Can work-related injuries be reimbursed by medical insurance?

Work-related injuries cannot be reimbursed by medical insurance. Medical insurance and industrial injury are two different categories. In case of work-related injury, the medical expenses shall be paid in advance by the enterprise and then reimbursed. The medical insurance card was used in the industrial injury accident, and all the expenses paid by the medical insurance fund can be reimbursed by the industrial injury insurance. All the expenses of work-related accidents are paid by the unit. Workers with work-related injuries can go to the labor bureau for disability appraisal after discharge, and get corresponding compensation for work-related injuries according to the grade of appraisal report.

Work-related injury identification procedures are as follows:

1. First of all, you need to apply to the local labor department for work-related injury identification, which is the prerequisite for obtaining compensation.

2. Fill in an application form for work-related injury, and prepare a copy of ID card and disease certificate.

(1) If the company agrees to work-related injuries, please ask the legal person to sign the relevant position and affix the official seal of the company. Social security staff will issue a work-related injury certificate after investigation. Those identified as work-related injuries can be reimbursed for related treatment expenses.

(2) The other is that if the unit does not agree to identify a work-related injury, the applicant will provide evidence that does not belong to the work-related injury, and the social security agency will determine whether it belongs to the work-related injury according to the evidence provided by the applicant.

(3) In another case, the boss simply doesn't admit that you are his laborer, so you first collect relevant materials with employment relationship, then file labor arbitration, and then go to social security related institutions for work-related injury identification according to the arbitration results.

4. After the work-related injury is identified, the level and degree of disability shall be assessed as the basis for calculating the amount of compensation.

5. If the factory still refuses to pay compensation, it may submit an arbitration request to the local labor arbitration department, and the arbitration commission shall make a ruling according to law. If the parties to the ruling refuse to accept the ruling, they can bring a civil lawsuit to the local people and enter the procedure of second instance and final appeal.

6, when calculating the amount of compensation should be based on the provisions of the "Regulations on Work-related Injury Insurance", according to the average monthly salary of the injured and the average annual salary of employees in the province.

Legal basis:

People's Republic of China (PRC) social insurance law

Article 30

The following medical expenses are not included in the payment scope of the basic medical insurance fund:

(a) shall be paid by the industrial injury insurance fund;

(2) It shall be borne by a third party;

(3) borne by public health;

(4) Go abroad for medical treatment.

Medical expenses that should be borne by a third party according to law. If the third party is unable to pay or cannot determine the third party, the basic medical insurance fund will pay in advance. After the basic medical insurance fund pays in advance, it has the right to recover from the third party.