Chương II Nghị định 88/2020/NĐ-CP: Chế độ bảo hiểm tai nạn lao động, bệnh nghề nghiệp

Chapter II

OCCUPATIONAL ACCIDENT AND DISEASE INSURANCE BENEFITS

Article 4. Occupational accident and disease insurance benefits for employees signing contracts with multiple employers

1. If employer who signs an employment contract with multiple employers as prescribed in Clause 2 Article 43 of the Law on Occupational Safety and Health and is a victim of an occupational accident or occupational disease, he/she will be provided with the following benefits by the Insurance Fund:

a) The benefits specified in Section 3 Chapter III of the Law on Occupational Safety and Health for the employees participating in compulsory insurance, including: Costs of assessing his/her occupational injury or disease; monthly or lump sum benefits; attendance benefits; assistance in living aids or orthopedic devices; convalescence and health rehabilitation benefits; insurance benefits in connection with his/her death due to the occupational accident; payment of health insurance premiums for the employee who takes leave and receives monthly occupational accident or occupational disease benefits;

b) Assistance in career change; occupational examination and treatment; occupational rehabilitation; provision of occupational safety and health training as specified in Chapter III hereof.

2. The salary as the basis for calculation of monthly or lump sum occupational accident or occupational disease benefits specified in Point a Clause 1 of this Article shall be determined as prescribed in Point d Clause 7 Article 11 hereof.

3. Applications, conditions and procedures for receiving occupational accident and disease insurance benefits for employees signing contracts with multiple employers are as follows:

a) Applications, conditions and procedures for receiving the benefits specified in Point a Clause 1 of this Article are specified in Articles 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 57, 58, 59, 60 and 61 of the Law on Occupational Safety and Health;

b) Conditions, applications and procedures for receiving the benefits specified in Point b Clause 1 of this Article are specified in Chapter III hereof.

4. The Ministry of Labor, War Invalids and Social Affairs shall provide specific guidelines for the method of calculating occupational accident or occupational disease benefits upon the first assessment, re-assessment and general assessment of the injury or disease caused by an occupational accident or occupational disease to an employee signing employments contract with multiple employers.

Article 5. Benefits for employees who contract an occupational disease after their retirement or no longer do the jobs posing risk of occupational diseases

1. An employee who has retired or resigned or worked for another employer and then suspects or finds symptoms of an occupational disease caused by his/her dangerous job which poses a risk of occupational disease may undergo a medical examination and assessment of his/her whole person impairment (WPI) caused by the occupational disease as follows:

a) The employee who has retired or resigned shall send a copy of his/her personal heath record to an occupational health facility for examination of the occupational disease (with an original for comparison). After the medical examination result is available, the occupational health facility shall complete the employee’s occupational disease record according to regulations of the Ministry of Health;

b) The employee who has worked for another employer shall send his/her personal health record to an occupational health facility for examination of the occupational disease. If the medical examination result shows that he/she contracts an occupational disease, the employee or his/her current employer shall prepare an occupational disease record based on the employee’s personal health record;

c) After having the occupational health record, the employee shall, on his/her own initiative, take a medical examination or requests the unit for which the employee has worked or is working to introduce a health facility for assessment of his/her WPI.

2. If the employee's record does not contain any data on the occupational environment monitoring at the time on which the employee was doing the job that pose a risk of occupational disease or the data on the occupational environment monitoring or the personal health record has been lost, before implementing the regulations set out in Clause 1 of this Article, the employee or his/her current employer shall send a written request for occupational disease verification to a competent health authority in compliance with guidelines of the Minister of Health.

If the competent health authority certifies that the employee has an occupational disease, the occupational health facility shall conduct a diagnosis and specify the certification given by such competent health authority in the occupational disease examination report.

3. If an employee contracts an occupational disease as prescribed in Clause 1 of this Article, the Insurance Fund shall provide the following benefits to the employee or his or her relatives:

a) The benefits specified in Section 3 Chapter III of the Law on Occupational Safety and Health for an employee participating in compulsory insurance, including: Costs of assessing his/her occupational injury or disease; monthly or lump sum benefits; attendance benefits; assistance in living aids or orthopedic devices; convalescence and health rehabilitation benefits; insurance benefits in connection with his/her death due to the occupational disease; payment of health insurance premiums for the employee who takes leave and receives monthly occupational disease benefits;

b) 100% of the costs of examination of the occupational disease determined on the basis of list of prices of occupational disease examination promulgated by Minister of Health at the time on which the employee had the occupational disease examination and after health insurance payout has been provided; the assistance is provided to each employee twice at the maximum and only once a year.

c) 100% of the costs of treatment of the occupational disease determined on the basis of list of prices of occupational disease examination promulgated by Minister of Health at the time on which the employee had the occupational disease examination and after health insurance payout has been provided; the assistance is provided to each employee twice at the maximum and only once a year.

4. An employee is entitled to the benefits specified in Clause 3 of this Article if the following conditions are met:

a) An occupational disease is discovered during the coverage period according to regulations of the Minister of Health;

b) He/she participated in compulsory social insurance during the period he/she did the job causing the occupational disease prescribed in Point a of this Clause;

c) He/she suffers from WPI of at least 5% due to the occupational disease, in the cases where the benefits specified in Point a Clause 3 of this Article may be provided. 

5. An application for occupational disease benefits in the case specified in Point a Clause 3 of this Article includes:

a) An application form made by the employee who has retired or resigned using the Form No. 01 in the Appendix hereof; or a written request made by the current employer using the form promulgated by the Vietnam Social Security if the employee who has worked for another employer;

b) A WPI assessment report prepared by the Medical Examination Council.

6. An application for costs of occupational disease examination or treatment in the case specified in Point b or c Clause 3 of this Article includes:

a) An application form made by the employee who has retired or resigned using the Form No. 02 in the Appendix hereof; or a written request made by the current employer according to Clause 1 Article 18 and Clause 2 Article 22 of this Decree if the employee has worked for another employer;

b) The documents mentioned in Clause 2 Article 18 and Clause 2 Article 22 of this Decree;

c) A copy of the hospital discharge paper or copy of the medical record after the occupational disease treatment;

d) Originals of documents evidencing payment of costs of occupational disease examination or treatment.

7. Sequence of providing occupational disease benefits

a) If there is a sufficient application as prescribed in Clause 5 of this Article, the employee or his/her current employer shall submit it to the social security office for provision of benefits within the time limit specified in Article 59 of the Law on Occupational Safety and Health.

b) If there is a sufficient application as prescribed in Clause 6 of this Article, the employee or his/her current employer shall submit it to the Department of Labor, War Invalids and Social Affairs for provision of benefits according to the sequence specified in Clauses 2 and 3 Article 19 and Clauses 2 and 3 Article 23 of this Decree.

8. The period of entitlement to occupational disease benefits begins from the month in which a conclusion from the Medical Examination Council is given.

9. The Minister of Health shall provide professional guidelines for verifying an occupational disease in the case where the data on the occupational environment monitoring is not available or has been lost or the employee’s personal health record or medical record has been lost.

Article 6. Application for death benefits prescribed in Article 53 of the Law on Occupational Safety and Health for an employee having a traffic accident while performing a task or on the way to or from the working location

1. A social insurance book.

2. A copy of the death certificate or death notice or a copy of the court’s effective decision declaring that the employee is dead.

3. Declaration of the relatives and minutes of their meeting in the case of eligibility for the monthly death benefits but selection of lump sum death benefits.

4. An occupational accident investigation report.

Article 7. Application for occupational accident or occupational disease benefits for an employee undergoing a re-assessment after his/her injury or disease relapses

1. A social insurance book if the victim of the occupational accident or occupational disease has undergone an assessment but if his/her WPI is not qualified for benefits; a legitimate copy of the application for occupational accident or occupational disease benefits if the employee has received the occupational accident or occupational disease benefits

2. An occupational accident investigation report; in a case where the employee met with a traffic accident which was considered as an occupational accident, one of the following documents is required: a scene examination report, a traffic accident scene diagram or a traffic accident report of the police authority or military criminal investigating body if the employee’s treatment was done or if the employee was discharged from hospital before July 01, 2016 and the previous assessment stated that the employee’s WPI is not qualified for benefits.

3. Results of monitoring of the occupational environment if the employee’s treatment was done or if the employee was discharged from hospital before July 01, 2016 and the previous assessment stated that the employee’s WPI is not qualified for benefits.

4. The latest WPI assessment report given by Medical Examination Council, if the employee’s WPI was not qualified for benefits.

5. A report on re-assessment of employee’s WPI given by Medical Examination Council.

6. An indication provided by the health facility or orthopaedic and functional rehabilitation facility in accordance with regulations on supply of living aids and orthopaedic devices (if any).

Article 8. Application for an employee undergoing a general assessment as a result of having an occupational accident or occupational disease again

1. A social insurance book; a legitimate copy of the application for occupational accident or occupational disease benefits if the employee has received the occupational accident or occupational disease benefits.

2. A hospital discharge paper or copy of the medical record after having been treated for the accident or disease on the last inpatient occasion.

3. An occupational accident investigation report; in a case where the employee met with a traffic accident which was considered as an occupational accident, one of the following documents is required: a scene examination report, a traffic accident scene diagram or a traffic accident report of the police authority or military criminal investigating body if the employee’s treatment was done or if the employee was discharged from hospital before July 01, 2016 but has not undergone a WPI assessment.

4. Results of monitoring of the occupational environment if the employee’s treatment was done or if the employee was discharged from hospital before July 01, 2016 but has not undergone a WPI assessment.

5. A report on general assessment of WPI given by Medical Examination Council; if the employee's previous WPI has not been qualified for benefits, such an assessment report is also required.

6. A claim on occupational accident or disease benefits made using the prescribed form as to the last occupational accident or disease; if the claim on benefits made for the previous occupational accident or disease has not been settled, a claim made by the unit in the place where the previous occupational accident or disease occurs is also required.

7. An indication provided by the health facility or orthopaedic and functional rehabilitation facility in accordance with regulations on supply of living aids and orthopaedic devices (if any).

Article 9. Days of leave for convalescence and health rehabilitation after injury or disease treatment

1. The number of days of leave for convalescence and health rehabilitation after injury or disease treatment specified in Article 54 of the Law on Occupational Safety and Health includes public holidays and weekends prescribed by the labor laws.

2. If an employee does not take leave, he/she is not entitled to the benefits for convalescence and health rehabilitation after injury or disease treatment.

Article 10. Participation in the Insurance Fund

1. If an employee who is sent to study or for probation or to work domestically or overseas and still salaried or whose work is suspended or who is awaiting job but still salaried, he/she must still pay his/her insurance premiums to the Insurance Fund for the period of the employee's study, probation, working trip, work suspension or waiting for work.

2. If an employee meets with an occupational accident within the first month of payment of his/her insurance premiums to the Insurance Fund or within the first month of returning to work and payment of his/her insurance premiums to the Insurance Fund after the period of interruption of insurance premium payment due to termination of the employment contract, the employer must pay the insurance premiums to the Insurance Fund for such months.

3. While an employee has taken leave period due to an occupational accident or occupational disease for treatment and functional rehabilitation, his/her employer must pay full salary to the employee under the employment contract as prescribed in Clause 3 Article 38 of Law on Occupational Safety and Health.

4. The employer must full pay occupational accident or occupational disease insurance premiums, including the prescribed interests regarding an employee who is eligible for occupational accident and disease benefits or who terminates his/her employment contract or job contract to provide benefits to the employee in a timely manner.

Article 11. Period of time and monthly salary as the basis for calculation of occupational accident and disease benefits

1. The period of time as the basis for calculation of occupational accident or occupational disease benefits is total period of payment of insurance premiums to the Insurance Fund, except the overlapping period of different employment contracts over which insurance premiums are paid; if the period of insurance premium payment has intervals, they shall be accumulated; the period of time over which the employee held any of the titles prescribed in the Decree No. 09/1998/ND-CP dated January 23, 1998 before January 01, 1998 and was entitled to social insurance benefits shall be included in the period for calculation of occupational accident or occupational disease benefits.

2. For the period of time over which an employee takes leave and enjoys his/her sickness benefits as prescribed by the Law on Social insurance and over which an employee does not work or takes unpaid leave for at least 14 working days in a month, the employer is not required to pay insurance premiums to the Insurance Fund for such month and such month is not included in the period of time over which insurance premiums are paid to the Insurance Fund, except for the case specified in Clause 2 Article 3 hereof.

3. For the period of time over which an employee takes maternity leave as prescribed by the Law on Social insurance for at least 14 days in a month, the employer is not required to pay insurance premiums to the Insurance Fund, but that month is included in the period of time over which insurance premiums are paid to the Insurance Fund. To be specific:

a) If the employment contract of an employee expires while he/she is on maternity leave, the period of entitlement to maternity benefits beginning from the time off to the expiry of the employment contract shall be included in the period of time over which insurance premiums are paid to the Insurance Fund, but the period of maternity leave after the expiry of the employment contract shall not be included in the period of premium payment.

b) The period of time over which an employee received maternity benefits and terminated her employment contract or working contract or resigned before the time of childbirth or adoption of a child aged under 6 months under Clause 4 Article 31 of the Law on Social Insurance shall not be included in the period of time over which insurance premiums are paid to the Insurance Fund;

c) If a female employee goes back to work before expiry of her maternity leave as prescribed, the period of time over which the employee is entitled to maternity benefits beginning from the time off to the time of returning to work before expiry of her maternity leave shall be included in the period of time over which insurance premiums are paid to the Insurance Fund, from the time of returning to work before expiry of her maternity leave, the employee is still entitled to maternity benefits until expiry of the period mentioned in Clause 1 or Clause 3 Article 34 of the Law on Social Insurance and the employer is still required to pay insurance premiums to the Insurance Fund;

d) If a father or direct fosterer, intended parent who is entitled to maternity benefits does not take leave, the employer is still required to pay insurance premiums to the Insurance Fund.

4. If an employee is kept in temporary detention or is suspended from work, thereby resulting in suspension of participation in the Insurance Fund but if full premiums are then paid for the period of temporary detention or work suspension in accordance with regulations of the Law on Social Insurance, the period of payment of full premiums shall be included in the period of time over which such premiums were paid.

5. The insurance premium payment period that is taken to receive lump-sum social insurance payout shall not be included in the period of time as the basis for calculation of occupational accident and disease benefits.

6. The total number of years of payment of insurance premiums to the Insurance Fund shall be determined as follows:

a) If an employee meets with an occupational accident, the total number of years of payment of premiums to the Insurance Fund is determined until the month preceding the month of the occupational accident;

b) If an employee suffers from an occupational disease, the total number of years of payment of premiums to the Insurance Fund is determined until the month preceding the month of doing the job causing such occupational disease;

c) If an employee enters into employment contracts simultaneously with multiple employers, the overlapping period of different employment contracts over which insurance premiums are paid to the Insurance Fund shall not add up;

d) A year means a period of 12 months of payment of insurance premiums to the Insurance Fund.

7. Salary for payment of premiums into the Insurance Fund as the basis for calculation of occupational accident or disease benefits shall be determined as follows:

a) The salary is the monthly salary of the month immediately preceding the month in which the occupational accident occurred or the employ met with the occupational disease; if an employee meets with an occupational accident within the first month of payment of his/her insurance premiums to the Insurance Fund or meets with an occupational accident or suffers from an occupational disease within the first month of returning to work and payment of his/her insurance premiums to the Insurance Fund after the period of interruption of insurance premium payment due to termination of the employment contract, the salary as the basis for calculation of benefits shall be the salary of such month;

b) The salary is the salary of the last month in which premiums were paid to the Insurance Fund for a job causing the occupational disease in the case where the employee contracted the disease after retirement or after no longer working in the job posing a risk of occupational disease;

c) If an employee whose salary is paid by the State started to participating in social insurance before January 1, 2016, the monthly salary as the basis for calculation of benefits shall be determined according to the coefficient and allowance (if any) multiplied by (x) statutory pay rate at the time of entitlement to the allowance;

d) If an employee enters into employment contracts simultaneously with multiple employers, the salary as the basis for calculation of benefits is the sum of the salaries as basis for payment of insurance premiums to the Insurance Fund of all employment contracts in the month preceding the month of the last occupational accident or occupational disease but not exceeding 20 times the statutory pay rate.