The Measures for the Implementation of Shanxi Province have been adopted at the147th executive meeting of the provincial people's government on April 3, 20/kloc-0, and are hereby promulgated and shall come into force as of June 3, 20/kloc-0. In order to give you a better understanding of the details, the following is a collection of the full text of the Measures for Implementing the Regulations on Work-related Injury Insurance in Shanxi Province and its related interpretations. Welcome to read!
Interpretation of "Measures for Implementing the Regulations on Work-related Injury Insurance in Shanxi Province": 1. Units that should participate in industrial injury insurance are listed clearly and in detail:
The original "Trial Measures for Shanxi Province to Participate in Work-related Injury Identification" (referred to as the old measures).
The insured units are all kinds of enterprises and individual industrial and commercial households. The Shanxi Implementation Measures (hereinafter referred to as the new measures) clearly includes enterprises, institutions, social organizations, social service institutions, foundations, law firms, accounting firms and other organizations and individual industrial and commercial households with employees.
2, the employer's obligation to increase publicity to the insured:
The new method stipulates that the list of employees participating in work-related injury insurance, the time of participation and the payment situation shall be publicized in the unit within 30 days from the date of payment or within 15 days from the date of change of payment.
3, included in the scope of work-related injury insurance fund payment of transportation, accommodation and other expenses:
The new method stipulates that the transportation and accommodation expenses for medical treatment outside the overall planning area, the one-time medical subsidy, labor ability appraisal fee and work-related injury prevention training fee that should be enjoyed when the labor contract is terminated or dissolved shall be included in the payment method of the work-related injury insurance fund. In addition, the payment conditions of various expenses, such as life care expenses, have been revised in the expression, making the content more scientific and rigorous.
4, the unit to apply for work-related injury identification can be extended to apply for compression:
According to the old regulations, if the employer cannot apply for work-related injury identification due to special reasons, it may be extended after approval, but the longest time shall not exceed 150 days. The new method shortens the time to 90 days.
5. The jurisdiction of work-related injury identification has changed:
The work-related injury identification of central and provincial employers is under the jurisdiction of the employer's location, and the work-related injury identification of other employers is under the jurisdiction of the employer's insured location.
6. Identification requiring major adjustment:
6. 1 include the degree of self-care disorder in the scope of identification;
6.2 In addition to extending the paid downtime, the paid downtime is also used as the scope of assessment;
6.3 Other identification and confirmation items stipulated by laws, regulations and rules have been added, which has a local legal basis for the identification of the problem that Article 40 of the Labor Contract Law cannot engage in the original work after the first medical treatment expires. Of course, it remains to be seen whether it can be implemented.
7. The appraisal fees for initial appraisal, re-appraisal and re-appraisal were further clarified. If the employer pays the work-related injury insurance premium according to law, the agency shall pay it from the work-related injury insurance fund; Failing to pay work-related injury insurance premiums according to law shall be borne by the employer.
If the application for re-appraisal or re-appraisal is consistent with the original appraisal conclusion, the appraisal fee shall be borne by the applicant. If the appraisal conclusion is inconsistent with the original appraisal conclusion, if the employer pays the work-related injury insurance premium according to law, the appraisal fee shall be paid by the agency from the work-related injury insurance fund; If the work-related injury insurance premium is not paid according to law, the appraisal fee shall be borne by the employer.
The charging standard confirmed by the labor ability appraisal shall be formulated by the provincial price management department in conjunction with the provincial finance department and the provincial social insurance administrative department.
8, clear the employer's care during the shutdown:
The Regulations on Work-related Injury Insurance, the parent law of the new method, stipulates that the employer shall undertake the care during the paid shutdown, but it does not specify how to undertake it. The new method stipulates that if an injured worker who can't take care of himself needs care during the paid shutdown, the medical institution that admitted him shall issue a certificate and the employer shall send someone to accompany him. With the consent of the injured employee or his near relatives, the employer may pay the escort fee monthly according to the standard of the average monthly salary of an employee in the previous year.
It seems that workers enjoy more autonomy, but even if the injured workers disagree, the employer refuses to send someone to take care of them. Finally, injured workers can only make compensation through judicial procedures, and it is impossible to force others to accompany them without money. But on the whole, being clear is better than not being clear.
9. The payment standard of escort fee is very favorable:
The nursing fee for downtime stipulated in the old method is 60% of the average monthly salary of employees in the last year as a whole.
The payment is now adjusted to 100%, with a monthly net increase of 1765 yuan as per the above annual standard.
10. There are new regulations for handling the change of appraisal conclusion:
The so-called review refers to the appraisal when the parties think that the injury has changed one year after the appraisal of labor ability has been made.
Workers with work-related injuries who change their disability level after re-examination and appraisal shall enjoy the corresponding treatment of work-related injury insurance according to the conclusion of re-examination, but not including one-time disability allowance.
After review, those who meet the requirements for receiving disability allowance and living care expenses shall be approved according to their average monthly payment salary1February before the review appraisal conclusion, and the living care expenses shall be approved according to the average monthly salary of employees in the overall planning area before the review appraisal conclusion.
The above summary is the standard of disability allowance before review, and the new standard applies to disability allowance after review conclusion.
1 1, which determines the payment and responsibility of social security fees for disabled employees with grades 5 and 6:
If an employee's work-related disability is identified as level 5 or level 6 disability, the employer and individual employees shall pay the social insurance premiums that should be paid in accordance with the regulations.
12, the payment wage base will become the focus of controversy, directly affecting the amount of compensation for work-related injuries:
Before the actual implementation of industrial injury compensation, my salary base includes social salary, my actual salary,
I pay wages and other standards, the new method is further clarified on the basis of the payment wages stipulated in the Regulations on Industrial Injury Insurance, and the difference in payment wages will be highlighted, so the compensation for social insurance losses will be further increased.
13, the allowance for multiple work-related injuries and disabilities is clearly based on the high principle:
If an employee suffers multiple work-related injuries during the continuous work in the same employer, the one-time medical subsidy for work-related injuries and one-time employment subsidy for disability shall be calculated according to the highest disability level of the employee who suffers work-related injuries in the same employer.
14, payment salary is difficult to determine;
If an employee works in the employing unit for less than 1 year, the agency shall verify his/her industrial injury insurance benefits based on the average monthly payment salary of the employee's actual work.
For construction enterprises, small service enterprises,
Small mining enterprises and other employers who pay work-related injury insurance premiums, if their employees have work-related injuries, the agency shall take my salary as the base when approving the treatment of work-related injury insurance; It is difficult to determine my salary, based on the average monthly salary of employees in the overall planning area.
15. If a subcontractor subcontracts or subcontracts its business to an organization or individual that does not have the qualification as an employer, it shall bear the responsibility of industrial injury insurance:
If a contractor with the qualification of employment subcontracts the contracting business to an organization or a natural person without the qualification of employment in violation of laws and regulations, and the workers recruited by the organization or natural person suffer work-related injuries or die while engaging in the contracting business, the contractor with the qualification of employment shall bear the responsibility of work-related injury insurance that the employer should bear according to law.
16. Cancel the limitation of single compensation;
The old method stipulated that work-related injuries occurred due to traffic accidents. Make up the difference with the industrial injury insurance fund.
Ren is at most compensated. This provision is contrary to the Social Insurance Law, which leads to the application of different laws by law enforcement departments. After the introduction of the new measures, workers with work-related injuries can not only avoid the trouble of proof, but also get more compensation.
17. The confirmation period of labor relations constitutes the suspension of the limitation of work-related injury identification:
There are two standards for work-related injuries: 30 days and 1 year. However, the identification of work-related injuries is based on the recognition of labor relations. Some labor relations disputes last for years. Whether to apply the suspension of prescription during this period is basically the same in theoretical circles, but there has been a lack of legislative basis. The Provisions of the Supreme People's Court on Several Issues Concerning the Trial of Administrative Cases of Work-related Injury Insurance provides a legal basis for the suspension of the limitation of action. However, there are still some problems whether the administrative department applies the judicial interpretation of the Supreme Law. This new method completely solved the problem.
Measures for the Implementation of the Regulations on Work-related Injury Insurance in Shanxi Province Article 1 In order to ensure that employees who suffer from accidents or occupational diseases at work get medical treatment and economic compensation, promote work-related injury prevention and vocational rehabilitation, and disperse the risk of work-related injuries of employers, these measures are formulated in accordance with the provisions of the Social Insurance Law and the Regulations on Work-related Injury Insurance (hereinafter referred to as the Regulations) and in light of the actual situation of this province.
Article 2 Enterprises, institutions, social organizations, social service agencies, foundations, law firms, accounting firms and other organizations within the administrative region of this province and individual industrial and commercial households with employees (hereinafter referred to as employers) shall participate in work-related injury insurance according to law and pay work-related injury insurance premiums for all employees or employees (hereinafter referred to as employees).
The employees of the employing unit have the right to enjoy the treatment of work-related injury insurance according to law.
Third provincial social insurance administrative department is responsible for the work of industrial injury insurance in the province.
City, county (city, district) social insurance administrative department is responsible for the work-related injury insurance within their respective administrative areas.
The social insurance agency established by the administrative department of social insurance in accordance with the provisions (hereinafter referred to as the agency) specifically undertakes work-related injury insurance affairs.
Article 4 Departments of public security, civil affairs, housing and urban and rural construction, transportation, health and family planning, coal industry, industry and commerce, and supervision and administration of production safety shall, within their respective functions and duties, assist the social insurance administrative department in doing a good job in work-related injury insurance.
The financial department and the auditing organ shall supervise the income and expenditure and management of the industrial injury insurance fund according to law.
Article 5 The administrative department of social insurance and relevant departments shall solicit the opinions of the representatives of trade unions and employers when formulating policies and standards for industrial injury insurance.
Trade unions shall safeguard the legitimate rights and interests of employees and supervise the work-related injury insurance of employers.
Article 6 The employing unit shall abide by the laws and regulations on production safety and occupational disease prevention and control, establish a responsibility system for production safety and occupational disease prevention and control, and take measures to prevent the occurrence of industrial accidents and avoid and reduce the occupational disease hazards.
The employing unit shall, within 30 days from the date of insurance payment or within 0/5 days from the date of change of insurance payment, publicize the list of employees participating in work-related injury insurance, the time of insurance participation, the payment situation, etc.
When an employee suffers from a work-related injury, the employing unit shall take measures to enable the employee to receive timely treatment.
Article 7 The industrial injury insurance fund consists of the following items:
(a) the work-related injury insurance premium paid by the employer;
(two) the interest of the industrial injury insurance fund;
(three) overdue payment of work-related injury insurance premiums;
(four) when the industrial injury insurance fund is insufficient to pay, the subsidy given by the government according to law;
(five) other funds incorporated into the industrial injury insurance fund according to law.
Article 8 The industrial injury insurance fund shall be co-ordinated at the municipal level with districts and gradually at the provincial level.
Ninth overall regional agencies shall, according to the business scope registered by the employer, determine the initial payment rate of the employer according to the industry benchmark rate; If the business scope is cross-industry, it shall be determined according to the industry rate standard applicable to the main business of the employer.
Overall regional agencies shall determine the employer's payment rate within the industry rate level according to the use of work-related injury insurance premiums, the incidence of work-related injuries, the degree of occupational hazards and other factors.
It is difficult for construction enterprises, small service enterprises and small mining enterprises to pay work-related injury insurance premiums according to the total wages. , in accordance with the relevant provisions of the state and province.
Article 10 The industrial injury insurance fund shall be deposited in the financial special account of the social security fund for the following expenses:
(a) medical expenses and rehabilitation expenses for the treatment of work-related injuries;
(2) Hospitalization food subsidies;
(three) transportation and accommodation expenses for medical treatment outside the overall planning area;
(four) the cost of installing and configuring assistive devices for the disabled;
(five) life can not take care of themselves, confirmed by the labor ability appraisal committee of life care costs;
(6) One-time disability allowance and monthly disability allowance for disabled employees of Grade I to IV;
(seven) the one-time medical subsidy that should be enjoyed when the labor contract is terminated or dissolved;
(eight) death due to work, the funeral subsidies, dependent relatives' pensions and one-time work-related death subsidies received by their survivors;
(nine) industrial injury investigation and verification fees and labor ability appraisal fees;
(ten) publicity, training and other expenses for work-related injury prevention;
(eleven) other work-related injury insurance fees stipulated by laws and regulations.
Eleventh overall planning areas should establish a work-related injury insurance reserve system. The industrial injury insurance reserve fund is used to co-ordinate the payment of industrial injury insurance benefits for major accidents in the region.
The extraction ratio of the reserve fund is determined according to the industrial structure of the overall planning area and the proportion of the industrial injury insurance expenses to the total industrial injury insurance expenses in the event of a major accident, which generally does not exceed 20% of the total fund collection in that year. The total accumulated balance of the reserve fund shall not exceed 30% of the total fund payable in the current year. If the reserve fund is insufficient to pay, it shall be paid in advance by the people's government of the overall planning area. Measures for the use of reserves shall be formulated by the provincial social insurance administrative department jointly with the provincial finance department and implemented after being approved by the provincial people's government.
Article 12 The identification of work-related injuries of employees of employers in Shanxi and Shanxi provinces by the central government shall be handled by the municipal social insurance administrative department located in the district where the employer is located in accordance with the principle of territoriality.
The identification of work-related injuries of employees of other employers shall be handled by the social insurance administrative department of the place where the employer is registered.
Article 13 An employing unit shall, within 30 days from the date when an employee is injured by an accident or diagnosed as an occupational disease, file an application for ascertainment of a work-related injury with the social insurance administrative department that has jurisdiction over ascertainment of a work-related injury. Under special circumstances, with the consent of the social insurance administrative department that has jurisdiction over the identification of work-related injuries, the application time limit may be appropriately extended, but the extension time shall not exceed 90 days.
If the employing unit fails to apply for work-related injury identification in accordance with the provisions of the preceding paragraph, the workers with work-related injuries or their close relatives and trade unions may apply for work-related injury identification directly to the social insurance administrative department with jurisdiction over work-related injury identification within 1 year from the date of accident injury or diagnosis and identification as an occupational disease.
Article 14 When applying for work-related injury identification, an employer, an employee with a work-related injury or his close relatives or a trade union organization shall fill in an application form for work-related injury identification and submit the following materials:
(a) a copy of the text of the labor employment contract or other proof of the existence of labor relations (including factual labor relations) and personnel relations with the employer;
(2) A copy of the social security card or resident ID card of the injured employee and other identification certificates;
(3) Certificate of industrial injury diagnosis or occupational disease diagnosis issued by medical institutions (or occupational disease diagnosis certificate);
(four) other materials as prescribed by laws, regulations and rules.
Fifteenth social insurance administrative departments shall make a decision on work-related injury identification within 60 days from the date of accepting the application for work-related injury identification.
The administrative department of social insurance shall, within 20 days from the date of making the decision on ascertainment of work-related injuries, serve the decision on ascertainment of work-related injuries on the employees who apply for ascertainment of work-related injuries or their close relatives and employers, and send a copy to the agency.
Sixteenth provinces and cities divided into districts shall establish labor ability appraisal committees according to law.
The labor ability appraisal committee shall set up an office to be responsible for the daily work of the labor ability appraisal committee and the organization and management of the labor ability appraisal.
Seventeenth districts of the city labor ability appraisal committee is responsible for the identification and confirmation of the following matters:
(1) Preliminary appraisal and review appraisal of the degree of labor dysfunction;
(two) the preliminary identification and review of the degree of self-care disorders;
(3) Confirmation of paid shutdown and extension of paid shutdown;
(4) Confirmation of installation and configuration of auxiliary devices;
(5) Confirmation of recurrence of old injuries;
(six) identification of the degree of labor dysfunction of the dependent relatives of the workers who died at work;
(seven) other identification and confirmation matters stipulated by laws, regulations and rules.
Eighteenth provincial labor ability appraisal committee is responsible for the identification of the following matters:
(1) Re-appraisal of the degree of labor dysfunction;
(2) Re-appraisal of the degree of self-care disorder;
(three) other identification matters stipulated by laws, regulations and rules.
Nineteenth employers, workers injured at work or their close relatives apply for labor ability appraisal, they shall fill in the application form for labor ability appraisal and submit the following materials:
(a) a copy of the work-related injury determination decision;
(2) Complete medical records such as the diagnosis certificate issued by the medical institution and the inspection report copied or duplicated in accordance with the relevant provisions of medical institution medical record management;
(3) A copy of the social security card or resident identity card of the injured employee and other identification certificates;
(four) other materials as prescribed by the labor ability appraisal committee.
To apply for re-appraisal, it is necessary to submit a copy of the conclusion of the first or second labor ability appraisal.
Twentieth initial labor ability appraisal and confirmation costs, the employer shall pay work-related injury insurance premiums, paid by the agency from the work-related injury insurance fund; Failing to pay work-related injury insurance premiums according to law shall be borne by the employer.
If the application for re-appraisal or re-appraisal is consistent with the original appraisal conclusion, the appraisal fee shall be borne by the applicant. If the appraisal conclusion is inconsistent with the original appraisal conclusion, if the employer pays the work-related injury insurance premium according to law, the appraisal fee shall be paid by the agency from the work-related injury insurance fund; If the work-related injury insurance premium is not paid according to law, the appraisal fee shall be borne by the employer.
The charging standard confirmed by the labor ability appraisal shall be formulated by the provincial price management department in conjunction with the provincial finance department and the provincial social insurance administrative department.
Article 21 If an employee suffers from an accident or occupational disease at work and needs to be suspended from work to receive medical treatment for work-related injuries, the original salary and welfare benefits will remain unchanged during the paid suspension, and the employer will pay them monthly.
The paid shutdown period generally does not exceed 12 months. If the injury is serious or the situation is special, it may be appropriately extended upon confirmation by the Municipal Labor Ability Appraisal Committee with districts, but the extension period shall not exceed 12 months. Workers with work-related injuries shall stop the original treatment and enjoy the disability treatment according to the regulations after the assessment of disability level. Workers with work-related injuries who still need treatment after the expiration of paid shutdown shall continue to enjoy medical treatment for work-related injuries.
Workers with work-related injuries can't take care of themselves, and need nursing care during the period of suspension without pay. The medical institution that admitted them shall issue a certificate, and the employer shall send someone to accompany them. With the consent of the injured employee or his near relatives, the employer may pay the escort fee monthly according to the standard of the average monthly salary of an employee in the previous year.
Twenty-second workers injured at work, the level of disability changes, according to the review conclusion, enjoy the corresponding treatment of work-related injury insurance, but does not include a one-time disability allowance.
After review, those who meet the requirements for receiving disability allowance and living care expenses shall be approved according to their average monthly payment salary1February before the review appraisal conclusion, and the living care expenses shall be approved according to the average monthly salary of employees in the overall planning area before the review appraisal conclusion.
Twenty-third disability allowance, life care expenses and one-time disability allowance shall be calculated from the next month after the conclusion of labor ability appraisal is made. The pension for dependent relatives shall be calculated and paid from the month following the death of the employee due to work.
Twenty-fourth employees who are disabled due to work are identified as five or six levels of disability, the employer and individual employees shall pay the social insurance premiums that should be paid in accordance with the regulations.
Article 25 The administrative department of social insurance in the overall planning area shall adjust the disability allowance, pension for dependent relatives and living care expenses according to the changes in the average wages and living expenses of employees. The adjustment time and range refer to the adjustment of the basic pension for retirees.
Article 26 If an employee is disabled due to work, and is identified as a five-level to ten-level disability, in accordance with the provisions of Articles 36 and 37 of the Regulations, if the employee and the employer terminate or terminate the employment relationship, the agency shall pay a one-time medical subsidy for work-related injuries from the work-related injury insurance fund, and the employer shall pay a one-time disability employment subsidy.
One-time medical subsidy for work-related injuries and one-time disability employment subsidy are calculated according to the following standards based on the average monthly payment salary 12 months before the termination or dissolution of the labor-employment relationship between the employee and the employer:
(1) One-time medical subsidy standard for work-related injuries: 36 months' salary for level 5 disability, 33 months for level 6 disability, 24 months for level 7 disability, 2 1 month for level 8 disability, 0/8 months for level 9 disability and 0/5 months for level 10 disability;
(II) One-time disability employment subsidy standard: Grade 5 disability is my 24-month salary, Grade 6 disability is my 2 1 month salary, Grade 7 disability is my 0/5-month salary, Grade 8 disability is my 0/2-month salary, Grade 9 disability is my 9-month salary, and Grade 10 disability is my 9-month salary.
Workers with work-related injuries are less than five years away from the statutory retirement age, and the one-time work-related injury medical subsidy and one-time disability employment subsidy are based on five years, and are reduced by 1 year.
Workers with work-related injuries who have reached retirement age or gone through retirement procedures do not enjoy one-time medical subsidies for work-related injuries and one-time employment subsidies for disabled people.
If an employee suffers multiple work-related injuries during the continuous work in the same employer, the one-time medical subsidy for work-related injuries and one-time employment subsidy for disability shall be calculated according to the highest disability level of the employee who suffers work-related injuries in the same employer.
Twenty-seventh employees in the employer's work dissatisfaction 1 year, the agency should be based on the actual work of the average monthly payment of wages for the approval of their work-related injury insurance benefits.
In accordance with the provisions of the third paragraph of Article 9 of these Measures, the employer who pays the work-related injury insurance premium, if its employees have work-related injuries, the agency shall take my salary as the base when approving the work-related injury insurance benefits; It is difficult to determine my salary, based on the average monthly salary of employees in the overall planning area.
Article 28 If a contractor with the employer qualification subcontracts the contracted business to an organization or a natural person without the employer qualification in violation of laws and regulations, the contractor with the employer qualification shall bear the industrial injury insurance liability that the employer shall bear according to law.
Twenty-ninth employees of the employer who should participate in work-related injury insurance but did not participate in work-related injury insurance shall be paid by the employer in accordance with the work-related injury insurance treatment items and standards stipulated in the Regulations and these Measures.
Article 30 Where a dispute arises between a laborer and an employer due to the employment relationship, the parties concerned shall apply to the Labor and Personnel Dispute Arbitration Committee for arbitration, and the Labor and Personnel Dispute Arbitration Committee shall determine the employment relationship according to law. The time for handling personnel and labor disputes according to legal procedures is not included in the time limit for determining work-related injuries.
Thirty-first in violation of the provisions of these measures, one of the following circumstances, resulting in the loss of work-related injury insurance fund, the social insurance administrative department shall order it to return, and impose a fine of more than 2 times and less than 5 times the amount of fund loss; If the circumstances are serious enough to constitute a crime, criminal responsibility shall be investigated according to law:
(a) posing as an insured employee to defraud the treatment of work-related injury insurance;
(two) fabricating the facts of hospitalization, rehabilitation, and the allocation of assistive devices, and making false medical records and files;
(three) drugs or medical care, rehabilitation services and auxiliary devices that do not meet the requirements of the fund are included in the fund settlement;
(four) by other means to defraud the industrial injury insurance benefits or industrial injury insurance fund expenditure.
Article 32 Where the staff of the administrative department of social insurance and the agency abuse their powers, engage in malpractices for selfish ends or neglect their duties in the management of industrial injury insurance, resulting in the loss of the industrial injury insurance fund, the administrative department of social insurance shall recover the lost industrial injury insurance fund; If it does not constitute a crime, it shall be given administrative sanctions according to law; If a crime is constituted, criminal responsibility shall be investigated according to law.
Article 33 These Measures shall come into force on June 1 day, 2065. The Trial Measures for the Implementation of Industrial Injury Insurance Regulations in Shanxi Province promulgated by Shanxi Provincial People's Government on June 65438+10/October 65438+September 65438, 2004 (DecreeNo. 170 of Shanxi Provincial People's Government) shall be abolished at the same time.
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