workers compensation process

Obtaining compensation for work-related injuries can be summarized as follows:

1. The employer or the employee himself applies for work-related injury determination. If he is dissatisfied with the work-related injury determination, he or she may apply for administrative reconsideration or file an administrative lawsuit.

2. After confirming the work-related injury, a working ability appraisal will be conducted. If you are not satisfied with the working ability appraisal, you can apply for review.

3. After confirming the disability level, if the employer has paid ICBC insurance, the employee will enjoy work-related injury insurance benefits in accordance with the law. On the contrary, employees can initiate labor arbitration against the employer. If they are dissatisfied with the arbitration award, they can initiate a civil lawsuit in court.

4. If the employer fails to perform the above-mentioned aspects involving court judgments, it may apply for compulsory execution.

Let’s look at the specific process:

1. Identification of work-related injuries

The identification of uninsured work-related injuries shall be the responsibility of the county/city/district labor and social security administrative department where the employer is located. Fill out the corresponding "Application Form for Work Injury Determination" and submit the following materials:

1. Copy of unit business license
2. The original and copy of the labor contract, or other certification materials that can prove the existence of a labor relationship between the employee and the employer
3. Issue a medical diagnosis certificate from a hospital at or above the county level
4. Copy of the injured person’s ID card
5. If you are injured due to a motor vehicle accident, submit a responsibility determination letter from the public security and transportation department or relevant proof of treatment.
6. Work-related injury accident report (completed by the employer or its designated agent) and witness testimony

Based on the above materials, the labor and social security administrative department will make and prepare a "Work Injury Determination Decision" within 60 days after receiving the work-related injury determination application or supplementary materials, and send this "Decision" to the determination applicant and the injured employee (or his or her immediate family). Relatives) and the employer, and send a copy to the handling agency at the same time.

2. Labor ability appraisal

The employer or the injured employee (or immediate family member) shall submit a labor ability appraisal to the Municipal Labor Ability Appraisal Committee, fill out the "Work Ability Appraisal Form", and submit the following materials:

1. "Work Injury Determination Decision"
2. Copy of ID card and recent photos of the injured employee
3. Diagnosis certificates, case copies and other diagnosis and treatment materials from medical institutions at or above the county level
4. Other materials required by the Labor Ability Appraisal Committee
5. If immediate family members apply for labor ability appraisal, they need to provide proof of relationship with the injured employee.

The Labor Capacity Appraisal Committee shall make a labor ability appraisal conclusion within 60 days from the date of receipt of the labor ability appraisal application. If necessary, the period for making a labor ability appraisal conclusion may be extended by 30 days.

3. Work Injury Compensation

The following benefits are based on work-related injury insurance. If you do not participate in work-related injury insurance, your employer will pay for it.

1. Hospitalization food subsidy: The unit shall pay 70% of the unit’s food subsidy standard for business trips.

2. Transportation expenses, food and accommodation expenses: If the medical institution issues a certificate and reports to the handling agency for approval, and seeks medical treatment outside the coordinating area, the necessary transportation expenses, food and accommodation expenses will be reimbursed by the unit in accordance with the standards for employees of the unit on business trips.

3. Rehabilitation treatment fee: The cost of rehabilitation treatment for a work-injured employee at a medical institution that has signed a service agreement shall be paid from the work-related injury insurance fund if it meets the regulations.

4. Assistive device fees: Due to daily work or employment needs, employees injured at work can be installed with prostheses, orthotics, prosthetic eyes, dentures, wheelchairs and other assistive devices after confirmation by the Labor Capacity Appraisal Committee. The required fees are based on the standards stipulated by the state. Insurance fund payment.

5. Suspension salary benefits:

① If it is necessary to suspend work to receive medical treatment for work-related injuries, the original wages and benefits will remain unchanged and will be paid by the unit on a monthly basis.
② The period of suspension of work and salary retention shall generally not exceed 12 months. If the injury is serious or under special circumstances, it may be appropriately extended after confirmation by the district-level municipal labor capacity appraisal committee, but the extension shall not exceed 12 months. That is, the period of suspension of work and salary retention shall generally be within 12 months. Within 24 months.
③ After the disability assessment is registered, the original benefits will be suspended and you will enjoy the disability benefits.
④ If an employee injured at work still needs treatment after the suspension of work and salary retention period expires, he or she will continue to enjoy work-related injury medical treatment.
⑤ If a work-injured employee who cannot take care of himself needs care during the period of suspension of work and salary, the cost shall be borne by the employer.

6. Living care expenses: If an employee injured at work has been assessed as having a disability level and confirmed by the Labor Capacity Appraisal Committee as needing living care, the living care expenses will be paid monthly from the work-related injury insurance fund.

  • Completely unable to take care of themselves: 50% of the average monthly salary of employees in the coordinating area in the previous year
  • Unable to take care of themselves for most of life: 40%
  • Unable to take care of oneself in daily life: 30%

4. Disability appraisal compensation

If the disability level is not enough, the amount of compensation shall be negotiated between the enterprise and the employee, and special regulations shall apply if there are special local regulations.

1. One-time disability subsidy (paid from the work-related injury insurance fund, if not insured, paid by the employer)

  • Level 7: 12 months personal salary
  • Level 8: 10 months personal salary
  • Level 9: 8 months personal salary
  • Level 10: 6 months personal salary

2. If the labor contract expires or the employee proposes to terminate the labor contract, the unit shall pay a one-time work-related injury medical subsidy and disability employment subsidy.

① One-time work-related injury medical subsidy: The standard is the average monthly salary of employees in the coordinating area in the previous year
  • Level 7: 12 months
  • Level 8: 10 months
  • Level 9: 8 months
  • Level 10: 6 months
        • ② Disability employment subsidy: The standard is the average monthly salary of employees in the coordinating area in the previous year
      • Level 7: 12 months
      • Level 8: 26 months
      • Level 9: 16 months
      • Level 10: 6 months
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