[Direct answer]In the Beijing area, workers who suffer from recurrence of old injuries and need treatment may continue to enjoy work-related injury medical benefits after being confirmed by the Labor Capacity Appraisal Committee. According to Article 38 of the Work-Related Injury Insurance Regulations (issued in 2003 and amended in 2010), workers who suffer from recurrence of old injuries and need treatment may enjoy the work-related injury benefits stipulated in Articles 30, 32, and 33 of the Regulations; among which, the treatment costs specified in Article 30 that meet the requirements of the Work-Related Injury Insurance Diagnosis and Treatment Project Catalogue, the Work-Related Injury Insurance Drug Catalogue, and the Work-Related Injury Insurance Hospitalization Service Standards shall be paid by the work-related injury insurance fund. In other words, whether the recurrence treatment can be included in work-related injury benefits depends on the precondition of "confirmation of recurrence". If the employer participates in work-related injury insurance according to law, the eligible medical expenses shall be paid by the work-related injury insurance fund; if the employer does not participate in work-related injury insurance, according to Article 62 of the Regulations, the employer shall pay the expenses in accordance with the work-related injury insurance benefit items and standards stipulated in the Regulations.

I. Problem Background and Typical Scenarios

"The old injury has recurred. Can this treatment still be considered a work-related injury?" This is a common problem that workers injured at work often encounter. Common situations include: after fracture healing, needing another surgery due to the removal of internal fixation; knee joint, lumbar vertebrae, and other injuries worsening over the years, requiring surgery or long-term rehabilitation; occupational disease patients needing continued treatment as their condition progresses; and work-related injuries that were not completely cured at the time, resulting in after-effects requiring secondary intervention. Workers are often confused about two points: first, whether recurrent treatment requires reapplying for recognition; and second, whether the expenses will be borne by the fund or the employer. It should be noted that recurrent treatment is different from "new work-related injuries". There is no need to re-apply for work-related injury recognition, but it is necessary to confirm the recurrence of the old injury through the Labor Capacity Appraisal Committee before initiating corresponding benefits.

II. Key points of contention

First, the recurrence confirmation procedure. The Labor Capacity Appraisal Committee confirms the recurrence of old injuries, which is a prerequisite for enjoying benefits. Second, the subject of payment for treatment costs. Those who are insured are paid by the work-related injury insurance fund, while those who are not insured are paid by their employers. Third, the application of medical catalogs and standards. Drugs, diagnostic and treatment items, and hospitalization service standards must comply with the prescribed catalogs. Fourth, the waiting period for work suspension and salary compensation. During the treatment of recurrence, the waiting period for work suspension and salary compensation is calculated based on the original salary and benefits. Fifth, the fixation of evidence of recurrence. It requires the original work-related injury identification materials and the current medical records to corroborate each other, demonstrating the correlation with the original work-related injury.

III. Professional analysis by Henglue Lawyers

The key to handling "recurrence" cases lies in "connecting" the two treatments, old and new. In practice, we usually advise employees to prepare three sets of materials: first, the original work-related injury identification decision and the labor capacity assessment conclusion, which prove the existence and severity of the work-related injury; second, the medical records and discharge records from previous treatments, which illustrate the original injury condition; third, the current medical treatment materials, including outpatient medical records, imaging examination reports, and surgical records, which are used to demonstrate the causal relationship between the current injury and the original work-related injury. Only when these three sets of materials are complete can the recurrence confirmation be successfully approved. It should be noted that some employers may argue that "it has been a long time and it might be their own subsequent reasons", so the demonstration of the causal relationship becomes particularly important in this case. For issues involving work-related injury benefits and recurrence confirmation, please refer to the relevant provisions.Labor arbitration and work-related injury compensationFor cases involving medical expenses and medical treatment disputes, the parties concerned may resolve the disputes through mediation.Personal injury and medical disputesAndSpecialised legal services.

IV. Practical suggestions and legal basis

According to Article 30 of the "Regulations on Work-Related Injury Insurance" (amended in 2010) regarding the provisions on work-related injury medical treatment and expense payment, Article 33 on the provisions on the suspension of work with pay during the waiting period, Article 38 on the provisions on the treatment for recurrence of old injuries, and Article 62 on the provisions that the unit shall pay the expenses according to its standards when it has not participated in the insurance, as well as the provisions on the confirmation of recurrence in the "Administrative Measures for the Evaluation of Labor Capacity of Work-Related Injury Victims", it is recommended to follow four steps: First, when the recurrence occurs, go to the agreed medical institution for treatment and keep a complete medical record to clarify the necessity of this treatment; Second, submit an application for the confirmation of the recurrence of old injuries to the labor capacity appraisal committee, attaching the original work-related injury materials and the medical records of this treatment; Third, after the confirmation, apply for the reimbursement of work-related injury medical treatment according to the regulations or have the unit pay it; Fourth, if the unit refuses to bear the responsibility, apply for labor dispute arbitration to claim the corresponding treatment according to law. Those involved in disputes over work-related injury benefits can refer to the above-mentioned provisions for reference.Labor arbitration and work-related injury compensation; Cases involving medical records and the determination of causality can be combined together.Personal injury and medical disputes.

5. Henglu Law Firm's Reminder

If your old injury recurs, don't bear the cost on your own. Here are three reminders: First, keep all original work-related injury materials, as the certification letter, appraisal conclusion, and previous medical records are the cornerstones for confirming the recurrence of the injury. Second, when seeking medical treatment, explain your previous work-related injury history to the doctor to ensure the consistency of the injury description in the medical records. Third, if your employer hasn't provided insurance coverage, you can still claim reimbursement for the recurrence treatment costs from the employer. Don't give up just because "the employer hasn't purchased insurance".Beijing Henglu Law FirmIt is recommended that employees consult a lawyer before receiving recurrence treatment, clarify the process and list of materials for recurrence confirmation, and avoid having their reimbursement affected by procedural issues after treatment.

VI. Frequently Asked Questions

Q1: Who will bear the cost of treatment after a work-related injury recurrence?

If the labor ability appraisal committee confirms that the recurrence of old injuries requires treatment, the worker shall continue to enjoy work-related injury medical treatment, and the expenses meeting the catalogue and standards shall be paid by the work-related injury insurance fund; if the unit has not participated in work-related injury insurance, the unit shall pay according to the treatment items and standards prescribed by the regulations.

Q2: What materials are needed to confirm a recurrence?

The decision on work-related injury identification, the conclusion of labor capacity assessment, the previous medical records and discharge records, the current outpatient and hospitalization medical records, imaging and examination reports, diagnosis certificates, and medical opinions that can demonstrate the correlation between the current injury and the original work-related injury.

Q3: Do I need to pay for the recurrence treatment myself first?

Generally, medical treatment is settled in accordance with the local work-related injury insurance settlement procedures. In most cases, direct settlement can be made at agreed-upon medical institutions. If advance payment is required, keep the receipts and medical records, and apply for reimbursement in accordance with the regulations after confirmation.

Q4: How long does it take to confirm the recurrence and get reimbursed?

The labor capacity appraisal committee shall generally make the appraisal conclusion within 60 days from the date of receiving the appraisal application, and may extend the time limit to 30 days if necessary; and the reimbursement shall be handled in accordance with the working time limit of the local social security agencies.

Q5: What should I do first?

First, organize the original work-related injury materials and past medical records, then visit a designated medical institution and keep complete medical records. On this basis, submit an application for confirmation of recurrence of old injuries to the Labor Capacity Appraisal Committee and initiate corresponding benefits.

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 Henglu Law Firm 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 Henglue 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 case of disputes, please consult a practicing lawyer in time.