Chapter I General Principles
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 implementation measures are formulated in accordance with the Social Insurance Law of People's Republic of China (PRC), the Regulations on Work-related Injury Insurance (hereinafter referred to as the Regulations) and other laws and regulations, combined with the actual situation of this province.
Article 2 Enterprises, institutions, social organizations, private non-enterprise units, 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 (including part-time employees, hereinafter referred to as employees).
Article 3 Work-related injury insurance adheres to the principle of "unified system, sound mechanism, prevention first, hierarchical management, fair treatment and sustainable development", and gradually improves the "trinity" work-related injury insurance system of work-related injury prevention, work-related injury compensation and work-related injury rehabilitation.
Fourth provincial social insurance administrative department is responsible for the work of industrial injury insurance in the province; State (city) and county (city, district) social insurance administrative departments are responsible for the work-related injury insurance within their respective administrative areas.
The social insurance agency established by the administrative department of social insurance specifically undertakes the work-related injury insurance affairs, and the social security station (institute) of the township (town) or subdistrict office specifically undertakes the work-related injury insurance affairs according to the entrustment of the social insurance agency.
Fifth the province's industrial injury insurance fund to implement state (city) level management, the establishment of industrial injury insurance reserves in all co-ordination areas, and gradually realize the provincial co-ordination management of industrial injury insurance funds.
The overall planning area should unify the payment method of insurance, unified identification standard, unified treatment payment level, unified business handling procedures and unified system networking application.
Sixth governments at all levels should use legal, administrative and economic means to ensure the collection of work-related injury insurance funds and the payment of work-related injury insurance benefits.
Article 7 Employers participating in industrial injury insurance shall implement territorial management, and the institutions designated by the social insurance agencies in the overall planning area shall handle insurance registration and related business.
Where an employer with large inter-provincial production mobility applies for centralized registration to participate in work-related injury insurance procedures, the provincial social insurance administrative department shall, jointly with relevant departments, determine the centralized insured area.
Insured units and their employees managed by provincial social insurance agencies shall be gradually handed over to local overall management when conditions are ripe.
Other employers and their employees to whom the Regulations and these Measures apply shall participate in work-related injury insurance, and the social insurance agencies in the counties (cities, districts) where the employers are located shall handle the insurance procedures.
Chapter II Fund Management
Article 8 The rate of work-related injury insurance shall be determined according to the principle of fixed income by expenditure and balance of payments. Overall regional agencies shall, according to the occurrence rate of work-related injuries of employers and the use of work-related injury insurance funds, reasonably determine the benchmark rates and floating rates applicable to employers.
Article 9 Work-related injury insurance premiums shall be uniformly approved by the social insurance agencies in the overall planning area in accordance with the Regulations on the Collection and Payment of Social Insurance Fees in Yunnan Province, and shall be collected by the social insurance fee collection agencies.
The employer shall pay the industrial injury insurance premium in full and on time according to law. Individual employees do not pay work-related injury insurance premiums.
The amount of work-related injury insurance premium paid by the employer is the product of the total wages of employees multiplied by the unit payment rate.
If it is difficult to pay the work-related injury insurance premium according to the total wages of the employer, it can be calculated and paid according to a certain proportion of the construction project cost, the approved number of people in the business service area and the corresponding ton mineral product rate, and real-name registration can be implemented. The specific measures shall be formulated separately by the administrative department of social insurance in the overall planning area.
Tenth industrial injury insurance funds deposited in the financial accounts of social security funds, the implementation of two lines of revenue and expenditure management. The work-related injury insurance fund shall be used for the following expenses such as work-related injury prevention, compensation and rehabilitation according to law:
(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 auxiliary devices confirmed by the labor ability appraisal committee;
(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) a one-time medical subsidy for work-related injuries that should be enjoyed when the labor contract is terminated or dissolved;
(8) Funeral grants, dependent relatives' pensions and one-time work-related death grants received by survivors of work-related deaths;
(nine) the appraisal fee for work-related disability;
(10) Work-related injury prevention fees;
(eleven) other expenses stipulated by laws and regulations.
Eleventh work-related injury prevention fees should be used for work-related injury prevention, policy propaganda, business training, accident investigation, difficult case studies and other work funds. The extraction ratio of work-related injury prevention fees shall be implemented in accordance with relevant state regulations.
Article 12 The industrial injury insurance reserve shall be established by withdrawing 65,438+00% from the industrial injury insurance fund collected in the current year in all co-ordination areas, and will not be withdrawn when the industrial injury insurance reserve reaches 65,438+05% of the total accumulated balance of the industrial injury insurance fund in the co-ordination areas. The use of industrial injury insurance reserve is proposed by the social insurance agency in the overall planning area, audited by the social insurance administrative department and reported to the people's government at the same level for approval.
Thirteenth the employer fails to pay work-related injury insurance premiums in accordance with the law, and after the work-related injury accident, the employer fails to pay work-related injury insurance benefits to employees; Or a work-related injury is caused by a third person, and the third person fails to pay the medical expenses for the work-related injury or cannot identify the third person. When applying for paying the related expenses in advance, he shall submit a written application to the local social insurance agency with the work-related injury identification decision and related materials. Work-related injuries that meet the conditions of advance payment after examination shall be paid from the work-related injury insurance fund, and then the social insurance agency shall recover the relevant expenses according to law.
The social insurance agency shall not refuse to pay the relevant treatment that should be paid in advance according to laws and regulations on the grounds that the decision on work-related injury identification is under administrative reconsideration or administrative litigation.
Chapter III Identification of Work-related Injury
Fourteenth industrial injury identification shall apply to the administrative department of social insurance in the overall planning area; If the place where the accident occurred is inconsistent with the place where the employer is located, an application may also be made to the social insurance administrative department of the overall planning area where the accident occurred. If the jurisdiction of work-related injury identification is controversial, it shall be designated by the administrative department of social insurance at the next higher level. If the staff of state organs and institutions managed by reference to the Civil Service Law suffers work-related injuries, and the employer managed by the provincial social insurance agency suffers work-related injuries, the social insurance administrative department in the area where the unit is located shall accept and identify the work-related injuries in accordance with the regulations.
Fifteenth employees in any of the following circumstances, according to the provisions of the "Regulations" fourteenth, according to the work-related injuries:
(a) acute poisoning caused by toxic and harmful substances in the working environment or eating in the canteen of the employing unit, and verified and diagnosed by the health and epidemic prevention department at or above the county level;
(2) Being infected with infectious diseases due to the arrangement of the employer to work in an epidemic area;
(three) during working hours, participating in sports, entertainment, sports competitions and other activities organized by the employer or assigned by the employer has been accidentally injured;
(4) During the business trip arranged by the employer, he was accidentally injured due to the basic needs of life.
Article 16 The identification of traffic accidents for which I am not primarily responsible shall be based on relevant valid certification materials issued by traffic management, transportation, railways and other departments of public security organs or judicial organs and organizations authorized by laws and regulations.
Article 17 The determination of drunkenness in Item (2) of Article 37 of People's Republic of China (PRC) Social Insurance Law shall be carried out in accordance with Threshold and Test of Alcohol Content in Blood and Breath of Motor Vehicle Drivers (GB 19522—2044). The test conclusion, diagnosis certificate and other data issued by the traffic management department of public security organs, medical institutions and other relevant units according to law can be used as the basis for identifying drunkenness.
Eighteenth in the "Regulations" article sixteenth (two) in the identification of drug abuse, according to the relevant provisions of the state, the public security organs or their authorized institutions issued by the inspection conclusion, diagnosis and other materials, can be used as the basis for drug abuse.
Article 19 If there is evidence that the injured employee is suspected of being drunk or taking drugs, and the applicant fails to provide valid evidence to the contrary or refuses to test, it shall not be deemed as a work-related injury or regarded as a work-related injury.
Twentieth employees engaged in occupational hazards in the original employer, and were diagnosed with occupational diseases after arriving at the current employer, the current employer, himself or his close relatives may apply for work-related injury identification according to law; If you have no contact history with occupational diseases after leaving the original employer, are not employed and are diagnosed with occupational diseases, you or your close relatives can apply to the social insurance administrative department of the original employer for work-related injury identification within one year from the date of being diagnosed with occupational diseases.
If an employee is diagnosed as an occupational disease after going through the retirement formalities because he is engaged in operations exposed to occupational hazards before retirement, he shall apply for work-related injury identification within 1 year from the date of being diagnosed as an occupational disease.
Twenty-first employees in two or more employers exist labor relations at the same time, each employer shall pay work-related injury insurance premiums for employees according to law. If an employee suffers from a work-related injury, the employer shall bear the responsibility of work-related injury insurance according to law.
Article 22 In case of division, merger or transfer of the employing unit, the successor unit shall, within 30 days from the date of change, go through the formalities of industrial injury insurance registration or change registration at the local social insurance agency, and continue to undertake the industrial injury insurance liability of the original employing unit.
Article 23 If an employer who participates in work-related injury insurance sends its employees to work abroad and cannot participate in local work-related injury insurance, it shall go through the filing procedures with the social insurance administrative department in the overall planning area and continue to pay work-related injury insurance premiums. If the relevant formalities have not been handled, the expenses incurred during working abroad shall be borne by the employer.
Twenty-fourth employees or their close relatives think it is a work-related injury, and the employer thinks it is not. The local social insurance administrative department shall inform the employer in writing to bear the burden of proof.
The employer shall provide relevant evidence that the employee should not be deemed as a work-related injury within 15 days after receiving the notice of proof. Employees or their close relatives still bear the burden of proof on whether there is a labor relationship with the employer, as well as the time, place and injury of the industrial injury.
If the employer fails to provide relevant information or fulfill the burden of proof, the administrative department of social insurance may make a conclusion on the determination of work-related injuries according to law based on the evidence provided by the workers or their close relatives or trade unions.
Twenty-fifth when applying for work-related injury identification, the applicant shall submit the labor contract signed with the employer or other supporting materials that can confirm the existence of labor relations with the employer (including factual labor relations).
The administrative department of social insurance believes that the labor relationship is established and the information is complete, and it shall accept the application for work-related injury identification according to law. If the information provided by the applicant is incomplete, it shall issue a Notice of Correcting Information to the applicant within 5 working days, and inform the applicant in writing of all the information that needs to be corrected at one time. In case of disputes over labor relations, inform the parties that they can apply to the Labor Dispute Arbitration Committee for confirmation of labor relations.
The period of suspension of labor dispute arbitration, force majeure and other legal reasons is not included in the application time limit for work-related injury identification.
Twenty-sixth applicants apply for work-related injury identification, but under any of the following circumstances, the social insurance administrative department will not accept it:
(a) unable to apply within the statutory time limit;
(two) the applicant does not have the qualification to apply;
(3) The administrative department of social insurance that accepts the application has no jurisdiction or has not been entrusted to accept it;
(four) other circumstances that are not accepted by laws and regulations.
Twenty-seventh social insurance administrative departments to accept the application for work-related injury identification, one of the following circumstances, you can suspend the work-related injury identification:
(1) It needs to be based on the conclusion of the relevant department on the corresponding accident, but the relevant department has not yet made a conclusion;
(two) due to force majeure, it is difficult to identify work-related injuries;
(three) other circumstances that need to be suspended as stipulated by laws, regulations and rules. If the work-related injury identification is suspended, it shall serve a Notice of Suspension of Work-related Injury Identification on the applicant. If the disappearance is suspended, the procedures for determining work-related injuries shall be resumed. The time for suspension of work-related injury identification is not included in the time limit for work-related injury identification.
Chapter IV Appraisal of Labor Ability
Article 28 The appraisal of labor ability refers to the grading appraisal of the degree to which employees are injured at work and undergo treatment and necessary rehabilitation treatment, or employees are disabled or sick at work, resulting in obstacles to labor function and self-care according to the methods and standards of labor ability appraisal published by the state.
If an employee is identified as a work-related injury or regarded as a work-related injury, the provincial or state (city) labor ability appraisal committee will issue a certificate of work-related injury and disability in Yunnan Province to the employee, and load the relevant information into the social security card held by the employee with the certificate (card) to enjoy the corresponding work-related injury insurance benefits.
Article 29 If an injured worker is disabled after treatment and affects his working ability, the employer, the injured worker or his close relatives shall apply to the Autonomous Region Committee for labor ability appraisal, fill in the application form for labor ability appraisal, and submit the following materials:
(1) Identity certificate;
(two) the decision on the determination of work-related injuries;
(3) Medical records, discharge records, occupational disease diagnosis certificates, etc. To apply for re-examination and re-appraisal, in addition to the above information, the conclusion of the last appraisal shall also be submitted.
The institutions of the central state organs in Yunnan, institutions managed with reference to the Civil Service Law and provincial social insurance agencies shall apply to the Provincial Labor Ability Appraisal Committee for the appraisal of the disability and life care grades of employers and their employees and the allocation of assistive devices, and shall be implemented in accordance with the relevant national and provincial appraisal methods and standards.
Thirtieth injured workers apply for re-appraisal of labor ability, and if the appraisal conclusion changes, they shall enjoy the treatment of work-related injury insurance according to the re-appraisal conclusion.
Workers with work-related injuries apply for re-examination and appraisal of their labor ability, and if the appraisal conclusion changes, they will enjoy the corresponding treatment of work-related injury insurance in accordance with the conclusion of re-examination and appraisal, in addition to the one-time disability allowance.
Chapter V Work-related Injury Insurance Benefits
Thirty-first provincial social insurance administrative departments shall, according to the relevant provisions of the state, adjust and supplement the medical rehabilitation drugs, diagnosis and treatment items and service items for work-related injuries, and determine the agreed medical rehabilitation institutions among the existing designated medical institutions.
Co-ordinate regional social insurance agencies, medical rehabilitation institutions and assistive devices allocation institutions to sign service agreements on the basis of equal consultation, and bring medical rehabilitation institutions into the unified social security information system management of the whole province, and accept the supervision of social insurance administrative departments.
Thirty-second employees who suffer from accidents or occupational diseases at work and receive timely treatment shall enjoy medical rehabilitation treatment for work-related injuries in accordance with regulations; Workers with work-related injuries should seek medical treatment in designated medical rehabilitation institutions that have signed service agreements. In case of emergency, they can go to the nearest medical institution for first aid.
Workers with work-related injuries shall, after receiving first aid in non-designated medical institutions, report to the social insurance agency for the record within 7 working days. After the injury is stable, it will be transferred to a designated medical rehabilitation institution for treatment.
Article 33 If the expenses incurred by injured workers in medical rehabilitation institutions meet the standard payment scope of national and provincial basic medical insurance, industrial injury insurance and maternity insurance drug list, diagnosis and treatment items and service facilities, they shall be paid by the industrial injury insurance fund.
The payment methods and standards for hospitalization food subsidies and transportation accommodation fees for medical treatment in different places of the insured units managed by provincial social insurance agencies shall be formulated separately by the provincial social insurance administrative department.
Article 34 If an injured worker needs to install and configure assistive devices due to his daily life or employment, the medical institution that signed the service agreement shall put forward a plan, and after it is determined by the labor ability appraisal committee, he shall go to the assistive device configuration institution that signed the service agreement for installation and configuration. The cost limit and management regulations for the installation and configuration of assistive devices shall be formulated separately by the provincial social insurance administrative department.
Thirty-fifth one-time work-related injury and disability allowance, one to four-level work-related injury and disability allowance, and living care expenses shall be paid from the next month after the conclusion of labor ability appraisal or re-appraisal.
Funeral allowance and one-time work death allowance are paid in the month of death; The pension for dependent relatives shall be paid from the month following the employee's death.
Article 36 In case of the death of a first-class to fourth-class injured worker, the pension for supporting the survivors shall be calculated according to the average monthly salary 12 months before the death of the injured worker, and if the salary is lower than the disability allowance (pension), it shall be calculated according to the average monthly disability allowance (pension) 12 months before the death.
Thirty-seventh employees who have gone through retirement procedures and received basic old-age security benefits on a monthly basis, if the basic old-age insurance benefits are higher than the disability allowance, the work-related injury disability allowance will no longer be issued; If the basic old-age insurance benefits are lower than the work-related injury and disability allowance, the work-related injury and disability allowance will be paid by making up the difference.
Workers with one to four work-related injuries have reached the statutory retirement age to go through retirement procedures, and their monthly living nursing expenses and medical expenses for treating the recurrence of work-related injuries are still paid by the work-related injury insurance fund.
Thirty-eighth employees who are disabled due to work are identified as five or six levels of disability, and their labor relations with the employer shall be preserved, and the unit shall arrange appropriate work for them. If the employing unit has difficulties in arranging work, it shall pay a monthly disability allowance and pay various social insurance premiums according to the disability allowance. After deducting individual contributions, if the actual amount of disability allowance is lower than the local minimum wage, the unit will make up the difference.
The employing unit may terminate or terminate the labor relationship with the disabled employees of Grade 5 and Grade 6 who apply.
When the labor relationship is dissolved or terminated, the employer shall pay a one-time disability employment subsidy according to the average monthly salary of employees in the overall planning area last year. The standard is: 33 months for Grade 5 and 29 months for Grade 6.
By the industrial injury insurance fund in accordance with the dissolution or termination of labor relations, the overall planning area last year's average monthly salary of employees as the base to pay a one-time work-related injury Medicaid. The standard is: level 5 15 months, level 6 13 months. For employees suffering from occupational diseases, the one-time medical subsidy for work-related injuries will be increased by 30% on the basis of the above standards.
Thirty-ninth disabled workers from grade seven to ten terminate the labor contract or the employee himself proposes to terminate the labor contract, the employer may terminate or terminate the labor relationship with him.
When the labor relationship is dissolved or terminated, the employer shall pay a one-time disability employment subsidy according to the average monthly salary of employees in the overall planning area last year. The criteria are: 22 months for Grade 7, 8 months for Grade 8 18 months, 9 months for Grade 9 13 months, and 7 months for Grade 10. By the industrial injury insurance fund in accordance with the dissolution or termination of labor relations, the overall planning area last year's average monthly salary of employees as the base to pay a one-time work-related injury Medicaid. The criteria are: 8 months in grade 7, 6 months in grade 8, 3 months in grade 9, and 2 months in grade 10. For employees suffering from occupational diseases, the one-time medical subsidy for work-related injuries will be increased by 30% on the basis of the above standards.
Fortieth inductrial injury worker receives a one-time disability employment subsidy and a one-time medical subsidy for work-related injuries, the industrial injury insurance relationship is terminated.
Workers with work-related injuries who have gone through retirement procedures continue to enjoy relevant treatment of work-related injury insurance according to law, but they do not enjoy one-time disability employment subsidy and one-time work-related injury medical subsidy.
Forty-first employees engaged in occupational hazards before retirement and were identified as work-related injuries, enjoy medical treatment for work-related injuries. After retirement, the insured employee is diagnosed as an occupational disease and identified as a work-related injury. Those who have reached the disability level through labor ability appraisal shall enjoy one-time disability allowance according to their average monthly salary or pension 12 months before being diagnosed as occupational diseases. To achieve the degree of nursing dependence, from the next month after the conclusion of the appraisal, the monthly living nursing fee will be paid.
Forty-second injured workers who regularly receive disability allowance and living care expenses or relatives who receive dependent relatives' pensions shall provide survival certificates to social insurance agencies on an annual basis before they can continue to receive the above treatment respectively.
Dependent relatives need to enjoy corresponding treatment on the basis of the work-related injury identification decision, the conclusion of labor ability appraisal, the identification certificate of close relatives issued by the public security household registration management institution, the certificate of no source of income issued by the subdistrict office or the township (town) people's government, the valid certificate of the lonely elderly or orphans issued by the civil affairs department, and the notarial certificate of adopted children (adoptive parents).
Article 43 If an employee dies at work, the one-time work-related death allowance shall be 20 times of the per capita disposable income of urban residents in the previous year at the time of death; Funeral subsidies are calculated and paid for 6 months according to the average monthly salary of employees in the overall planning area at the time of death.
Forty-fourth local state organs and institutions managed by reference to the Civil Service Law can be included in the overall management of industrial injury insurance in the overall planning area, and the treatment of industrial injury workers is paid in the form of disability and pension. Or the fund can make up the difference.
Article 45 The payment standards of disability allowance, pension for dependent relatives and living nursing fees shall be adjusted in a timely manner by the provincial social insurance administrative department according to the social and economic development of the province and the balance of the industrial injury insurance fund.
Article 46 Employers and their employees who participate in industrial injury insurance and voluntarily participate in other commercial insurance shall enjoy relevant treatment respectively according to law. Employers and employees who participate in work-related injury insurance, and at the same time purchase compulsory insurance according to law, or are injured due to infringement by a third party, shall be supplemented with corresponding work-related injury insurance benefits by the work-related injury insurance fund after obtaining other insurance or economic compensation.
Chapter VI Supplementary Provisions
Forty-seventh according to the civil service law management of state organs and institutions, with reference to the "Regulations" and these measures.
Article 48 The term "employees" as mentioned in these Measures refers to urban and rural workers and migrant workers who have established labor relations with employers in various employment forms and employment periods. Does not include retirees and interns employed by employers.
Article 49 The term "labor relations" as mentioned in these Measures refers to the labor relations (including factual labor relations) or personnel relations established between the employer and the employee.
Article 50 These Measures shall come into force as of 20 12 10 1. The Notice of the People's Government of Yunnan Province on Printing and Distributing the Measures for Implementing the Regulations on Work-related Injury Insurance in Yunnan Province (YF [2003]185) shall be abolished at the same time.