Research On The Competing Issues Of Compensation Between Work Injury Insurance And Accident Insurance

With the improvement of economic level,the development of diversified remedies for work-related accidents has become an inevitable trend,and the number of cases in which workers trigger both work injury insurance and accident insurance after workrelated accidents is increasing day by day.The problem of competing compensation between work injury insurance and accident insurance is at the intersection of public law and private law,and the lack of legislative provisions to solve this problem has led to the serious phenomenon of "different judgments in the same case" in judicial practice,which has brought many difficulties for workers to obtain relief for work injury.There are two controversial points in judicial practice: firstly,whether the employer and the worker can agree to replace the work injury insurance with accident insurance;secondly,whether the specific compensation items of work injury insurance treatment and accident insurance benefit can offset each other.In dealing with these focal issues,the courts have come up with three different types of decisions,namely:double compensation,full offset,and partial offset.Although double compensation protects workers’ rights and interests to the greatest extent,it affects the realization of substantive fairness;full credit protects the legitimate rights and interests of the employer,but infringes on workers’ rights and interests,both of which are suspected of missing one another;partial credit model can balance the rights and interests of all parties,but lacks reasoning.There are competing norms between the work injury insurance system and the accident insurance system,which is the root of the conflict in judicial practice,but there is a lack of legal provisions to solve the problem of competing compensation at the legislative level in China.At the level of laws and administrative regulations,the relevant provisions of work injury insurance and accident insurance are not related to the resolution of this compensation problem.Although at the level of local normative documents,individual provinces and cities have clarified the rules of handling,but the validity level of these documents is too low and does not have guiding significance.When the work injury insurance and accidental injury insurance compensation competition,in principle,should support the workers on the abstract loss to obtain double compensation.Work-related injury insurance and accidental injury insurance differ in the legislative purpose,the subject of responsibility and the scope of compensation liability,and the degree of protection of work-related injury insurance is higher than that of accidental injury insurance,and intentional accidental injury insurance should be used as a supplement to work-related injury insurance.On the other hand,Article 39 of the Insurance Law restricts the scope of beneficiaries under labor relations,so the employer cannot be the actual beneficiary of accidental injury insurance.Therefore,the employer cannot agree with the workers to replace the work injury insurance with accidental injury insurance,and the workers are entitled to double compensation for the abstract loss part.The workers should be compensated for the specific loss to the extent of filling the loss,i.e.,they can only receive supplementary compensation.The court held that work injury insurance and accident insurance belonged to different legal relationships,and that the practice of claiming workers to be doubly compensated for specific losses was inconsistent with the legislative spirit of Article 42 of the Social Insurance Law.Whether the specific losses such as medical expenses can be doubly compensated is essentially a question of whether the specific losses are subject to the principle of compensation for damages.By analyzing the three domestic doctrines on the applicability of the principle of compensation for damages and taking into account the existing legislative experience in foreign countries,this article believes that the specific damages incurred by the workers should be subject to the principle of compensation for damages,i.e.,the accident insurance will only supplement the compensation when the work injury insurance cannot fully compensate the workers’ damages.Based on the above theoretical analysis,when the compensation of work injury insurance and accident injury insurance are competing,the principle of double compensation should be adopted,with the exception of supplementary compensation.Specifically,workers can get both work injury insurance treatment and accident insurance benefits to compensate for the abstract losses suffered,but for specific losses,the amount of compensation is limited to fill the losses.In view of the fact that work injury insurance has more powerful protection function and more convenient claim process than accident insurance,the principle that work injury insurance pays first should be established.However,the current duplicate insurance system and insurance subrogation system cannot reasonably share the loss,so it is necessary to introduce the insurance competition system to solve the problem of loss sharing.