowance, family pension, funeral subsidy, one-off labor subsidy and so on.

    These two kinds of expenses are paid by the employer in the industrial injury insurance fund, where the employer has taken part in the industrial injury insurance.

    The way of payment.

    The above type I fees shall be settled by the social insurance agencies in accordance with the service agreements signed by the medical institutions and assistive devices, and the relevant national catalogues and standards. After verification, they shall be settled with the corresponding medical institutions and assistive devices allocation agencies.

    The second type of expenses should be paid by the industrial injury insurance fund, and the social insurance agencies directly distribute them to industrial injury workers or their relatives or entrust banks, post offices and communities to make social payments.

    Adjustment of treatment.

    Disability allowance, family pension and life care fee belong to long-term treatment. To ensure that the treatment of industrial injury is not affected by rising prices and other factors, and to share the fruits of national economic development, the thirty-eighth regulation of the Regulations stipulates that the level of the long-term treatment should be adjusted in a timely manner according to the changes in the average wage and living expenses of the labor and social security administrative department.

    The link between treatment and average wage change is based on the principle of equity.

    After the improvement of the national economic level, the wages of labourers will be increased correspondingly, and workers with industrial injuries should enjoy higher insurance benefits than before.

    Treatment is linked to price changes because the treatment of the same standard is different under different price levels, and the price of goods is on the rise. In order to ensure that the long-term treatment of workers suffering from industrial injury is not affected by price fluctuations, it is necessary to adjust the prices according to the magnitude of the rise in the price of goods.

    Stop of treatment

    The regulations stipulate several cases of stopping the enjoyment of industrial injury insurance benefits.

    Loss of treatment conditions.

    If the situation of work-related injuries has changed, such as the full recovery of labor capacity and the guarantee of no industrial injury insurance system, the conditions for enjoying compensation will be lost.

    Under such circumstances, the industrial injury insurance should be suspended.

    Excellent topic recommendation: Interpretation of the new labor contract

    Refusing to accept the appraisal of labor capacity.

    Labor capacity appraisal is the basis and prerequisite for determining the treatment of work-related injury insurance.

    If the injured workers do not have the right reasons to refuse to accept the appraisal of the labor capacity, they should not continue to enjoy work-related injury insurance.

     

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