Cases of defrauding industrial injury insurance benefits

Cases of defrauding industrial injury insurance benefits

Work-related injury insurance fund is a social insurance fund paid by the insured unit according to law, which is used for the treatment and compensation of workers with work-related injuries, and no one may occupy or misappropriate it. The following cases of defrauding work-related injury insurance benefits are collected. Let's take a look!

Recently, our bureau investigated and dealt with a case suspected of defrauding work-related injury insurance benefits. A company in our city submitted an application for work-related injury identification to our bureau on April 20 17, claiming that its employee Wu Mou fell down the stairs while patrolling the workplace at around 23: 30 on March 29, 20 1 7, causing injuries to his left eye and local soft tissues. Then, to determine whether Wu Mou was injured at work, the key point is to verify whether he was injured at work.

After investigation and verification by our bureau, his working hours were from 0: 00 to 9: 00 on March 30, 20 17, but he claimed that he had to go back to work early because of a call from his boss Zhong. However, according to Zhong's investigation transcript, Zhong said that he would notify him to go back to work in advance in the form of WeChat on the same day. Zhong has different answers to the above notification method of going to work early, and can't provide the call list and WeChat chat record of the day to prove it.

According to this, Wu Mou was not injured during working hours, and his intention of defrauding industrial injury insurance benefits was obvious. After reviewing the case, the staff of our bureau immediately criticized and educated the person in charge of work-related injury insurance in this unit.

If the work-related injury identification is fraudulently obtained through fraud or fabrication of facts and has been reimbursed by the social security department, after investigation, the new provisions on work-related injury insurance, which came into effect on 2011,will not only be fully refunded, but also the relevant parties will be fined 2-5 times of the reported medical expenses. However, because the case was not recognized as a work-related injury and was not reimbursed by the social security department, it was ordered to make corrections. Work-related injury insurance cannot reimburse medical expenses in Wu Mou. At the same time, the unit is warned to learn a lesson. In the future, it must be strictly examined and applied for the identification of work-related injury insurance according to the facts.

Reference regulations

1. Article 88 of the Social Insurance Law: If the social insurance benefits are defrauded by fraud, forged certification materials or other means, the social insurance administrative department shall order it to return the defrauded social insurance benefits and impose a fine of more than two times and less than five times the amount defrauded;

2. Article 60 of the Regulations on Work-related Injury Insurance: If an employer, an employee with a work-related injury or his close relatives defraud the work-related injury insurance benefits, and if a medical institution or an auxiliary device allocation institution defrauds the work-related injury insurance fund, the social insurance administrative department shall order it to be returned and impose a fine of more than 2 times and less than 5 times the amount defrauded; If the circumstances are serious enough to constitute a crime, criminal responsibility shall be investigated according to law;

3. Article 266 of the Criminal Law: whoever defrauds public or private property in a relatively large amount shall be sentenced to fixed-term imprisonment of not more than one year, criminal detention or public surveillance, and shall also or only be fined; If the amount is huge or there are other serious circumstances, he shall be sentenced to fixed-term imprisonment of not less than three years but not more than ten years and shall also be fined; If the amount is especially huge or there are other especially serious circumstances, he shall be sentenced to fixed-term imprisonment of not less than 10 years or life imprisonment, and shall also be fined or confiscated. Where there are other provisions in this Law, those provisions shall prevail.

4. Article 27, paragraph 2, of the Regulations on Labor Security Supervision: Anyone who defrauds social insurance benefits or defrauds social insurance fund expenditures shall be ordered by the labor security administrative department to return it and be fined 1 times and less than 3 times; If a crime is constituted, criminal responsibility shall be investigated according to law.

Article 60 of the Regulations on Work-related Injury Insurance stipulates that if an employer, an employee with a work-related injury or his immediate family members defraud work-related injury insurance benefits, and if a medical institution or an assistive device configuration institution defrauds work-related injury insurance fees, the social insurance administrative department shall order it to be refunded and impose a fine of more than 2 times and less than 5 times the amount defrauded; If the circumstances are serious enough to constitute a crime, criminal responsibility shall be investigated according to law.

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