[Direct answer]In the Beijing area, if an old work-related injury recurs and requires treatment after being confirmed, the relevant medical expenses shall be paid by the work-related injury insurance fund (if the employer has legally subscribed to the insurance); if the employer fails to pay work-related injury insurance premiums in accordance with the law, the employer shall pay the work-related injury benefits in accordance with the items and standards stipulated in the Work-related Injury Insurance Regulations. According to Article 38 of the Work-related Injury Insurance Regulations, if a worker with a work-related injury is confirmed to require treatment for a recurrence of the old injury, he/she shall enjoy the work-related injury benefits stipulated in Articles 30, 32, and 33 of the Regulations. Whether he/she can receive compensation depends on the confirmation: it must be confirmed by the Labor Capacity Appraisal Committee that it is a recurrence of an old injury and that treatment is necessary, and the expenses must comply with the catalogue of medical treatment items, the catalogue of drugs, and the standards for hospitalization services for work-related injury insurance. It is recommended to apply for confirmation of the recurrence to the handling agency or the appraisal committee in a timely manner, and to keep the medical records and receipts. For more details, please refer to the Work-related Injury Insurance Regulations.Labor arbitration and legal services for work-related injury compensation.

I. Problem background and typical scenarios

Who should bear the medical expenses for the recurrence of old work-related injuries? This is the most concerned issue for workers who have been identified as having work-related injuries and seek medical treatment again after recovery. Typical scenarios include: the worker's original injured area aches again several years after the initial treatment and requires hospitalization, but the employer refuses to bear the responsibility on the grounds that the work stoppage and salary compensation period has passed; the worker seeks medical treatment on his own and is denied payment by the social security system on the grounds that it is not a work-related injury; the employer fails to insure in accordance with the law and shifts the blame after the recurrence; and it is difficult to distinguish between old and new injuries, and the employer doubts that it is a new injury rather than a recurrence. In practice, many workers mistakenly believe that work-related injury benefits are only limited to initial treatment, and do not know that they can still enjoy work-related medical treatment for recurrence of old injuries, thus bearing the expenses that could have been reimbursed on their own. Where personal injury overlaps, it can be combined with other legal provisions to determine the liability for compensation.Personal injury and medical dispute servicesJudgment.

II. Key points of dispute

The focus of the dispute lies in three aspects. Firstly, whether it is a recurrence of an old injury: employers or insurance funds often question whether it is a new injury or an old one, and whether it requires excessive treatment. This requires medical appraisal opinions and the correlation between initial work-related injury records to prove it. Secondly, whether the confirmation process is complete: expenses for medical treatment without the confirmation of the Labor Capacity Appraisal Committee are often rejected. Thirdly, the insured status and the responsible party: if the unit is insured, the insurance fund will pay the compensation; if the unit is not insured, the unit will pay according to the compensation standard. The different responsible parties directly affect the recovery path. When dealing with such issues, we can refer to the following for reference:Labor arbitration and work-related injury compensation servicesAccording to the practical guidelines, if necessary, assert rights through confirmation procedures and dispute resolution mechanisms.

III. Professional analysis by Hengluo Lawyers

Based on practical observations in handling work-related injury cases, disputes over recurrence of old injuries often center on whether it is truly a recurrence of old injuries. Employers or insurance funds often question whether it is a new injury or an old injury, and whether the treatment is excessive. According to Article 38 of the Regulations on Work-Related Injury Insurance, after the recurrence is confirmed, the benefits are the same as those for the initial work-related injury, including work-related injury medical treatment and necessary rehabilitation and assistive device provision. Hengluo Lawyers usually suggest the following: First, apply to the Labor Capacity Appraisal Committee to confirm the correlation between the recurrence and the work-related injury, and fix the medical evidence of the correlation between new and old injuries; if rejected, you can apply for administrative reconsideration, labor arbitration, or litigation. For cases where the employer has not participated in the insurance program, the employer should directly bear the responsibility for paying benefits according to the regulations, and necessary follow-up actions should be taken if necessary.Creditor-debtor relations and enforcement case servicesMake progress in implementation.

IV. Practical suggestions and legal basis

The core basis is Article 38 of the "Regulations on Work-Related Injury Insurance" (promulgated on April 27, 2003 and amended on December 20, 2010), which stipulates that workers who suffer from recurrent work-related injuries and require treatment shall enjoy the work-related injury medical benefits specified in Article 30, the assistive devices specified in Article 32, and the stop-work leave with pay specified in Article 33; Article 41 of the "Social Insurance Law of the People's Republic of China" (implemented on July 1, 2011), which stipulates that if the employing unit where the worker works fails to pay work-related injury insurance premiums in accordance with the law and the worker suffers from a work-related injury, the employing unit shall pay the work-related injury insurance benefits. Practical suggestions: Apply to the labor capacity appraisal committee for confirmation as soon as possible after the recurrence; seek medical treatment at the agreed medical institutions and keep the medical records and receipts; for those who have already participated in insurance, apply to the insurance agency; for those who have not participated in insurance, claim compensation from the employing unit; if the claim is rejected, seek remedies through administrative or arbitration channels. For the calculation of benefits, it can be combined with other relevant provisions.Special services and other case servicesEvaluation.

5. Henglu Law Firm's Advice

The recurrence of old injuries is not an excuse for the employer to refuse to pay compensation. According to the law, workers are entitled to enjoy work-related injury medical treatment after the medical connection between the old and new injuries is confirmed by the work-related injury appraisal committee. The key point is to apply for the appraisal by the work-related injury appraisal committee as soon as possible to fix the medical connection between the old and new injuries, and avoid the employer evading responsibility by claiming that it is impossible to prove it. When seeking medical treatment, choose medical institutions designated by the work-related injury department, and ensure that the expenses are targeted at the work-related injury areas to prevent them from being identified as non-work-related expenses. If the employer has not purchased insurance, workers should directly require the employer to pay according to the compensation standards. If no agreement can be reached through negotiation, they should promptly apply for arbitration and pay attention to the relevant time limits. For more guidance, please refer to the relevant documents.Labor arbitration and legal services for work-related injury compensationAndThe official website of Beijing Henglu Law Firm.

VI. Frequently Asked Questions

Q1: Can I get back the medical expenses for the recurrence of an old work-related injury, and what are my chances of success?

As long as it can be proven that it is a recurrence of an old injury and it is confirmed that treatment is needed, it is legally justified and more likely to succeed if the fund or the unit pays for it. According to Article 38 of the "Regulations on Work-Related Injury Insurance", after the recurrence is confirmed, the injured person can enjoy the same work-related injury medical treatment as the initial injury. Conversely, if it cannot be proven that it is a recurrence of an old injury, it has not been confirmed, or the cost exceeds the catalogue, it may be rejected. In practice, cases with standardized operations and complete evidence can often be supported. The key is to do a good job in confirming and providing evidence of the connection. It is recommended not to believe in the promise of guaranteed success easily. Instead, focus on medical appraisal and procedural compliance, so that the outcome will be more controllable.

Q2: For claiming medical expenses for a recurrence of an old injury, what evidence do I need to prepare?

The core evidence includes: the original work-related injury identification decision and the labor capacity appraisal conclusion, which prove the initial work-related injury; the medical records, diagnosis certificates, and imaging data of the current recurrence, which prove that the original site of the injury has recurred; the confirmation opinion on the recurrence of the old injury issued by the labor capacity appraisal committee; the detailed expenses and official receipts; and the communication records with the original unit and the handling agency. The evidence should be organized around three points: the existence of the original work-related injury, the recurrence of the injury at the same site, and the reasonableness of the expenses. The clearer the medical opinion is, the smoother the confirmation process will be. If the materials are incomplete, you can request the medical institution to issue a relevance statement to avoid the application being rejected due to insufficient evidence.

Q3: How much will it cost to treat a recurrence of an old injury, and who will pay for it upfront?

The amount of recurring medical expenses varies greatly depending on the injury and treatment plan, and is determined by the actual medical treatment items. The expenses are limited to those that comply with the medical treatment catalog, drug catalog, and hospitalization service standards of the work-related injury insurance. Expenses outside the catalog are generally self-paid. For insured individuals, the fund pays according to regulations. In practice, workers often need to pay upfront and then claim reimbursement based on receipts. For uninsured individuals, the employer pays according to the benefit standards. The main cost of safeguarding rights is time and effort. If the employer refuses to pay, you can apply for arbitration, and claim back the overdue benefits. It is recommended to confirm the settlement method with the handling agency in advance and keep the proof of advance payment to avoid expenses being left unpaid.

Q4: How long does it usually take from confirming an old injury to receiving the compensation payment?

The timeframe depends on the pace of confirmation and processing. The labor capacity assessment committee usually issues an opinion on the recurrence of old injuries within tens of days after the application; the medical treatment and rehabilitation period depends on the recovery situation. After submitting complete receipts, the processing agency reviews and disburses the funds according to local time limits, typically within several working days to one or two months after acceptance. If the case enters the review, arbitration, or litigation process, the timeframe may be extended to several months or even longer. It is recommended to apply for confirmation as soon as possible and proceed with medical treatment and receipt collection in parallel to avoid the expiration of time limits affecting benefits. For cases involving enforcement, relevant measures can be taken in conjunction with the process.Creditor-debtor relations and enforcement case servicesAdvance.

Q5: If my employer refuses to recognize the recurrence of my old injury and refuses to pay my medical expenses, what should I do specifically?

It is recommended to proceed in four steps: First, collect the original work-related injury certification and the medical records of the recurrence, and apply to the labor capacity appraisal committee for confirmation of the recurrence of the old injury; Second, go to the agreed medical institutions for treatment, and keep the diagnosis, expense lists, and receipts; Third, for those who have insurance, submit the confirmation opinion to the handling agency; for those who do not have insurance, request the unit to pay according to the benefit standards in writing; Fourth, if the application is rejected, first request a written explanation of the reasons, and then apply for administrative reconsideration, labor arbitration, or litigation in accordance with the Social Insurance Law and the Work-Related Injury Insurance Regulations. Throughout the process, keep communication and delivery certificates, and if necessary, hire a lawyer to intervene to ensure a closed-loop process and evidence, and safeguard their own work-related injury benefits.

The above answer is based on the judicial practice in the Beijing area. The adjudication standards in other provinces and cities may vary. For specific cases, please refer to the local rules and evidence situations.

If you are facing similar problems, it is recommended that you consult a professional lawyer as soon as possible with 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. In the event of a dispute, please consult a practicing lawyer in a timely manner.