Chapter I General Provisions
Article 1 In order to implement the Regulations on Industrial Injury Insurance formulated by the State Council (hereinafter referred to as the Regulations), these Measures are formulated in light of the actual situation of this province.
Article 2 All kinds of enterprises and individual industrial and commercial households with employees within the administrative region of this province (hereinafter referred to as employers) shall participate in work-related injury insurance in accordance with the Regulations and these Measures, and pay work-related injury insurance premiums for all employees or employees of their own units.
Employees of various enterprises and individual industrial and commercial households within the administrative region of this province (hereinafter referred to as employees) have the right to enjoy the treatment of work-related injury insurance in accordance with the Regulations and these Measures.
Article 3 The administrative department of labor security of the people's governments at or above the county level shall be responsible for the work-related injury insurance within their respective administrative areas.
The social insurance agency (hereinafter referred to as the agency) established by the administrative department of labor and social security to handle industrial injury insurance business specifically undertakes industrial injury insurance affairs. The business expenses required by the agency shall be borne by the finance at the corresponding level.
Fourth production safety supervision and management, health, finance, local taxation and other relevant departments shall, within the scope of their respective duties, do a good job in work-related injury insurance.
The government and relevant departments shall solicit the opinions of trade union organizations, relevant departments and employers when formulating policies and standards for industrial injury insurance.
Article 5 The employing unit shall establish and improve the responsibility system for production safety, prevent industrial accidents and avoid and reduce occupational hazards. Employers with low incidence of industrial accidents and occupational diseases in the same industry in the overall planning area can be rewarded. Incentive measures shall be formulated by the provincial labor security administrative department in conjunction with the provincial finance department.
Chapter II Industrial Injury Insurance Fund
Article 6 The industrial injury insurance fund shall be co-ordinated by cities divided into districts. The overall planning of the whole city is difficult to implement. With the consent of the municipal people's government with districts and the approval of the provincial people's government, the overall planning of counties (cities) shall be implemented.
Article 7 The industrial injury insurance fund consists of the following items:
(a) the work-related injury insurance premium paid by the employer;
(2) Late payment fees for work-related injury insurance premiums;
(three) the interest of the industrial injury insurance fund;
(4) social donations;
(five) other funds incorporated into the industrial injury insurance fund according to law.
The industrial injury insurance fund is deposited in the financial special account of the social security fund.
Article 8 Work-related injury insurance premiums shall be determined according to the principle of fixed income by expenditure and balance of payments.
The industry benchmark rate standard is determined by the people's government of the overall planning area; The measures for floating rates shall be formulated by the administrative department of labor and social security in the overall planning area in conjunction with the departments of finance, local taxation, health and safety production supervision and management in accordance with state regulations. The specific payment rate of the employer shall be proposed by the agency in the overall area according to the use of work-related injury insurance premiums, the occurrence of work-related injuries and the management of work-related injury insurance (work-related injury relief, declaration, etc.). ), safety production management and occupational health examination, and report to the administrative department of labor and social security in the overall planning area for approval before implementation.
The employer whose business scope is cross-industry shall determine the applicable industry rate standard according to its main business.
Ninth industrial injury insurance fund for the following items:
(1) Industrial injury insurance benefits paid in accordance with regulations;
(2) Fees for occupational rehabilitation treatment;
(three) the labor ability appraisal fee;
(four) the investigation fee for the identification of work-related injuries;
(five) the incentive fee stipulated in Article 5 of these Measures;
(six) other expenses stipulated by laws, regulations and rules.
Tenth the establishment of provincial and municipal industrial injury insurance reserves. Reserves are retained from the industrial injury insurance premiums collected. After the total reserve reaches 30% of the annual collection amount of work-related injury insurance premiums, it will not increase, and 30% of it will be turned over to the provincial reserve. The reserve fund is used to pay work-related injury insurance benefits for major accidents. If the municipal reserve fund is insufficient, it shall be paid by the people's government at the same level and the provincial reserve fund according to a certain proportion. The specific measures shall be formulated by the provincial labor security administrative department in conjunction with the provincial finance department.
Eleventh work-related injury insurance fee collection and management in accordance with the relevant provisions of the state and the "Interim Provisions on the Collection and Payment of Social Insurance Fees in Anhui Province".
The employing unit shall publicize the list of employees participating in work-related injury insurance, payment wages and payment amount, etc. At work.
Chapter III Identification of Work-related Injury
Article 12 When an employer has an accident of casualties, it shall promptly report to the administrative department of labor and social security in the overall planning area. The longest time is no more than 48 hours.
Thirteenth in special circumstances, with the approval of the administrative department of labor and social security in the overall planning area, the employer may extend the application time limit for work-related injury identification for 30 days.
Article 14 The administrative department of labor and social security in the overall planning area shall be responsible for the identification of work-related injuries of employees of production and operation enterprises across the overall planning area, and the administrative department of labor and social security in the place where the accident occurred shall assist in the investigation. The administrative department of labor and social security in the overall planning area may also entrust the administrative department of labor and social security in the place where the accident occurred to investigate and collect evidence, and the entrusting party shall issue a conclusion.
Fifteenth applications for work-related injury identification shall submit the following materials:
(a) the application form for work-related injury identification;
(two) the existence of labor relations with the employer (including factual labor relations);
(3) Medical diagnosis certificate or occupational disease diagnosis certificate (or occupational disease diagnosis certificate);
(4) Proof of injury due to special reasons.
1. Proof materials or legal documents of violent injury made by public security organs or people's courts;
2. Traffic accident certification materials issued by the traffic accident handling department;
3. Proof materials made by the civil affairs department or other relevant departments to safeguard national interests and public interests for emergency rescue and disaster relief;
4. Proof materials for the labor ability appraisal committee to confirm the recurrence of old injuries;
5. Accidental injury certificates provided by other relevant units or individuals.
Sixteenth employees or their immediate family members to apply for work-related injuries, the employer does not consider it a work-related injury. The employing unit shall provide evidence within 15 days from the date of receiving the notice from the administrative department of labor security. The time of proof is not counted in the time limit for work-related injury identification.
Chapter IV Appraisal of Labor Ability
Seventeenth provinces and cities divided into districts shall set up labor ability appraisal committees composed of representatives of labor security, personnel and health administrative departments, trade union organizations, agencies and employers. The number of members of the labor ability appraisal committee shall be odd.
Eighteenth city labor ability appraisal committee to undertake the following tasks:
(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 downtime;
(four) the confirmation of continuing treatment after the expiration of the suspension period;
(5) Confirmation that work-related injuries directly lead to diseases;
(6) Confirmation of rehabilitation treatment;
(seven) the confirmation of the recurrence of old injuries;
(eight) confirmation of auxiliary equipment configuration;
(nine) identification of the ability to support relatives;
(ten) other identification and confirmation items stipulated by laws, regulations and rules.
The third to eighth cases of the preceding paragraph need to be confirmed by experts, and the Municipal Labor Ability Appraisal Committee shall organize experts to appraise them.
Nineteenth provincial labor ability appraisal committee undertakes the re-appraisal of the units or individuals who are dissatisfied with the appraisal conclusion of the municipal labor ability appraisal committee on the degree of labor dysfunction and the degree of self-care dysfunction, as well as other appraisals as stipulated by laws, regulations and rules.
Twentieth labor ability appraisal committee appraisal fee standard proposed by the provincial administrative department of labor security, the provincial price department in conjunction with the provincial finance department for approval.
Article 21 If an employee is cured after treatment for work-related injury or the injury is in a relatively stable state, the medical institution shall make a medical conclusion, and the unit or individual shall apply for labor ability appraisal in time.
Chapter V Work-related Injury Insurance Benefits
Twenty-second employees who are disabled due to work are identified as first-class to fourth-class disabilities, retain labor relations, quit their jobs, and enjoy relevant treatment according to the provisions of Article 33 of the Regulations.
During the period of receiving disability allowance, the employer and individual employees shall pay the basic medical insurance premium based on disability allowance. After deducting the basic medical insurance premiums paid by individuals, if the actual amount of disability allowance is lower than the local minimum wage, the industrial injury insurance fund will make up the difference.
Twenty-third employees who have been identified as five or six levels of disability due to work-related disability shall enjoy relevant treatment in accordance with the provisions of Article 34 of the Regulations and retain labor relations. If it is difficult for the employing unit to arrange appropriate work, it shall pay disability allowance in accordance with the regulations. During the period of receiving disability allowance, the employer and employees shall pay various social insurance premiums based on disability allowance. After deducting various social insurance premiums paid by individuals, if the actual amount of disability allowance is lower than the local minimum wage, the employer shall make up the difference.
Workers who are disabled at work are identified as five or six disabled. Upon my own proposal, they can terminate or terminate the labor relationship with the employer, and the employer shall pay the one-time work-related injury medical subsidy and disability employment subsidy, and stop issuing disability allowance. One-time medical subsidy standard for work-related injuries: the average monthly salary of employees in the overall planning area for 20 months with level 5 disability, and the level 6 disability 15 months; One-time disability employment subsidy standard: the average monthly salary of employees in the five-level disability for 35 months and the six-level disability for 30 months.
Twenty-fourth employees who are disabled at work are identified as seven to ten levels of disability. If the labor contract expires or the employee proposes to terminate the labor contract, the employer shall pay a one-time work-related injury medical subsidy and disability employment subsidy. One-time work-related injury medical subsidy standard: the average monthly salary of employees in the last year in the overall planning area is 10 month, the eighth disability is 8 months, the ninth disability is 6 months, and the tenth disability is 4 months; One-time disability employment subsidy standard: the average monthly salary of employees in the overall planning area with seven-level disability for 20 months, eight-level disability 15 months, nine-level disability 10 months, and ten-level disability for 5 months.
Twenty-fifth in accordance with the provisions of article twenty-third, article twenty-fourth, enjoy a one-time disability employment subsidies for workers, less than five years from the statutory retirement age, one-time disability employment subsidies according to the following standards:
(a) less than two years, according to the full payment of 60%;
(two) less than three years, according to the full payment of 70%;
(three) less than four years, according to the full payment of 80%;
(four) less than five years, according to the full payment of 90%.
Twenty-sixth disabled workers in accordance with the provisions of retirement procedures, one-time work-related injury medical subsidies and disability employment subsidies will not be paid.
Article 27 The following work-related injury benefits for employees shall be paid by the work-related injury insurance fund:
(1) Medical expenses for work-related injuries;
(2) Fees for assistive devices for the disabled;
(3) Living nursing expenses;
(four) a one-time work death grant;
(5) One-time disability allowance;
(6) Disability allowance for disabled employees of Grade I to IV;
(7) Funeral subsidies;
(8) Pension for supporting relatives;
(nine) other expenses stipulated by laws, regulations and rules.
Article 28 The following work-related injury benefits for employees shall be paid by the employer:
(1) Nursing expenses during shutdown with pay;
(two) wages and benefits during the period of suspension;
(three) in the overall area of hospitalization food subsidies;
(four) to co-ordinate the transportation and accommodation expenses for medical treatment outside the region;
(five) the difference between hospitalization and nursing expenses after the expiration of the suspension period;
(6) Disability allowance for disabled employees of Grade V and VI;
(seven) one-time medical subsidies for work-related injuries and disability employment subsidies;
(eight) other expenses stipulated by laws, regulations and rules.
Article 29 If an employee's whereabouts are unknown during work or during emergency rescue and disaster relief, and then reappears or the death conclusion is revoked by the people's court, the work-related injury benefits received by his relatives shall be returned.
Thirtieth employees who are injured by work-related accidents during the export of labor services by their labor relations units shall be liable for work-related injury insurance by their labor relations units. The unit where the labor relations are located shall agree with the employer on the compensation measures for work-related injury insurance.
Employees who have applied for domestic work-related injury insurance will not be paid domestic work-related injury insurance benefits if they suffer work-related injuries during their overseas assignment and receive overseas compensation; However, if the overseas compensation is lower than the treatment of industrial injury insurance in the overall planning area, the difference will be made up.
Thirty-first workers with work-related injuries who have changed their disability level after review shall be paid corresponding work-related injury insurance benefits according to the new appraisal conclusion from the next month; If the disability level is higher than the previous level, make up the difference of one-time disability allowance.
Article 32 If a unit or an injured worker refuses to accept the appraisal conclusion of the Municipal Labor Ability Appraisal Committee and applies for re-appraisal by the Provincial Labor Ability Appraisal Committee, the industrial injury insurance benefits of the injured worker shall be calculated according to the appraisal conclusion of the Municipal Labor Ability Appraisal Committee, and shall be calculated according to the appraisal conclusion of the Provincial Labor Ability Appraisal Committee after the appraisal conclusion is made.
Thirty-third measures for the adjustment of disability allowance, pension for dependent relatives and living care expenses shall be formulated by the provincial labor and social security administrative department in conjunction with the provincial finance department.
Chapter VI Medical Management of Work-related Injury
Thirty-fourth industrial injury insurance is managed by designated medical institutions and designated auxiliary equipment allocation institutions. Designated medical institutions shall be identified and published by the administrative department of labor and social security in the overall planning area, and the allocation mechanism of designated auxiliary devices shall be identified and published by the administrative department of labor and social security in the province.
Article 35 Laborers shall seek medical treatment in qualified medical institutions that have signed service agreements. In case of emergency, you can be rescued nearby, and after the injury is stable, you can be transferred to the agreed medical institution for treatment in time. After the treatment, employees should go through the discharge formalities in time.
If it is necessary to give first aid nearby, the employer shall report to the overall regional agency within 5 days after the injury occurs, and go through relevant procedures.
Thirty-sixth workers accidental injury treatment costs paid by the injured workers in advance, by the administrative department of labor and social security to participate in work-related injury insurance, the employer shall apply to the agency for settlement; The medical expenses that continue to occur shall be directly settled by the agreed medical institution and the agency.
Thirty-seventh injured workers or employers and agencies to settle medical expenses, should provide the following materials:
(1) Work-related injury certification materials;
(2) The diagnosis certificate, expense bill, expense list and relevant medical records issued by medical institutions according to regulations.
If you are transferred to other places for medical treatment, you should also provide the approval of the agency.
Thirty-eighth workers need care during hospitalization due to work-related injuries, and the nursing expenses shall be paid monthly by the unit with the certificate of medical institutions. The standard of nursing expenses is 80% of the average monthly salary of employees in the previous year. Before the medical institution issues a certificate, if the living nursing fee received is lower than the prescribed standard, the unit will make up the difference.
Thirty-ninth expenses incurred due to the following circumstances, the industrial injury insurance fund will not pay:
(1) Medical expenses for work-related injuries that occurred in non-agreed medical institutions without approval;
(two) the auxiliary equipment configuration expenses incurred by the non-agreement auxiliary equipment configuration institution;
(three) the expenses beyond the scope of 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;
(four) medical expenses unrelated to the treatment of work-related injuries;
(five) other expenses that are not paid by laws, regulations and rules.
Chapter VII Legal Liability
Fortieth the staff of the administrative department of labor security shall be given administrative sanctions according to law in any of the following circumstances; If the circumstances are serious enough to constitute a crime, criminal responsibility shall be investigated according to law:
(1) Failing to accept the application for ascertainment of a work-related injury without justifiable reasons, or resorting to fraud to identify a person who does not meet the conditions for work-related injury as a work-related injury;
(2) Failing to properly keep the evidence materials of work-related injury identification, resulting in the loss of relevant evidence;
(3) accepting the property of the party concerned.
Forty-first agencies have one of the following acts, the administrative department of labor security shall order them to make corrections, and the directly responsible person in charge and other responsible personnel shall be given disciplinary sanctions according to law; If the circumstances are serious enough to constitute a crime, criminal responsibility shall be investigated according to law; Causing economic losses to the parties, the agency shall be liable for compensation according to law:
(1) Failing to keep the records of employer's payment and employees' enjoyment of work-related injury insurance benefits;
(two) not according to the provisions of the approved treatment of work-related injury insurance;
(3) accepting the property of the party concerned.
Forty-second employers, workers injured at work or their immediate family members, medical institutions, and auxiliary equipment allocation institutions that violate these measures shall be punished in accordance with the provisions of Articles 58 and 59 of the Regulations.
Forty-third in violation of the provisions of these measures, unreasonable, riot, violation of public security management, by the public security organs in accordance with the provisions of the regulations on administrative penalties for public security shall be punished; If a crime is constituted, criminal responsibility shall be investigated by judicial organs according to law.
Chapter VIII Supplementary Provisions
Article 44 Before the implementation of these Measures, the living care expenses of employees who are disabled due to work and the pension for dependent relatives of employees who have died due to work shall be calculated according to the standards of the Regulations since June 65438+ 10/,2004, and the payment channels shall remain unchanged. If the original treatment standard is higher than the provisions of the Regulations, it shall be implemented according to the original treatment standard. If the adjusted standard according to Article 33 of these Measures is higher than the original standard, the new standard shall prevail.
Article 45 Before 1 and 1 in 2004, the treatment and payment of relatives of disabled employees and deceased employees were gradually brought into the unified management of the overall planning area. Specific measures shall be formulated by the overall planning area.
Forty-sixth individual industrial and commercial households with employees to participate in work-related injury insurance, municipalities can formulate implementation rules according to local actual conditions.
Forty-seventh problems in the application of these measures shall be interpreted by the provincial labor security administrative department.
Article 48 These Measures shall come into force as of August 6, 2004. 65438+1Interim Measures for Industrial Injury Insurance in Anhui Province promulgated by the provincial people's government on February 20, 1997 (Decree No.82 of the provincial people's government) shall be abolished at the same time.
Supplementary answer:
Regulations of Anhui Province on Industrial Injury Insurance
Twenty-third employees who are disabled at work are identified as five or six levels of disability. Upon my request, I can terminate or terminate the labor relationship with the employing unit, and the employing unit shall pay the one-time medical subsidy for work-related injuries and disability employment subsidy, and stop issuing disability allowance. One-time medical subsidy standard for work-related injuries: the average monthly salary of employees in the overall planning area for 20 months with level 5 disability, and the level 6 disability 15 months; One-time disability employment subsidy standard: the average monthly salary of employees in the five-level disability for 35 months and the six-level disability for 30 months.
Twenty-fourth employees who are disabled at work are identified as seven to ten levels of disability. If the labor contract expires or the employee proposes to terminate the labor contract, the employer shall pay a one-time work-related injury medical subsidy and disability employment subsidy. One-time work-related injury medical subsidy standard: the average monthly salary of employees in the last year in the overall planning area is 10 month, the eighth disability is 8 months, the ninth disability is 6 months, and the tenth disability is 4 months; One-time disability employment subsidy standard: the average monthly salary of employees in the overall planning area with seven-level disability for 20 months, eight-level disability 15 months, nine-level disability 10 months, and ten-level disability for 5 months.
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