Work-related injury insurance refers to a social insurance system in which workers or their surviving family members receive material assistance from the state and society when they suffer from accidental injuries or occupational diseases resulting in temporary or permanent loss of working ability and death at work or under specified special circumstances.
Reporting: After a work-related injury occurs, the employer should report the case within 12 hours as soon as possible.
Medical treatment: The unit should immediately admit the employee to the nearest hospital for rescue, and ensure that the hospital is a public hospital at or above the town level or a local hospital recognized by basic medical care. The rescue should be stamped with an "emergency stamp". Employees should inform their doctor of their symptoms and the circumstances of the accident when they see a doctor.
Materials to be provided: Employees with work-related injuries need to provide the following materials for reporting work-related injuries: a copy of their ID card, proof of labor relationship (de facto labor relationship), medical records, eyewitnesses, etc.
Determination of work-related injury: The functional department shall make a conclusion within 15-60 days after receiving the materials to determine whether it is a work-related injury.
Labor ability appraisal: If an employee has a disability that affects his or her ability to work after the injury is relatively stable, he or she shall apply for a labor ability appraisal to determine the specific level of disability.
Compensation: If there is any objection to the work-related injury treatment or the enterprise refuses to pay the expenses, it can apply for labor arbitration, and the labor dispute arbitration commission will award the employer to pay the expenses, or it can sue the court.
Claim formalities: After the work-related injury identification and labor ability appraisal, the employer needs to submit the "Work-related Accident Declaration Form", "Work-related Accident Certificate", medical invoices, hospitalization expenses list and other materials to Qingyuan Social Security to apply for benefits.
Compensation to the account: After receiving the claim information, the social security will make a claim processing and transfer within 30 working days, and notify the unit. After receiving the claim payment, the employer shall transfer the money to the employer within 15 working days.
If the work-related injury does not reach the disability level, the following compensation can be obtained:
Medical expenses: As long as the first fee, examination fee, diagnosis and treatment fee, surgery fee, medical fee, etc. arising from work-related injuries are met, as long as they meet the requirements of the work-related injury insurance diagnosis and treatment items, the work-related injury insurance drug list, and the work-related injury insurance hospitalization service standards, they can claim compensation according to the actual loss of expenses.
Leave of absence with pay: If an employee is injured in an accident or suffers from an occupational disease at work and needs to suspend work to receive medical treatment for work-related injuries, the original salary and benefits shall remain unchanged during the period of suspension with pay, and shall be paid by the employer on a monthly basis. The maximum length of time is 12 months.
Necessary food allowance: The injured employee may claim the hospitalization meal allowance arising from the work-related injury, as well as the transportation expenses and accommodation expenses for medical treatment in other places due to the work-related injury, and the compensation standard shall generally be determined in combination with the number of days of hospitalization of the injured employee and the compensation standard of the area where the employer is located.
Possible nursing expenses: If the doctor's order states that a certain amount of nursing care is required, then the employee can claim the nursing expenses for the period of suspension with pay according to the actual loss.
Please note that specific compensation standards and policies may vary by region and industry, and it is advisable to consult the relevant department or agency for more detailed information.
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