Provisions on Several Issues Concerning the Trial of Administrative Work-related Injury Insurance Cases

(Promulgated by the Supreme People's Court on June 18 2014 and effective as of September 1 2014.)

SPC Interpretation [2014] No.9

These Provisions have been formulated pursuant to the PRC Social Insurance Law, the PRC Labour Law, the PRC Administrative Procedure Law, the Regulations for Work-related Injury Insurance and other relevant laws and administrative regulations, and by taking into account the realities of administrative trials in order to correctly try administrative work-related injury insurance cases.

Article 1: When a people's court tries an administrative case involving the determination of a work-related injury, it shall treat the written determination of liability for an accident or conclusive opinion issued by the competent authority, the effective judgment or ruling of a people's court or other such legal document as the basis for determining whether “he/she bears the main responsibility” as set forth in Item (6) of Article 14, “he/she was under the influence of alcohol or a narcotic” as set forth in Item (2) or “he/she deliberately injured himself/herself or committed suicide” as set forth in Item (3) of Article 16 of the Regulations for Work-related Injury Insurance applies, unless there is counterevidence sufficient to overturn the written determination of liability for an accident or conclusive opinion.

If there is no legal document as mentioned above or the content thereof is unclear, but the social insurance administrative department renders a determination in respect of a fact mentioned in the preceding paragraph, the people's court shall take into consideration the relevant evidence provided thereby in conducting its review in accordance with the law.

A determination of “he/she was willfully committing a criminal offence” as set forth in Item (1) of Article 16 of the Regulations for Work-related Injury Insurance shall be based on the effective legal document or conclusive opinion of the criminal investigation authority, procuratorial authority or judicial authority.

Article 2: If a people's court, after accepting an administrative case involving the determination of a work-related injury, becomes aware that the plaintiff or a third party had, before the institution of the administrative procedure, applied for labour arbitration or instituted a civil procedure in respect of whether an employment relationship existed, it shall stay the trial of the administrative case.

Article 3: If the social insurance administrative department determines that an entity as set forth below is the entity that bears work-related injury insurance liability, the people's court shall uphold such determination:

(1) where an employee has an employment relationship with two or more entities, the entity for which he/she was working when the work-related injury event occurred is the entity that bears the work-related injury insurance liability;

(2) where an employee of a temporary placement agency is injured or dies resulting from work during his/her placement at the service recipient of temporary placement workers, the temporary placement agency is the entity that bears the work-related injury insurance liability;

(3) where an employee seconded by an entity to another entity is injured or dies resulting from work, the entity that seconded him/her is the entity that bears the work-related injury insurance liability;

(4) where a service recipient of temporary placement workers violates laws or regulations by subcontracting business that it has contracted for to an organisation or natural person that lacks the qualifications to act as a service recipient of temporary placement workers and an employee employed by such organisation or natural person is injured or dies resulting from work while engaging in the contracted business, the service recipient of temporary placement workers is the entity that bears the work-related injury insurance liability; or

(5) where an individual associated with another entity engages in business in respect of third parties and an employee whom he/she employs is injured or dies resulting from work, the associated entity is the entity that bears the work-related injury insurance liability.

Once the entity that bears the work-related injury insurance liability specified in Item (4) or (5) of the preceding paragraph bears the liability for compensation or the social insurance handling authority pays the work-related injury insurance benefits from the work-related injury fund, it shall have the right to recover the same from the relevant organisation, entity or individual.

Article 4: Where the social insurance administrative department determines the following to be a work-related injury, the people's court shall uphold such determination:

(1) the employee sustained an injury during working hours in the place of work, and the employer or social insurance administrative department has no evidence showing that the same was due to a non-work-related reason;

(2) the employee sustained an injury while taking part in an activity organised by his/her employee or by another entity that he/she was directed to take part in by his/her employer;

(3) the employee sustained a work-related injury during working hours within a reasonable area in which he/she travels between the several places of work related to his/her work duties; or

(4) another injury sustained in connection with the performance of work duties during working hours within a reasonable area.

Article 5: Where the social insurance administrative department determines the following to be “while in the field for work reasons”, the people's court shall uphold such determination:

(1) while the employee was engaging in activities relating to his/her work duties outside of the place of work as directed by his/her employer or due to the needs of his/her work;

(2) while the employee was studying or at a meeting away from his/her place of work as directed by his/her employer; or

(3) while the employee was engaging in other activities away from his/her place of work as required for his/her work.

Where an employee, while away from his/her place of work for work, is injured in engaging in personal activities unrelated to his/her work or the study or meeting he/she was directed to take part in by his/her employer and the social insurance administrative department does not determine the same to be a work-related injury, the people's court shall uphold such determination.

Article 6: Where the social insurance administrative department has determined the following to be “on the way to or from work”, the people's court shall uphold such determination:

(1) on the way to or from work on a reasonable route between the place of work and place of domicile, usual place of residence or dormitory of the entity within a reasonable period of time;

(2) on the way to or from work on a reasonable route between the place of work and the place of residence of the person's spouse, parents or children within a reasonable period of time;

(3) on the way to or from work on a reasonable route within a reasonable period of time doing an activity that is required for a routine working life; or

(4) on the way to or from work within a reasonable period of time on another reasonable route.

Article 7: If the deadline for applying for the determination of a work-related injury is exceeded due to a reason not attributable to the employee or a close family member thereof himself/herself, the period of the delay shall not be counted toward such deadline.

Where an application is delayed for any of the following reasons, the same shall be deemed a reason not attributable to the employee or a close family member thereof himself/herself:

(1) force majeure;

(2) restriction of personal freedom;

(3) the same is due to a reason attributable to the employer;

(4) the registration system of the social insurance administrative department is flawed; or

(5) a concerned party applied for arbitration or instituted a civil procedure in respect of whether an employment relationship existed.

Article 8: If an employee sustains an injury due to a reason attributable to a third party and the social insurance administrative department renders a decision not to accept an application for a determination of work-related injury or not to recognise a work-related injury on the grounds that the employee or a close family member thereof has instituted a civil procedure against the third party or was awarded civil compensation, the people's court shall reject such decision.

If an employee sustains an injury due to a reason attributable to a third party, the social insurance administrative department renders a finding of work-related injury and neither the employee nor a close family member thereof institutes a civil procedure against the third party or receives civil compensation and he/she institutes a legal action requesting that the social insurance handling authority pay the work-related injury insurance benefits, the people's court shall uphold such request.

If an employee sustains a work-related injury due to a reason attributable to a third party and the social insurance handling authority refuses to pay the work-related injury insurance benefits on the grounds that the employee or a close family member thereof has instituted a civil procedure against the third party, the people's court shall reject such refusal, unless the third party has paid the medical expenses.

Article 9: If a determination of work-related injury is in error due to the applicant for such determination or his/her employer withholding relevant information or providing false materials, the social insurance administrative department may correct the same in accordance with the law during the legal action.

If, after correction of the determination of work-related injury in accordance with the law, the plaintiff does not apply for withdrawal of the legal action and the social insurance administrative department was at fault at the time of rendering the original determination, the people's court shall render a judgment confirming a violation of the law; if the social insurance administrative department was not at fault, the people's court may dismiss the plaintiff's claims.

Article 10: In the event of a discrepancy between these Provisions and judicial interpretations previously issued by the Supreme People's Court, these Provisions shall prevail.