Original title: When companies stop production, who will pay for work-related injury insurance, public hearings reached consensus
Disability due to work should be entitled to work-related injury insurance benefits, however, because the company stopped production and was unable to pay for work-related injury insurance, it was difficult to receive disability allowances for injured employees. In the face of this case where the court’s judgment was not improper and the injured employees’ claims were legitimate and reasonable, the prosecutors actively carried out the substantive resolution of administrative disputes, and sought a good solution to the problem within the framework of laws and policies.
If the company stops production, who will pay for the work-related injury insurance
Feng XX caused a fourth-degree disability due to a work-related accident, and suffered a company’s suspension of production. No work-related injury insurance was paid, and it was difficult to receive the disability allowance. After suing the Medical Insurance Center to no avail, Feng Moumou applied for supervision to the Yangquan City Procuratorate in Shanxi Province with the mentality of trying it out. Unexpectedly, things turned around…
The company stopped production after work injury
Suspension of Disability Allowance Sues Medical Insurance Center
Feng Moumou, 64 this year, was originally an electrician in a Shanxi Building Material Manufacturing Co., Ltd. (“Building Material Company” for short). On May 10, 2014, the building material company plant lost control during the maintenance process and crashed into Feng Moumou who was working on the circuit, causing him to be injured. Pelvic fractures and urethral injuries.
In January 2015, according to the appraisal of the Labor Ability Appraisal Committee of Yangquan City, Shanxi Province, Feng XX constituted the fourth degree of disability. The fourth-degree disability means the loss of the ability to work and will quit the job. Feng Moumou is the backbone of the family. Before the injury, he received a monthly salary of 3,500 yuan, but after the injury, he only enjoys a monthly rural pension insurance benefit of 120 yuan.
The troubled family thought of work-related injury insurance. According to regulations, insured employees can enjoy work-related injury benefits in accordance with the law after being identified as a work-related injury. On June 30, 2016, the medical insurance center of a district in Yangquan City (hereinafter referred to as the medical insurance center) paid a total of 150,668.05 yuan to Feng XX for work-related injury insurance, including physical therapy fees, rehabilitation fees, auxiliary utensils, and one-time disability subsidies , Disability allowance from February 2015 to June 2016, etc. Since the building materials company paid insurance for Feng XX until July 2016, after the company stopped production, he no longer paid work injury insurance for him, and the medical insurance center did not pay the subsequent disability allowance. Since then, Feng Moumou has embarked on a long road to litigation…
In October 2017, Feng XX filed a labor dispute lawsuit with a district court in Yangquan City, demanding that the building material company pay his disability allowance. After the court’s explanation of the legal principles and recommendations to withdraw the lawsuit, Feng XX took the Medical Insurance Center to court and asked it to perform the duty of paying the work-related injury benefits after July 2016.
The court rejected the prosecution on the grounds that “Feng XX did not submit to the court the relevant evidence to apply for advance payment to the medical insurance center.” Feng XX had to submit to the medical insurance center the disability allowance for the period from July 2016 to August 2017. And the application to make up the difference in pension insurance benefits after retirement in August 2017, and hope that the work-related injury benefits will be in place as soon as possible.
The advance payment of social insurance funds is a benefit to the people to protect the legitimate rights and interests of workers. However, in practice, the lack of advance payment recovery has always been a difficult task for the human resources and social sectors. Due to the suspension of payment of work-related injury insurance by the building materials company, the Medical Insurance Center decided not to pay in advance. In desperation, Feng XX filed a lawsuit to the court again, but was rejected again. After that, Feng XX appealed to the Yangquan Intermediate Court, but the appeal was rejected and the original verdict was upheld.
Apply for supervision after dismissing the prosecution
In-depth investigation and verification by the case handling team
The Feng Moumou case entered the prosecutor’s vision during the case evaluation work of the Yangquan City Procuratorate’s administrative prosecution department. The prosecutor learned from Feng Moumou that Feng Moumou was also seeking help from the procuratorial organ, hoping to fulfill his request through procuratorial supervision. However, for several cases rejected by the court, can the procuratorate help? After applying for supervision, Feng’s heart was full of uncertainty.
The prosecutor in the case conducted an in-depth and detailed review of all the materials of the case and found that Feng Moumou could not prove that he requested the building material company to pay the disability allowance and was rejected by the building material company, and could not provide the social The employer’s refusal to pay the evidence issued by the insurance department, and the court’s judgment was not obviously improper.
However, thinking from the perspective of Feng XX, his appeal has certain legitimacy and rationality. If you simply make a decision not to support the supervision application, Feng Moumou’s heart will never be solved. Reported by the prosecutor handling the case, the Yangquan City Procuratorate set up a case-handling team headed by Zhang Cunqing, a full-time member of the Procuratorial Committee of the court. A good recipe for XX’s legitimate rights and interests.
After many times of communication with the parties and in-depth field visits to Feng’s home, the case handling team learned that Feng’s recovery from injury was not satisfactory. Due to the inability to stand and walk for long periods of time, Feng needs his wife to accompany him for a long time. In addition, he has spent a lot of transportation and litigation expenses for requesting disability treatment over the years. Both children have married and lived independently without a stable source of income. Has been in trouble.
Case prosecutors have visited the social security department many times to learn about the policies and regulations of work-related injury benefits, advance payment, etc., and listen to the professional interpretation of the relevant policies and regulations of work-related injury insurance by experts in the field of human resources and social security, and have a better understanding of the case and related laws and regulations. Clear understanding and judgment.
After completing a large number of investigations and verifications, the Yangquan City Procuratorate convened a joint meeting of prosecutors to fully discuss the case, breaking the stereotype of the case-handling team’s “single-soldier combat” and opening up multiple perspectives of thinking about the problem.
Public hearing to reach consensus
Work injury insurance fund shall pay work injury benefits
In view of the interests of different parties involved, the process of identification of work-related injuries and the determination of remuneration standards often occurs in a situation where “the public is justified and the mother-in-law is justified”. The Yangquan City Procuratorate decided to change the previous model of “handling cases in a courtroom”, and with the help of “outside brains”, a public hearing was held on June 10 this year to present facts, present evidence, and explain legal principles face to face, and jointly promote the thorough, effective and proper resolution of administrative disputes. .
At the hearing, Feng Moumou entrusted his wife and children to express his appeals due to inconvenience, and relevant personnel of the Medical Insurance Center also expressed their opinions. Subsequently, the hearing officers conducted a thorough discussion on whether the medical insurance center has the obligation to pay the disability allowance of Feng XX in advance after August 2016, and whether there is a situation in which statutory duties have not been performed in accordance with the law.
“When a work-related injury accident occurs, if the employee has been insured and is classified as first to fourth-degree disability after identification, the Work Injury Insurance Fund shall be responsible for the payment of various work injury benefits in accordance with the “Work Injury Insurance Regulations.”
“According to the “Interim Measures for the Advance Payment of Social Insurance Funds”, if an enterprise does refuse to pay expenses, the social insurance agency shall pay the work-related injury insurance benefits in advance based on the application of the injured employee.”
“In response to Feng XX’s incomplete materials, the medical insurance center made a decision not to pay the work-related injury insurance benefits in advance without clearly telling him the content of the materials that should be supplemented. This is not in compliance with the regulations, and it also makes it difficult for workers to defend their rights. .”
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After full discussion, everyone agreed that Feng XX should obtain work-related injury benefits from the work-related injury insurance fund, and social insurance agencies should fulfill their obligation to pay in advance. A certain district work injury insurance center (responsible for work injury insurance business after institutional reform) promised on the spot to review the case.
Subsequently, Feng XX, the representative of Feng XX’s wife and children, under the guidance of relevant departments, once again submitted an application for the advance payment of work-related injury insurance benefits to the social insurance agency.
“The purpose of our supervision is to truly solve the problems of the common people. Only by facilitating payment in place can we truly resolve the contradictions between the two parties and effectively resolve the distress in life caused by Feng XX’s inability to work.” Zhang Cunqing said.
After the hearing, the Yangquan City Procuratorate continued to follow up the case, strengthened communication and coordination with social insurance agencies, and urged Feng XX to be resolved as soon as possible.
■Prosecutor’s Statement
Efforts to resolve administrative disputes and safeguard the legitimate rights and interests of workers injured at work
When an employee enters a job, the employer shall pay for his work injury insurance. This is a mandatory provision of the law. For example, an employee is injured by an accident due to work during working hours and in the workplace, or is injured by violence or other accidents due to the performance of work duties. Those who are identified as work-related injuries by the labor ability appraisal committee of the city divided into districts can enjoy the corresponding work-related injury treatment in accordance with the law.
According to the “Work Injury Insurance Regulations,” employees who are identified as first to fourth levels of disability due to work-related disability shall retain the labor relationship and withdraw from the job, and enjoy benefits including: one-time disability subsidy paid from the work-related injury insurance fund according to the level of disability Disability allowance is paid monthly from the work-related injury insurance fund; after the work-injured employee reaches the retirement age and completes the retirement procedures, the disability allowance is suspended, and the basic pension insurance benefits are enjoyed in accordance with national regulations. The basic pension insurance benefits are lower than the reason for the disability allowance. The work-related injury insurance fund makes up the difference. In response to the employer’s refusal to pay all or part of the expenses, the “Interim Measures for the Advance Payment of Social Insurance Funds” specifically stipulates that workers with work-related injuries can apply for work-related injury insurance benefits in writing to the social insurance agency with a work-related injury determination decision and related materials.
It can be seen that both the “Regulations on Work Injury Insurance” and the “Interim Measures for the Advance Payment of Social Insurance Funds” are all out of relief and protection for workers injured at work. In this case, the court decision was not obviously improper, and the party’s Feng Moumou’s request was reasonable and legitimate. Based on the legislative intent of the relevant laws and safeguarding the legitimate rights and interests of applicants, we will actively carry out the substantive resolution of administrative disputes, build a communication platform for applicants and work-related injury insurance payment institutions, and guide all parties to seek the best path to resolve disputes. Only in this way can the people have a real sense of gain, and the “people-centered” can be truly implemented.
(Zhang Cunqing, Yuehua and Li Yiting, Procuratorate of Yangquan City, Shanxi Province)
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