The work-related injury insurance system is an important part of the social insurance system, which plays an important role in ensuring the livelihood of injured workers and their dependents, and promoting the safe production of enterprises.
On the way to work, ......he was involved in a traffic accident and was injured by a fall from a height at a construction siteBut the Minhang District Human Resources and Social Security Department said, ".Work-related injuries will not be recognized”。What's going on here? Let's take a look
Case 1: On the way to work or on the way to delivery? Exhaustive investigation in search of the truth
Jiang, a truck driver of a logistics company in Minhang, claimed to have been injured in a traffic accident on the way from his residence in Kunshan to work at the Jiading freight point on October 2022, and applied to the District Human Resources and Social Security Bureau for recognition of work-related injuries. When reviewing the materials, the undertaker of the case found that Jiang's accident occurred 2 hours earlier than the normal working time, and the accident location and direction of travel deviated from the normal route to work. In the course of the investigation of Jiang, he argued that he had avoided the main road for the convenience of passage at the time of the incident, and that he had bought breakfast on the way to work that day, resulting in a deviation in the direction of travel.
With all kinds of doubts about the details of the case, the undertaker decided to return to the place where the incident occurred. After investigating Jiang's driving route on the day of the accident and verifying the evidence at the scene of the accident with the local traffic police department, the undertaker found major clues. According to these clues, the undertaker also investigated and verified with a takeaway platform through big data comparison, and finally obtained evidence that Jiang was working part-time to deliver food for the platform at the time of his injury, and Jiang's accident has been confirmed as an occupational injury by the Kunshan Municipal Human Resources and Social Security Bureau, and has obtained occupational injury protection treatment for employees in the new industry.
In the end, the District Human Resources and Social Security Bureau refused to recognize the work-related injury on the grounds that Jiang had an accident on the way to deliver takeaways, rather than an accident on the way to work at the freight point, as he claimed. Although laws and regulations do not restrict workers from engaging in other part-time jobs to obtain remuneration in addition to their own work, Jiang's attempt to enjoy both occupational injury protection and work-related injury insurance for the same accident injury through deceptive means is both reasonable and law-based, and this behavior also made Jiang pay the price.
Case 2: "Sharp eyes" see through the trick, and there is nothing to hide from work-related injury fraud
Tan, a carpenter of a construction labor company in Minhang, was allegedly injured by a fall from a height at the project site in April 2023 when he was dismantling the mold, and was later diagnosed with a rib fracture by a hospital in the city. To this end, the employer applied to the District Human Resources and Social Security Bureau for a determination of work-related injury, and after investigation and verification with the parties concerned and relevant witnesses, the District Human Resources and Social Security Bureau made a decision to determine the work-related injury. Subsequently, the employer submitted an application for labor ability appraisal to the District Labor Inspection Committee. After arrangement, Tan went to the district social security service center to receive an interview with medical and health experts.
However, during the interview, the expert found something suspicious by consulting the medical history data carried by Tan. It turned out that according to Tan's imaging manifestations (commonly known as X-rays), when he first visited the clinic for filming, the fracture line at the rib fracture site was blurred and callus had been formed, and usually such callus takes at least 3 weeks to form after injury, which is enough to show that the rib fracture diagnosed by Tan in April is not a fresh fracture, but an old fracture, and there is a significant discrepancy between the alleged fracture caused by a fall on the construction site in April and the actual situation. After realizing the seriousness of the problem, the district security center organized 3 appraisal experts to collectively read and review the film on the spot, which further confirmed the inference of the chief inspection expert that Tan's actual fracture time was earlier than the self-claimed work injury time.
In the face of ironclad evidence, Tan finally admitted that his actual injury was in March 2023, because the company had not yet insured him at that time, in order to enjoy the work-related injury insurance smoothly, the employer conspired with him, first went through the insurance registration, and then lied about the time of injury when he first sought medical treatment. Accordingly, the District Human Resources and Social Security Bureau made a decision to revoke the original work-related injury determination conclusion based on the new evidence. Because Tan's deception was discovered in time during the labor ability appraisal process, he had not yet received the relevant benefits of work-related injury insurance, so it did not constitute the criminal act of illegally fraudulently obtaining work-related injury insurance. However, the behavior of the employer and Tan was still duly punished, and the District Human Resources and Social Security Bureau interviewed and criticized the company's misconduct, and registered the situation in the dishonest list database of the District Human Resources and Social Security Government Affairs Collaboration Platform.
Case 3: Being smart is mistaken by being smart, and lying about a work-related injury is not child's play
In October 2023, Yao's employer applied to the District Human Resources and Social Security Bureau for recognition of work-related injuries, claiming that Yao was on his way to work one morning in September, when he fell down the stairs of the building where he lived, causing a fracture in his right foot, and provided two colleagues who knew what had happened to prove it. After investigation and verification, because Yao's alleged accident occurred on the way to work, according to the relevant provisions of the "Regulations on Work-related Injury Insurance", if he is injured in a traffic accident or an urban rail transit, passenger ferry, or train accident that is not his primary responsibility on the way to and from work, it shall be found to be a work-related injury. The undertaker of the case explained the application of the relevant legal provisions to the employer and Yao, and required both parties to provide proof of the accident in accordance with the procedures. After discussion with Yao, the employer decided that there was no need to continue to apply for work-related injury, so it withdrew the work-related injury application.
However, the day after the case was terminated with dismissal, things took a turn for the worse. The training institution again submitted an application to the District Human Resources and Social Security Bureau for a determination of work-related injury, claiming that Yao's memory was biased after the fall, and that the accident injury he suffered in September was actually caused by a slip and fall while preparing to go to the classroom in the workplace, and that two colleagues who had previously testified against him also changed their testimony to confirm this claim. Subsequently, the undertaker of the case immediately sent a letter to the local police station for assistance, and after checking the monitoring of the surrounding roads of the institution to confirm that Yao had never been on duty that day, he took turns to investigate and interrogate Yao, the witnesses and the person in charge of the institution, and the witnesses finally admitted that at Yao's request, they made false testimony in order to help their colleagues, and Yao did fall and be injured when he went downstairs in his own building, and only made a foolish thing of changing his statement and lying about the accident in order to enjoy work-related injury benefits.
Finally, the District Human Resources and Social Security Bureau reported the relevant situation to the higher-level competent department of the training institution, and the competent department interviewed and criticized the institution, and the annual evaluation of the institution will be affected.
Article 60 of the Regulations on Work-related Injury Insurance stipulates that if an employer, an injured employee or his close relatives fraudulently obtains work-related injury insurance benefits, or a medical institution or assistive device allocation institution fraudulently obtains work-related injury insurance expenditures, the social insurance administrative department shall order a refund and impose a fine of not less than 2 times but not more than 5 times the amount fraudulently obtained; where the circumstances are serious and constitute a crime, criminal responsibility is pursued in accordance with law.
A vivid case warns everyone that any toFraudulent means to obtain work-related injury insurance**The violation of the law must bePunishment in accordance with law
In order to effectively prevent and eliminate the occurrence of fraud and insurance fraud, it is reported that in recent years, the Minhang District Human Resources and Social Security Bureau has first repaired "internal strength", closely followed the "practical, strict and detailed", compacted the responsibilities of each link of acceptance, investigation and review, and must investigate and investigate carefully when in doubt; Reunite "joint efforts" and set up a district-level leading group for work-related injury identification, which will implement the whole process of handling work-related injury cases in a multi-cross coordination and weave a dense safety "protective net"; Triple "scientific", improve the "judicial appraisal and medical consultation of work-related injury cases" work system, standardize the workflow of judicial appraisal and medical consultation, ensure that the conclusion is reasonable and well-founded, and tighten the "safety valve" of work-related injury insurance.
At the same time, we will continue to increase the publicity of work-related injury insurance policies, and send work-related injury insurance policies to enterprises, construction sites and communities through "point-to-point publicity and face-to-face services", so that employers and workers can experience the intimate services of the social security department "zero distance". Further popularize work-related injury insurance policies and laws and regulations, improve the quality of handling services, improve the awareness of enterprise risk prevention, maximize the protection of employees' life safety and health, enhance the initiative and enthusiasm of enterprises to participate in insurance, cast a strong "warm people's society" brand, and continuously improve the satisfaction of the masses.
*: Minhang today.