Chapter III
ASSESSMENT AS THE BASIS FOR SOCIAL INSURANCE PAYOUT
Section 1. ASSESSMENT DOCUMENTS
Article 7. Cases of assessment
1. Assessment of disability due to an occupational accident.
2. Assessment of occupational diseases.
3. Assessment as the basis for provision of pension or death benefits.
Article 8. Application for first assessment
1. First assessment of disability due to an occupational accident:
a) The employer’s letter of introduction according to the template in Appendix 3 enclosed herewith;
b) A valid copy of the injury confirmation issued by the health facility that provided treatment for the worker according to the template in Appendix 4 enclosed herewith.
2. First assessment of occupational diseases:
a) The employer's letter of introduction according to the template in Appendix 3 enclosed herewith or a written request for assessment prepared by the worker whose social insurance participation period is reserved or a retired worker pending pension or monthly benefits;
b) A discharge note or occupational disease record or medical record summary.
3. Assessment as the basis for provision of pension for a person paying compulsory social insurance:
a) The employer’s letter of introduction according to the template in Appendix 3 enclosed herewith;
b) A valid copy of any of the following documents (if any): medical record summary, disability confirmation, discharge note, documents about examination or treatment of diseases, injuries or disabilities such as: health book, prescriptions, follow-up appointment forms, outpatient medical record summary.
4. Assessment pending early provision of pension for a worker paying social insurance premiums or a worker whose social insurance participation period is reserved or a retired worker pending pension or monthly benefits; assessment as the basis for provision of death benefits; assessment of a retired worker or a worker suffering an occupational disease whose social insurance participation period is reserved:
a) A written request for examination according to the template in Appendix 7 enclosed herewith.
b) A valid copy of any of the following documents (if any): medical record summary, disability confirmation, discharge note, documents about examination or treatment of diseases, injuries or disabilities such as: health book, prescriptions, follow-up appointment forms, outpatient medical record summary.
Article 9. Application for assessment of relapse
1. Assessment of occupational accident relapse:
a) A written request for assessment according to the template in Appendix 7 enclosed herewith;
b) Documents about treatment of injury relapse:
- For inpatient treatment: a valid copy of the discharge note according to the template in Appendix 5 or medical record summary according to the template in Appendix 6 enclosed herewith.
- For outpatient treatment: valid copies of documents about examination and/or treatment of diseases, injuries or disabilities caused by the occupational accident such as: health book, prescriptions, follow-up appointment forms or outpatient medical record summary.
c) Previous medical assessment record.
2. Assessment of occupational disease relapse:
a) A written request for assessment according to the template in Appendix 7 enclosed herewith;
b) Documents about the occupational disease or health book that contains information about the discovery of the occupational disease;
c) Documents about treatment of the occupational disease relapse:
- For inpatient treatment of the occupational disease or diseases, injuries or disabilities related to the occupational disease relapse: a valid copy of the discharge note according to the template in Appendix 5 or medical record summary according to the template in Appendix 6 enclosed herewith;
- For outpatient treatment: valid copies of documents about examination and/or treatment of diseases, injuries or disabilities caused by the occupational disease relapse such as: health book, prescriptions, follow-up appointment forms or outpatient medical record summary.
d) A valid copy of the previous medical assessment record.
Article 10. Application for general reassessment
1. The employer's letter of introduction according to the template in Appendix 3 enclosed herewith or a written request for assessment according to Appendix 7 enclosed herewith if the worker is having his/her social insurance participation period reserved or has retired.
2. A valid copy of the previous medical assessment record.
3. Other documents specified in Clause 1 and Clause 2 Article 8 or Clause 1 and Clause 2 Article 9 depending on the patient and type of assessment.
Article 11. Application for assessment by Central Medical Assessment Council
1. Ann application for assessment by Central Medical Assessment Council shall bear the signature and seal of the head of the governing organization of the Medical Assessment Council.
2. Valid copies of the application for assessment specified in Article 8, 9 or 10 of this Circular depending on the patient and type of assessment.
3. Any of the following documents:
a) A valid copy of the medical assessment record prepared by the Provincial Medical Assessment Council if an assessment has been carried out;
b) Minutes of meeting of the Medical Assessment Council saying the case is beyond its capacity if no assessment has been carried out.
Article 12. Application for reassessment by Central Medical Assessment Council or final reassessment
1. Application for reassessment by Central Medical Assessment Council:
a) If the reassessment is requested by an organization: a written request for reassessment by Central Medical Assessment Council prepared by the Ministry of Health, the Ministry of Labor, War Invalids and Social Affairs, Social Security Administration of Vietnam or the employer;
b) If the reassessment is requested by an individual: a written request for reassessment by Central Medical Assessment Council prepared by the Provincial Medical Assessment Council bearing the signature and seal of the head of the governing organization of the Medical Assessment Council. The request shall specify the person that disagrees with the conclusion given by the Council and requests the reassessment and be enclosed with a written request for reassessment prepared by such person;
c) Valid copies of the application for assessment specified in Article 8, 9 or 10 of this Circular depending on the patient and type of assessment;
d) The medical assessment record prepared by the Provincial Medical Assessment Council.
2. Application for final reassessment:
a) If the reassessment is requested by an organization: a written request for reassessment by Central Medical Assessment Council prepared by the Ministry of Health, the Ministry of Labor, War Invalids and Social Affairs, Social Security Administration of Vietnam or the employer;
b) If the reassessment is requested by an individual: a written request for reassessment by Central Medical Assessment Council prepared by the Provincial Medical Assessment Council bearing the signature and seal of the head of the governing organization of the Medical Assessment Council. The request shall specify the person that disagrees with the conclusion given by the Central Medical Assessment Council and requests the reassessment and be enclosed with a written request for final reassessment prepared by such person;
c) Valid copies of the application for assessment specified in Article 8, 9 or 10 of this Circular depending on the patient and type of assessment;
d) The medical assessment record prepared by the Central Medical Assessment Council.
Article 13. Responsibility for preparing the application
1. The worker shall prepare the application and send it to the Medical Assessment Council in the following cases:
a) The worker is having his/her social insurance participation period reserved and applies for assessment to receive pension;
b) The worker is having his/her social insurance participation period reserved and applies for assessment to receive lump-sum social insurance payout;
c) A relative of the worker applies for assessment to receive monthly benefits.
d) A retired worker applies for assessment of relapse.
2. The employer shall prepare the application and send it to the Medical Assessment Council in cases other than those specified in Clause 1, Clause 3 and Clause 4 of this Article.
3. Governing organization of the Provincial Medical Assessment Council shall prepare the application for reassessment by Central Medical Assessment Council
4. Governing organization of the Central Medical Assessment Council shall prepare the application for final reassessment.
Section 2. PROCEDURES FOR MEDICAL ASSESSMENT
Article 14. Time limits
1. Reassessment of an occupational accident or occupational disease shall be carried out at least after 02 years (24 months) from the day on which Medical Assessment Council gives a conclusion of the rate of work capacity reduction because of the occupational accident or occupational disease.
2. Where the worker’s health deteriorates rapidly, the governing organization of the Medical Assessment Council shall request the Chairperson or Deputy Chairperson of the Medical Assessment Council to consider carrying out a reassessment before the time specified in Clause 1 of this Article.
Article 15. Power to carry out medical assessment
1. A Provincial Medical Assessment Council is entitled to:
a) Carry out first assessment for workers or workers’ relatives (who applies to receive death benefits);
b) Carry out assessment of relapse and general assessment for workers, unless it has been carried out by another Medical Assessment Council;
c) Send patients other health facilities for clinical examination, testing or medical imaging where necessary.
2. Medical Assessment Councils affiliated to the Ministry of Public Security, the Ministry of National Defense, the Ministry of Transport are entitled to carry out assessments for workers of units under their management. To be specific:
a) Carry out first assessment for workers or workers’ relatives (who applies to receive death benefits);
b) Carry out assessment of relapse and general assessment for workers;
c) Send patients to other health facilities for clinical examination, testing or medical imaging where necessary.
3. Central Medical Assessment Council is entitled to:
a) Carry out first assessment for workers or workers’ relatives (who applies to receive death benefits);
b) Carry out assessment of relapse and general assessment for workers;
c) Carry out assessment of relapse and general assessment for workers who have undergone first assessment by Provincial Medical Assessment Councils;
d) Carry out reassessment requested by Provincial Medical Assessment Council and the Minister of Health.
Article 16. Receipt of application for medical assessment
1. Applications for medical assessment shall be received as follows:
a) The governing organization of a Provincial Medical Assessment Council or Central Medical Assessment Council shall receive applications for first assessment, reassessment or general assessment;
b) The governing organization of Central Medical Assessment Council shall receive applications for reassessment by Central Medical Assessment Council;
c) Regarding applications for final reassessment:
The individual or organization that disagrees with the result given by Central Medical Assessment Council shall send an application for final reassessment to the Ministry of Health.
2. After an application is received, the governing organization of the Medical Assessment Council or the Ministry of Health shall send the applicant a receipt note according to the template in Appendix 9 enclosed herewith.
3. If the application is satisfactory:
a) The Medical Assessment Council shall carry out assessment within 30 days from the day written on the receipt note;
b) The Minister of Health shall establish a Final Medical Assessment Council to carry out the final reassessment within 20 days from the day written on the receipt note.
Within 10 working days from the day on which a decision to establish the Final Medical Assessment Council, the Council shall carry out the final assessment.
4. If the application is not satisfactory, within 10 working days from the day written on the receipt note, the governing organization of the Medical Assessment Council or the Ministry of Health shall send a written notice to the applicant.
Article 17. Medical assessment procedures
1. Comparison: the person who carries out the medical assessment shall compare the patient with one of his/her documents: ID card, passport, confirmation by the police department of the commune where he/she resides (whether temporarily or permanently) which bears the patient’s picture (the picture must be taken on a white background within 6 months before the application is made out and bear a seal of the police).
2. Overall examination: a physician of the governing organization of the Medical Assessment Council shall act as an assessor who carries out the overall examination and prescribes specialist examinations and subclinical examinations. If such physician is not an assessor, the overall examination shall be carried out and the head of the governing organization shall prescribes specialist examinations and subclinical examinations.
3. Specialist examinations: specialists shall examine and draw conclusion according to prescriptions of the competent person.
4. Consultation: Chairperson of the Council or head of the governing organization of the Medical Assessment Council shall chair the consultation before the meeting of the Council. Where necessary, the governing organization of the Medical Assessment Council shall invite the patient and specialists to participate in the meeting.
5. Meeting of Medical Assessment Council:
a) Conditions for holding the meeting:
- The meeting is participated by more than 50% of its members, two of whom must be specialists;
- The meeting is chaired by the chairperson or deputy chairperson of the Medical Assessment Council.
b) Conclusion given by Medical Assessment Council:
- The conclusion shall be given by voting by every member of the Council. In case of dissenting opinions, the chair of the meeting shall consider prescribing additional examinations or treatment before holding a ballot.
- In case of ballot, the result shall be announced at the meeting. The conclusion must be concurred with by more than 50% of participating members.
c) The conclusion shall be given in writing according to the template in Appendix 2 enclosed herewith. The governing organization of the Medical Assessment Council shall issue the medical assessment record.
6. The medical assessment record shall be circulated and retained by the governing organization of the Medical Assessment Council as follows:
a) 02 copies shall be sent to the patient who shall submit 01 copy to the social insurance authority (via the employer if the patient is still working);
b) 01 copy shall be kept by the applicant for medical assessment and 01 copy to the Medical Assessment Council that gave the result appealed against.
c) 01 copy shall retain at the governing organization of the Medical Assessment Council.
In case of assessment of relapse, reassessment by Central Medical Assessment Council and final reassessment, the conclusion must contain conclusions of all previous examinations.
7. The conclusion given by Medical Assessment Council is permanent, unless another conclusion is given by another Medical Assessment Council at the same or superior level.
8. Medical assessment documents shall be retained at the governing organization of the Medical Assessment Council in accordance with regulations of law on document retention.
Article 18. Assessment of work capacity reduction
1. Work capacity reduction shall be assessed in accordance with Circular No. 28/2013/TTLT-BYT-BLDTBXH.
2. Methods for assessment of work capacity reduction are specified in Circular No. 28/2013/TTLT-BYT-BLDTBXH. Assessment of work capacity reduction for general assessment:
a) Where a person who is already suffering from an injury or disease or occupational diseases catches another injury or disease or occupational disease which causes the same disability:
The rate of work capacity reduction shall be determined according to results of examination of all the injuries, diseases or occupational diseases.
b) Where a person who is already suffering from an injury or disease or occupational diseases catches another injury or disease or occupational disease which causes a different disability:
The rate of work capacity reduction caused by the new injury, disease or occupational disease shall be aggregate with that of the previous occupational accident or occupational disease written in the previous medical assessment record.
c) In case of relapse of a person’s injury, disease or occupational disease, the rate of work capacity reduction shall be determined according to result of examination of the injury, disease or occupational disease.
3. The rate of work capacity reduction specified in this Article is valid until the next medical assessment record is issued.
Tìm kiếm
Thông tư 14/2016/TT-BYT (Bản Word)