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工傷保險(xiǎn)條例
出處:法律顧問(wèn)網(wǎng)·涉外m.jeanmcdaniel.com     時(shí)間:2012/4/9 12:04:24

l 

國(guó)務(wù)院令第375號(hào)

(Promulgated by the State Council on 27 April 2003 and effective as of 1 January 2004.)

頒布日期:20030427  實(shí)施日期:20040101  頒布單位:國(guó)務(wù)院

  PART ONE GENERAL PROVISIONS

  Article 1 These Regulations are formulated in order to guarantee availability of medical treatment and economic compensation to staff and workers that suffer from work-related accidental injury or occupational disease, to promote prevention of work-related injury and vocational rehabilitation, and to distribute work-related injury risks of employers.

  Article 2 All types of enterprises and sole traders that hire workers (Employer(s)) shall participate in work-related injury insurance and pay work-related injury insurance premiums for all of the staff and workers or hired workers in their work unit (Employee(s)) in accordance with the provisions hereof.

  The Employees of all types of enterprises and the hired workers of sole traders in the People's Republic of China shall have the right to enjoy the benefits of work-related injury insurance in accordance with the provisions hereof.

  The specific steps and implementing procedures for participation of sole traders that hire workers in work-related injury insurance shall be stipulated by the people's governments of provinces, autonomous regions and municipalities directly under the central government.

  Article 3 Collection and payment of work-related injury insurance premiums shall be carried out in accordance with the provisions in the Collection and Payment of Social Insurance Premiums Tentative Regulations regarding collection and payment of basic old age insurance premiums, basic medical insurance premiums and unemployment insurance premiums.

  Article 4 An Employer shall announce within the work unit the relevant details of its participation in work-related injury insurance.

  An Employer and its Employees shall abide by the laws and regulations regarding safe production and prevention and treatment of occupational diseases, implement safety and health regulations and standards, prevent occurrence of work-related injury accidents and avoid and mitigate the harms of occupational diseases.

  If an Employee suffers from work-related injury, the Employer shall adopt measures to ensure that such Employee receives timely rescue and treatment.

  Article 5 The administrative department of labour security of the State Council shall be in charge of the work of work-related injury insurance throughout the country.

  The administrative departments of labour security of all levels of local people's governments at the county level and above shall be in charge of work-related injury insurance work within their respective administrative areas.

  The social insurance agencies established by the administrative departments of labour security in accordance with relevant provisions of the State Council (Agency/Agencies) shall undertake the practical affairs of work-related injury insurance.

  Article 6 Administrative departments of labour security and other departments shall seek the opinion of trade unions and representatives of Employers when formulating policies and standards for work-related injury insurance.

  PART TWO WORK-RELATED INJURY INSURANCE FUNDS

  Article 7 Work-related injury insurance funds shall be composed of work-related injury insurance premiums paid by Employers, interest on work-related injury insurance funds and other funds paid into the work-related injury insurance funds in accordance with law.

  Article 8 The premium rate for work-related injury insurance shall be determined on the principles that receipt be determined on the basis of payment and that receipt and payment be balanced.

  The State shall determine premium rate differentials between industries according to the degree of risks of work-related injuries in different industries, and shall determine several tiers of premium rates within each industry according to circumstances such as the use of work-related injury insurance premiums and the frequency of occurrence of work-related injuries. Inter-industry premium rate differentials and intra-industry premium rate tiers shall be formulated by the administrative department of labour security of the State Council in conjunction with the finance department, health administrative department and safe production regulatory department of the State Council, and shall be promulgated and implemented upon approval by the State Council.

  The Agency for a pooling region shall determine the work unit payable premium rate for an Employer on the basis of such circumstances such as use of work-related injury insurance premiums and frequency of occurrence of work-related injuries of the Employer, and the corresponding premium rate tier applicable to the industry to which the Employer belongs.

  Article 9 The administrative department of labour security of the State Council shall periodically obtain the details of receipt and payment of work-related injury insurance funds of all pooling regions throughout the country, and shall propose adjustment to the inter-industry premium rate differentials and the intra-industry premium rate tiers in a timely manner and in conjunction with the finance department, health administrative department and safe production regulatory department of the State Council. Such adjustment shall be promulgated and implemented upon approval by the State Council.

  Article 10 Employers shall pay work-related injury insurance premiums on time. Employees shall not pay work-related injury insurance premiums themselves.

  The amount of work-related injury insurance premium payable by an Employer shall be the product of the total payroll of the Employees of the work unit and the work unit payable premium rate.

  Article 11 Work-related injury insurance funds in municipalities directly under the central government and municipalities having districts shall be pooled on a municipality-wide basis. The level of pooling in other regions shall be determined by the people's government of the province or autonomous region.

  An inter-region industry or an industry with a relatively high level of production mobility may participate from another region in work-related injury insurance in a pooling region by adopting a method of relative concentration. The specific procedures shall be formulated by the administrative department of labour security of the State Council in conjunction with the department in charge of the relevant industry.

  Article 12 Work-related injury insurance funds shall be deposited into a dedicated finance account for social security funds for benefits of work-related injury insurance, assessment of work capability and payment of other expenses for work-related injury insurance stipulated herein. No work unit or individual may use the work-related injury insurance funds for investment and operation, construction or renovation of office site, distribution of bonuses, or divert such funds to other uses.

  Article 13 A certain ratio of work-related injury insurance funds shall be maintained as reserves for payment of work-related injury insurance benefits in the event of major accidents in the pooling region. In case of a shortage of reserves, the people's government of the pooling region shall advance the payment. The specific ratio of reserves to the total amount of funds and the procedures for the use of reserves shall be stipulated by the people's governments of provinces, autonomous regions or municipalities directly under the central government.

  PART THREE DETERMINATION OF WORK-RELATED INJURY

  Article 14 An Employee shall be determined as having a work-related injury if:

  1. he is injured in an accident at work during working hours in the workplace;

  2. he is injured in an accident while engaging in preparatory or finishing-up work related to work before or after working hours in the workplace;

  3. he is injured by violence or in other accident in his performance of job duties during working hours in the workplace;

  4. he suffers from an occupational disease;

  5. he is injured at work or his whereabouts became unknown in an accident, during work-related travel;

  6. he is injured in a motor vehicle accident while going to or returning from work; or

  7. he is in other circumstances that shall be determined as work-related injury according to the provisions of laws and administrative regulations.

  Article 15 An Employee shall be deemed as having a work-related injury if:

  1. he dies immediately or within 48 hours after emergency treatment for a disease suddenly arising during working hours in the workplace;

  2. he is injured in an act to protect national interests or public interests such as emergency rescue and disaster relief; or

  3. he is injured and disabled in war or on duty while in military service and has obtained a revolutionary injured and disabled soldier certificate, and suffers from a relapse of the old injury while being employed by the Employer.

  Where an Employee is in the circumstance of Item (1) or (2) of the preceding paragraph, he shall be entitled to work-related injury insurance benefits in accordance with the relevant provisions hereof. Where an Employee is in the circumstance of Item (3) of the preceding paragraph, he shall be entitled to work-related injury insurance benefits other than the lump sum disability allowance in accordance with the relevant provisions hereof.

  Article 16 An Employee shall not be determined or deemed as having work-related injury if:

  1. he is injured or he dies as a result of commission of crime or violation of public security administration;

  2. he is injured or he dies as a result of intoxication; or

  3. he inflicts harm on himself or commits suicide.

  Article 17 If an Employee is injured in an accident or diagnosed or certified as having occupational disease pursuant to the provisions of the Prevention and Treatment of Occupational Diseases Law, his work unit shall file an application for determination of work-related injury to the administrative department of labour security of the relevant pooling region within 30 days of the date of occurrence of the accidental injury or the date of diagnosis or certification of the occupational disease. In special circumstances, the time limit for application may, subject to the consent of the administrative department of labour security, be extended as appropriate.

  If the Employer fails to file an application for determination of work-related injury pursuant to the preceding paragraph, the Employee with work-related injury, his directly-related family members or the trade union may directly file an application for determination of work-related injury to the administrative department of labour security of the pooling region in which the Employer is located within one year of the date of occurrence of the accidental injury or the date of diagnosis or certification of the occupational disease.

  Matters concerning the determination of work-related injury that is required under the first paragraph of this Article to be conducted by the administrative department of labour security at the provincial level shall be handled by the administrative department of labour security of a municipality having districts in which the Employer is located according to the principle of jurisdiction.

  If the Employer fails to file an application for determination of work-related injury within the time limit prescribed in the first paragraph of this Article, the relevant expenses such as the work-related injury benefits that comply with the provisions hereof arising during this period shall be borne by the Employer.

  Article 18 When filing an application for determination of work-related injury, the following materials shall be submitted:

  1. an application for determination of work-related injury;

  2. the evidential materials of labour relationship with the Employer (including de facto labour relationship); and

  3. a certificate of medical diagnosis or a certificate of diagnosis of occupational disease (or an assessment of diagnosis of occupational disease)。

  The application for determination of work-related injury shall include the basic details of the accident such as the time and place of occurrence, the cause of the accident and the degree of injury to the Employee.

  If the materials provided by the applicant for determination of work-related injury are incomplete, the administrative department of labour security shall notify the applicant of all the materials that need to be supplemented in a one-time written notice. After the applicant has supplemented the materials as required by the written notice, the administrative department of labour security shall accept the application.

  Article 19 After the administrative department of labour security has accepted an application for determination of work-related injury, it may investigate and verify the accident and injury as required in examining and verifying the application, and the Employer, Employee, trade union, medical institution and other relevant departments shall provide assistance. Assessment of diagnosis of occupational disease and diagnosis dispute shall be handled in accordance with the relevant provisions of the Prevention and Treatment of Occupational Diseases Law. The administrative department of labour security shall not carry out further investigation or verification on certificates of diagnosis of occupational disease or assessment of diagnosis of occupational disease that are obtained in accordance with the law.

  Where an injury is considered as work-related by the Employee or his directly-related family members but not by the Employer, the burden of proof shall be borne by the Employer.

  Article 20 The administrative department of labour security shall render a decision on determination of work-related injury within 60 days of the date of acceptance of the application for determination of work-related injury, and shall notify the Employee applying for determination of work-related injury or his directly-related family members and his work unit in writing.

  Where the personnel of the administrative department of labour security has a material interest in the applicant for determination of work-related injury, he shall withdraw from the case.

  PART FOUR ASSESSMENT OF WORK CAPABILITY

  Article 21 If an Employee suffers from a work-related injury and he is in stable condition after treatment but has disability or his work capability is affected, the Employee shall undergo an assessment of work capability.

  Article 22 An assessment of work capability is an assessment of the degree of impairment in work functions and the ability to self-care.

  Impairment in work functions is classified into ten disability classes, from class one, the most severe, to class ten, the mildest.

  Impairment in the ability to self-care is classified into three classes: total self-care disability, substantial self-care disability and partial self-care disability.

  Standards for assessment of work capability shall be formulated by the administrative department of labour security of the State Council in conjunction with the health administrative department and other departments of the State Council.

  Article 23 Applications for assessment of work capability shall be filed by the Employer, the Employee with work-related injury or his directly-related family members to the assessment of work capability committee of a municipality having districts, and the decision on determination of work-related injury and the information relevant to the medical treatment of the work-related injury of the Employee shall be provided.

  Article 24 The assessment of work capability committee of provinces, autonomous regions, municipalities directly under the central government and municipalities having districts shall be composed of representatives of the administrative department of labour security, personnel administrative department, health administrative department, trade unions, Agencies and Employers of provinces, autonomous regions, municipalities directly under the central government and municipalities having districts respectively.

  The assessment of work capability committee shall set up a pool of medical and health experts. Medical and health professional technicians included in the expert pool shall satisfy the following conditions:

  1. possessing the qualifications for a senior technical position in the medical or health profession;

  2. possessing the relevant knowledge for assessment of work capability; and

  3. having good professional conduct.

  Article 25 After the assessment of work capability committee of a municipality having districts has received an application for assessment of work capability, it shall select three or five relevant medical and health experts at random from its expert pool to form an expert panel, which shall provide an assessment opinion. The assessment of work capability committee of the municipality having districts shall render an assessment of work capability conclusion in regards to the Employee with work-related injury on the basis of the assessment opinion of the expert panel. Where necessary, it may entrust a qualified medical institution to assist in the relevant diagnosis.

  The assessment of work capability committee of the municipality having districts shall render an assessment of work capability conclusion within 60 days of the date of receipt of the application for assessment of work capability. The time limit for rendering an assessment of work capability conclusion may be extended for 30 days if necessary. The assessment of work capability conclusion shall be served in a timely manner on the work unit and individual that applies for assessment.

  Article 26 If the work unit or individual that applies for assessment is dissatisfied with the assessment conclusion of the assessment of work capability committee of the municipality having districts, the work unit or individual may, within 15 days of the date of receipt of the assessment conclusion, apply to the assessment of work capability committee of the province, autonomous region or municipality directly under the central government for a reassessment. The assessment of work capability conclusion of the assessment of work capability committee of the province, autonomous region or municipality directly under the central government shall be final.

  Article 27 Assessment of work capability shall be objective and impartial. If any member of the assessment of work capability committee or expert participating in the assessment has a material interest in the party, he shall withdraw from the assessment.

  Article 28 If, within one year after an assessment of work capability conclusion is made, the Employee with work-related injury or his directly-related family members, his work unit or the Agency believes that there is a change in the disability condition, he may apply for a review of the assessment of work capability.

  PART FIVE

  WORK-RELATED INJURY INSURANCE BENEFITS

  Article 29 An Employee that receives treatment for work-related accidental injury or occupational disease shall be entitled to work-related injury medical benefits.

  An Employee shall seek medical treatment for work-related injury at a medical institution that has entered into a service agreement. In cases of emergency, the Employee may first seek emergency treatment at the nearest medical institution.

  If the costs required for treating the work-related injury fall within the treatment item catalogue, pharmaceutical catalogue and/or hospitalization service standard for work-related injury insurance, they shall be paid from work-related injury insurance funds. The treatment item catalogue, pharmaceutical catalogue and hospitalization service standard for work-related injury insurance shall be stipulated by the administrative department of labour security of the State Council in conjunction with the health administrative department, the pharmaceutical regulatory department and other departments of the State Council.

  Where an Employee is hospitalized for treatment of work-related injury, his work unit shall pay an amount of meal allowance at 70% of the meal allowance rate payable by the work unit for travel on duty. If the Employee with work-related injury seeks medical treatment outside the pooling region with the referral certificate of a medical institution and the consent of the Agency, the necessary travel and boarding expenses shall be reimbursed by his work unit according to the standard for travel on duty of Employees of the work unit.

  An Employee with work-related injury shall not be entitled to work-related injury medical benefits for treatment of a disease not arising from work-related injury, and such treatment shall be handled in accordance with the procedures on basic medical insurance.

  Where the costs of rehabilitative treatment of the Employee with work-related injury at a medical institution that has entered into a service agreement satisfy the conditions in the third paragraph of this Article, they shall be paid from work-related injury insurance funds.

  Article 30 An Employee with work-related injury may, due to daily life or employment needs and subject to the confirmation of assessment of work capability committee, wear artificial limbs, orthosis, artificial eyes and false teeth and equip himself with an aiding device such as wheelchair, and the necessary costs shall be paid from work-related injury insurance funds at the standards stipulated by the State.

  Article 31 If an Employee needs to suspend working in order to receive medical treatment for work-related accidental injury or occupational disease, his original wage and welfare benefits shall remain unchanged and payable monthly by his work unit during the suspension-of-work-with-pay period.

  The suspension-of-work-with-pay period shall normally not exceed 12 months. If the injury is severe or the circumstances are exceptional, such period may, subject to confirmation by the assessment of work capability committee of a municipality having districts, be extended as appropriate, but such extension may not be more than 12 months. After the disability class of the Employee with work-related injury is assessed, the original benefits shall be terminated, and the Employee shall be entitled to the disability benefits according to the relevant provisions of this Part. If the Employee with work-related injury still needs medical treatment after the end of the suspension-of-work-with-pay period, the Employee shall continue to enjoy work-related injury medical benefits.

  If an Employee with work-related injury with self-care disability needs nursing care during the suspension-of-work-with-pay period, his work unit shall be responsible for such needs.

  Article 32 If an Employee with work-related injury has been assessed with respect to his disability class and confirmed by the assessment of work capability committee as having need for living care, the fees for living care shall be paid monthly from work-related injury insurance funds.

  Fees for living care shall be paid according to the three different classes of self-care disability, namely, total self-care disability, substantial self-care disability and partial self-care disability, and the standards shall be 50%, 40% or 30% of the average monthly wage of Employees in the pooling region in the preceding year respectively.

  Article 33 If an Employee with work-related disability is assessed as having class one to class four disability, the labour relationship shall remain, and the Employee shall withdraw from the work post and enjoy the following benefits:

  1. a disability allowance shall be paid from the work-related injury insurance funds according to the disability class in a lump sum, and the standards are: for class one disability, the Employee's wages for 24 months; for class two disability, the Employee's wages for 22 months; for class three disability, the Employee's wages for 20 months; and for class four disability, the Employee's wages for 18 months;

  2. a monthly disability subsidy shall be paid from the work-related injury insurance funds, and the standards are: for class one disability, 90% of the Employee's wage; for class two disability, 85% of the Employee's wage; for class three disability, 80% of the Employee's wage; and for class four disability, 75% of the Employee's wage. If the actual amount of the disability subsidy is lower than the local minimum wage standard, the difference shall be made up from the work-related injury insurance funds; and

  3. the disability subsidy shall be terminated once the Employee with work-related injury has reached retirement age and completed the retirement procedures, and the Employee shall then be entitled to basic old age insurance benefits. If the basic old age insurance benefits are lower than the disability subsidy, the difference shall be made up from the work-related injury insurance funds.

  If an Employee with work-related disability is assessed as having class one to class four disability, the Employer and the Employee shall pay the basic medical insurance premium on the basis of the disability subsidy.

  Article 34 If an Employee with work-related disability is assessed as having class five or class six disability, the Employee shall be entitled to the following benefits:

  1. a disability allowance shall be paid from work-related injury insurance funds according to the disability class in a lump sum, and the standards are: for class five disability, the Employee's wages for 16 months; and for class six disability, the Employee's wages for 14 months; and

  2. his labour relationship with the Employer shall remain and the Employer shall arrange appropriate work for the Employee. Where it is difficult to arrange any work for the Employee, the Employer shall pay a monthly disability subsidy to the Employee, and the standards are: for class five disability, 70% of the Employee's wage and for class six disability, 60% of the Employee's wage, and the Employer shall also pay as required on behalf of the Employee all the social insurance premiums payable by the Employee. If the actual amount of the disability subsidy is lower than the local minimum wage standard, the difference shall be made up by the Employer.

  Upon request of the Employee with work-related injury, the labour relationship between the Employee and the Employer may be dissolved or terminated, and the Employer shall pay the work-related injury medical allowance and a disability employment allowance in a lump sum. The specific standards shall be stipulated by the people's governments of provinces, autonomous regions and municipalities directly under the central government.

  Article 35 If an Employee with work-related disability is assessed as having class seven to class ten disability, the Employee shall be entitled to the following benefits:

  1. a disability allowance shall be paid from work-related injury insurance funds according to the disability class in a lump sum, and the standards are: for class seven disability, the Employee's wages for 12 months; for class eight disability, the Employee's wages for 10 months; for class nine disability, the Employee's wages for eight months; and for class ten disability, the Employee's wages for six months; and

  2. upon termination of the labour contract at the end of the term thereof, or upon dissolution of the labour contract at the request of the Employee, the Employer shall pay the work-related injury medical allowance and disability employment allowance in a lump sum. The specific standards shall be stipulated by the people's governments of provinces, autonomous regions and municipalities directly under the central government.

  Article 36 If an Employee suffers from a relapse of the work-related injury and is confirmed as in need of medical treatment, the Employee shall be entitled to the work-related injury benefits specified in Articles 29, 30 and 31 hereof.

  Article 37 In the case of a work-related death of an Employee, the directly-related family members of the Employee shall receive a funeral allowance, bereavement payments for dependent family members and a lump sum work-related death allowance from work-related injury insurance funds in accordance with the following provisions:

  1. the funeral allowance shall be six months' average monthly wage of the Employees in the pooling region in the preceding year;

  2. bereavement payments for dependent family members shall be made at a certain percentage of the Employee's wage to each of the family members of the Employee that, before the Employee's death, was dependent on the Employee for primary source of income and that has no work capability. The standards are: 40% per month for the spouse, 30% per person per month for other family members, with an additional 10% on the basis of the afore-mentioned standards per person per month in the case of an elderly living alone or an orphan. The sum of the bereavement payments to all dependent family members so determined shall not be higher than the wage of the Employee before his work-related death. The specific scope of dependent family members shall be specified by the administrative department of labour security of the State Council; and

  3. the standard for the lump sum work-related death allowance shall be 48 to 60 months' average monthly wage of the Employees in the pooling region in the preceding year. The specific standard shall be stipulated by the people's government of the pooling region according to the circumstances of the local economic and social development, and shall be filed with the people's government of provinces, autonomous regions or municipalities directly under the central government for the record.

  If a disabled Employee dies as a result of the work-related injury during the suspension-of-work-with-pay period, the directly-related family members of the Employee shall be entitled to the benefits specified in the first paragraph of this Article.

  If an Employee with class one to class four disability dies after the suspension-of-work-with-pay period, the directly-related family members of the Employee shall be entitled to the benefits specified in Items (1) and (2) of the first paragraph of this Article.

  Article 38 Disability subsidies, bereavement payments for dependent family members and living care fees shall be adjusted from time to time by the administrative department of labour security of the pooling region in light of changes in the average wage of Employees and the living expenses. Methods for such adjustment shall be stipulated by the people's governments of provinces, autonomous regions and municipalities directly under the central government.

  Article 39 If, during work-related travel, an Employee's whereabouts became unknown in an accident or in emergency rescue or disaster relief, payment of his wage shall continue from the month in which the accident occurred for three months and be terminated from the fourth month, and thereafter the dependent family members of the Employee shall be paid monthly bereavement payments for dependent family members from work-related injury insurance funds. If the family members have difficulty in maintaining a living, 50% of the lump sum work-related death allowance may be paid in advance. If the Employee is declared dead by a people's court, the case shall be handled according to the provisions on work-related death in Article 37 hereof.

  Article 40 An Employee with work-related injury shall cease to enjoy the work-related injury insurance benefits if:

  1. he has lost eligibility to receive the benefits;

  2. he refuses to undergo an assessment of work capability;

  3. he refuses to receive medical treatment; or

  4. he is convicted and incarcerated.

  Article 41 In case of a division, merger or transfer in respect of the Employer, the succeeding work unit shall bear the responsibility for work-related injury insurance of the original Employer. If the original Employer has already participated in work-related injury insurance, the succeeding work unit shall carry out a change of work-related injury insurance registration with the local Agency.

  Where the Employer is operated on a contract basis, the responsibility for work-related injury insurance shall be borne by the Employer that has a labour relationship with the Employee.

  If an Employee is injured in a work-related accident while on temporary transfer to another work unit, the original Employer shall bear the responsibility for work-related injury insurance, but it may agree with the hosting unit on the compensation methods.

  In the case of a bankrupt enterprise, benefit payments under work-related injury insurance payable by the work unit according to law shall be made in priority during liquidation.

  Article 42 If an Employee is sent to work abroad and is required to participate in local work-related injury insurance according to the law of the destination country or region, the Employee shall participate in local work-related injury insurance and his work-related injury insurance relationship in China shall be suspended. If the Employee cannot participate in local work-related injury insurance, his work-related injury insurance relationship in China shall not be suspended.

  Article 43 If an Employee suffers from work-related injury for a second time and is entitled to disability subsidy according to regulations, the Employee shall enjoy the disability subsidy benefits according to the newly determined disability class.

  PART SIX SUPERVISION AND ADMINISTRATION

  Article 44 Agencies shall handle the specific matters of work-related injury insurance and perform the following duties:

  1. collect work-related injury insurance premiums in accordance with the provisions of the people's governments of provinces, autonomous regions and municipalities directly under the central government;

  2. verify the total payrolls and the number of Employees of Employers, carry out work-related injury insurance registration and be responsible for keeping records of premium payments of Employers and receipts by Employees of work-related injury insurance benefits;

  3. carry out investigation and compile statistics in respect of work-related injury insurance;

  4. administer payments from work-related injury insurance funds as required;

  5. assess work-related injury insurance benefits as required; and

  6. provide free information services to Employees with work-related injury or their directly-related family members.

  Article 45 Agencies shall enter into service agreements with medical institutions and aiding device supplying institutions on the basis of equal negotiation, and shall announce the list of the medical institutions and aiding device supplying institutions that have entered into service agreements. The specific procedures shall be formulated by the administrative department of labour security of the State Council in conjunction with the health administrative department and the civil affairs department of the State Council respectively.

  Article 46 Agencies shall verify the accounts of medical, rehabilitation and aiding device costs on Employees with work-related injury in accordance with the agreement and the relevant catalogues and standards of the State, and shall settle such fees in full in a timely manner.

  Article 47 Agencies shall periodically publicize the details of the receipt and payment in respect of work-related injury insurance funds and make timely recommendations to the administrative departments of labour security regarding premium rate adjustments.

  Article 48 The administrative departments of labour security and Agencies shall periodically seek opinions from Employees with work-related injury, medical institutions, aiding device supplying institutions and all sectors of the society for their comments on improving the work of work-related injury insurance.

  Article 49 The administrative departments of labour security shall supervise and inspect the collection of work-related injury insurance premiums and the receipt and payment of work-related injury insurance funds in accordance with the law.

  The finance departments and auditing departments shall supervise the receipt, payment and management of work-related injury insurance funds in accordance with the law.

  Article 50 Any organization or individual has the right to report illegal acts relating to work-related injury insurance. The administrative departments of labour security shall investigate such report in a timely manner, handle it in accordance with regulations, and maintain the confidentiality of the person making such report.

  Article 51 Trade unions shall safeguard the lawful rights and interests of Employees with work-related injury and implement supervision over the work-related injury insurance work of Employers in accordance with the law.

  Article 52 Disputes arising between Employees and Employers in regards to work-related injury shall be handled in accordance with the relevant provisions on the handling of labour disputes.

  Article 53 In any of the following circumstances, the relevant work unit or individual may apply for administrative review in accordance with the law; and if the work unit or individual is dissatisfied with the review decision, the work unit or individual may institute administrative proceedings in accordance with the law:

  1. the Employee that applies for determination of work-related injury, his directly-related family member or the Employee's work unit is dissatisfied with the conclusion of the determination of work-related injury;

  2. the Employer is dissatisfied with the work unit payable premium rate assessed by the Agency;

  3. the medical institution or the aiding device supplying institution that has entered into a service agreement believes that the Agency has failed to comply with the relevant agreement or provisions; or

  4. the Employee with work-related injury or his directly-related family members disagrees/disagree with the work-related injury insurance benefits verified by the Agency.

  PART SEVEN

  LEGAL LIABILITY

  Article 54 If a work unit or an individual misappropriates work-related injury insurance funds in violation of Article 12 hereof and such act constitutes a criminal offence, criminal liability shall be pursued according to law. If the act is not sufficient to constitute a criminal offence, administrative penalty or disciplinary punishment shall be imposed according to law. The misappropriated funds shall be recovered by the administrative department of labour security and consolidated with work-related injury insurance funds. The confiscated illegal income shall be handed over to the State treasury according to law.

  Article 55: If the personnel of the administrative department of labour security is in any of the following circumstances, he shall be subjected to administrative penalty according to law. If the circumstances are serious and a criminal offence is constituted, criminal liability shall be pursued according to law:

  1. refusal to accept an application for determination of work-related injury without proper reason, or determination of a person that does not meet the conditions for work-related injury as an Employee with work-related injury by way of falsehood;

  2. failure to appropriately safe keep the evidential materials for application for determination of work-related injury, thereby causing the loss of such evidence; or

  3. receipt of property from a party concerned.

  Article 56: If an Agency commits any of the following acts, the administrative department of labour security shall order rectification and impose disciplinary punishment on the person directly in charge and other responsible persons according to law. If the circumstances are serious and a criminal offence is constituted, criminal liability shall be pursued according to law. If economic loss is caused to the party concerned, the Agency shall be liable for compensation according to law:

  1. failure to maintain the records of payment of premiums by Employers and the payment of work-related injury insurance benefits to Employees as required;

  2. failure to determine work-related injury insurance benefits as required; or

  3. receipt of property from a party concerned.

  Article 57: If a medical institution or aiding device supplying institution fails to provide services pursuant to a service agreement, the Agency may dissolve the service agreement.

  If the Agency fails to settle accounts in full on time, the administrative department of labour security shall order rectification. The medical institution or aiding device supplying institution may dissolve the service agreement.

  Article 58: If an Employer has unreported some amount in its report of total payroll or number of Employees, the administrative department of labour security shall order rectification and impose a fine of not less than one time and not more than three times the amount of the payroll not reported.

  If an Employer, an Employee with work-related injury or his directly-related family member fraudulently obtains work-related injury insurance benefits, or if a medical institution or aiding device supplying institution fraudulently obtains payments from work-related injury insurance funds, the administrative department of labour security shall order the return of such benefits or payments, and shall impose a fine of not less than one time and not more than three times the amount obtained fraudulently. If the circumstances are serious and a criminal offence is constituted, criminal liability shall be pursued according to law.

  Article 59: If an organization or individual that is engaged in assessment of work capability commits any of the following acts, the administrative department of labour security shall order rectification and impose a fine of not less than Rmb 2,000 and not more than Rmb 10,000. If the circumstance are serious and a criminal offence is constituted, criminal liability shall be pursued according to law:

  1. provides false assessment opinion;

  2. provides false diagnosis certificate; or

  3. receives property from a party concerned.

  Article 60: If an Employer is required by these Regulations to participate in work-related injury insurance but fails to do so, the administrative department of labour security shall order rectification. If an Employee of the work unit suffers from work-related injury during the period in which the work unit has not participated in work-related injury insurance, the Employer shall make payments according to the item of work-related injury insurance benefits and at the standard stipulated herein.

  PART EIGHT SUPPLEMENTARY PROVISIONS

  Article 61: For the purposes of these Regulations, an Employee shall refer to an Employee under any form of employment and any term of employment that has a labour relationship (including de facto labour relationship) with an Employer.

  For the purposes of these Regulations, total payroll shall refer to the aggregate amount of remunerations for labour directly payable by the Employer to all of its Employees.

  For the purposes of these Regulations, the Employee's wage shall refer to the average monthly wage of the Employee with work-related injury in the 12 months prior to the work-related accidental injury or occupational disease. If the Employee's wage is higher than 300% of the average wage of the Employees in the pooling region, it shall be calculated at 300% of the average wage of the Employees in the pooling region. If the Employee's wage is lower than 60% of the average wage of the Employees in the pooling region, it shall be calculated at 60% of the average wage of the Employees in the pooling region.

  Article 62: If the personnel of a State authority or an institution or social organization whose personnel affairs are managed pursuant to the State civil service system suffers from work-related accidental injury or occupational disease, payments shall be made by his work unit. The specific procedures shall be stipulated by the administrative department of labour security of the State Council in conjunction with the personnel administrative department and finance department of the State Council.

  Procedures of work-related injury insurance and other matters for other institutions, social organizations and all kinds of non-governmental non-enterprise work unit shall be stipulated separately by the administrative department of labour security of the State Council in conjunction with the personnel administrative department, civil affairs department and finance department of the State Council by reference to these Regulations, and shall be implemented upon approval of the State Council.

  Article 63: If, in relation to a work unit that has no business licence or has not registered or filed for record according to law or a work unit whose business licence has been revoked or whose registration or record filing has been cancelled, an Employee of such work unit suffers from accidental injury or occupational disease, the work unit shall pay compensation in a lump sum to the injured Employee or the directly-related family members of the deceased Employee. The compensation standard shall not be lower than the work-related injury insurance benefits specified herein. No Employer shall employ child labour. If an Employer employs child labour and causes disability or death of such child labour, the work unit shall pay compensation in a lump sum to the child labour or the directly-related family members of the child labour. The compensation standard shall not be lower than the work-related injury insurance benefits specified herein. The specific procedures shall be stipulated by the administrative department of labour security of the State Council.

  If a dispute in respect of the amount of compensation arises between the injured Employee or the directly-related family members of the deceased Employee specified in the preceding paragraph and the work unit, or between the child labour or the directly-related family members of the child labour specified in the preceding paragraph and the work unit, the dispute shall be handled in accordance with the relevant provisions on the handling of labour disputes.

  Article 64: These Regulations shall be implemented as of 1 January 2004. In the case of an Employee that suffered accidental injury or occupational disease before the implementation hereof the determination of work-related injury of whom has not been completed, the provisions hereof shall apply.


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