Provisions of the Supreme People's Court on Several Issues concerning Trial of Administrative Cases Relating to Work-related Injury Insurance

Fa Shi [2014] No.9

June 18, 2014

(Adopted at the 1613th meeting of the Judicial Committee of the Supreme People's Court on April 21, 2014)

The Provisions of the Supreme People's Court on Several Issues concerning Trial of Administrative Cases Relating to Work-related Injury Insurance, adopted at the 1613th meeting of the Judicial Committee of the Supreme People's Court on April 21, 2014, are hereby promulgated and shall take effect as of September 1, 2014.

In order to properly hear the administrative cases of work-related injury insurance, the Provisions of the Supreme People's Court on Several Issues concerning Trial of Administrative Cases Relating to Work-related Injury Insurance (hereinafter referred to as the "Provisions") are formulated in accordance with the Social Insurance Law of the People's Republic of China, the Labor Law of the People's Republic of China, the Law of the People's Republic of China on Administrative Proceedings, the Regulations on Work-related Injury Insurance and the provisions of other relevant laws and administrative regulations and in combination with the practice of administrative trials.

Article 1 When a people's court hears an administrative case on recognition of work-related injury to identify whether an circumstance containing facts such as "main liability incurred by the employee" specified in Item 6 of Article 14 of Regulations on Work-related Injury Insurance, "drunkenness or drug-taking" specified in Item 2 of Article 16 thereof, and "self-harm or suicide" specified in Item 3 of Article 16 thereof, it shall take the legal documents as the basis, which include accident responsibility identification and conclusive results issued by institutions with competent power and the effective judgment made by the people's court; provided, however, that there is sufficient evidence to the contrary to repudiate the accident responsibility identification and conclusive results.
Where there are no above-mentioned legal documents or the contents therein are unclear, if the administrative department of social insurance has made identification on the facts specified in the preceding paragraph, the people's court shall carry out reviews and investigations in accordance with the law by using the relevant evidence that has been provided.
The identification of "intentional crime" as specified in Item 1 of Article 16 of the Regulations on Work-related Injury Insurance shall be based on effective legal documents or conclusive results issued by criminal investigation organs, procuratorial organs and adjudication organs.

Article 2 After the people's court accepts an administrative case on recognition of work-related injury and finds that the plaintiff or the third party has applied for labor arbitration or instituted a civil action in respect of the existence of labor relationship before instituting the administrative action, it shall discontinue the trail of such administrative case.

Article 3 Where the administrative department of social insurance recognizes any entity described below to be liable for the work-related injury insurance, the people's court shall support such recognition:
1. where an employee has established labor relationships with two or more entities, the entity that he or she works for when the industrial accident occurs shall be the one liable for the work-related injure insurance;
2. where an employee dispatched by a labor dispatch entity suffers from work-related injuries or death when working for an employer, the labor dispatch entity shall be the one liable for the work-related injure insurance;
3. where an employee designated by an entity to work for another entity suffers from work-related injuries or death, the entity making the designation shall be the one liable for the work-related injure insurance;
4. where an employer subcontracts its contract business to an organization or natural person with no competent employment subject qualification in violation of the provisions of laws and regulations, and an employee employed by such organization or natural person suffers from work-related injuries or death while engaging in such contract business, the employer shall be the entity liable for the work-related injure insurance;
5. where an individual affiliates himself or herself to an entity to conduct external operations and his or her employee suffer from work-related injuries or death, the entity he or she has affiliated to shall be the one liable for the work-related injure insurance.
After the entity liable for the work-related injure insurance as mentioned above in Item 4 and Item 5 takes the compensation liability, or the social insurance agency pays the work-related injury insurance benefits from the work-related injury insurance funds, such entity is entitled to claim compensation against the relevant institutions, entities and individuals.

Article 4 Where the administrative department of social insurance recognizes the following circumstances as work-related injuries, the people's court shall support such recognition:
1. the employee is injured at workplace during working hours, and the employer or the administrative department of social insurance has no evidence showing the injury is not related to work;
2. the employee is injured when participating in an activity organized by the employer or by another entity under the designation by the employer;
3. during the working hours, the employee is injured due to work-related reasons in the reasonable area when going between workplaces relevant to his or her work duties; and
4. other circumstances in which an employee is injured due to performance of his or her work duties in a reasonable area during the working hours.

Article 5 Where the administrative department of social insurance recognizes that the following circumstances fall into the scope of "during the period of a business trip", the people's court shall support such recognition:
1. the period when the employee designated by the employer or due to work needs engages in activities related to his or her work duties beyond the workplace;
2. the period when the employee is designated by the employer to go out for study or to attend a meeting; and
3. the period when the employee goes out for other activities due to work needs.
During the period of a business trip, where an employee is injured when he conducts personal activities irrelevant to his or her work or the study or meeting that he or she has been designated to attend by the employer, and the administrative department of social insurance does not recognize such injury as work-related injury, the people's court shall support such recognition.

Article 6 Where the administrative department of social insurance recognizes that the following circumstances fall into the scope of "during the commuting", the people's court shall support such recognition:
1. the journey on which the employee commutes on reasonable routes between the workplace and the domicile, habitual residence or staff quarters within reasonable time;
2. the journey on which the employee commutes on reasonable routes between the workplace and the residence of his spouse, parents and children within reasonable time;
3. the journey on which the employee commutes on reasonable routes when engaging in activities necessary for daily work and life within reasonable time; and
4. the journey on which the employee commutes on other reasonable routes within reasonable time.

Article 7 Where the employee fails to apply for work-related injury identification within the time limit not due to his or her personal reasons or the reasons of his or her immediate family, the delay shall not be included in the time limit for the work-related injury identification.
The delay caused by any of the following circumstances shall not be recognized as personal reasons of the employee or his or her immediate family:
1. force majeure;
2. that personal freedom is restricted;
3. reasons of the employer;
4. imperfect registration system of the administrative department of social insurance; and
5. that the party concerned applies for arbitration and files a civil lawsuit in respect of the existence of labor relation between the employee and the employer.

Article 8 Where the employee is injured for a third party's reason, and the administrative department of social insurance decides not to accept the work-related injury identification or not grant the identification of the work-related injury for the reason that the employee or his immediate family has filed a civil lawsuit against or obtain civil compensation from the third party, the people's court shall not support such decision.
Where the employee is injured for a third party's reason and the administrative department of social insurance has recognized the injury as the work-related injury, but the employee or his immediate family does not file a civil lawsuit against or get civil compensation from the third party, if the employee or his immediate family sues the social insurance agency for payment of benefits for work-related injury insurance, the people's court shall support such claim.
Where the employee is injured for a third party's reason but the social insurance agency refuses to pay the benefits for work-related injury insurance for the reason that the employee or his immediate family have filed a civil lawsuit against the third party, the people's court shall not support such refusal except that the third party has paid the medical costs.

Article 9 Where the applicant for work-related injury identification or the employer conceals the relevant situation or provide false information, thus leading to wrong identification, the administrative department of social insurance may correct the identification during the proceedings in accordance with the law.
Upon correction of the work-related injury identification in accordance with the law, if the plaintiff does not apply for withdrawal of the lawsuit and the administrative department of social insurance had faults when making the original identification of work-related injury, the people's court shall judge and confirm the violation of the law by the administrative department of social insurance; if the administrative department of social insurance did not have any fault, the people's court may reject the plaintiff's claim.

Article 10 Where the judicial interpretation previously promulgated by the Supreme People's Court is inconsistent with the Provisions, the latter shall prevail.