Mr. Xu is an employee of a company without a signed labor contract. At 11:00 a.m. on June 22, 2019, while at work, Mr. Xu accidentally fell and was hospitalized for treatment. The diagnosis upon admission was: 1. Cerebral hemorrhage; 2. Hypertension stage three.
On July 6, 2020, Mr. Xu’s wife, Mrs. Wang, submitted an application for work-related injury recognition to the city’s social security bureau. On August 17 of the same year, the city’s social security bureau issued a decision of non-recognition, stating that Mr. Xu’s sudden illness at work did not meet the requirements of Article 15(1) of the Regulation on Work-Related Injury Insurances.
Mr. Xu believes that the cerebral hemorrhage was caused by various factors, including long-term forced overtime at work, resulting in high work pressure, excessive fatigue, and overwhelming stress, all of which are triggering factors for the illness.
Furthermore, Mr. Xu believes that he was injured due to work-related reasons during work hours and at the workplace. Therefore, according to Article 14 of the Regulation on Work-Related Injury Insurances, Mr. Xu believes that his injury should be recognized as a work-related injury. He filed a lawsuit with the court and requested a judgment in his favor.
First Instance Court’s Opinion:
The focus of the dispute in this case is whether Mr. Xu’s sudden cerebral hemorrhage can be recognized as a work-related injury or equivalent to a work-related injury.
First, there is no dispute among the parties about the time and place of Mr. Xu’s injury. Mr. Xu was injured while working at the company, and there is no disagreement between the parties on this point. Second, the identification of the cause of Mr. Xu’s cerebral hemorrhage. Mr. Xu claims that the unreasonable work arrangement by the company resulted in high work pressure and excessive fatigue, triggering the illness, but has not provided corresponding evidence to support this claim, which is not supported by the court. Third, the application of the law in determining work-related injury for Mr. Xu. At the time of the incident, Mr. Xu was working during work hours at the workplace, and there is no disagreement between the parties.
Although Mr. Xu’s illness meets the requirements of sudden illness during work hours and at the workplace, it does not meet the requirement of “death on the spot or death within 48 hours after ineffective rescue” as stipulated in Article 15(1) of the Regulation on Work-Related Injury Insurances, nor does it meet the requirement of Article 14(1) of the Regulation on Work-Related Injury Insurances. Therefore, Mr. Xu’s request to revoke the decision of non-recognition of work-related injury and make a new determination of work-related injury is not well-founded and is not supported by the court. Mr. Xu appealed against the first instance judgment.
The Second Instance Court holds that:
Article 14 and Article 15 of the Regulation on Work-Related Injury Insurances respectively stipulate the circumstances that should be recognized as work-related injuries and deemed as equivalent to work-related injuries by way of enumeration.
Among them, Article 14, item (1) stipulates that if an employee suffers an injury due to work-related reasons during working hours and at the workplace, it should be recognized as a work-related injury. The term “accidental injury” in the Regulation on Work-Related Injury Insurances generally refers to personal injury or acute poisoning caused by external factors during the employee’s work process. Xu’s hospitalization records did not show that his personal injury was caused by external factors, so it is clearly not within the scope of accidental injury.
Article 15, item (1) of the Regulation on Work-Related Injury Insurances stipulates that if an employee dies of sudden illness during working hours and at the workplace, or dies within 48 hours after ineffective rescue, it shall be deemed as equivalent to a work-related injury.
From the legislative purpose of the Regulation on Work-Related Injury Insurances, work-related injury insurance is a social security system that compensates workers for injuries caused by accidental accidents or occupational diseases during work or other professional activities. The prerequisite for recognizing work-related injuries is “caused by work-related reasons”.
Therefore, in general, self-inflicted diseases should not fall within the scope of protection of the Regulation on Work-Related Injury Insurances. However, the Regulation on Work-Related Injury Insurances include sudden illness in the scope of work-related injury protection, reflecting the principle and purpose of legislative inclination to protect workers. At the same time, in order to avoid unlimited expansion of sudden illness into the scope of work-related injury insurance, the regulation has made restrictive provisions, that is, it clearly states that the circumstances equivalent to work-related injuries must simultaneously meet three elements: “during working hours”, “in workspace”, and “death due to sudden illness or ineffective rescue within 48 hours”.
In this case, Xu claimed that he suddenly felt chest tightness and fell to the ground. According to Xu’s medical records, he was diagnosed with sequelae of cerebral hemorrhage and extremely high-risk level 3 hypertension. Combined with Xu’s statement, discharge summary and evidence in the case, Xu was injured by a sudden illness causing him to fall. This sudden illness did not meet the requirements of Article 15, item (1) of the Regulation on Work-Related Injury Insurances, that is, it did not meet the result element of “death due to sudden illness or ineffective rescue within 48 hours”. Xu’s reason that his illness was closely related to long-term overtime and poor management is irrelevant to the reason for recognizing work-related injuries in this case. Therefore, the Municipal Human Resources and Social Security Bureau’s decision not to recognize Xu’s injury as a work-related injury was not inappropriate.
In conclusion, Xu’s grounds for appeal are insufficient, and this court upholds the first-instance verdict. Therefore, according to the provisions of Article 89(1)(1) of the Administrative Procedure Law of the People’s Republic of China, the judgment is as follows:
The appeal is dismissed, and the original verdict is upheld.
Xu shall bear the acceptance fee of 50 yuan.
This judgment is final.