Question:
Currently, in our company, there is an employee who had a workplace accident. We have fully paid for their medication. When the employee is discharged from the hospital with a medical certificate, are they eligible for social insurance (BHXH) payments for the days they were hospitalized?
Is there any additional cost that the company needs to bear for the employee?
Answer:
– According to Article 25 of the Social Insurance Law, as amended in 2014, employees who are absent due to illness or accidents (but not workplace accidents) must be confirmed by a qualified medical facility according to the Ministry of Health’s regulations to be eligible for sickness benefits.
– In cases where the illness or accident results from self-inflicted harm, alcohol intoxication, or drug use (including precursor substances listed by the government), the employee is not eligible for sickness benefits.
– Article 43 of the Social Insurance Law, as amended in 2014, states that employees are eligible for occupational accident benefits if they meet the following conditions:
They suffer an accident in one of the following situations:
At the workplace and during working hours.
Outside the workplace or after working hours while performing work required by the employer.
While commuting between their place of residence and workplace within a reasonable time and route.
They experience a loss of working capacity of 5% or more due to the accident, as defined in paragraph 1 of this Article.
Therefore, if an employee is absent from work due to illness and their absence is confirmed as a workplace accident, they are not entitled to receive sickness benefits for the days they were hospitalized. Instead, they are eligible for occupational accident benefits as long as they meet the conditions outlined in Article 43 of the Social Insurance Law.
The level of occupational accident benefits depends on the extent of the loss of working capacity:
For a loss of working capacity from 5% to 30%, the employee receives a one-time benefit based on a specific formula.
For a loss of working capacity of 31% or more, the employee receives monthly benefits.
Additional support may also be provided for certain disabilities or circumstances, and the benefits are calculated based on the employee’s previous contributions to social insurance.
In summary, if the employee’s illness or accident qualifies as a workplace accident, they are not entitled to sickness benefits. Instead, they should receive occupational accident benefits based on their level of disability, and the company may need to assist in facilitating this process. Additional support, such as medical aids or devices, may also be provided to the employee based on the nature of their disability.
