Employees in Shanghai may have questions about work-related injury insurance, such as:

- Do only employers in high-risk industries need to participate in work-related injury insurance?

- Is there a time limit for applying for recognition of a work-related injury?

- Can employees apply for recognition of a second work-related injury?

- Are part-time workers eligible for work-related injury benefits?

- If an employee is injured on a business trip and the case is recognized as a work-related injury, are the medical expenses reimbursable?

To help employees better understand their rights and the relevant regulations, the Shanghai Municipal Human Resources and Social Security Bureau has released a reference guide addressing these frequently asked questions.

I. Do only employers in high-risk industries need to participate in work-related injury insurance?

Q:

An employee in a low-risk industry was told that her employer did not need to participate in work-related injury insurance because only high-risk industries require such coverage. Is this correct?

A:

No. Work-related injury insurance is a statutory and mandatory social insurance in China. All employers are legally required to participate, and failure to do so constitutes a violation of the law.

According to China's Regulation on Work-Related Injury Insurance, organizations, including enterprises, public institutions, social groups, private non-enterprise institutions, foundations, law firms, accounting firms, and individually-owned businesses with employees in China must participate in work-related injury insurance and pay premiums for all their employees. Employees of these organizations and workers of individually-owned businesses have the right to receive relevant work-related injury insurance benefits.

In addition, Shanghai's work-related injury insurance measures also clarify the scope of application: organizations, including enterprises, public institutions, state organs, social groups, private non-enterprise institutions, foundations, law firms, accounting firms, and individually-owned businesses with employees, as well as their employees within Shanghai, are entitled to the relevant benefits.

Reminder:

Shanghai implements an industry-based benchmark premium rate system for work-related injury insurance, with a floating rate mechanism based on factors such as the employer's claim payment ratio and workplace accident rate.

Enterprises are classified into eight industry risk categories, with corresponding benchmark rates ranging from 0.2 percent to 1.9 percent.

II. Is there a time limit for applying for recognition of a work-related injury?

Q:

An employee was injured at work, but an HR staff member said he could apply for recognition of a work-related injury after recovery. Is it true that there is no time limit?

A:

No. According to Shanghai's work-related injury insurance regulations, when an employee suffers a workplace accident or is diagnosed with an occupational disease as stipulated by the Occupational Disease Prevention and Control Law of the People's Republic of China, the employer must submit an application for work-related injury recognition to the district human resources and social security administrative department within 30 days from the date of the accident or diagnosis.

If the employer fails to apply within the prescribed period, the injured employee, their close relatives, or the trade union organization may submit the application directly to the district human resources and social security administrative department within one year of the accident or diagnosis. Any related expenses incurred during that period shall be borne by the employer.

III. Can employees apply for recognition of a second work-related injury?

Q:

An employee, who previously suffered a work-related accident, was injured again at work. He was told that since this was a second injury, he would not be eligible for benefits even if the injury were recognized. Is this correct?

A:

No. Recognition of a previous work-related injury applies only to that specific incident and does not affect any new accidents. When an employee suffers a subsequent work-related injury, the employer must submit a new application for recognition to the social insurance administrative department.

Once the subsequent injury is recognized and the employee’s work capacity has been assessed, they are entitled to benefits including medical treatment, rehabilitation, and disability allowances in accordance with relevant regulations.

IV. Are part-time workers eligible for work-related injury benefits?

Q:

An employee, who signed a part-time employment agreement, had an accident at work. When applying for work-related injury recognition, she was told that, as a part-time worker, she was not entitled to work-related injury benefits. Is this correct?

A:

No. Under Shanghai's work-related injury insurance regulations, employers hiring part-time workers must pay work-related injury insurance premiums based on the prescribed contribution base and rate. If a part-time worker suffers a work-related accident, they are legally entitled to the corresponding insurance benefits.

Reminder:

Paying work-related injury insurance premiums for part-time employees is a mandatory legal requirement. If a work-related accident occurs and the company has not paid the premiums as stipulated, the employer must bear the relevant expenses according to regulations.

Under Shanghai's work-related injury insurance regulations, if a part-time worker is injured at work or diagnosed with an occupational disease, the employer responsible for the work-related injury insurance shall pay benefits during the medical treatment leave period, which shall not be lower than Shanghai's monthly minimum wage standard.

V. If an employee is injured on a business trip and the case is recognized as a work-related injury, are the medical expenses reimbursable?

Q:

An employee had an accident while on a business trip and was later recognized as having sustained a work-related injury. After recovery, she was told that the medical expenses incurred at a hospital outside Shanghai could not be reimbursed. Is this true?

A:

No. Employees injured during work are required to receive treatment at designated medical institutions in Shanghai or at designated medical institutions for occupational diseases. In emergencies, they may receive first aid at the nearest medical facility. Once their condition stabilizes, they should be transferred to a designated medical institution in Shanghai for further treatment promptly.

Medical expenses incurred for treating a work-related injury that comply with national and Shanghai's catalogs for treatment items, drug lists, and hospitalization standards are reimbursable. Therefore, eligible expenses will be covered by the work-related injury insurance fund.

 

Sources: Official WeChat account of the General Office of the Shanghai Municipal People's Government (ID: "shanghaifabu"), Shanghai Municipal Bureau of Human Resources and Social Security