Decree of the State Council of the People's Republic of China
No. 375
工 The Regulations on Work Injury Insurance have been discussed and adopted at the 5th Executive Meeting of the State Council on April 16, 2003, and are now promulgated, which will be implemented as of January 1, 2004.
Wen Jiabao
April 27, 2003
Work injury insurance regulations
Chapter 1 General Rules
Article 1 These Regulations are formulated to ensure that employees who have suffered injuries due to work accidents or occupational diseases receive medical treatment and economic compensation, promote work-related injury prevention and vocational rehabilitation, and disperse the risk of work-related injuries at employers.
Article 2 All types of enterprises in the People's Republic of China and self-employed industrial and commercial households (hereinafter referred to as employers) shall participate in work injury insurance in accordance with the provisions of this Regulation, and pay the work injury insurance premiums for all employees or employees (hereinafter referred to as workers) of the unit.
的 Employees of all types of enterprises in the People's Republic of China and employees of individual industrial and commercial households have the right to enjoy industrial injury insurance benefits in accordance with the provisions of these regulations.
具体 The specific steps and implementation methods for individual industrial and commercial households with hired workers to participate in work injury insurance shall be prescribed by the people's governments of provinces, autonomous regions, and municipalities directly under the Central Government.
Article 3 The collection 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 concerning the collection of basic old-age insurance premiums, basic medical insurance premiums, and unemployment insurance premiums.
Article 4 单位 Employers shall publicize the relevant information about participating in work injury insurance in their own units.
Employing units and employees shall abide by laws and regulations related to production safety and prevention of occupational diseases, implement safety and health regulations and standards, prevent occupational accidents, and avoid and reduce occupational disease hazards.
时 In the event of a work-related injury to an employee, the employing unit shall take measures to provide timely treatment to the employee.
Article 5 The Labor Security Administration Department of the State Council is responsible for national work-related injury insurance.
The labor security administrative departments of the local people's governments at or above the county level are responsible for work-related injury insurance in their respective administrative areas.
的 The social insurance agency (hereinafter referred to as the agency) set up by the labor security administrative department in accordance with the relevant regulations of the State Council specifically undertakes work injury insurance matters.
Article 6 When formulating policies and standards for work injury insurance, the labor security administrative department and other departments shall solicit the opinions of union representatives and employer representatives.
Chapter II Work Injury Insurance Fund
Article 7 The work injury insurance fund consists of the work injury insurance premiums paid by the employer, the interest of the work injury insurance fund, and other funds included in the work injury insurance fund according to law.
Article 8 Injury insurance premiums are determined based on the principle of fixed income and balance of income.
The state determines the industry's differential rates based on the degree of work injury risk in different industries, and determines several rate grades in each industry based on the use of work injury insurance premiums and the incidence of work injury. Different industry rates and intra-industry rate grades shall be formulated by the State Council ’s labor security administrative department in conjunction with the State Council ’s financial department, health administrative department, and work safety supervision and administration department.
Coordinating regional agencies shall determine the unit payment rate based on the use of industrial injury insurance premiums and the incidence of industrial injury by the employer, and apply the corresponding rate level in the industry to which they belong.
Article 9 The labor security administrative department of the State Council shall regularly understand the income and expenditure of the work-related injury insurance funds in all the coordinated regions of the country, and shall promptly work with the financial department, health administrative department, and work safety supervision and administration department of the State Council to adjust the industry differential rate and the rate of the industry's internal rate The plan will be announced and implemented after being submitted to the State Council for approval.
Article 10 The employing unit shall pay the work injury insurance premium on time. Individual workers do not pay industrial injury insurance.
工 The amount of the employer-sponsored insurance premiums paid by the employer is the product of the total wages of the employee of the unit multiplied by the unit's contribution rate.
Article 11 Injury insurance funds are implemented in the municipalities and municipalities with districts as a whole. The overall planning levels in other areas are determined by the people's governments of provinces and autonomous regions.
(2) Industries that are cross-regional and have relatively high production mobility can take a relatively centralized approach to participate in regional work-related injury insurance. The specific measures shall be formulated by the labor security administrative department of the State Council in conjunction with the competent departments of relevant industries.
Article 12 The work injury insurance fund is deposited in a special financial account of the Social Security Fund for the payment of work injury insurance benefits, labor capacity appraisal, and other expenses for work injury insurance provided by laws and regulations. No unit or individual may use the work injury insurance fund for investment and operation, construction or reconstruction of office space, bonus distribution, or other purposes.
十三 Article 13 The work injury insurance fund shall reserve a certain percentage of reserve funds for the payment of work injury insurance benefits for major accidents in the area; if the reserves are insufficient to pay, the people ’s government in the area shall make advances. The specific proportion of the reserve fund in the total fund and the method of using the reserve fund shall be prescribed by the people's governments of provinces, autonomous regions and municipalities.
Chapter III Identification of Workplace Injuries
Article 14 Employees shall be identified as work-related injuries in any of the following circumstances:
(1) during working hours and in the workplace, who were injured by an accident due to work reasons;
(2) in the workplace before or after working hours, engaged in preparatory or finishing work related to work and suffered injuries;
(3) during work hours and in the workplace, who have been accidentally injured by violence or the like due to the performance of their work duties;
(4) Those suffering from occupational diseases;
(5) During the period of going out of work, if he is injured due to work or his whereabouts are unknown;
(6) Being injured by a motor vehicle accident while commuting;
(7) Other situations that should be recognized as work-related injuries as provided by laws and administrative regulations.
十五 Article 15 Employees shall be deemed to be injured at work if:
(1) during working hours and positions, died of sudden illness or died after rescue within 48 hours;
(2) Those who have been harmed in activities such as rescue and disaster relief to protect national interests and public interests;
(3) Employees who had previously served in the army and were disabled due to war or injuries due to work, have obtained revolutionary disabled military personnel IDs, and their old injuries have recurred after reaching the employer.
If the employee has the circumstances of items (1) and (2) of the preceding paragraph, he shall enjoy the benefits of work injury insurance in accordance with the relevant provisions of this Regulation; if the employee has the circumstances of item (c) of the preceding paragraph, he shall receive one exemption in accordance with the relevant provisions of this Regulation Work injury insurance benefits other than sexual disability benefits.
十六 Article 16 Employees under any of the following circumstances shall not be identified as work injuries or deemed to be work injuries:
(1) Those who have suffered injuries or deaths due to crimes or violations of public security management;
(2) Those who are drunk and cause casualties;
(3) Those who harm themselves or commit suicide.
Article 17 Employees who suffer accidental injuries or are diagnosed or identified as occupational diseases in accordance with the provisions of the Occupational Disease Prevention and Control Law shall, within 30 days from the date of the accident or the day when they are diagnosed or identified as occupational diseases, report to the regional labor security administration File an application for work injury identification. In special cases, the time limit for application can be extended appropriately with the consent of the labor security administrative department.
If the employer fails to submit an application for the identification of an industrial injury in accordance with the preceding paragraph, the employee at work or his immediate family members or the trade union organization may, within one year from the date of the accident or the diagnosis and identification of an occupational disease, directly work in the area where the employer is located The administrative department of protection submitted an application for the identification of work-related injuries.
The matters that should be determined by the provincial labor security administrative department in accordance with the first paragraph of this article shall be handled by the provincial labor security administrative department in the district where the employer is located in accordance with the principle of territoriality.
(2) The employer has not submitted an application for work injury identification within the time limit specified in the first paragraph of this article. During this period, the employer shall bear the related expenses such as treatment for work injury that are in accordance with these regulations.
(Article 18) The following materials shall be submitted for the application for the identification of work injury:
一 (1) Application form for identification of work injury;
(2) Proof materials of labor relationship (including factual labor relationship) with the employer;
(3) Medical diagnosis certificate or occupational disease diagnosis certificate (or occupational disease diagnosis certificate).
The application form for the identification of work injury should include the basic information such as the time, place, cause of the accident, and the degree of employee injury.
If the materials provided by the applicant for work-related injury are incomplete, the labor security administrative department shall notify the applicant of all the materials that the applicant for work-related injury requires correction in one time. After the applicant corrects the materials in accordance with the written notification requirements, the labor security administrative department shall accept them.
十九 Article 19 After the application for the identification of scientific and technological injuries by the labor security administrative department, the accidental injury may be investigated and verified according to the needs of the review, and the employer, employee, trade union organization, medical institution, and relevant departments shall assist. The identification of occupational disease diagnosis and diagnosis disputes shall be performed in accordance with the relevant provisions of the Occupational Disease Prevention Law. Where an occupational disease diagnosis certificate or an occupational disease diagnosis appraisal is obtained in accordance with law, the labor security administrative department will no longer conduct investigation and verification.
If the employee or his immediate family member considers it a work injury and the employer does not consider it a work injury, the employer shall bear the burden of proof.
Article 20 The administrative department of labor security shall make a decision on the determination of work injury within 60 days from the date of receiving the application for the identification of science and technology injury, and notify the employee or his immediate family members and the unit where the worker is applying for work injury determination in writing.
If the staff of the administrative department of labor security has an interest relationship with the applicant for the work injury, it shall be avoided.
Chapter 4: Labor Capacity Appraisal
Article 21 In the event of a work-related injury to an employee, who has a disability after treatment of the injury that is relatively stable and affects work ability, a work ability appraisal shall be performed.
Article 22 Ability appraisal refers to the level appraisal of the degree of labor dysfunction and the degree of self-care disability.
The labor dysfunction is divided into ten levels of disability, the most serious being the first level, and the lightest being the tenth level.
障碍 The obstacles to self-care of living are divided into three levels: life cannot be taken care of at all, most of the life cannot be taken care of itself, and part of life cannot be taken care of by itself.
Labor capacity appraisal standards shall be formulated by the labor security administrative department of the State Council in conjunction with the health administrative department of the State Council and other departments.
Article 23 Employment appraisal shall be submitted by the employing unit, work-injury staff or their immediate family members to the district-level work-capacity appraisal committee, and provide relevant information on determination of work-related injuries and medical treatment of work-related injuries.
Article 24 The labor capacity appraisal committees of provinces, autonomous regions, and municipalities directly under the central government and the city-level labor capacity appraisal committees with districts shall be set up by the provincial, autonomous region, municipality, and district-level labor security administrative department, personnel administrative department, health administrative department, Representatives of trade union organizations, handling agencies and employers.
The labor capacity appraisal committee establishes a medical and health expert database. Medical and health professional technicians listed in the expert database shall meet the following requirements:
(1) Qualifications for senior professional and technical positions in medical care;
(2) Master relevant knowledge of labor capacity appraisal;
(3) Good professional ethics.
Article 25 After receiving the application for labor capacity appraisal, the municipal labor capacity appraisal committee with districts 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 city-level labor capacity appraisal committees with districts shall draw conclusions about the labor capacity of workers injured according to the expert group's appraisal opinions; if necessary, they may entrust a qualified medical institution to assist in the relevant diagnosis.
The municipal-level labor capacity appraisal committees in the established districts shall make labor capacity appraisal conclusions within 60 days from the date of receipt of the labor capacity appraisal application. If necessary, the time limit for making labor capacity appraisal conclusions may be extended by 30 days. The conclusion of labor capacity appraisal shall be delivered to the unit and individual applying for appraisal in time.
Article 26 If an entity or individual applying for appraisal is dissatisfied with the appraisal conclusion made by a municipal labor capacity appraisal committee with districts, it may report to the labor capacity appraisal committee of the province, autonomous region, or municipality within 15 days of receiving the appraisal conclusion. File an application for re-identification. The labor capacity appraisal conclusions made by the labor capacity appraisal committees of the provinces, autonomous regions, and municipalities directly under the Central Government shall be final.
Article 27 The work ability appraisal shall be objective and fair. The members of the labor capacity appraisal committee or the experts participating in the appraisal shall have an interest relationship with the parties, and they shall be avoided.
(Article 28) One year after the conclusion of the labor capacity appraisal is made, if an injured employee or his immediate family members, the unit or the agency considers that the disability has changed, he may apply for a labor capacity review and appraisal.
Chapter V Benefits of Work Injury Insurance
Article 29 Employees are treated for accidents or occupational diseases as a result of their work, and enjoy medical treatment for work-related injuries.
The staff should seek medical treatment at the medical institution that signed the service agreement for treatment of work-related injuries. In case of emergency, they can go to the nearest medical institution for first aid.
费用 If the expenses required for the treatment of work-related injuries meet the work injury insurance diagnosis and treatment project catalog, work injury insurance medicine catalog, and work injury insurance hospitalization service standards, they shall be paid from the work injury insurance fund. The work injury insurance diagnosis and treatment project catalog, work injury insurance drug catalog, and work injury insurance hospitalization service standards shall be prescribed by the labor security administrative department of the State Council in conjunction with the health administrative department of the State Council, the drug supervision and administration department and other departments.
If an employee is hospitalized for work-related injuries, the unit will pay 70% of the subsidy for in-patient meals in accordance with the standard of subsidies for meals on business trips; Expenses for transportation, accommodation and accommodation shall be reimbursed by the work unit in accordance with the standards of the employees of the unit for business trips.
Workers with work-related injuries are not treated for work-related injury medical treatment for diseases caused by non-work-related injuries, and are treated in accordance with the basic medical insurance measures.
(2) The cost of rehabilitation treatment for an injured employee at a medical institution that has signed a service agreement that meets the requirements of Paragraph 3 of this Article shall be paid from the Injury Insurance Fund.
Article 30 Due to daily life or employment needs, employees with work-related injuries may be assisted with prosthetics, orthoses, false eyes, dentures, and wheelchairs, as confirmed by the Labor Capacity Appraisal Committee. Pay.
(Article 31) If an employee suffers an injury due to an accident at work or suffers from an occupational disease and needs to suspend work to receive medical treatment for work-related injury, the original salary and benefits shall remain unchanged during the pay period of suspension of work and be paid monthly by the employer.
The pay period for suspension of work generally does not exceed 12 months. If the injury is serious or the situation is special, it can be extended appropriately after confirmation by the district-level labor capacity appraisal committee, but the extension cannot exceed 12 months. After assessing the level of disability at work, the original treatment shall be suspended and the disability treatment shall be enjoyed in accordance with the relevant provisions of this chapter. Workers with work-related injuries who still need treatment after the expiration of the pay period will continue to enjoy medical treatment for work-related injuries.
的 Working injury employees who cannot take care of themselves and need nursing care during the period of stoppage and pay, shall be responsible by the unit where they work.
Article 32 In the case of an employee who has been injured at work and has been assessed for a disability level and confirmed by the Labor Capacity Appraisal Committee that he needs life care, he shall be paid monthly from the Work Injury Insurance Fund.
The living care fee is paid according to three different levels of life: self-care, most of the life, or self-care. The standards are 50%, 40%, or 30% of the average monthly salary of the employees in the previous year.
Article 33 Employees are identified as Class 1 due to disability at work