How long does it take to approve the medical insurance reimbursement for accidental falls?

If you apply for medical insurance reimbursement due to trauma, the review generally takes 15 working days. The medical insurance reimbursement process for accidental falls is as follows: register with the hospital medical insurance office within three working days of hospitalization, issue the hospitalization application form, hospitalization invoice, detailed list and medical record at the medical insurance office when leaving the hospital, and settle the reimbursement at the hospitalization expense office.

According to the Regulations on Work-related Injury Insurance, the unit shall, within 30 days from the date of the accident injury, apply to the social insurance administrative department in the overall planning area for work-related injury identification; If the employer misses the time to apply for work-related injury identification, the workers with work-related injuries and their close relatives may also apply for work-related injury identification within one year from the date of injury. After applying for work-related injury identification and social security acceptance, the conclusion of work-related injury identification shall be made within 60 days. Employees who participate in work-related injury insurance must go to the employer for reimbursement of medical expenses of work-related injury insurance within one year after the end of medical treatment. In the case of complete information, the medical insurance agency will complete the audit and settlement of expenses within 30 days, and the funds will be allocated by the Municipal Social Security Fund Center in the middle of next month. However, in case of doubt, large medical expenses, and the need for investigation and evidence collection, the audit and settlement of expenses are not limited by 30 working days. If you need treatment later, please apply to the labor ability appraisal department for follow-up medical treatment. It should be noted that when applying for work-related injury medical expenses, the medical expenses verified by work-related injury insurance will be allocated to the unit.

Legal basis:

Regulations on industrial injury insurance

Article 20

The administrative department of social insurance shall, within 60 days from the date of accepting the application for work-related injury identification, make a decision on work-related injury identification, and notify the employees who apply for work-related injury identification or their close relatives and the units where the employees work.

The administrative department of social insurance shall, within 15 days, make a work-related injury determination decision on the application with clear facts and clear rights and obligations.

If it is necessary to make a work-related injury determination decision according to the conclusion of the judicial organ or the relevant administrative department, the time limit for making a work-related injury determination decision shall be suspended during the period when the judicial organ or the relevant administrative department has not yet made a conclusion.

If the staff of the social insurance administrative department has an interest in the applicant for work-related injury identification, they should withdraw.