Work-related injury! It can have serious consequences if businesses ignore these 6 issues

Thread Content

1. Risk of not participating in work-related injury insurance 　In the event that an employee of an employer who should be covered by work-related injury insurance does suffer an injury at work, the employer shall pay the related compensation in accordance with the provisions on work-related injury insurance benefits and standards set out in the Work-Related Injury Insurance Regulations as well as the local regulations. After such employers enroll in work-related injury insurance and pay the overdue work-related injury insurance premiums and late fees, the work-related injury insurance fund and the employer shall cover the newly incurred expenses in accordance with the provisions of the Work-Related Injury Insurance Regulations as well as the local provincial and municipal regulations. 　　Legal basis: Article 62 of the Regulations on Work-related Injury Insurance stipulates that if an employer is required by these regulations to participate in work-related injury insurance but fails to do so, the social insurance administration department shall order it to join such insurance within a specified time frame, to pay the overdue insurance premiums, and shall impose a late fee of 0.05% per day starting from the date of non-payment. If the employer still fails to make the payments after the deadline, it shall be fined an amount ranging from one time to three times the amount owed. 　　If an employee of an employer who is required by these regulations to participate in work-related injury insurance fails to do so and suffers a work-related injury, the employer shall pay the relevant expenses in accordance with the items and standards for work-related injury insurance specified in these regulations. 　　After the employer participates in work-related injury insurance and pays the overdue work-related injury insurance premiums and late fees, the work-related injury insurance fund and the employer shall cover the newly incurred expenses in accordance with the provisions of these regulations. 　　2. Risk of failing to pay work-related injury insurance premiums on time and in full If an employer fails to pay the work-related injury insurance premiums on time and in full, the employer shall cover the benefits related to work-related injuries during the period of overdue payment. After making up the insurance premiums for work-related injuries that are due, as well as any late fees, any new expenses related to work-related injury insurance shall be covered by the work-related injury insurance fund and the employer in accordance with the provisions of the Regulations and the local regulations of the provinces and cities. 　　3. The risk of failing to submit an application for work-related injury recognition within the specified time limit Article 17, Paragraph 4 of the Regulations on Work-related Injury Insurance stipulates that \"if an employer fails to submit an application for work-related injury recognition within the time limit specified in Paragraph 1 of this article, the employer shall bear the relevant expenses related to work-related injury benefits that arise during that period, as required by these regulations.\" 　　Knowledge point: Regarding the “period”: Opinions on Several Issues Concerning the Implementation of the Regulations on Work-Related Injury Insurance, Letter No. 256 [2004] issued by the Ministry of Labor and Social Security. Article 17, Paragraph 4 of the regulations stipulates that the period during which the employer is responsible for covering expenses related to work-related injury benefits starts from the date of the accident or the diagnosis of an occupational disease, and ends on the date when the labor security administrative department accepts the application for work-related injury recognition. 　　What are “newly incurred expenses”? According to the Ministry of Human Resources and Social Security’s Opinions on Several Issues Concerning the Implementation of the Regulations on Work-related Injury Insurance (II) (Ministry of Human Resources and Social Security Document No. 29 [2016]), Article 3 states that the “newly incurred expenses” referred to in Article 62 of the Regulations on Work-related Injury Insurance are those expenses that arise after an employee suffers a work-related injury before the employer becomes covered by work-related injury insurance. The expenses covered by the work-related injury insurance fund are handled in different ways depending on the circumstances: (1) In the case of an injury sustained at work, payments are made for new medical expenses related to the work injury, costs associated with rehabilitation, hospital meal allowances, transportation, accommodation, and food expenses incurred when seeking treatment outside the designated area, costs for purchasing assistive devices, living care expenses, disability benefits for workers with disabilities from grade 1 to grade 4, as well as a one-time medical allowance upon termination of the employment contract after insurance coverage began; (2) In the case of death due to work, payments are made for pensions for dependents who meet the relevant criteria and were covered under the insurance after the accident. 　　Risk Warning: Although the employer is covered by work-related injury insurance, it may still happen that the insurance fund will refuse to pay certain amounts if the employer fails to make the necessary payments on time or fails to submit the application for work-related injury recognition within the specified deadline. 　　Suggestions for countermeasures: Employers should enroll employees in insurance promptly, make monthly payments, report any changes in the number of employees as well as any work-related accidents in a timely manner, and apply for work-related injury recognition for their employees without delay. In particular, they need to handle the issue of work-related injury insurance for newly hired employees with care. 　　4. The risk of the employer failing to provide evidence promptly Article 17 of the Measures for Determining Work-Related Injuries states that if an employee or his/her close relatives consider it to be a work-related injury, but the employer does not agree, then the employer shall bear the burden of providing evidence. If the employer refuses to provide evidence, the social insurance administration department may, based on the evidence provided by the injured employee or evidence obtained through investigation, make a decision regarding work-related injury recognition in accordance with the law. Analysis: When there is a discrepancy between the employee’s claims and those of the employer, the employer bears the burden of proof. 　　5. Risk of the employer failing to cooperate with the investigation Article 63 of the Regulations on Work-related Injury Insurance: If an employer violates the provisions of Article 19 of these regulations and refuses to cooperate with the social insurance administration department in investigating and verifying an accident, the social insurance administration department shall order it to make corrections and impose a fine of not less than 2,000 yuan but not more than 20,000 yuan. 　　6. The risk of employers or employees filing false claims to obtain insurance fraud benefits: The main risks include the revocation of work-related injury recognition, administrative fines, and criminal charges. 　　(1) Opinions of the Ministry of Human Resources and Social Security on Several Issues Concerning the Implementation of the Regulations on Work-Related Injury Insurance (II) (Ministry of Human Resources and Social Security Document No. [2016] 29): 10. If, due to the applicant for work-related injury recognition or the employer concealing relevant information or providing false materials, an incorrect decision regarding work-related injury recognition is made, the social insurance administration department shall correct it promptly once it becomes aware of this. Article 9 of the Provisions of the Supreme People’s Court on Several Issues Concerning the Trial of Administrative Cases Involving Work-related Injury Insurance, Legal Interpretation No. 9: If an applicant for work-related injury recognition or an employer conceals relevant information or provides false materials, resulting in an incorrect determination of a work-related injury, the social insurance administration department may make corrections accordingly in accordance with the law during litigation. 　　(2) Article 60 of the Regulations on Work-related Injury Insurance: If an employer, an employee who has suffered a work-related injury, or their close relatives defraud insurance benefits under this regulation, or if medical institutions or organizations that supply assistive devices defraud funds intended for work-related injury insurance, the social insurance administration department shall order them to return the fraudulent amounts, and impose a fine of not less than twice but not more than five times the amount defrauded; if the circumstances are serious enough to constitute a crime, criminal liability shall be pursued in accordance with the law. 　　(3) Article 87 of the Social Insurance Law of the People’s Republic of China: If social insurance agencies, as well as medical institutions, drug distributors and other social insurance service providers, defraud social insurance funds by means of fraud, falsification of documentation or other tactics, the social insurance administration department shall order them to return the fraudulent amounts obtained, and impose a fine of not less than twice but not more than five times the amount defrauded; in the case of social insurance service providers, their service agreements shall be terminated; if the persons in charge who are directly responsible and other directly liable persons possess professional qualifications, such qualifications shall be revoked in accordance with the law. 　　(4) Interpretation by the Standing Committee of the National People’s Congress on Article 266 of the Criminal Law of the People’s Republic of China: Obtaining social insurance benefits such as those for old-age care, medical treatment, work-related injuries, unemployment, or childbirth, or other social security benefits, by means of fraud, falsification of documents, or other tactics, constitutes the act of defrauding public or private property as stipulated in Article 266 of the Criminal Law. Appendix: Article 266 of the Criminal Law: Whoever defrauds public or private property, if the amount involved is relatively large, shall be sentenced to fixed-term imprisonment of not more than three years, criminal detention, or public surveillance, and shall also be fined or solely fined; if the amount is huge or there are other serious circumstances, they shall be sentenced to fixed-term imprisonment of not less than three years but not more than ten years, and shall also be fined; if the amount is especially huge or there are other especially serious circumstances, they shall be sentenced to fixed-term imprisonment of not less than ten years or life imprisonment, and shall also be fined or have their property confiscated. Where otherwise provided by this Law, such provisions shall apply. 　　(5) Notice of the Ministry of Human Resources and Social Security and the Ministry of Public Security on Strengthening the Investigation, Handling, and Referral of Cases Involving Social Insurance Fraud (MOHRSS Document No. 14): Social insurance administration departments shall, in accordance with the law, refer cases involving entities and individuals suspected of committing crimes related to social insurance fraud to the public security agencies at the same level. Public security agencies shall promptly examine and investigate such cases referred by the social insurance administration departments; where the facts of the crime are clear and the evidence is conclusive, criminal liability shall be pursued by referring the case to the people’s procuratorate for prosecution.