Dongguan work injury insurance how to reimbursement

Dongguan work injury insurance how to reimbursement

Work injury insurance treatment expenses include work injury medical reimbursement, that is, the medical costs incurred by the injured worker hospitalized treatment can be reimbursed. However, the basic premise is that after the occurrence of work accidents, the employer should promptly submit a written application for work injury recognition to the local social security bureau in order to reimburse the relevant medical expenses. Below I have organized the Dongguan work injury insurance how to reimburse the relevant content, I hope to help you!

A, Dongguan work injury insurance reimbursement process

1, application. The insured person through the scene way to apply, as required to submit paper application materials.

2, acceptance. The staff received the application materials on the date of immediate acceptance or inadmissibility of the decision. Upon review, the participant meets the eligibility criteria, and the materials are complete, standardized format, in accordance with the statutory form, to be accepted; the participant does not meet the eligibility criteria or standards, inadmissible, issued the "Dongguan City, the social insurance benefits of the notice of withdrawal" by the participant's signature to confirm the participant. Materials are incomplete or do not meet the statutory form, inadmissible, fill out the "Dongguan City, social insurance entitlements need to make up information notice" to the participant's signature to confirm the handover of a joint participant in accordance with the requirements of additional materials.

3, review. After acceptance, the reviewer will review the materials in writing and make approval within the promised time limit.

4, decision. Participants meet the statutory qualifications, standards and materials complete, standardized format, in line with the statutory form, allowed to pass, issued "Dongguan City, industrial injury medical treatment claim information acceptance receipt" to the participants; participants do not meet the statutory qualifications, standards, not pass, issued "Dongguan City, social insurance treatment refund notice" to the participants. The material is not complete, the format is not standardized, does not meet the legal form of the issuance of "Dongguan City, social insurance entitlements to apply for supplementary information notice" to the participant to supplement the material.

Second, for the materials

The injured employee after the end of the medical treatment of industrial injuries, the medical institutions, rehabilitation institutions, labor capacity assessment institutions and rehabilitation equipment assembly institutions cash settlement of the relevant costs, you need to submit the following materials to the local social insurance agency for the medical reimbursement of industrial injuries sporadic procedures:

(1) (1) A copy of the front and back of the ID card or social security card of the injured worker (if someone else does it on behalf of the injured worker, a copy of the front and back of the ID card or social security card of the person who does it on behalf of the injured worker must be provided at the same time);

(2) A copy of the Decision on Determination of Work Injury;

(3) Confirmation of Information on Bank Account for Treatment of Work Injury Insurance;

(4) Copy of Certificate of Appraisal of Labor Ability of Dongguan Labor Ability Commission. Appraisal of Labor Capacity of Dongguan Municipal Labor Ability Commission", and the original "Declaration of Abandonment of Disability Appraisal" for those who give up the appraisal of disability;

(5) If the accident involves a third party's responsibility, it is necessary to submit documents proving the accident (e.g., the certificate of responsibility for the traffic accident, a copy of the receipt of the police report, and an original certificate of the Public Security Bureau, etc.); and a copy of the results of the accident's responsibility characterization and compensation processing (e.g., a copy of the court's judgment, a copy of the results of the claims of the commercial insurance, and an agreement, etc.);

(6) "Social Insurance Fund first payment approval form" (involving the first payment);

(7) the application for settlement of medical expenses for work-related injuries, you need to submit the following additional materials:

① a copy of the diagnosis of the disease certificate;

② outpatient treatment, the submission of outpatient fee receipts (invoices) original, corresponding to the breakdown of the expenses list, a copy of prescription or outpatient medical record, a copy of the report of outpatient laboratory tests and examinations;

③ For inpatient treatment, submit the original receipt (invoice) of the inpatient charges of the medical institution and the detailed list of the corresponding expenses, and a copy of the summary of the discharged person;

④ a copy of the examination and approval form for the transfer of the hospital (for those who are approved to be transferred to a hospital for treatment outside of the city);

⑤ for those who have the approval effective in a different place and who have to be treated in a chosen For those who are treated at the selected out-of-town hospitals, a copy of "Dongguan Municipal Social Insurance Approval Opinion on Medical Treatment for Long-term Out-of-Town Residents (Workers)" will be provided.

(8) the application for settlement of transportation and accommodation costs, you need to submit the following materials:

① a copy of the fee receipt (invoice) issued by the medical institution;

② a copy of the diagnosis of disease or a copy of the discharge summary;

③ the original approval form for the transfer of the transfer of the hospital (approved to transfer to designated hospitals outside of the city for treatment).

Note: If the original transfer approval form has been submitted to the hospital during the on-site settlement at the designated network hospital outside the city, a copy of the settlement statement or individual payment list should be submitted. The settlement statement or personal payment list in the category of "transfer hospitalization", can be regarded as the original transfer approval form.

(9) the settlement of hospital meal allowance application, you need to submit the following materials:

① medical institutions issued by the hospitalization fee receipts (invoices) copies;

② diagnosis of disease or a copy of the hospital discharge summary.

(10) the application for settlement of labor capacity appraisal fees, you need to submit the following additional materials:

Labor capacity appraisal agency issued the original fee receipts (invoices).

(11) put forward the application for settlement of rehabilitation appliances (prosthetics) fees, you need to submit the following materials:

① Dongguan social insurance designated rehabilitation appliances assembly organization issued the original receipt (invoice);

② need to install rehabilitation appliances (prosthetics) or installation of rehabilitation appliances (prosthetics) need to be replaced (maintenance), "Dongguan City, the identification of labor capacity (confirmation) and rehabilitation appliances configuration opinion form".

(12) rehabilitation treatment is not settled at the scene, the application for settlement of rehabilitation treatment fees, you need to submit the following additional materials:

① "notice of rehabilitation of work-related injuries," the original;

② a copy of the diagnosis of the disease;

③ approval agreed to designate the original fee receipts of the rehabilitation health care institutions (invoices) and the cost of the list;

④ the extension of rehabilitation of work-related injuries. > ③ Approval materials for extension of rehabilitation for work injury (limited to extension of rehabilitation for work injury):

⑤ Other materials related to rehabilitation treatment.

(13) medical dependence settlement, you need to submit the following additional materials:

① "Dongguan City Work Injury Insurance medical dependence approval" copy;

② outpatient fee receipts (invoices) original, corresponding to the cost of the detailed list of prescriptions or outpatient medical records copies, outpatient laboratory tests, copies of the report of the examination.

(14) Other information to be submitted to receive the relevant benefits.

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