[Direct answer]In most cases, this is possible. After a third party infringes the rights of an employee and causes a work-related injury, the party who actually pays the medical expenses has the right to claim compensation from the infringer for the actual expenses incurred. If the work injury insurance fund pays the expenses first, it has the right to recover the compensation from the third party in accordance with Article 42 of the Social Insurance Law of the People's Republic of China (effective July 1, 2011). If the employer has not participated in the work injury insurance and paid the medical expenses in advance, since the medical expenses are actual expenses, the infringer should not be exempted from liability just because the employer paid in advance. In practice, courts often support the employer's claim for reimbursement from the infringer based on the payment receipts. However, the scope of recovery is limited to actual expenses such as medical fees, and the employer's own work-related injury benefits cannot be transferred to the infringer. It is recommended to keep the payment receipts and payment certificates, claim compensation in a timely manner, and refer to relevant legal provisions when necessary.Work-related injuriesColumn.
I. Problem background and typical scenarios
Such disputes often occur in several situations: First, the employer fails to purchase insurance for its employees. If an employee is injured by a third party, the employer may advance a large sum of medical expenses out of its duty of treatment, but the infringer refuses to acknowledge the payment afterwards; Second, there are doubts about the responsibility for the accident, and the infringer refuses to pay on the grounds that "the employer itself is also at fault"; Third, the work injury insurance fund has already paid in advance, but the employer's request for compensation from the infringer is rejected; Fourth, there are internal disputes between the employer and the employee over the nature of the advance payment. The core issue is always that the medical expenses, as actual expenditures, should ultimately be borne by the infringer. For rules concerning compensation for third-party infringements, you may refer to the relevant provisions.Personal injury and medical disputesColumn.
II. Key points of dispute
The first focus is the legal nature of the unit's advance payment: whether it is a form of substitute payment or a transfer of creditor's rights, which affects the basis of the right to seek reimbursement. The second focus is whether the uninsured unit can seek reimbursement from third parties after making advance payments. In practice, it is generally held that actual expenses such as medical fees should not be exempted by the infringer and can be supported; however, the work-related injury benefits that the unit should bear due to its lack of insurance cannot be transferred to third parties. The third focus is the subject and procedure of seeking reimbursement after the fund makes advance payments. The social security agency is the statutory subject of seeking reimbursement. The fourth focus is the scope of reimbursement, which is limited to actual expenses such as medical fees. The fifth focus is the execution risk when the infringer lacks sufficient repayment capacity. Specifically, the current effective laws and regulations and judicial rulings shall prevail. For the implementation of reimbursement, reference can be made to the relevant provisions.Creditor's rights and debts, and enforcement casesColumn.
III. Professional analysis by Henglue Law Firm
Based on the practical experience of lawyers from our firm, the success or failure of recovering the medical expenses paid by the employer hinges on the dual evidence of bills and legal relationships. Common scenarios include: 1. The employer urgently pays the medical expenses after an infringement accident occurs, but fails to retain the employee's signed confirmation of payment and transfer receipts, making it difficult to prove the fact of payment during litigation. 2. The infringer claims that the employer is at fault for the accident and demands a proportional share of the liability. The court will determine the liability based on the accident responsibility determination document. 3. The work injury insurance fund pays first and then the social security agency recovers the funds. The employer no longer pursues separate claims. In terms of judicial rulings, medical expenses are determined based on actual expenditure receipts, and liability for infringement is determined according to the fault liability principle in Article 1165 of the Civil Code of the People's Republic of China (effective January 1, 2021) and the scope of personal injury compensation in Article 1179. Potential pitfalls include: - Failing to have employees confirm the nature of the payment in writing when making advance payments, leading to disputes with employees over whether it was an advance on wages or medical expenses. - Prolonged collection efforts without initiating litigation, approaching the statute of limitations. It is recommended to sign a confirmation document and keep the original bills on the day of payment.
IV. Practical suggestions and legal basis
Action recommendations: First, when advancing medical expenses, obtain the employee's signed confirmation of advance payment, receipts, and original invoices, and keep records of the handover process; Second, obtain the accident liability determination letter to identify the infringer and the liability ratio; Third, first send a written reminder to the infringer and keep records of the communication; Fourth, if no agreement is reached, sue for compensation based on the facts of advance payment and the infringer's liability; Fifth, for units without insurance coverage, they should simultaneously conduct self-inspections of employment compliance and insure as soon as possible to avoid similar risks. Legal basis: Article 41 of the Social Insurance Law of the People's Republic of China stipulates that if an employer fails to pay work-related injury insurance premiums in accordance with the law, the employer shall pay the work-related injury insurance benefits. If the employer fails to pay, the fund shall first pay the benefits and then require the employer to repay them; Article 42 stipulates that if a work-related injury is caused by a third party, the fund shall first pay the benefits and then have the right to recover the compensation from the third party; Article 1179 of the Civil Code of the People's Republic of China stipulates that the scope of compensation for personal injury caused by infringement includes medical expenses and other costs.
5. Henglue Law Firm's Advice
Risk Warning: Firstly, the scope of compensation that the employer can recover is usually limited to actual expenses such as medical fees, and cannot transfer all work-related injury benefits to the infringer; Secondly, the work-related injury benefits that the employer should bear in the absence of insurance cannot be recovered from third parties, and the compliance gap will ultimately be borne by the employer itself; Thirdly, the recovery is subject to the statute of limitations, and if the collection fails, the employer should sue in time; Fourthly, the payment receipts are the lifeline of recovery, and bills, transfer records, and confirmation letters are all indispensable. It is recommended that the employer consult before making advance paymentsBeijing Henglu Law FirmFor similar columns on the official website, follow standard procedures.
VI. Frequently Asked Questions
Q1: Can the unit successfully recover the reimbursement after advancing the medical expenses?
There is some basis for this, but it needs to be supported by evidence. Medical expenses are actual expenditures, and according to the principle of equalization, they should ultimately be borne by the person liable for infringement. If the unit sues based on the advance payment certificate, transfer records, and the accident liability determination letter, it is often supported in practice, especially in cases where the infringer is fully responsible. However, the work-related injury benefits that the unit should bear itself due to not being insured cannot be transferred. The scope of recovery is limited to actual expenses such as medical expenses, and the specific scope shall be subject to the interpretation of the court.
Q2: What evidence do I need to prepare for a claim for compensation?
The core evidence includes: the accident liability determination letter or the accident certificate issued by the public security organ, which identifies the infringer and the proportion of liability; the original medical expense receipts, medical records, and expense lists, which prove the actual amount of expenditure; the unit's transfer vouchers and the advance payment confirmation signed by the employee, which prove that the unit actually made an advance payment; and the records of reminders, which prove that claims have been made against the infringer. The evidence should form a complete chain of "who infringed, how much was spent, and who made the advance payment".
Q3: How much does it cost to file a lawsuit for recovery of damages?
The case acceptance fee is charged according to the standard of property cases, and the amount is calculated based on the advance payment of medical expenses. After the plaintiff wins the case, the defendant shall bear the fee or share it proportionally; the attorney's fee is negotiated based on the amount of the claim and the difficulty of the case, with no unified standard. If there are disputes over work-related injury benefits at the same time, labor arbitration generally does not charge fees. The overall cost is relatively controllable. It is recommended to evaluate the advance payment amount and the defendant's ability to pay before formulating a strategy.
Q4: How long does it take to recover the compensation?
First, the flexibility of the negotiation and reminder period is relatively large. After suing, the first-instance ordinary procedure generally does not exceed six months, and the simplified procedure takes about three months. The second-instance procedure takes about three months, and the enforcement period depends on the infringer's financial situation. Note that the ordinary statute of limitations is three years, starting from the date when the right holder knows that his rights have been infringed and the date when the obligee knows that he has an obligation. For long-term collection, it is necessary to keep evidence of interrupting the statute of limitations to avoid winning the case but losing the right to claim compensation.
Q5: What exactly should I do?
The first step is to fix the evidence of responsibility for the accident and obtain a liability determination letter; the second step is to organize all advance payment bills, transfer vouchers, and employee confirmation letters; the third step is to send a written reminder to the infringer and keep a record of it; the fourth step is to sue promptly if the reminder is unsuccessful, and claim the refund of actual expenses such as medical fees; the fifth step is to simultaneously improve the insurance coverage for work-related injuries to prevent the unit from bearing the risk of subsequent work-related injury benefits. For matters related to labor and work-related injuries, you can refer to the relevant provisions of the Labor Law and the Work Injury Insurance Regulations.Work-related injuriesColumn.
This article is written based on the common judicial interpretations in the Beijing area. If the case occurs in other regions, it is recommended to consult local lawyers to verify the regional differences.
If you are facing similar problems, it is recommended that you consult a professional lawyer as soon as possible with the evidence materials, so as to avoid missing the statutory time limit. →Labor arbitration legal services·Beijing Henglu Law Firm
Disclaimer: This article is compiled based on the current effective laws and regulations and open adjudication rules, and is for general reference only. It does not constitute a formal legal opinion on specific cases. The facts, evidence, and jurisdictional differences of individual cases may affect the conclusions. If you encounter disputes, please consult a practicing lawyer in time.