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Refuting a Work-Related Injury Claim: A Legal Analysis under Chinese Law

Introduction

Denying a work-related injury claim involves asserting that the injury did not arise out of or in the course of employment. This article presents a legal analysis of how to refute such claims under Chinese law, examining the relevant provisions and case law.

Legal Framework

The primary law governing work-related injuries in China is the Work Injury Insurance Law (WII Law). Article 14 defines a work-related injury as "an injury sustained by an employee in the course of performing work duties or during work hours."

Burden of Proof

In a work injury claim, the employee bears the initial burden of proving that their injury is work-related. This includes establishing that:

The injury occurred during the employee's work hours. The injury occurred in the course of the employee's work duties. There is a causal link between the injury and the work activities.

Denial Grounds

An employer may deny a work injury claim on several grounds, including:

Injury not during work hours: The injury occurred outside the employee's scheduled work hours or during a personal break. Injury not during work duties: The injury occurred while the employee was engaged in activities unrelated to their work responsibilities. No causal relationship: The employee cannot establish a causal link between the injury and their work activities. Pre-existing condition: The injury is solely attributable to a pre-existing medical condition unrelated to the employee's work. Self-inflicted injury: The employee intentionally or recklessly caused the injury themselves.

Investigation and Evidence

To refute a work injury claim, the employer must conduct a thorough investigation to gather evidence supporting their denial. This may include:

Obtaining witness statements from coworkers or supervisors. Reviewing medical records and work logs. Conducting an accident investigation to determine the circumstances of the injury. Consulting with medical experts to assess the causal relationship.

Administrative Appeal

If an employer denies a work injury claim, the employee can appeal to the local social insurance agency within 60 days. The agency will review the evidence and make a determination.

Judicial Review

If the social insurance agency upholds the employer's denial, the employee may pursue judicial review by filing a lawsuit in the people's court. The court will conduct a de novo review of the evidence and make a final decision on the claim.

Case Law

Chinese courts have issued numerous rulings on work injury claims. Some notable cases include:

In Henan Province Labor Dispute Arbitration Commission v. Henan Province Pingdingshan City People's Court (2018), the court held that an injury sustained by an employee while playing basketball during a company-organized activity was not work-related. In Yunnan Province Nujiang Lisu Autonomous Prefecture Labor Dispute Arbitration Commission v. Gongshan County People's Court (2017), the court denied a claim for a work-related injury where the employee had a pre-existing heart condition that caused the injury.

Conclusion

Denying a work-related injury claim in China requires the employer to carefully investigate the facts, gather supporting evidence, and present a strong legal argument. By understanding the legal framework and applying it to the specific circumstances of the case, employers can effectively refute illegitimate claims while safeguarding their employees' rights to compensation for genuine work-related injuries.