Detailed Guidance on Dossier and Procedures for Initial Claims for Occupational Accident and Disease Benefits in Vietnam

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Dossier Template for Receiving Occupational Accident and Disease Benefits for First-Time Occupational Accidents in Vietnam

Decision 777/QD-BHXH on the announcement of administrative procedures for social insurance benefits, and unemployment insurance is effective from June 24, 2020. This Decision provides detailed guidance on the dossier and procedures for receiving occupational accident and occupational disease benefits for cases of first-time occupational accidents in Vietnam as follows:

1. Implementation Order

Step 1: Submit the dossier

- The employee submits the dossier as prescribed to the employer unit.

- Employees who have retired, quit their job, or transferred to another employer unit and contracted an occupational disease during the insured period must prepare and submit the dossier as prescribed to the provincial/district Social Security Office (BHXH) where the pension is being paid or the Social Security Office at the place of residence (in case of quitting) or the Social Security Office at the place of social insurance contribution when transferring to another employer unit.

Step 2: The employer unit receives the dossier from the employee, completes the dossier as prescribed, and prepares a Request for Policies Resolvement for Occupational Accidents or Diseases (Form No. 05A-HSB) and submits it to the Social Security Office where the employer unit contributes social insurance within 30 days from the date of receiving the complete dossier; for employees who have retired, the dossier is sent to the provincial Social Security Office where the pension is paid.

- In case of electronic transactions: The employer unit prepares the dossier using the Vietnam Social Security declaration software or the I-VAN organization; digitally signs and sends it to the Vietnam Social Security Electronic Information Portal or through the I-VAN organization. If the paper dossier is not converted to electronic format, the paper dossier must be sent to the Social Security Office via public postal services within 30 days from the date of receiving the complete dossier.

- For retired employees or those who have quit their job or transferred to another unit and contracted an occupational disease within the insured period: The employee registers to receive a verification code and sends the electronic dossier to the Vietnam Social Security Electronic Information Portal or through the I-VAN organization. If the paper dossier is not converted to electronic format, the paper dossier must be sent to the Social Security Office via public postal services.

Step 3: The Social Security Office that receives the dossier will review and process the benefits and pay the benefits to the employee.

2. Implementation Methods

* The employer unit and employees can choose to submit the dossier and receive results through one of the following forms:

- Via electronic transactions (with or without accompanying paper dossier);

- Via public postal services;

- Directly at the Social Security Office.

* Employees receive benefits through one of the following forms:

- Through the employee's bank account;

- Directly at the Social Security Office (for one-time benefit reception) or via public postal services.

3. Components of the Dossier

The dossier requesting the resolution of occupational accident and disease benefits for first-time occupational accidents in Vietnam includes:

- The original Request for Policies Resolvement for Occupational Accidents or Diseases (Form No. 05A-HSB of the employer unit; the original Request for Policies Resolvement for Occupational Diseases (Form No. 05B-HSB of the employee;

- The original hospital discharge paper or excerpts of medical records after treatment for occupational accident or disease (in case of inpatient treatment);

- The assessment report on the reduction of working capacity by the Medical Examination Council or a copy of the Certificate of HIV/AIDS infection due to occupational accident risks in case of HIV/AIDS infection due to occupational accident risks (equivalent to a 61% reduction in working capacity), if assessed by the Medical Examination Council with a reduction in working capacity higher than 61%, the dossier for occupational disease benefits must include an assessment report;

- In case of occupational disease without inpatient treatment, a copy of the occupational disease examination paper is required;

- The original prescription of the medical examination, rehabilitation facility as prescribed for prosthetic devices (if any);

- The original invoice, fee receipt for the assessment; a list of assessment contents by the performing Medical Examination Council (in case of reimbursement for assessment fees).

4. Number of Dossiers

01 set (applies to direct transactions and electronic transactions that have not converted the paper dossier to electronic format).

5. Processing Time

Maximum 06 working days from the date of receiving the complete dossier as prescribed.

6. Conditions for Receiving Occupational Accident and Disease Benefits

* In case of occupational accidents

Employees participating in occupational accident and disease insurance are entitled to occupational accident benefits when their working capacity is reduced by 5% or more due to accidents in the following cases:

- At the workplace and during working hours, including while performing necessary personal needs at the workplace or during working hours as stipulated by the Labor Code and the internal regulations of the production/business establishment, including breaks, meals, supplementary meals, menstrual hygiene, showers, breastfeeding, and going to the toilet;

- Outside the workplace or outside working hours when performing tasks as required by the employer unit or the person authorized in writing by the employer unit to directly manage labor;

- On the route from residence to the workplace or from workplace to residence within a reasonable time and route.

Note: Employees are not entitled to occupational accident benefits if due to the following reasons:

+ Due to personal conflicts of the victim with the person causing the accident unrelated to the performance of work tasks;

+ Due to the employee's intentional self-harm;

+ Due to the use of drugs or other substances contrary to legal regulations.

* In case of occupational diseases

Employees participating in occupational accident and disease insurance are entitled to occupational disease benefits when they meet the following conditions:

- Suffering from an occupational disease listed in the Circular 15/2016/TT-BYT;

- Reduction in working capacity by 5% or more.

Note: Employees who suffer an occupational accident and have body function impairment are provided with prosthetic devices based on their disability condition on a periodic basis.

Nguyen Trinh

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