Concept of work accident, occupational disease? Compensation level of accident insurance? Or what are the conditions and documents to receive work accident, occupational disease benefits? Through this article, fdiinvietnam.com will answer all your questions related to the latest work accident and occupational disease benefits.
What is an occupational disease? What is a work accident?
First, fdiinvietnam.com will briefly introduce you to the concepts of work accidents and occupational diseases so that you have an overview of these two issues.
- Occupational disease is a disease caused by harmful working conditions, affecting the health of workers.
- An occupational accident is an accident that occurs during the process of a worker working or performing assigned tasks. The accident causes damage to any part or function of the body or leads to the death of the worker.
Latest conditions for receiving occupational accident and disease benefits
The Law on Labor Safety and Hygiene 2015 specifically stipulates the conditions for receiving benefits for work-related accidents and occupational diseases as follows:
➤ Conditions for receiving occupational accident benefits
Workers will be compensated for work-related accidents if the worker has an accident in one of the following cases:
- At the workplace and during working hours, even when the employee is not working but performing necessary personal needs such as: breastfeeding, personal hygiene issues, eating and resting between hours (including in-kind compensation)…;
- Outside the workplace and outside working hours but at the request of the employer;
- On the way to work and home with reasonable time and route;
- Workers who have work-related accidents in the above cases, resulting in a reduction in working capacity of 5% or more.
➤ Conditions for receiving occupational disease benefits
Employees will be entitled to occupational disease benefits if they fall into one of the following cases:
- Having an occupational disease on the List of occupational diseases issued by the Ministry of Health according to Circular 15/2016/TT-BYT;
- Workers with occupational diseases that result in a reduction in working capacity of 5% or more.
Compensation level for occupational accident and disease insurance
➤ Level of occupational accident and disease insurance benefits
According to Circular 04/2015/TT-BLDTBXH, the compensation level for occupational accident and disease insurance is prescribed as follows:
- Decreased working capacity from 5% to 10%: Compensation of at least 1.5 months salary;
- Reduced working capacity from 11% to 80%: Minimum compensation of 1.5 months salary plus 0.4 months salary for each additional 1%, according to the formula:
Tbt = 1.5 + {(a – 10) x 0.4} , in which:
>> Tbt: Compensation level for loss of working capacity of 11% or more (unit: monthly salary);
>> 1.5: Compensation level when the rate of labor capacity reduction is from 5% to 10%;
>> a: Level (%) of reduced working capacity of people with work-related accidents or occupational diseases;
>> 0.4: Compensation coefficient when the rate of labor capacity loss increases by 1%.
- Reduced working capacity from 81% or more or death due to work accident or occupational disease: Compensation of at least 30 months salary.
➤ Principles of compensation for work accidents and occupational diseases
Workers are compensated for work-related accidents and occupational diseases according to the following principles:
- For work accidents – Compensation for each accident, not cumulative;
- For occupational diseases – Compensation for each time is as follows:
>> 1st time: Based on the level of labor capacity reduction in the first examination;
>> From the 2nd time onwards: Compensation for the difference between the rate of increased labor capacity reduction compared to the previous assessment result.
Note :
In addition to receiving compensation for work-related accidents and occupational diseases from employers and social insurance agencies, employees who suffer from work-related accidents or occupational diseases are also entitled to health insurance benefits under the Law on Health Insurance.
Procedures and documents for receiving benefits for work-related accidents and occupational diseases
➤ Records for receiving benefits for work-related accidents and occupational diseases
To receive compensation for work accidents, workers prepare the following documents:
- Social insurance book;
- Hospital discharge certificate or copy of medical records after completing treatment for work-related accidents (in case of inpatient treatment);
- Minutes of assessment of the level of loss of working capacity by the Medical Assessment Council;
- Document requesting settlement of occupational accident regime (form number 05A-HSB);
- Invoice, receipt for appraisal fee with list of appraisal contents (if paying medical appraisal fee);
- Minutes of investigation of occupational accidents or minutes of scene examination, scene diagram of traffic accidents considered to be occupational accidents;
- Prescription of medical examination and treatment facilities, orthopedic and rehabilitation facilities according to regulations on provision of living aids (if any).
>> FREE DOWNLOAD: Work accident and occupational disease compensation records.
➤ Procedures for receiving benefits for work-related accidents and occupational diseases
- Within 30 days, the employer submits the application to the Social Insurance agency (from the date of receiving relevant documents to apply for occupational accident and disease benefits such as: hospital discharge papers, minutes of assessment of the level of reduced working capacity, etc.);
- Within 10 days from the date of receiving complete documents, the Social Insurance agency will resolve the employee’s receipt of occupational accident benefits or in case of refusal, must respond in writing with the reason.
➤ How to receive occupational accident and disease insurance money
Depending on how the employee registers to receive compensation for work accidents and occupational diseases or the payment regulations of each social insurance agency, the employee will receive compensation . However, in general, after completing the procedures for receiving benefits for work accidents and occupational diseases, the employee can receive compensation in one of the following four ways:
- Method 1: Receive transfer from the Social Insurance agency through the employee’s account number (if the employee fills in the personal account number in form 05A-HSB);
- Method 2: Receive money directly at the Social Security agency (one-time subsidy);
- Method 3: Receive money from the Social Security agency via post;
- Method 4: Receive money from businesses and employers. With this method, the Social Insurance agency will pay compensation for work accidents and occupational diseases to businesses, then the businesses will pay back to employees.
One-time allowance for occupational accidents and diseases
➤ Recipients of one-time occupational accident benefits
- Workers with a reduced working capacity of 5% to 30% are entitled to receive a one-time allowance for work-related accidents and occupational diseases;
- Workers die from work accidents or occupational diseases in the following cases:
>> While working;
>> During the first treatment period due to work accidents and occupational diseases;
>> During treatment but the level of labor capacity reduction has not been assessed.
➤ Regulations for receiving one-time benefits
- Receive a subsidy of 5 times the basic salary if the working capacity is reduced by 5%;
- Receive an additional subsidy of 0.5 times the base salary if there is a further 1% reduction in working capacity;
- Receive additional benefits based on the number of years of contributions to the Occupational Accident and Disease Insurance Fund, specifically:
>> For 1 year or less, the additional allowance is equal to 0.5 month;
>> For each additional year of contribution to the fund, an additional subsidy of 0.3 months of salary contributed to the fund in the month immediately preceding the month of the work accident or the month of being diagnosed with an occupational disease will be provided;
>> If you have a work accident in the first month of contributing to the fund or have a period of interruption in participation and then return to work, the allowance will be calculated based on the salary of that month.
- In case of work-related accidents or occupational diseases leading to death, the employee’s relatives will receive a one-time allowance equal to 36 times the basic salary in the month the employee died. At the same time, they will receive death benefits according to the Law on Social Insurance.
➤ How to calculate one-time occupational accident benefits
According to the Law on Labor Safety and Hygiene 2015, the formula for calculating one-time benefits for work-related accidents and occupational diseases is as follows:
| One-time subsidy level | = | The level of allowance is calculated according to the level of loss of working capacity. | + | The subsidy level is calculated based on the number of years of contribution to the Occupational Accident and Disease Insurance Fund. |
| = | {5 x Lmin + (m-5) x 0.5 x Lmin} | + | {0,5 x L + (t-1) x 0,3 x L} |
In there:
>> Lmin: Basic salary at the time of enjoyment;
>> L: Salary level for insurance contribution to the Occupational Accident and Disease Insurance Fund;
>> m: Level of reduced working capacity due to work accidents and occupational diseases (take absolute number 5 ≤ m ≤ 30);
>> t: Total number of years of insurance contributions to the Occupational Accident and Disease Insurance Fund;
Frequently asked questions about occupational accident and disease benefits
1. What is an occupational disease?
Occupational disease is a disease caused by harmful working conditions that affect workers.
2. How do you get paid for work accident leave?
According to the 2015 Law on Occupational Safety and Hygiene, when an employee takes time off work for treatment or rehabilitation, the employer must pay the full salary according to the labor contract for the period during which the employee suffered a work-related accident or occupational disease.
3. Are you entitled to social insurance if you have a work accident?
Yes. When a worker has a work accident, he/she will receive compensation and work accident benefits from the Social Insurance agency and the employer (enterprise).
4. What benefits are available for accidents on the way to and from work?
In case of an accident on the way to and from work, the employee will be compensated for the following expenses:
>> Medical expenses are paid from the first aid and emergency stages until treatment is stable;
>> Be paid for co-payment costs and costs not covered by health insurance (in case the employee participates in health insurance);
>> Full payment of medical expenses (in case the employee does not participate in health insurance);
>> Be paid full salary for having to take time off work for treatment and rehabilitation.
5. Are occupational accidents covered by health insurance?
Yes. According to the Law on Health Insurance, the subjects entitled to health insurance are: medical examination, treatment, rehabilitation, periodic pregnancy check-ups, childbirth… Therefore, employees who have occupational accidents will receive compensation from the Social Insurance agency, compensation from the employer and enjoy health insurance policies according to the Law on Health Insurance.
6. How does accident insurance pay?
Occupational accident or occupational disease insurance will be paid to compensate employees in 1 of the following 4 ways:
>> Method 1: Receive transfer from the Social Insurance agency through the employee’s account number (if the employee fills in the personal account number in form 05A-HSB);
>> Method 2: Receive money directly at the Social Security agency (one-time subsidy);
>> Method 3: Receive money from the Social Security agency via post;
>> Method 4: Receive money from businesses and employers. With this method, the Social Insurance agency will pay compensation for work accidents and occupational diseases to the business, then the business will pay back to the employee.
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