Therefore, for the medical expenses that have been reimbursed through medical insurance, the victim cannot claim compensation from the infringer, and the medical insurance institution has the right to recover from the infringer.
legal ground
Social medical insurance is related to the interests of the public, and neither the infringer nor the infringed can get additional benefits from it. Article 30 of the Social Insurance Law stipulates: "The medical expenses shall be borne by the third party according to law. If the third party is unable to pay or cannot determine the third party, the basic medical insurance fund will pay in advance. After the basic medical insurance fund pays in advance, it has the right to recover from the third party. " According to this regulation, in the case of infringement by a third party, the basic medical insurance fund has obtained the right to recover from the infringer after playing its rescue function.
Two principles should be clarified when dealing with infringement cases of medical insurance payment. First, it is impossible for the victim to have both medical insurance compensation and infringer; Second, the infringer cannot reduce the liability for compensation because the victim enjoys medical insurance. According to the principle of loss compensation, personal injury compensation is the actual loss of the victim and belongs to compensatory compensation. For example, if the victim gains additional benefits due to injury, it is easy to induce vicious incidents such as intentional injury and fraudulent insurance. The purpose of social medical insurance is to ensure that citizens can get proper medical care when they are sick, not to reduce the responsibility of the infringer who is at fault.
The First Court of the Supreme People's Court held that the social insurance system could not reduce the liability of the infringer in the dispute over personal injury compensation, and the infringed could not benefit from the infringer's illegal behavior.
According to the above provisions, the social security dispute court will not accept it. However, due to the pre-arbitration procedure for labor disputes, labor arbitration will support the request of workers to ask employers to pay social security. However, when the laborer or employer refuses to accept the labor arbitration award and brings a lawsuit to the court, the court will not hear the social security dispute, and the laborer will apply to the court for compulsory enforcement to pay back the social security based on the judgment (or labor arbitration award), which will not be supported by the court.
At this time, workers need to seek the help of social insurance agencies. According to the relevant provisions of the Social Insurance Law, workers can ask social insurance agencies to calculate the social insurance fees that employers need to pay back, apply for social insurance agencies to issue payment notices to employers, and order employers to pay back within a time limit. If the employer fails to pay within the time limit, the social insurance agency shall apply to the court for compulsory execution in accordance with Article 60 of the Social Insurance Law and Article 26 of the Regulations on the Administration of Reporting and Paying Social Insurance Fees.