【线上云德】疫情期间律师说（五十五）|司法实践中关于工伤赔偿的相关问题

在日常生活中，职工因为工作原因受伤后,按照国家法律规定，是享受工伤赔偿的。工伤保险的缴纳、工伤的认定与赔偿不仅关乎企业员工的医疗救助和经济补偿，也是对用人单位风险的分散，有助于提高企业应对风险的能力。

In daily life,after the worker is injured because of job reason, according to national law regulation,it is to enjoy inductrial injury compensation. The pay of inductrial injuryinsurance, the identification of inductrial injury and compensation are notonly related to the medical assistance and economic compensation of theenterprise employees, but also to the dispersion of the employer's risk, whichhelps to improve the enterprise's ability to deal with the risk.

01:工伤认定的法律规定解读

《工伤保险条例》第十四条职工有下列情形之一的，应当认定为工伤：（一）在工作时间和工作场所内，因工作原因受到事故伤害的；(二)工作时间前后在工作场所内，从事与工作有关的预备性或者收尾性工作受到事故伤害的；

“工作时间”，是指法律规定的或者用人单位要求职工工作的时间。包括：1）劳动合同约定的工作时间，2）用人单位规定的工作时间，3）完成用人单位临时指派或特定工作任务的时间，4）法律规定的工作时间。

“工作场所"，是指与职工工作职责相关的区域以及因履行工作职责所需的合理区域。包括：1）用人单位能够对从事日常生产经营活动进行有效管理的区域，2）职工为完成某项特定工作所涉及的单位以外的相关区域，3）职工因工作来往于多个与其工作职责相关的工作场所之间的合理区域。

“工作原因”，是指职工受伤与其 所从事的工作存在因果关系。包括：1）劳动合同约定或单位 规定的本职工作，2）用人单位临时指派的工作，3）维护用人单位合法利益的工作，4）工作期间在合理场所解决必需的基本生理需求。

（三）在工作时间和工作场所内，因履行工作职责受到暴力等意外伤害的；

“因履行工作职责受到暴力等意外伤害的”，有两层含义：一是指职工因履行工作职责，使某些人的不合理的或违法的目的没有达到，这些人出于报复而对该职工进行的暴力人身伤害；二是指在工作时间和工作场所内，职工履行工作职责受到的意外伤害，诸如地震、厂区失火、车间房屋倒塌以及由于单位其他设施不安全而造成的伤害等。

（四）患职业病的；

劳动者离开原岗位或原用人单位后，两年内出现疑似职业病症状的，可向职业病诊断机构申请诊断。经诊断，鉴定为职业病的职工，认定为工伤，依法享有工伤保险和其他职业病待遇，用人单位没有依法参加工伤保险的，其医疗和生活保障由用人单位承担。

（五）因工外出期间，由于工作原因受到伤害或者发生事故下落不明的；

“因工外出期间”的认定，应当考虑职工外出是否属于用人单位指派的因工作外出，遭受的事故伤害是否因工作原因所致。因此，“因工外出期间”可以从职工外出是否因工作或者为用人单位的正当利益等方面综合考虑。为了更好地明确“因工外出期间”的有关情形，以下三种情形应认定“因工外出期间”：（一）职工受用人单位指派或者因工作需要在工作场所以外从事与工作职责有关的活动期间。（二）职工受用人单位指派外出学习或者开会的活动期间。（三）职工因工作需要的其他外出期间。此为兜底条款。

（六）在上下班途中，受到非本人主要责任的交通事故或者城市轨道交通、客运轮渡、火车事故伤害的；

“非本人主要责任”的认定，应当以有关机关出具的法律文书或者人民法院的生效裁决为依据。

对“上下班途中”的认定至少应当考虑以下三个要素：一是目的要素。即以上下班为目的；二是时间要素。即上下班时间是否合理；三是空间要素。即往返于工作地和居住地的路线是否合理。

（七）法律、行政法规规定应当认定为工伤的其他情形。

"Bylawson industrial injury insurance" article 14 the worker has one of thefollowing circumstances, ought to identify as industrial injury:(2) Beinginjured by an accident while doing preparatory or finishing work related towork in the workplace before or after working hours;

"Workinghours" means the hours stipulated by law or required by the employingunit. It includes: 1) The working hours stipulated in the labor contract, 2)The working hours stipulated by the employing unit, 3) The time to complete thetemporary assignment or specific work task of the employing unit, and 4) Theworking hours stipulated by law.

"Workplace"means the area relating to the duties of the employee and the reasonable areanecessary for the performance of the duties. It includes: 1) The area where theemployer can effectively manage the daily production and business activities;2) The relevant area outside the unit that the employee is involved in in orderto complete a particular job; and 3) The reasonable area where the employeetravels between multiple workplaces related to his/her job responsibilities.

"Workreason" refers to the cause-and-effect relationship between an employee'sinjury and the work he or she is engaged in. It includes: 1) The labor contractor the work of the unit, 2) The work temporarily assigned by the employingunit, 3) The work to safeguard the legitimate interests of the employing unit,and 4) The basic physiological needs to be solved in a reasonable place duringthe work.

(3) Accidentalinjury, such as violence, caused by the performance of duties during workinghours and in the workplace;

"Becausefulfil job duty to suffer violence to wait for accidental injury", havetwo layer of meaning: it is to point to the worker because fulfil job duty,make the unreasonable of some person or the purpose that break the law did notachieve, these people are out of repaying and the violent personal injury thatundertakes to this worker; Two it is to point to in working time and inside theworkplace, the accident injury that the worker performs job duty to get, suchas earthquake, factory area is on fire, workshop building collapses and theinjury that because unit other facilities is not safe and so on.

(4) Sufferingfrom occupational diseases;

After laborerleaves former post or former unit of choose and employ persons, appear insidetwo years suspect occupational disease symptom, can apply to occupationaldisease diagnose orgnization diagnose. Classics diagnose, appraisal isoccupational disease worker, maintain inductrial injury, enjoy treatment ofinductrial injury insurance and other occupational disease lawfully, unit ofchoose and employ persons did not attend inductrial injury insurance lawfully,its medical treatment and life safeguard assume by unit of choose and employpersons.

(5) Beinginjured or missing in an accident due to work-related reasons during hisabsence from work;

During theperiod of "due to work out", it shall be considered whether theworker's going out belongs to the work out assigned by the employing unit andwhether the accident injury suffered is caused by work reasons. Accordingly,"because work goes out during" can go out from the worker whetherbecause of work or for the legitimate interest of unit of choose and employpersons to wait for respect to consider synthetically. In order to better clarifythe relevant circumstances of "working out period", the followingthree situations should be identified as "working out period" :(1)The period during which the employee is assigned by the employing unit orengaged in activities related to work duties outside the workplace due to workneeds. (2) During the period when the staff and workers are assigned by theemploying unit to go out for study or for meetings. (3) Other periods when thestaff and workers are away for work. This is the bottom line.

(6) Being injuredin a traffic accident or in an urban rail transit, passenger ferry or trainaccident on the way to and from work that is not his main responsibility;

Thedetermination of "not the principal responsibility of the person"shall be based on the legal document issued by the relevant authorities or theeffective award of the people's court.

Theidentification of "commuting" should consider at least the followingthree elements: the first is the purpose element. Namely the above work for thepurpose; Second, the time factor. Namely whether the commute time isreasonable; Third, the space element. That is, whether the route between workand residence is reasonable.

(7) Othercircumstances that shall be determined as work-related injuries in accordancewith the provisions of laws and administrative regulations.

02:视同工伤的法律规定解读

《工伤保险条例》第十五条 职工有下列情形之一的，视同工伤：（一）在工作时间和工作岗位，突发疾病死亡或者在48小时之内经抢救无效死亡的；

职工在工作时间和工作岗位，突发疾病死亡或者在48小时之内经抢救无效死亡， 社会保险行政部门应严格按照工作时间、工作岗位、突然发病、直接就医四要件并重，有同时性、连贯性来掌握，具体情形主要包括：（一）职工在工作时间和工作岗位突发疾病当场死亡；（二）职工在工作时间和工作岗位突发疾病，且情况紧急，直接送医院或医疗机构当场抢救并在48小时内死亡等。至于其他情形，如虽在工作时间、工作岗位发病或者自感不适，但未送医院抢救而是回家休息，48小时内死亡的，不应视同工伤。

（二）在抢险救灾等维护国家利益、公共利益活动中受到伤害的；

（三）职工原在军队服役，因战、因公负伤致残，已取得革命伤残军人证，到用人单位后旧伤复发的。

"Bylawson industrial injury insurance" article 15 the worker has one of thefollowing circumstances, regard as industrial injury :(1) In working hours andworking post, sudden disease dies or dies in 48 hours after rescue invalid;

Theworker in the work time and work, sudden illness or death within 48 hours afterrescue invalid death, social insurance administrative department shall be instrict accordance with the working time, jobs, and all of a sudden onset,directly to the four elements and go to a doctor, have sex, coherence to holdat the same time, the specific situation mainly includes: (1) The worker in thework time and work seizures died on the spot; (2) The staff and workers in theworking hours and the post of sudden disease, and the situation is urgent,directly sent to the hospital or medical institutions on the spot and diedwithin 48 hours. As to other circumstance, although be in working time, workpost comes on or feel unwell by oneself, but did not send a hospital to rescuehowever go home rest, those who die inside 48 hours, should not be regarded asinductrial injury.

(2) Beingharmed in such activities as emergency rescue and disaster relief to safeguardthe interests of the state or the public;

(3) Thestaff and workers originally served in the army, because of the war, injured inthe line of duty for the disabled, has obtained the revolutionary disabledmilitary personnel card, to the employing unit after the old injury recurrence.

03:关于影响工伤认定的特殊情形的问题

《工伤保险条例》第十六条   职工符合本条例第十四条、第十五条的规定，但是有下列情形之一的，不得认定为工伤或者视同工伤：（一）故意犯罪的；（二）醉酒或者吸毒的；

（三）自残或者自杀的。

因存在特殊情形而排除工伤认定，社会保险部门的不予认定工伤决定必须以能够证明存在特殊情形的证据为依据，如果没有相关证据，而职工受伤害符合认定为工伤的其他条件，则应当认定为工伤，不能以没有有权机构的法律文书为由拖延认定或不予认定。

认定是否存“醉酒或者吸毒”、“自残或者自杀”等情形时，应当以有权机构出具的事故责任认定书、结论性意见和人民法院生效裁判等法律文书为依据，但有相反证据足以推翻事故责任认定书和结论性意见的除外。

涉及到“故意犯罪”事实的认定，必须以刑事侦查机关、检察机关和审判机关的生效法律文书和结论性意见为依据，社会保险行政部门无权认定。

"Regulations on industrial injury insurance" article 16 theworker conforms to the provisions of article 14, article 15 of theseregulations, but has one of the following circumstances, shall not beidentified as industrial injury or regarded as industrial injury :(1)Intentional crime; (2) Being drunk or taking drugs;(3) Harming oneself orcommitting suicide.

Because of special circumstances and eliminate industrial injury, thesocial insurance department will not be recognized inductrial injury decisionmust be based on evidence can prove that there are special circumstances, ifthere is no evidence, and the worker hurt other conditions conforming to theprovisions of maintain for inductrial injury, should be maintain for inductrialinjury, not to not have the right to institute legal documents as identifyingor no delay.

In determining the existence of such circumstances as "drunkenness ordrug abuse", "self-harm or suicide", the case shall be based onthe written confirmation of accident liability issued by the competentauthorities, the concluding opinion, the effective judgment of the people'scourt and other legal documents, except that the contrary evidence issufficient to overturn the written confirmation of accident liability and theconcluding opinion.

Involve to "intentional crime" of fact affirmatory, must withcriminal investigation orgnaization, procuratorial orgnaization and judicatory orgnaizationeffective legal document and conclusive sex opinion are basis, social insuranceadministration branch does not have authority to affirm.