Work Injury Identification Process and Work Injury Insurance Benefits Application Guide

Work injury handling involves employee rights and enterprise costs. Timely and standardized work injury identification and benefit application are statutory obligations of enterprises.

1. Work Injury Identification Scope

Circumstances deemed work injury: accidental injury at work during working hours in the workplace; injury during preparatory or concluding work before/after working hours in the workplace; violent or accidental injury during working hours in the workplace due to performing duties; occupational disease; injury during business travel due to work or missing in an accident; traffic accident during commute not primarily the employee's fault. Deemed work injury: sudden death at work during working hours or death within 48 hours of failed rescue.

2. Identification Application Process

The employer must apply for work injury identification to the social insurance administrative department of the coordinated region within 30 days from the date of accidental injury or diagnosis/identification as occupational disease. If the employer fails to apply, the injured employee, close relatives, or labor union may apply directly within 1 year. Required submissions: work injury identification application form, labor relationship proof, medical diagnosis certificate or occupational disease diagnosis certificate. The social security department makes a determination within 60 days.

3. Labor Capacity Assessment

After treatment, if the injury is relatively stable with disability affecting labor capacity, a labor capacity assessment should be conducted. Assessment covers labor function impairment (Grades 1–10, Grade 1 most severe) and self-care impairment (3 grades). The employer, injured employee, or close relatives apply to the municipal labor capacity assessment committee at the prefecture level, which issues a conclusion within 60 days. Those disagreeing may apply for re-assessment within 15 days.

4. Work Injury Insurance Benefits

Main benefits: medical expenses (full reimbursement within catalog), hospital meal subsidy,the suspension-of-work-with-pay period wage (original wage and benefits unchanged, generally not exceeding 12 months), nursing care, one-time disability subsidy (Grade 1: 27 months' wage to Grade 10: 7 months' wage), disability allowance (Grades 1–6), one-time work injury medical subsidy and disability employment subsidy (Grades 5–10 upon contract termination). Work-related death benefits: funeral subsidy (6 months' average monthly wage of coordinated region previous year), dependent relative pension, one-time work death subsidy (20 times previous year's national per capita disposable income of urban residents).