千亿体育

關于省直事業單位等組織參加工傷保險有關問題的通知

為(wei)進一步貫徹落(luo)實省(sheng)人力資源社(she)會(hui)保(bao)障廳、省(sheng)財政廳、省(sheng)民政廳《關(guan)(guan)于事業單(dan)位等(deng)組織(zhi)工(gong)傷(shang)保(bao)險有關(guan)(guan)問題(ti)的通知(zhi)》(豫人社(she)工(gong)傷(shang)〔2011〕8號),切實保(bao)障職工(gong)合法權益,現就省(sheng)直事業單(dan)位等(deng)組織(zhi)參加(jia)工(gong)傷(shang)保(bao)險有關(guan)(guan)事宜通知(zhi)如(ru)下(xia):

一、工傷保險(xian)參保及(ji)繳費(fei)

(一)參保(bao)(bao)范圍(wei)。中央(yang)駐豫(yu)、省(sheng)直(zhi)駐鄭(zheng)的事(shi)業單(dan)位(wei)、社(she)會團體(參照公(gong)務(wu)員法(fa)管理的事(shi)業單(dan)位(wei)、社(she)會團體除外)、民辦(ban)非企(qi)業單(dan)位(wei)、基金(jin)會、律師事(shi)務(wu)所、會計師事(shi)務(wu)所等(deng)組(zu)織(zhi)(以(yi)下簡(jian)稱用人(ren)(ren)單(dan)位(wei))應當參加省(sheng)直(zhi)工(gong)傷保(bao)(bao)險統籌(chou),為本單(dan)位(wei)全部(bu)職工(gong)或者雇(gu)工(gong)(以(yi)下稱職工(gong))繳(jiao)納工(gong)傷保(bao)(bao)險費。職工(gong)個人(ren)(ren)不(bu)繳(jiao)納工(gong)傷保(bao)(bao)險費。

用人單位(wei)已(yi)經(jing)參加所(suo)在地工傷(shang)保(bao)險統籌的,可(ke)繼續在當地參保(bao)。

(二)參(can)(can)保(bao)(bao)(bao)(bao)登記(ji)。已參(can)(can)加省(sheng)(sheng)直基本(ben)醫(yi)(yi)療保(bao)(bao)(bao)(bao)險(xian)(xian)的(de)(de),其單位(wei)參(can)(can)保(bao)(bao)(bao)(bao)信(xin)(xin)(xin)息(xi)、參(can)(can)保(bao)(bao)(bao)(bao)人(ren)員(yuan)基本(ben)信(xin)(xin)(xin)息(xi)和繳費信(xin)(xin)(xin)息(xi)暫采用其在(zai)河南(nan)省(sheng)(sheng)社會醫(yi)(yi)療保(bao)(bao)(bao)(bao)險(xian)(xian)中心(xin)(以(yi)下稱(cheng)省(sheng)(sheng)醫(yi)(yi)療保(bao)(bao)(bao)(bao)險(xian)(xian)中心(xin))登記(ji)的(de)(de)信(xin)(xin)(xin)息(xi)。各單位(wei)需填(tian)寫《工(gong)傷(shang)保(bao)(bao)(bao)(bao)險(xian)(xian)登記(ji)表》于(yu)2011年9月(yue)15日前報河南(nan)省(sheng)(sheng)工(gong)傷(shang)保(bao)(bao)(bao)(bao)險(xian)(xian)中心(xin)(以(yi)下稱(cheng)省(sheng)(sheng)工(gong)傷(shang)保(bao)(bao)(bao)(bao)險(xian)(xian)中心(xin))備案。未參(can)(can)加省(sheng)(sheng)直基本(ben)醫(yi)(yi)療保(bao)(bao)(bao)(bao)險(xian)(xian)的(de)(de),由用人(ren)單位(wei)按照《社會保(bao)(bao)(bao)(bao)險(xian)(xian)登記(ji)管(guan)理(li)暫行辦法》的(de)(de)相關(guan)規定(ding)直接到省(sheng)(sheng)工(gong)傷(shang)保(bao)(bao)(bao)(bao)險(xian)(xian)中心(xin)辦理(li)參(can)(can)保(bao)(bao)(bao)(bao)登記(ji)手續。

(三)費用(yong)征繳。工(gong)傷保險費按月(yue)(yue)征繳。各(ge)單位(wei)(wei)工(gong)傷保險職工(gong)個人(ren)繳費工(gong)資基數(shu)和單位(wei)(wei)繳費工(gong)資總額暫采用(yong)省醫療保險中心每年(nian)核定(ding)的數(shu)額,經本(ben)單位(wei)(wei)公示并簽章后(hou)確(que)定(ding)。以后(hou)每月(yue)(yue)各(ge)單位(wei)(wei)工(gong)資總額隨(sui)單位(wei)(wei)職工(gong)變(bian)動(dong)情況(kuang)而(er)變(bian)動(dong)。

各單位(wei)2011年1-10月(yue)的工傷保(bao)險費(fei),由(you)省工傷保(bao)險中(zhong)心(xin)根據公示結果確定(ding)的10月(yue)份(fen)繳費(fei)工資總(zong)額,按(an)規定(ding)的費(fei)率一并(bing)征收。

工傷(shang)保(bao)險(xian)費(fei)原則上(shang)采用托收方式(shi)(shi)征(zheng)繳(jiao)。暫以各單(dan)位(wei)繳(jiao)納(na)基本(ben)醫療保(bao)險(xian)費(fei)的賬戶征(zheng)收工傷(shang)保(bao)險(xian)費(fei),若單(dan)位(wei)需用其他賬戶繳(jiao)費(fei)或變更繳(jiao)納(na)方式(shi)(shi)的,應以書(shu)面形(xing)式(shi)(shi)將賬戶信(xin)息和繳(jiao)費(fei)方式(shi)(shi)(同時提供規定格(ge)式(shi)(shi)的電(dian)子(zi)文檔)于2011年9月(yue)15日前報省工傷(shang)保(bao)險(xian)中心(xin)。

(四)人(ren)員(yuan)變(bian)更。各(ge)單位人(ren)員(yuan)發生增減變(bian)化的,應及(ji)時(shi)到省工(gong)傷保險中心辦理人(ren)員(yuan)增減變(bian)更手續(xu)。填報《參加省直工(gong)傷保險人(ren)員(yuan)增(減)明(ming)細表(biao)》,并(bing)提供規(gui)定格式的電子文檔。

二(er)、工(gong)傷認定

(一)職(zhi)(zhi)工(gong)發生(sheng)事(shi)(shi)故(gu)傷害(hai)(hai)或者按照職(zhi)(zhi)業病(bing)防(fang)治法(fa)規定(ding)(ding)(ding)(ding)被診斷(duan)、鑒(jian)定(ding)(ding)(ding)(ding)為(wei)職(zhi)(zhi)業病(bing),所在單位應當(dang)自事(shi)(shi)故(gu)傷害(hai)(hai)發生(sheng)之日(ri)或者被診斷(duan)、鑒(jian)定(ding)(ding)(ding)(ding)為(wei)職(zhi)(zhi)業病(bing)之日(ri)起30日(ri)內,向省人力資(zi)源(yuan)社會(hui)保障(zhang)廳(ting)提出(chu)工(gong)傷認(ren)定(ding)(ding)(ding)(ding)申請(qing)。因(yin)交通事(shi)(shi)故(gu)、失蹤、因(yin)工(gong)外出(chu)期間發生(sheng)事(shi)(shi)故(gu)傷害(hai)(hai)以(yi)及其他不可(ke)抗力因(yin)素導(dao)致不能在規定(ding)(ding)(ding)(ding)時(shi)限內提出(chu)申請(qing)的,經省人力資(zi)源(yuan)社會(hui)保障(zhang)廳(ting)同意,可(ke)以(yi)適當(dang)延(yan)長(chang)申請(qing)時(shi)限,但最長(chang)不得超過90日(ri)。

(二)用人單位(wei)未(wei)按(an)本條第(一)項規定提(ti)出(chu)工(gong)傷認定申請的(de),工(gong)傷職工(gong)或(huo)(huo)者其近親屬、工(gong)會組織(zhi)在事故傷害發生之日或(huo)(huo)者被診斷、鑒定為職業病之日起1年(nian)內,可以(yi)直接省人力資(zi)源(yuan)社(she)會保障廳提(ti)出(chu)工(gong)傷認定申請。

(三)提出工(gong)傷認定申請應當(dang)提交下(xia)列材料:

1、工傷認定申請表(biao);

2、與用人單(dan)位(wei)存在勞動(dong)關(guan)(guan)(guan)系、人事關(guan)(guan)(guan)系(包括事實勞動(dong)關(guan)(guan)(guan)系)的證(zheng)明材料;

3、醫療診斷(duan)證明或(huo)者職業病(bing)診斷(duan)證明書(shu)(或(huo)者職業病(bing)診斷(duan)鑒定書(shu))。

4、省(sheng)人力資源社(she)會保障廳要求的其他材(cai)料。

(四(si))用(yong)人單位未在本條(tiao)第(一)項規(gui)定的(de)時限內(nei)提(ti)交(jiao)工(gong)傷認(ren)定申(shen)請,在此期(qi)間發生符(fu)合《工(gong)傷保(bao)險條(tiao)例(li)》(國務(wu)院令第375號頒布,國務(wu)院令第586號修改,以下(xia)簡稱《條(tiao)例(li)》)規(gui)定的(de)工(gong)傷待(dai)遇(yu)等有關(guan)費用(yong)由該用(yong)人單位負擔(dan)。

(五)職工(gong)或者(zhe)其近親屬認(ren)為是(shi)工(gong)傷,用人單(dan)位不認(ren)為是(shi)工(gong)傷的,由用人單(dan)位承擔舉證(zheng)責任。

(六(liu))職(zhi)工(gong)于2010年12月31日前因工(gong)作(zuo)遭受事故傷害或者(zhe)患職(zhi)業病,未超出《條例(li)》規定(ding)申請時限的,按(an)照《條例(li)》規定(ding)辦(ban)理工(gong)傷認定(ding)。

(七)職(zhi)工于2010年12月31日前因(yin)工作遭(zao)受事故傷(shang)害或者患職(zhi)業(ye)病,已經超出《條(tiao)例》規(gui)定申請時限的(de),由職(zhi)工或者其近親屬(shu)提出申請,經所在單位(wei)審核同意(yi),統(tong)一報省人(ren)力資源社會保障(zhang)廳(ting)辦理工傷(shang)確認手(shou)續。

三、勞動能(neng)力鑒定(ding)

(一)職(zhi)工發生工傷,經治療傷情相對穩定后存在(zai)殘(can)疾、影響勞(lao)動能力的,應當(dang)進行勞(lao)動能力鑒定。

(二)勞動能(neng)(neng)(neng)力鑒定(ding)是指勞動功能(neng)(neng)(neng)障礙(ai)程度(du)和(he)生(sheng)活自(zi)理(li)(li)(li)障礙(ai)程度(du)的等(deng)(deng)級(ji)(ji)(ji)鑒定(ding)。勞動功能(neng)(neng)(neng)障礙(ai)分(fen)為十(shi)個(ge)傷(shang)殘(can)等(deng)(deng)級(ji)(ji)(ji),最重的為一級(ji)(ji)(ji),最輕的為十(shi)級(ji)(ji)(ji)。生(sheng)活自(zi)理(li)(li)(li)障礙(ai)分(fen)為三(san)個(ge)等(deng)(deng)級(ji)(ji)(ji): 生(sheng)活完全不能(neng)(neng)(neng)自(zi)理(li)(li)(li)、生(sheng)活大(da)部分(fen)不能(neng)(neng)(neng)自(zi)理(li)(li)(li)和(he)生(sheng)活部分(fen)不能(neng)(neng)(neng)自(zi)理(li)(li)(li)。

(三)勞(lao)動(dong)(dong)能(neng)力(li)鑒(jian)定(ding)由(you)用人單位、工(gong)傷(shang)(shang)職工(gong)或者其近親(qin)屬向省(sheng)勞(lao)動(dong)(dong)能(neng)力(li)鑒(jian)定(ding)委員會(hui)辦公室(以下(xia)簡稱省(sheng)鑒(jian)定(ding)辦)提出申請,并提供工(gong)傷(shang)(shang)認定(ding)決定(ding)書(shu)和職工(gong)工(gong)傷(shang)(shang)醫(yi)療的(de)有關(guan)資料(liao)。具體按《關(guan)于(yu)規(gui)范省(sheng)直工(gong)傷(shang)(shang)保(bao)險勞(lao)動(dong)(dong)能(neng)力(li)鑒(jian)定(ding)程序的(de)通知》(豫勞(lao)鑒(jian)〔2011〕1號)規(gui)定(ding)執行。

(四)申請鑒(jian)定的(de)單(dan)位或者個人對鑒(jian)定結(jie)論(lun)不服的(de),可(ke)在收到結(jie)論(lun)之日(ri)起15日(ri)內向(xiang)省勞動(dong)能力(li)鑒(jian)定委(wei)(wei)員會(hui)提出再次鑒(jian)定申請,由省勞動(dong)能力(li)鑒(jian)定委(wei)(wei)員會(hui)作出最終鑒(jian)定結(jie)論(lun)。

(五)自(zi)勞(lao)動能(neng)力鑒(jian)定(ding)結論作出(chu)之(zhi)日起(qi)1年(nian)后,工(gong)傷職工(gong)或(huo)者其近親屬、所在單位或(huo)者經(jing)辦機構認為傷殘情況發生變化的,可以申(shen)請勞(lao)動能(neng)力復查鑒(jian)定(ding)。

四、工傷保險待遇審核與支付

職(zhi)工(gong)因(yin)工(gong)作原因(yin)受(shou)到事(shi)故傷(shang)害或者(zhe)患職(zhi)業(ye)病,且經(jing)工(gong)傷(shang)認(ren)定的,享受(shou)工(gong)傷(shang)保險待遇;其(qi)中,經(jing)勞動能(neng)力鑒定喪失勞動能(neng)力的,享受(shou)傷(shang)殘待遇。

(一)就(jiu)診就(jiu)醫。職(zhi)(zhi)工(gong)(gong)(gong)發生工(gong)(gong)(gong)傷(shang)(shang)后,應到與(yu)省工(gong)(gong)(gong)傷(shang)(shang)保(bao)險(xian)中(zhong)心簽(qian)訂協(xie)議(yi)的(de)(de)(de)醫療(liao)機構就(jiu)診就(jiu)醫(急(ji)診急(ji)救除外)。協(xie)議(yi)簽(qian)訂前,可到獲得省直工(gong)(gong)(gong)傷(shang)(shang)保(bao)險(xian)定(ding)點資格的(de)(de)(de)醫療(liao)機構或(huo)基本醫療(liao)保(bao)險(xian)定(ding)點醫療(liao)機構就(jiu)診就(jiu)醫。職(zhi)(zhi)工(gong)(gong)(gong)舊傷(shang)(shang)復發需要進一步治療(liao)或(huo)病(bing)情需要轉(zhuan)診轉(zhuan)院的(de)(de)(de),用人單位(wei)應按照《工(gong)(gong)(gong)傷(shang)(shang)保(bao)險(xian)待遇審(shen)核(he)和支付程序》(豫工(gong)(gong)(gong)傷(shang)(shang)〔2005〕17號(hao))的(de)(de)(de)要求,分別填寫《工(gong)(gong)(gong)傷(shang)(shang)職(zhi)(zhi)工(gong)(gong)(gong)舊傷(shang)(shang)復發申請(qing)表(biao)》、《工(gong)(gong)(gong)傷(shang)(shang)職(zhi)(zhi)工(gong)(gong)(gong)轉(zhuan)診轉(zhuan)院申請(qing)表(biao)》等,報省工(gong)(gong)(gong)傷(shang)(shang)保(bao)險(xian)中(zhong)心審(shen)核(he)同意后進行(xing)(xing)。工(gong)(gong)(gong)傷(shang)(shang)病(bing)情特(te)殊的(de)(de)(de),可以先(xian)行(xing)(xing)治療(liao),但應于10日內補辦手續。

(二)待(dai)遇申(shen)(shen)報(bao)。由用人(ren)單(dan)位(wei)按照有關規定(ding)(ding)(ding)填寫(xie)相關表格,攜帶工(gong)傷(shang)認(ren)定(ding)(ding)(ding)決(jue)定(ding)(ding)(ding)書(shu)、勞動能力鑒定(ding)(ding)(ding)結論及(ji)其他材料(liao),于每月(yue)20日(ri)前向省工(gong)傷(shang)保(bao)(bao)險(xian)中心申(shen)(shen)報(bao)工(gong)傷(shang)保(bao)(bao)險(xian)待(dai)遇。職工(gong)于2010年12月(yue)31日(ri)前因工(gong)作遭(zao)受事(shi)(shi)故傷(shang)害或(huo)者患(huan)職業(ye)病(bing),未能取得社會保(bao)(bao)險(xian)行(xing)政(zheng)部門(men)(men)工(gong)傷(shang)認(ren)定(ding)(ding)(ding)決(jue)定(ding)(ding)(ding)書(shu)但通過工(gong)傷(shang)確認(ren)的,申(shen)(shen)報(bao)新發生的待(dai)遇時(shi),參保(bao)(bao)單(dan)位(wei)應攜帶社會保(bao)(bao)險(xian)行(xing)政(zheng)部門(men)(men)出具的工(gong)傷(shang)確認(ren)書(shu)、原始工(gong)傷(shang)界定(ding)(ding)(ding)文(wen)書(shu)資料(liao)、以及(ji)事(shi)(shi)故發生時(shi)的醫(yi)療診斷證明、病(bing)歷等相關資料(liao)及(ji)復(fu)印(yin)(yin)件(jian)(復(fu)印(yin)(yin)件(jian)由省工(gong)傷(shang)保(bao)(bao)險(xian)中心留存,原件(jian)退回(hui)用人(ren)單(dan)位(wei))。

(三(san))待(dai)(dai)(dai)遇審核(he)。省工傷保險中心接到用人(ren)單位的待(dai)(dai)(dai)遇申請(qing)后(hou),應對(dui)申請(qing)享(xiang)受(shou)待(dai)(dai)(dai)遇人(ren)員進行待(dai)(dai)(dai)遇資格審核(he)與(yu)驗(yan)證。經審核(he)符(fu)合(he)享(xiang)受(shou)待(dai)(dai)(dai)遇條(tiao)件的,按(an)規定(ding)支(zhi)付有關待(dai)(dai)(dai)遇。

(四(si))待(dai)遇支(zhi)付(fu)。用(yong)人(ren)(ren)單位按(an)規定參(can)保繳費的,按(an)以下情形核(he)定支(zhi)付(fu)參(can)保人(ren)(ren)員工傷保險(xian)待(dai)遇:

1、本通知下發(fa)后發(fa)生的工傷,取得社會保(bao)險(xian)(xian)行政部門工傷認定決(jue)定書的,按照《條(tiao)例》和我省有關規定核(he)定支(zhi)付其(qi)工傷保(bao)險(xian)(xian)待遇(yu)。

2、本通知下發(fa)前發(fa)生的(de)工(gong)(gong)(gong)傷(shang)(shang),屬于《條例》規定(ding)(ding)申(shen)請(qing)工(gong)(gong)(gong)傷(shang)(shang)認定(ding)(ding)時限內,取得社會保(bao)(bao)險(xian)(xian)行政部門工(gong)(gong)(gong)傷(shang)(shang)認定(ding)(ding)決定(ding)(ding)書的(de),統一按單(dan)位申(shen)請(qing)認定(ding)(ding)工(gong)(gong)(gong)傷(shang)(shang)的(de)情形,核定(ding)(ding)支付其工(gong)(gong)(gong)傷(shang)(shang)保(bao)(bao)險(xian)(xian)待遇。

3、職工(gong)于2010年(nian)12月31日(ri)(ri)前因工(gong)作遭受事故傷(shang)(shang)(shang)(shang)害或者(zhe)患職業病,未能取得社會(hui)保險行(xing)政部門工(gong)傷(shang)(shang)(shang)(shang)認定(ding)(ding)決(jue)定(ding)(ding)書但通過工(gong)傷(shang)(shang)(shang)(shang)確認的,按照《條例》和(he)(he)我省有(you)關規定(ding)(ding),由工(gong)傷(shang)(shang)(shang)(shang)保險基金支付其2011年(nian)1月1日(ri)(ri)后再發(fa)生的醫療(康復)和(he)(he)輔助器具配置費用(yong);其他工(gong)傷(shang)(shang)(shang)(shang)保險待遇標準解決(jue)辦法另行(xing)規定(ding)(ding)。

 


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