According to the provisions of Article 30 of the Social Insurance Law, the medical insurance fund cannot reimburse the treatment expenses for work-related injuries. According to the provisions of Articles 30 and 62 of the Regulations on Work-related Injury Insurance, if the expenses for treating work-related injuries of workers with work-related injuries meet the catalogue of work-related injury insurance diagnosis and treatment items, the catalogue of work-related injury insurance drugs and the hospitalization service standard of work-related injury insurance, they shall be paid from the work-related injury insurance fund. If the employer fails to participate in work-related injury insurance, it shall be paid by the employer.
Social insurance law
Thirtieth the following medical expenses are not included in the basic medical insurance fund payment scope:
(a) shall be paid by the industrial injury insurance fund;
Regulations on industrial injury insurance
Thirtieth employees who suffer from accidents or occupational diseases at work shall enjoy medical treatment for work-related injuries.
Workers with work-related injuries should seek medical treatment in medical institutions that have signed service agreements. In case of emergency, they can go to the nearest medical institution for first aid.
If the expenses required for work-related injury treatment meet the catalogue of work-related injury insurance diagnosis and treatment items, the catalogue of work-related injury insurance drugs and the hospitalization service standard of work-related injury insurance, they shall be paid from the work-related injury insurance fund. The catalogue of work-related injury insurance diagnosis and treatment items, the catalogue of work-related injury insurance drugs and the hospitalization service standard of work-related injury insurance shall be stipulated by the social insurance administrative department of the State Council in conjunction with the health administrative department of the State Council, the food and drug supervision and management department and other departments.
Food subsidies for hospitalization of workers with work-related injuries, and certificates issued by medical institutions and approved by agencies. The transportation and accommodation expenses required for workers with work-related injuries to seek medical treatment outside the overall planning area shall be paid by the work-related injury insurance fund, and the specific standards for fund payment shall be stipulated by the people's government of the overall planning area.
Workers with work-related injuries who treat diseases caused by non-work-related injuries do not enjoy medical treatment for work-related injuries, and are treated according to the basic medical insurance method.
The expenses for work-related injury rehabilitation treatment for workers with work-related injuries to medical institutions that have signed service agreements shall be paid by the work-related injury insurance fund if they meet the requirements.
Article 62 If an employer fails to participate in work-related injury insurance in accordance with the provisions of these Regulations, the social insurance administrative department shall order it to participate within a time limit, pay back the work-related injury insurance premium that should be paid, and impose a daily overdue fine of 0.5 ‰ from the date of default; Failing to pay within the time limit, a fine of 1 times shall be imposed.
If an employee of an employer who should participate in work-related injury insurance in accordance with the provisions of these regulations suffers from work-related injuries, the employer shall pay the fees in accordance with the treatment items and standards of work-related injury insurance stipulated in these regulations.
After the employer participates in work-related injury insurance and pays back the work-related injury insurance premium and overdue fine, the work-related injury insurance fund and the employer shall pay new fees in accordance with the provisions of these regulations.