China – Filing Work Comp Claim

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Filing A Compensation Claim In China Has Some Similarities

A Compensation claim of China filing workers. China has now overtaken us as the world’s largest economy.  China’s Workers Compensation system seems to be very complex.   The system on paper looks very straightforward.  There are five basic steps that are very similar to the US system:

5 star china Compensation Claim Flag On Map
(c) 123RF
  1. A claim is filed
  2. Diagnosis by an official health authority; 
  3. Verification by the local labor and social security authorities that the diagnosed injury/illness is actually work-related; 
  4. Assessment of the worker’s degree of disability as a result of the injury/illness; and
  5. Calculation by the social security authorities of the benefits to be paid. 

After researching the information more thoroughly, one would have to say the Chinese system is very similar in many aspects to the US. 

 The one major difference in China is the collusion of the medical providers and the employers.  It seems that corruption exists very heavily in this area.  The social security system is tasked with adjusting the WC claims.  There are no insurance carriers. 

 The four main compensable claim definitions are in some sense even more liberal than the US system. Definition #3 is sometimes denied by US carriers when the employee is on break. 

  1. The contraction of an illness as a direct result of the employee’s working conditions.
  2. Injuries suffered during work hours and within the workplace, when the worker is the victim of violence or suffers an unexpected injury whilst carrying out their duties. 
  3. Accidental injuries suffered before or after formal work hours and within workplace, due to activity considered preparation for work or conclusion of work. 
  4. Injuries suffered in an accident when the employee is on a business trip or assigned to work outside of the work place, including cases where the body cannot be found.
Graphic of china Compensation Claim Table
123RF

The main reasons for a claim denial are:

  1. Intoxication by alcohol or drugs
  2. Employee is knowingly committing a crime.
  3. The employee deliberately self-harms or commits suicide.
  4. Cases where an employee does not die within 48 hours of the onset of sudden illness while at work – interesting that the employee must die within 48 hours to collect benefits. 

There are corresponding grades for the severity of the disability due to injury.   The levels of disability are:  (by Grade) 

  • 1 to 4 indicate that the employee no longer has any ability to work; grades 
  • 5 and 6 signify that an employee has lost most of their ability to work 
  • 7 to 10 injuries are classified as partially disabled.

This is an example of a chart of benefits for an injured worker (click here) .  The specific grades are determined by a description of each grade.  

 I am sure there are off-paper differences between the Chinese and American Workers Compensation systems.  However, there are many striking similarities.  

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James Moore

Raleigh, NC, United States

About The Author...

James founded a Workers’ Compensation consulting firm, J&L Risk Mgmt Consultants, Inc. in 1996. J&L’s mission is to reduce our clients’ Workers Compensation premiums by using time-tested techniques. J&L’s claims, premium, reserve and Experience Mod reviews have saved employers over $9.8 million in earned premiums over the last three years. J&L has saved numerous companies from bankruptcy proceedings as a result of insurance overpayments.

James has over 27 years of experience in insurance claims, audit, and underwriting, specializing in Workers’ Compensation. He has supervised, and managed the administration of Workers’ Compensation claims, and underwriting in over 45 states. His professional experience includes being the Director of Risk Management for the North Carolina School Boards Association. He created a very successful Workers’ Compensation Injury Rehabilitation Unit for school personnel.

James’s educational background, which centered on computer technology, culminated in earning a Masters of Business Administration (MBA); an Associate in Claims designation (AIC); and an Associate in Risk Management designation (ARM). He is a Chartered Financial Consultant (ChFC) and a licensed financial advisor. The NC Department of Insurance has certified him as an insurance instructor. He also possesses a Bachelors’ Degree in Actuarial Science.

LexisNexis has twice recognized his blog as one of the Top 25 Blogs on Workers’ Compensation. J&L has been listed in AM Best’s Preferred Providers Directory for Insurance Experts – Workers Compensation for over eight years. He recently won the prestigious Baucom Shine Lifetime Achievement Award for his volunteer contributions to the area of risk management and safety. James was recently named as an instructor for the prestigious Insurance Academy.

James is on the Board of Directors and Treasurer of the North Carolina Mid-State Safety Council. He has published two manuals on Workers’ Compensation and three different claims processing manuals. He has also written and has been quoted in numerous articles on reducing Workers’ Compensation costs for public and private employers. James publishes a weekly newsletter with 7,000 readers.

He currently possess press credentials and am invited to various national Workers Compensation conferences as a reporter.

James’s articles or interviews on Workers’ Compensation have appeared in the following publications or websites:

  • Risk and Insurance Management Society (RIMS)
  • Entrepreneur Magazine
  • Bloomberg Business News
  • WorkCompCentral.com
  • Claims Magazine
  • Risk & Insurance Magazine
  • Insurance Journal
  • Workers Compensation.com
  • LinkedIn, Twitter, Facebook and other social media sites
  • Various trade publications

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