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人社部擬明確工傷新規爭議 盤點新規七大亮點 2013年03月19日

       人社部擬明確工傷新規爭議 盤點新規七大亮點
       目前,我國工傷保險參保人數已達1.9億人,9年來累計享受待遇人數達816.8萬人。不過,在實施新修訂的《工傷保險條例》過程中,許多地方發現,一些政策、標準和程序不夠明確,引發了糾紛。為此,人社部擬定了《關于執行〈工傷保險條例〉若干問題的意見(征求意見稿)》,向社會公開征求意見。這里我們整理了新規的七大亮點,以供參考。.
       亮點1:
       明確“因工外出期間工傷”認定條件
       工傷認定是工傷職工享受工傷待遇的前提和基礎,不論工傷職工所在單位是否參加了工傷保險,職工遭受事故傷害或確診為職業病后,都有提出工傷認定申請的權利。
       但在工作實踐中,出現了一些邊界條件模糊不清或相關證據不足采信的情況,如有的職工外出工作并無明確的用人單位指派的證明,或雖由用人單位指派,但所受事故傷害與工作無關;又如有些責任或排除情形判定,缺乏有權機關的證明等。
為了增強《條例》的可操作性,征求意見稿規定對“因工外出期間”的認定,應當考慮職工外出是否是用人單位指派的因工作外出,遭受的事故傷害是否與其從事的工作有直接的、緊密的聯系;對“非本人主要責任”、“故意犯罪”、“醉酒或者吸毒”、“自殺”的確認分別明確了有權機關的證明依據。
       亮點2:
       所享工傷保險長期待遇 不得一次支付
       原勞動和社會保障部印發的《關于農民工參加工傷保險有關問題的通知》規定農民工可一次性領取長期待遇,以解決受工傷農民工回鄉后按月領取待遇不便的問題。這在當時條件下,對促進農民工參加工傷保險,保障其權益發揮了重要作用。
       隨著社會保險服務網絡的健全和信息化水平的提高,異地領取待遇的條件逐步具備。2011年施行的《社會保險法》規定,一至四級傷殘職工按月領取傷殘津貼。據此,《征求意見稿》規定,由工傷保險基金支付的各項待遇,除《條例》第66條第一款規定的應由用人單位支付的一次性賠償外,由工傷保險基金支付的長期待遇不得一次性支付。
       核定工傷職工工傷保險相關待遇時,若上一年度相關數據尚未公布,可暫按前一年度的全國城鎮居民人均可支配收入、統籌地區職工月平均工資核定和計發,待相關數據公布后再重新核定,社會保險經辦機構予以補發差額部分。
       《征求意見稿》還規定,職工在同一用人單位發生多次工傷事故的,在依法計發一次性傷殘就業補助金和一次性工傷醫療補助金時,應遵循“就高”原則,按照勞動能力鑒定最高傷殘級別確定。
       亮點3:
       學生實習受傷索賠 可走商業保險
       我國每年都有大批大專院校和中等職業學校在校學生到企事業等單位實習。2009年,教育部等部門曾發文,明確在中等職業學校推行學生實習商業保險制度,以保障他們在實習期間受到事故傷害后的權益。
       有關部門研究認為,實習學生與實習單位之間未建立勞動關系,不是勞動法意義上的勞動者,實習學生這方面權益保護應通過購買商業保險等方式解決。據此,《征求意見稿》規定,全日制普通大專院校和中等職業學校學生,到企事業等單位實習,實習學生與實習單位的關系不屬于勞動關系,學生實習期間受到事故傷害的,可通過商業保險等途徑予以保障。
       亮點4:
       突發疾病死亡申請工傷 須按期報告
       關于職工因突發疾病死亡申請工傷認定,《條例》第十五條第(一)項規定,“在工作時間和工作崗位,突發疾病死亡或者在48小時之內經搶救無效死亡的”,屬于視同工傷。
       為便于社會保險行政部門盡早了解掌握情況,及時做出是否屬于視同工傷的認定結論,保障工亡職工和相關用人單位的權益,征求意見稿規定,按照《條例》申請工傷認定的,職工所在用人單位原則上應自職工死亡之日起5個工作日內向社會保險行政部門報告。
       亮點5:
       明確轉包責任主體 誰轉包誰負責
       針對當前一些地區工程項目層層轉包,有的甚至轉包給不具備用工主體資格的組織或者自然人,一旦發生工傷事故,責任主體難以確認的情況。《征求意見稿》規定,具備用工主體資格的單位違反法律、法規規定,將承包業務轉包給不具備用工主體資格的組織或者自然人,而其所聘職工從事承包業務時因工傷亡的,按照誰轉包誰負責的原則,由具備用工主體資格的單位承擔用人單位依法應承擔的工傷保險責任。
       專家解讀:北京盈科律師事務所何力律師表示,這一規定與2005年發布的《關于確立勞動關系有關事項的通知》的精神是一致的,強調項目承包方的法律責任,對于打擊建筑行業違法分包、轉包、對于勞動者權益保護都是利好的信息。
       當然,因為《征求意見稿》沒有限定行業,在實際中可能出現適用領域過于寬泛的問題。比如一些評估、審計、設計行業里存在的業務分包情況,是否適用此條規定,產生的問題就不僅僅局限于勞務和建筑承包領域了。
       亮點6:
       到年齡不給辦退休 受傷屬于工傷
       隨著勞動者身體健康水平的提高,越來越多的勞動者在達到法定退休年齡以后,出于種種原因繼續留在原用人單位工作,暫不辦理領取基本養老金或退休手續。
       對上述人員因工作原因遭受事故傷害或患職業病如何處理其權益保障問題,在實踐中各地做法不一,有的通過工傷保險予以保障,有的通過民事賠償予以解決。《征求意見稿》明確上述人員的工傷認定申請應予受理。
       專家解讀:北京義聯農民工法律援助中心韓世春律師指出,《征求意見稿》關于該問題的規定,統一了處理尺度,對于解決現實用工現狀中存在的問題具有積極的意義。
       亮點7:
       離崗后查出職業病 也可認定工傷
       為規范工傷保險管理工作,保障離開工作崗位后被診斷為職業病人員的合法權益,綜合考慮職工離開工作崗位或原單位前從事接觸職業病危害作業以及某些職業病潛伏期長等因素,征求意見稿對有關內容做了進一步的明確。
       一是在工傷認定環節,規定了退休前以及在終止或解除勞動、聘用合同及終止勞動關系前從事接觸職業病危害作業,在離開工作崗位或原單位后被診斷為職業病的人員,可以進行工傷認定。
       二是在待遇核定方面,規定了退休工傷職工可采取“就高”的原則,選擇本人退休前12個月平均繳費工資或者確診職業病前12個月平均養老金為基數核定待遇。終止或解除勞動、聘用合同及終止勞動關系的人員分別以本人終止或解除勞動、聘用合同前以及終止勞動關系前12個月平均繳費工資為基數核定待遇。
       三是在待遇支付方面,首先明確了相關責任單位是“職業病診斷書中明確的用人單位”;其次按照該用人單位是否在該職業病職工從業期間依法為其繳納工傷保險費,規定了兩種情形:參保繳費的,由工傷保險基金和用人單位按規定分別支付待遇,未參保繳費,由用人單位按照規定支付全部待遇。

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