Explain the law by case | If the employer fails to report the work-related injury in time, who will be responsible for the medical expenses?

The employer fails to report the work-related injury in a timely manner,

As a result, the corresponding medical expenses,

Hospitalization meal allowance cannot be reimbursed.

Can an employee claim compensation from the employer?

Recently, the People's Court of Pingjiang County, Yueyang City, Hunan Province

One such case was heard.

Basic facts of the case

In March 2021, Mr. Wang joined a company that registered for work-related injury insurance and paid work-related injury insurance premiums for Mr. Wang.

In May 2021, Wang was injured at work. After the accident occurred, a company did not declare a work-related injury, and Wang filed an application for work-related injury recognition with the Pingjiang County Human Resources and Social Security Bureau in January 2022.

It was determined that the injury suffered by Wang at work was a work-related injury, and the disability level was Grade 7 disability. Mr. Wang reached a mediation agreement with the company by applying for labor arbitration, and the company paid a total of 107,000 yuan for work-related injuries such as a one-time employment subsidy, wages for the period of suspension of work, nursing expenses, and transportation expenses that should be compensated by the employer.

Subsequently, Wang applied to the Pingjiang County Work-related Injury Insurance Center for payment of medical expense reimbursement, one-time disability subsidy, one-time work-related injury medical subsidy, hospital meal subsidy and other work-related injury benefits totaling 143,090 yuan.

The Pingjiang County Work-related Injury Insurance Service Center paid Wang a one-time disability subsidy and a one-time work-related injury medical subsidy of 112,400 yuan according to the application, but the medical expenses and inpatient meal subsidies for Wang's treatment totaled 30,690 yuan, and the Pingjiang County Work-related Injury Insurance Center indicated that it would not pay it, but should be paid by the employer.

A company refused to pay the fee, and Wang sued the other party to the Pingjiang County People's Court.

Court decision

According to the relevant laws and regulations, if an employee is injured in an accident, the unit to which he belongs shall submit an application for recognition of work-related injury to the social insurance administrative department of the coordinating area within 30 days from the date of occurrence of the accident injury. If the employer fails to submit an application for work-related injury determination within the aforesaid time limit, the employer shall bear the work-related injury benefits and other related expenses incurred during this period.

In this case, if the employer did not submit an application for work-related injury recognition to the social insurance administrative department within 30 days after the accident injury occurred, the medical expenses and hospital meal subsidies incurred during the period from the date of the accident injury to the date on which the social insurance administrative department accepted the application for work-related injury determination should be borne by the employer, i.e., the company.

After the court's interpretation of the law, Wang reached a settlement with a company, and the company paid 20,000 yuan in court for the medical expenses and hospital meal subsidies claimed by Wang, and Wang voluntarily gave up other litigation claims.

What the judge said

The work-related injury insurance system is formulated to ensure that employees who are injured by accidents or suffer from occupational diseases due to work receive medical treatment and economic compensation, promote work-related injury prevention and vocational rehabilitation, and disperse the work-related injury risk of employers. On the premise that the employer has paid work-related injury insurance for the employee and the injury suffered by the employee is recognized as a work-related injury, the work-related injury insurance fund has the legal obligation to pay the medical expenses for the treatment of the work-related injury to the injured employee. At the same time, in order to prevent employers from concealing or delaying the declaration and thus harming the legitimate rights and interests of employees, paragraphs 1 and 4 of Article 17 of the Regulations on Work-related Injury Insurance make relevant provisions, which are intended to urge employers to report work-related injuries in a timely manner after accidents, so as to protect the rights and interests of employees and maintain the healthy operation of the work-related injury insurance system.

The judge reminded that the employer has the obligation to pay work-related injury insurance premiums for the employee, and also has the obligation to actively apply for work-related injury recognition within the statutory time limit.

Links to legal provisions

Paragraphs 1 and 4 of Article 17 of the Regulations on Work-related Injury Insurance stipulate that: "If an employee is injured in an accident or is diagnosed or appraised as an occupational disease in accordance with the provisions of the Law on the Prevention and Treatment of Occupational Diseases, the unit to which he or she belongs shall, within 30 days from the date of occurrence of the accident injury or the date of diagnosis or appraisal of an occupational disease, submit an application for recognition of work-related injury to the social insurance administrative department of the coordinating region." In case of special circumstances, the time limit for application may be appropriately extended with the consent of the social insurance administrative department. "If an employer fails to submit an application for determination of work-related injury within the time limit specified in the first paragraph of this Article, the employer shall bear the relevant expenses such as work-related injury benefits that comply with the provisions of these Regulations during this period."

Article 6 of the Opinions of the Ministry of Labor and Social Security on <工伤保险条例>Several Issues Concerning Implementation (Lao She Bu Han [2004] No. 256) stipulates that: "Paragraph 4 of Article 17 of the Regulations stipulates that 'if an employer fails to submit an application for recognition of work-related injury within the time limit specified in the first paragraph of this Article, the employer shall bear the relevant expenses such as work-related injury benefits incurred during this period in accordance with the provisions of these Regulations'." Here, the period during which the employer bears the work-related injury benefits and other related expenses refers to the period from the date of occurrence of the accident injury or the date of diagnosis of the occupational disease to the date on which the labor and social security administrative department accepts the application for recognition of work-related injury. ”

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