Who should pay for medical expenses beyond the scope of work-related injury reimbursement?
2023-09-11
If a guide worker suffers work-related injuries and the medical expenses required for treating work-related injuries meet the requirements of the work-related injury insurance diagnosis and treatment project catalog, work-related injury insurance drug catalog, and work-related injury insurance hospitalization service standards, they can be paid by the work-related injury insurance fund. However, who should bear some medical expenses that exceed the reimbursement scope of the work-related injury insurance fund? Recently, the People's Court of Kaihua County, Zhejiang Province, tried a dispute over work-related injury insurance benefits. It accurately positioned the function of work-related injury insurance, supported the reasonable demands of workers in accordance with the law, and ruled that employers paid medical expenses beyond the scope of work-related injury insurance fund reimbursement, as well as wages, nursing expenses, and other expenses during the shutdown and salary retention period, totaling over 170000 yuan. This judgment focuses on the theme of "fairness and efficiency", effectively protecting the legitimate rights and interests of workers, and helping to build harmonious labor relations. It is a vivid practice of practicing the concept of active justice. Employee fall injury: The company refuses to assist in handling work-related injury insurance benefits. Dai Jun is an employee of Dahua Company and is engaged in chimney painting work at a construction site contracted by Dahua Company. On November 30, 2020, Dai Jun accidentally fell from a high place while working and was sent to the hospital for rescue. Although there was no life-threatening condition, the injury was relatively serious, including intracranial infection, sepsis, and severe head injury. During this period, the company advanced some medical expenses for Dai Jun's rescue and treatment. After the accident, the injuries suffered were recognized as work-related injuries by the local human resources and social security departments, with a disability level of three, and most of them had self-care barriers in their daily lives. Looking at the high medical expenses, Dai Jun repeatedly requested the company's assistance in handling relevant work-related injury insurance benefits, but was refused. On June 2, 2022, Dai Jun applied for arbitration to the Labor Dispute Arbitration Commission of Kaihua County, Zhejiang Province. The arbitration committee ruled that Dahua Company paid Dai Jun a total of over 170000 yuan in unpaid wages and nursing fees, which were paid within five days after Dai Jun returned the over 340000 yuan advanced by Dahua Company. Dai Jun was dissatisfied and filed a lawsuit with the People's Court of Kaihua County, demanding that Dahua Company pay 200000 yuan in medical expenses, over 170000 yuan in wages and nursing expenses during the shutdown period, as well as one-time disability subsidies, disability allowances, and other expenses. The total economic losses of the above-mentioned items were over 500000 yuan. Dahua Company filed a counterclaim, requesting that Dai Jun be ordered to return the medical expenses advanced by the company for his rescue and treatment of over 340000 yuan. Logical Game: How to Determine the Subject of Compensation Liability for Exceeding Part in the Trial? The lawyer representing the plaintiff Dai Jun stated that Article 1 of the "Work Injury Insurance Regulations" stipulates: "In order to ensure that employees who suffer from accidents or occupational diseases due to work receive medical treatment and economic compensation, promote work injury prevention and occupational rehabilitation, and disperse the risk of work injuries for employers, this regulation is formulated, The legislative spirit of the work-related injury insurance system is to "disperse" the risks of employers, rather than "transfer and replace", that is, as long as the treatment cost is necessary for work-related injury treatment, employers are not exempt from liability and should still bear compensation liability. In addition, the principle of protection for workers under current laws is "no fault liability". If a worker suffers damage due to their own fault, the employer still needs to bear compensation responsibility, let alone if they do not have any fault during the painting operation. As an employer, Dahua Company should fulfill the law of providing medical treatment to its employees
Edit：Wang Chen Responsible editor：Zhou Shu
Source：rmfyb.chinacourt.org
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