1. If the expenses required for work-related injury treatment meet the catalogue of work-related injury insurance diagnosis and treatment items, the catalogue of work-related injury insurance drugs and the hospitalization service standard of work-related injury insurance, 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 hospitalization service standard of work-related injury insurance shall be stipulated by the administrative department of labor and social security of the State Council in conjunction with the administrative department of health and the drug supervision and administration department of the State Council.
2, agencies and medical institutions, auxiliary equipment configuration institutions signed a service agreement on the basis of equal consultation, and announced the list of medical institutions and auxiliary equipment configuration institutions signed a service agreement. The specific measures shall be formulated by the administrative department of labor and social security of the State Council jointly with the administrative department of health and the civil affairs department of the State Council respectively.
3, agencies in accordance with the agreement and the relevant national directory, standard of inductrial injury worker medical expenses, rehabilitation costs, the use of assistive devices for verification, and timely and full settlement costs.
4. It is a prerequisite for the victim to obtain compensation for medical expenses of work-related injuries, that is, except for emergencies, employees should seek medical treatment in medical institutions that have signed service agreements, and all expenses should conform to the catalogue of work-related injury insurance diagnosis and treatment items, the catalogue of work-related injury insurance drugs and the hospitalization service standard of work-related injury insurance. After meeting the above conditions, the victim can get compensation for medical expenses.
Second, the rehabilitation fee.
At the time of compensation, if the patient's body has not recovered and it is really necessary to continue treatment, the inevitable expenses shall be determined according to the medical certificate or appraisal conclusion, and the medical expenses that have already occurred may be compensated together.
If the rehabilitation expenses, proper cosmetic expenses and other follow-up treatment expenses necessary for organ function recovery training after injury fixation and the dysfunction left after treatment really need to be treated again, the compensation obligee may sue separately after the actual occurrence. If the victim is treated in a rehabilitation hospital, the compensation for his medical expenses shall be handled according to different situations:
1, the victim should be treated in a general hospital. If a rehabilitation hospital is not needed to treat an injury, the compensation for medical expenses shall be calculated according to the charging standard for treating the same injury in ordinary hospitals.
2. After being treated in a general hospital, he is transferred to a rehabilitation hospital for further treatment with the consent of the treatment hospital, and it is really necessary to treat the injury. The medical expenses are calculated according to the charging standard of rehabilitation hospitals formulated by the state. After treatment, the injury is stable, but rehabilitation and symptomatic treatment are still needed. And a certificate issued by a medical institution at or above the county level can be treated in a medical institution or outpatient clinic below the county level.
Three. Food subsidy
1. It is really necessary for the victim to go to other places for treatment. If the victim and his entourage cannot be hospitalized for objective reasons, a reasonable part of the actual accommodation expenses incurred by the victim and his entourage shall be compensated.
2. In principle, the compensation period of food allowance is the hospitalization period, that is, the number of days of food allowance is calculated according to the victim's hospitalization period and multiplied by the daily standard of the general staff of the local state organs, and the specific food allowance can be obtained.
Fourth, transportation and accommodation costs.
1, about the doctor's travel expenses.
If the doctor visits the victim, if the transportation fee for the visit has been included in the medical expenses, the victim gets compensation from the medical expenses and does not need to be included in the transportation fee. If it is not included in the visiting expenses and is paid separately by the victim, the expenses shall be compensated according to the transportation expenses.
2. About the expenses for the victims or their accompanying persons to use private cars. If you use a private car as a means of transportation when you go to a hospital for treatment or transfer to a hospital, you should compensate yourself for normal and actual expenses, such as corresponding and reasonable fuel costs, parking fees, tolls, etc.
3. Calculation standard of transportation fee.
In practice, it is generally believed that transportation expenses should be paid according to the standard of travel expenses of ordinary staff of state organs where the infringement occurred. However, it should also be flexibly mastered according to the actual situation of the victims and the actual needs of treatment.
1. Ordinary buses are the main means of transportation. Under special circumstances, you can take an ambulance, taxi, etc. , but the victim should explain the rationality of the use.
2, when taking the train, should give priority to with ordinary hard seat train, under special circumstances, need to take a soft seat, sleeper, should also be allowed, but the victim should explain its rationality.
In case of emergency, you should also be allowed to fly, and the victim should also explain its justified reasons.
Verb (abbreviation of verb) nursing expenses
Workers with work-related injuries who have been assessed as disabled and confirmed by the labor ability appraisal committee need life care shall be paid by the work-related injury insurance fund on a monthly basis.
Life care fees are paid according to three different levels: completely unable to take care of themselves, mostly unable to take care of themselves or partially unable to take care of themselves, and their standards are 50%, 40% or 30% of the average monthly salary of employees in the overall planning area respectively.
Six, stop paying wages during the period of wages
1. If the employee has worked in this unit for full 12 months before the work injury, the original salary standard shall be calculated according to the monthly average salary (including basic salary, bonus, subsidy and overtime) of the salary payable for 12 months before the work injury;
2. If the employee has been working in this unit for less than 12 months before the work-related injury, the original salary standard shall be calculated according to the actual monthly average salary before the work-related injury.
3. If the employee's work before the work injury is less than 1 month, the original salary standard shall be calculated according to the monthly salary agreed in the contract; If the original salary is not agreed upon or cannot be determined, the original salary standard shall be calculated at not less than 60% of the average monthly salary of employees in this Municipality in the previous year.
Seven, disability AIDS.
Workers with work-related injuries may install artificial limbs, orthotics, artificial eyes, dentures and wheelchairs and other auxiliary devices due to their daily life or employment needs, and the required expenses shall be paid from the work-related injury insurance fund according to the standards stipulated by the state.
VIII. One-time Disability Allowance
1. If the actual amount of disability allowance is lower than the local minimum wage, make up the difference; Keep labor relations and quit your job. Workers with work-related injuries who reach retirement age and go through retirement formalities will stop receiving disability allowance and enjoy basic old-age insurance benefits. If the basic old-age insurance benefits are lower than the disability allowance, make up the difference. Employers and employees pay basic medical insurance premiums based on disability allowance.
2. My salary refers to the average monthly payment salary of the injured workers 12 months before they suffer from accidents or occupational diseases. If my salary is higher than 300% of the average wage of employees in the overall planning area, it shall be calculated according to 300% of the average wage of employees in the overall planning area; If my salary is lower than 60% of the average wage of employees in the overall planning area, it shall be calculated according to 60% of the average wage of employees in the overall planning area.
Nine. Disability allowance
Retain the labor relationship with the employer, and the employer will arrange appropriate work. If it is difficult to arrange the work, the employer shall issue a monthly disability allowance, and the employer shall pay the social insurance premiums payable for it 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.
X. One-time medical subsidy for work-related injuries
One-time medical subsidy for work-related injuries. According to my salary, the salary is calculated as follows: ten months for grade five, eight months for grade six, six months for grade seven, four months for grade eight, two months for grade nine and one month for grade ten.
Eleven, a one-time disability employment subsidy
One-time disability employment subsidy. Pay according to my salary: grade five 50 months, grade six 40 months, grade seven 25 months, grade eight 15 months, grade nine 8 months and grade ten 4 months. If the age is less than 1 one year old, it will be paid at 10% of the total amount.
legal ground
regulation on work related injury insurance
Twenty-fourth work-related injury treatment costs meet the catalogue of work-related injury insurance diagnosis and treatment items, the catalogue of work-related injury insurance drugs and the hospitalization service standard of work-related injury insurance, and 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 hospitalization service standard of work-related injury insurance shall be implemented in accordance with the relevant provisions of the state and province.
Food subsidies for hospitalization and rehabilitation of workers with work-related injuries, as well as food subsidies for outpatient treatment, rehabilitation, hospitalization and approved transfer to prefecture-level listing, shall be paid by the industrial injury insurance fund in accordance with the standards set by the provincial people's government.
Twenty-fifth employees need to suspend work to receive work-related injury medical treatment because of work-related injuries. During the paid suspension, the original salary and welfare benefits will remain unchanged and will be paid by the unit on a monthly basis. The period of shutdown with pay shall be determined according to the medical termination period and confirmed by the labor ability appraisal committee, and the longest period shall not exceed 24 months.
Workers with work-related injuries stop receiving the original treatment and enjoy disability treatment in accordance with the relevant provisions of this chapter. Workers with work-related injuries who still need treatment after the disability grade appraisal shall enjoy disability allowance and medical treatment for work-related injuries with the approval of the labor ability appraisal committee. Five to ten levels of disability, enjoy medical treatment for work-related injuries and shutdown with pay.
If it is confirmed by the labor ability appraisal committee that rehabilitation can be carried out, the work-related injury rehabilitation expenses incurred by the injured workers in the rehabilitation institutions that signed the service agreement shall be paid by the work-related injury insurance fund.
Workers with work-related injuries who can't take care of themselves during the paid shutdown period shall be responsible by their units. If the unit does not send people to nurse, it shall pay the nursing fee to the injured employee according to the local labor remuneration standard for nurses engaged in the same level of nursing.
Twenty-sixth injured workers were identified as one to four levels of disability and confirmed by the labor ability appraisal committee that they need life care, and the work-related injury insurance fund will pay life care fees according to the degree of self-care obstacles of injured workers.
Living nursing expenses are paid monthly according to a certain proportion of the average monthly salary of employees in the province in the previous year. The standards are: 60% for Grade I, 50% for Grade II, 40% for Grade III and 30% for Grade IV.
Life nursing expenses are adjusted synchronously every year according to the growth ratio of the average wage of employees in the province in the previous year, and are not adjusted when the average wage of employees in the province in the previous year is negative.
Thirtieth work-related disability was identified as five or six disabled workers enjoy the following benefits:
(1) One-time disability allowance. Paid by the industrial injury insurance fund, the standard is: level 5 disability is my 18 month salary, and level 6 disability is my 16 month salary.
(two) to retain the labor relationship with the employer, and the employer shall arrange appropriate work. If it is difficult to arrange a job, the employer will pay a monthly disability allowance. The standard is: level 5 disability is 70% of my salary, level 6 disability is 60% of my salary, and the employer shall pay the social insurance premium that should be paid according to the regulations. If the actual amount of disability allowance is lower than the local minimum wage, the employer shall make up the difference.
Article 32 Employees are disabled due to work.