[Direct answer]In the Beijing area, the work-related injury insurance fund and the employing units share the costs according to regulations, provided that the recurrence of the old injury is confirmed by the Labor Capacity Appraisal Committee. According to Article 38 of the Work-Related Injury Insurance Regulations, if an employee's old injury recurs and is confirmed to require treatment, they are entitled to the work-related injury insurance benefits stipulated in Articles 30, 32, and 33: Treatment fees, hospitalization subsidies, and hospitalization service standards that comply with the work-related injury insurance treatment item catalog, drug catalog, and hospitalization service standards are paid by the fund, and the employer shall pay the wages during the period of suspension of work and retention of salary on a monthly basis. If the employer fails to participate in work-related injury insurance or pay the full amount of contributions according to the law, the corresponding expenses shall be borne by the employer. It is recommended to first apply for confirmation of the recurrence, and then take the confirmation conclusion to the agreed medical institutions for treatment and online settlement.

1. Problem background and typical scenarios

Work-related injury victims often receive disability benefits in the year they are injured, but years later, they may face large medical expenses due to pain in the injured area, the need for secondary surgery, or the removal of implants. At this point, they may discover that the employer has long since stopped paying social insurance or changed its employment entity. Typical situations include: no one covering the cost of surgery to remove internal fixation devices; requiring long-term leave during the recurrence period but having their wages deducted by the employer as sick leave; and having their out-of-town medical expenses denied reimbursement. Most disputes focus on whether the recurrence has been officially confirmed and whether the treatment items are within the scope of the insurance coverage.

II. Key points of dispute

First, confirm whether the procedure is a prerequisite. Funds are usually not paid for self-treatment that has not been confirmed by the Labor Capacity Appraisal Committee, which is the most common threshold in practice. Second, the boundaries of cost sharing. Medical expenses, hospitalization meal subsidies, and approved transportation and accommodation expenses for medical treatment in other places fall within the scope of fund payment. The employer is responsible for the wages during the period of suspension of work and the nursing responsibilities during the period of suspension of work. If this is not clearly distinguished, it may lead to an incorrect claim direction. Third, the correlation between the original work-related injury identification and the current treatment. If the treatment area or disease is inconsistent with the original identification conclusion, additional proof of causality is needed. Fourth, the handling of changes in labor relations. If the unit merges, is dissolved, or changes its legal representative, how to transfer the insurance responsibility and payment responsibility needs to be determined based on the payment records and transfer documents, and corresponding measures should be taken accordingly.Work-related injury compensationThe rules are the basis for judgment.

III. Professional analysis by Henglue Law Firm

When handling such cases, Henglue Lawyers found that the disputes often stem not from differences in legal application, but from skipping procedural steps. There are three common scenarios: workers who, after obtaining the original work-related injury certification, feel unwell and directly seek hospitalization at their own expense, only to remember to confirm the recurrence later, only to have their expenses reimbursement blocked; units that suspend production or are deregistered, leaving workers unable to find a payment entity and thus having to apply for arbitration for the portion they personally paid; and cases where workers confuse recurrence treatment with disability grade review, applying repeatedly only to be repeatedly rejected. When judges review the cases, they typically first examine whether a recurrence confirmation conclusion has been obtained, then calculate which portion belongs to the fund and which portion belongs to the unit. Invoices that are incomplete or drugs outside the reimbursement catalog will be directly excluded. Therefore, the most important actions in practice are: completing the confirmation before starting treatment, keeping a full set of medical records, imaging reports, and expense lists during treatment, and obtaining a written confirmation from the unit regarding the work suspension and salary payment period. If the unit refuses to pay, the worker can first apply for labor and personnel dispute arbitration and, if dissatisfied with the arbitration result, file a lawsuit with the court; if the unit still fails to perform after the arbitration decision takes effect, the worker can apply for enforcement.Creditor's rights and debts, and enforcementThe preparation of evidence for this stage is also essential and cannot be overlooked.

IV. Practical suggestions and legal basis

According to Articles 30, 32, 33, and 38 of the "Regulations on Work-Related Injury Insurance" (promulgated by the State Council on April 27, 2003, implemented on January 1, 2004, and amended on December 20, 2010, implemented on January 1, 2011) and Article 38 of the "Social Insurance Law of the People's Republic of China" (adopted on October 28, 2010, implemented on July 1, 2011), regarding the payment items of the work-related injury insurance fund, it is recommended to operate according to the following list: First, submit an application for confirmation of recurrence of old injuries to the municipal-level labor capacity appraisal committee, attaching the original work-related injury identification decision and recent medical records and imaging reports; Second, after obtaining the confirmation conclusion, seek medical treatment at the work-related injury insurance agreement medical institutions to ensure that the medical treatment and settlement processes correspond; Third, for those requiring medical treatment outside the local area, obtain approval procedures in advance, otherwise transportation and accommodation expenses will be difficult to be included in the compensation; Fourth, during the treatment period, timely apply to the unit in writing for a work stoppage and wage retention period, and keep records of the application and responses; Fifth, archive and retain all receipts, medical records, and lists to prepare original evidence for arbitration or litigation.

5. Henglu Law Firm's Advice

The two most vulnerable time points are before the start of treatment and when there are major changes in the employing unit. The former relates to whether the expenses can be covered by the fund, and the latter relates to who will ultimately pay the money. Neither can be remedied afterwards. In addition, the disability rating is not fixed. If the injury worsens, the victim can apply for a review and appraisal, but the review and appraisal and the confirmation of the recurrence of old injuries are two separate procedures. Confusing the applications will only delay treatment and reimbursement. In the case where the original unit has been deregistered, it is necessary to simultaneously verify whether there are clues such as the existence of a successor entity or the unfulfilled responsibilities of shareholders, and then decide the direction of the claim for liability. For cases involving medical harm and work-related injuries, reference can be made to the relevant provisions.Personal injury and medical disputesTheir processing experience; for complex situations involving multi-party coordination, we can seek assistance fromSpecialised legal servicesOverall coordination. For any procedural issues, please feel free to contact us.Beijing Henglu Law FirmConsultation.

VI. Frequently Asked Questions

Q1: Is there a high chance of winning compensation for the recurrence of old injuries?

If the recurrence has been confirmed and the treatment item is included in the list, the support rate will be higher; if the treatment is carried out without confirmation, it will usually be difficult to obtain fund support. However, employees who are not insured can still claim compensation from their employers, but they need to go through arbitration to enforce their rights.

Q2: What evidence do I need to prepare?

The original work-related injury identification decision, the conclusion of labor capacity appraisal, the application and conclusion of confirming the recurrence of old injuries, the medical records and discharge summaries, the list of expense invoices, the written application for suspension of work and retention of wages, and the social security payment records.

Q3: What's the approximate cost?

There are no fees charged for recurrence confirmation and labor capacity assessment, nor for labor and personnel dispute arbitration. If the case proceeds to litigation, the litigation fees shall be paid in installments according to the amount of the dispute, and the attorney's fees shall be subject to the provisions of the entrustment contract.

Q4: How long does the process take?

The confirmation of recurrence is generally made within 60 days from the date of acceptance, and the time limit may be extended by 30 days in complex cases; the treatment and settlement are carried out simultaneously. If arbitration is necessary, the trial period is generally 45 days and can be extended by 15 days.

Q5: What should I do first?

First, submit an application for confirmation of the recurrence of old injuries to the Labor Capacity Appraisal Committee, and do not undergo surgery at your own expense in advance. After the confirmation, you can go to the agreed medical institutions for medical treatment and settlement, and at the same time, confirm the period of suspension of work and retention of wages in writing.

The above content is based on the compilation of judicial practices in the Beijing area. The facts of individual cases and the jurisdiction of the court may affect the conclusions. Welcome to consult Henglue Lawyers about specific situations.

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 publicly available 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.