cciia.org.cn 2023-9-11 9:39:43 人民(min)法院(yuan)報
勞動(dong)(dong)者(zhe)因工(gong)受傷(shang)(shang)(shang)(shang)(shang)，對于治療(liao)工(gong)傷(shang)(shang)(shang)(shang)(shang)所需醫療(liao)費用(yong)符合工(gong)傷(shang)(shang)(shang)(shang)(shang)保(bao)險(xian)診療(liao)項目(mu)目(mu)錄、工(gong)傷(shang)(shang)(shang)(shang)(shang)保(bao)險(xian)藥品目(mu)錄、工(gong)傷(shang)(shang)(shang)(shang)(shang)保(bao)險(xian)住院(yuan)服務標(biao)準的(de)，可以由工(gong)傷(shang)(shang)(shang)(shang)(shang)保(bao)險(xian)基金支付，但部分超(chao)出工(gong)傷(shang)(shang)(shang)(shang)(shang)保(bao)險(xian)基金報銷(xiao)范圍的(de)醫療(liao)費用(yong)應(ying)當(dang)由誰來承擔呢？近(jin)日(ri)，浙江省開化縣人民法院(yuan)審理了一起(qi)工(gong)傷(shang)(shang)(shang)(shang)(shang)保(bao)險(xian)待遇糾(jiu)紛案件，精準定(ding)位工(gong)傷(shang)(shang)(shang)(shang)(shang)保(bao)險(xian)功能，依法支持勞動(dong)(dong)者(zhe)的(de)合理訴求，判(pan)決(jue)用(yong)人單位支付超(chao)出工(gong)傷(shang)(shang)(shang)(shang)(shang)保(bao)險(xian)基金報銷(xiao)范圍的(de)醫療(liao)費及停工(gong)留薪期間的(de)工(gong)資、護理費等費用(yong)合計17萬余元。該判(pan)決(jue)聚焦“公正與效率”主題，切實保(bao)障了勞動(dong)(dong)者(zhe)合法權益，有助(zhu)于構建和諧勞動(dong)(dong)關系，是(shi)踐行能動(dong)(dong)司(si)法理念的(de)生動(dong)(dong)實踐。
員工摔(shuai)傷：企業拒(ju)絕協助辦(ban)理工傷保險待遇
戴俊系(xi)大(da)華(hua)公司員(yuan)工(gong)，在(zai)大(da)華(hua)公司承建(jian)的某工(gong)地從事煙囪粉刷作業(ye)(ye)。2020年11月(yue)30日，戴俊在(zai)作業(ye)(ye)時不慎從高(gao)處摔(shuai)下，后被(bei)送醫院搶救，雖(sui)沒(mei)有生命危險，但傷情較為嚴重，存在(zai)顱(lu)內感染、膿(nong)毒血癥、重型(xing)顱(lu)腦(nao)損傷等情況。期間，公司為戴俊搶救治療(liao)墊付了(le)部分醫療(liao)費(fei)用。
事(shi)故發生后，其受到(dao)的(de)傷害經當地(di)人力資源和社會保(bao)障部門認定為工傷，傷殘等級為三級，大部分生活存(cun)在自理障礙(ai)。看著高額的(de)醫療(liao)費用(yong)，戴俊多(duo)次請(qing)求公司協助辦理相(xiang)關工傷保(bao)險待遇(yu)，均被拒絕。
2022年6月2日(ri)，戴俊向(xiang)浙江省開化縣勞(lao)動(dong)爭議仲(zhong)裁(cai)委(wei)員(yuan)會申(shen)請仲(zhong)裁(cai)。該仲(zhong)裁(cai)委(wei)員(yuan)會裁(cai)決：大華公(gong)司支(zhi)付戴俊停(ting)工留薪工資及護(hu)理費(fei)等合(he)計17萬余元(yuan),上(shang)述費(fei)用于戴俊返還大華公(gong)司墊(dian)付的34萬余元(yuan)后五日(ri)內(nei)支(zhi)付。
戴(dai)(dai)俊(jun)不服，向(xiang)開化縣(xian)人民法院(yuan)起訴，要(yao)求大華公(gong)司(si)支付(fu)醫療(liao)費(fei)20萬元(yuan)(yuan)及(ji)(ji)停工(gong)(gong)留(liu)薪期(qi)間工(gong)(gong)資、護(hu)理費(fei)17萬余元(yuan)(yuan)及(ji)(ji)一次性傷殘(can)補助金、傷殘(can)津貼(tie)等費(fei)用，上(shang)述各項經濟損(sun)失(shi)共計(ji)50余萬元(yuan)(yuan)。大華公(gong)司(si)則提出(chu)反(fan)訴，請求判令戴(dai)(dai)俊(jun)返還公(gong)司(si)為其因(yin)搶救治療(liao)而墊付(fu)的(de)醫療(liao)費(fei)用34萬余元(yuan)(yuan)。
邏輯博(bo)弈：超(chao)出部分(fen)賠償(chang)責任主(zhu)體如何確定(ding)
庭(ting)審中，原(yuan)告(gao)戴俊的(de)(de)代理律師陳述(shu)，《工(gong)(gong)(gong)傷(shang)保險條(tiao)例》第一條(tiao)規定：“為了保障因工(gong)(gong)(gong)作遭(zao)受(shou)事故傷(shang)害或者患職業(ye)病的(de)(de)職工(gong)(gong)(gong)獲得醫療(liao)救治(zhi)(zhi)和(he)經濟(ji)補償(chang)(chang)，促(cu)進工(gong)(gong)(gong)傷(shang)預(yu)防和(he)職業(ye)康復，分(fen)(fen)散(san)(san)用人單位(wei)的(de)(de)工(gong)(gong)(gong)傷(shang)風險，制定本(ben)條(tiao)例。”可見，工(gong)(gong)(gong)傷(shang)保險制度的(de)(de)立(li)法精神(shen)系“分(fen)(fen)散(san)(san)”用人單位(wei)的(de)(de)風險，而不是(shi)(shi)“轉移(yi)替代”，即只(zhi)要治(zhi)(zhi)療(liao)費(fei)用是(shi)(shi)工(gong)(gong)(gong)傷(shang)治(zhi)(zhi)療(liao)必要費(fei)用，用人單位(wei)不當然免除(chu)責任，仍(reng)應承擔賠償(chang)(chang)責任。
此外(wai)，現行(xing)法(fa)律對(dui)勞動者(zhe)保護的原則(ze)是“無(wu)過錯(cuo)責任(ren)”，勞動者(zhe)因自身(shen)存在(zai)過錯(cuo)致使(shi)受到(dao)損害，用人(ren)單位(wei)尚需承擔賠(pei)償責任(ren)，何況其在(zai)粉刷作業時(shi)并不存在(zai)過錯(cuo)。大華公司作為用人(ren)單位(wei)，對(dui)職(zhi)工進行(xing)救治是應履行(xing)的法(fa)定(ding)義務，現其要(yao)求返(fan)還(huan)超出工傷保險基金報銷(xiao)范(fan)圍醫療費(fei)用的反訴(su)請(qing)求，于(yu)法(fa)于(yu)理(li)于(yu)情都是相悖的，請(qing)求法(fa)院予以駁回(hui)。
被告大華公司(si)則辯稱(cheng)，該企業按時為(wei)(wei)原告戴(dai)俊繳(jiao)納了工傷保險。為(wei)(wei)搶救治(zhi)療(liao)需(xu)要，公司(si)墊付了住院治(zhi)療(liao)費(fei)(fei)用、住院康復費(fei)(fei)用合計122萬(wan)余元，其中(zhong)社保基金已(yi)(yi)報(bao)銷88萬(wan)余元，因(yin)超出社保基金報(bao)銷目(mu)錄范圍不能報(bao)銷的(de)醫(yi)療(liao)費(fei)(fei)為(wei)(wei)34萬(wan)余元。在公司(si)已(yi)(yi)履行工傷投保和(he)救治(zhi)義務的(de)前提(ti)下，墊付的(de)超出報(bao)銷目(mu)錄范圍的(de)醫(yi)療(liao)費(fei)(fei)用，戴(dai)俊應當(dang)予以返還。
至于(yu)(yu)戴(dai)俊提出(chu)的(de)(de)(de)停(ting)工留(liu)薪期(qi)間工資(zi)和護(hu)理費(fei)，處于(yu)(yu)合理范(fan)圍內(nei)的(de)(de)(de)公(gong)司(si)愿意支付(fu)，但是(shi)該(gai)部(bu)分應(ying)從先行墊(dian)付(fu)的(de)(de)(de)34萬(wan)余元中扣(kou)除。此外，戴(dai)俊明(ming)知部(bu)分醫療費(fei)用(yong)存在無(wu)法報銷的(de)(de)(de)風險，仍(reng)然予(yu)(yu)以(yi)(yi)(yi)使用(yong)，可(ke)以(yi)(yi)(yi)證明(ming)其是(shi)自愿承擔該(gai)筆費(fei)用(yong)的(de)(de)(de)。關于(yu)(yu)支付(fu)一(yi)次性傷殘補(bu)助金、傷殘津貼的(de)(de)(de)訴(su)訟請(qing)求，該(gai)責任主體為社保中心而(er)不在企(qi)業(ye)，應(ying)予(yu)(yu)以(yi)(yi)(yi)駁回(hui)。
法院判(pan)決：用人單位應當承(cheng)擔賠償責任
開化(hua)法院經審理查明，原(yuan)(yuan)告(gao)戴俊的治療費(fei)用共計139萬余(yu)元，社(she)保基金報銷了(le)88萬余(yu)元，被告(gao)大華公司付了(le)34萬余(yu)元，原(yuan)(yuan)告(gao)個人則(ze)支付了(le)16萬余(yu)元。雙方當事人對治療費(fei)用的合理性均無(wu)異議，也認可原(yuan)(yuan)告(gao)停工(gong)留薪(xin)期間(jian)的工(gong)資、護理費(fei)為(wei)17萬余(yu)元。
本案的爭(zheng)議焦點(dian)為(wei)(wei)超(chao)過社保基金報銷目(mu)錄范圍的醫療費應由誰來承擔？法院認為(wei)(wei)，工傷(shang)(shang)保險的首要(yao)目(mu)的在(zai)于(yu)及時救治、補償工傷(shang)(shang)職工。雖(sui)然《工傷(shang)(shang)保險條例》對(dui)爭(zheng)議焦點(dian)問題(ti)未作明文規(gui)定，但從其立法目(mu)的和相(xiang)關法理可知，工傷(shang)(shang)保險制度是(shi)為(wei)(wei)了分散用人單位的工傷(shang)(shang)風險，而非免除風險。
此外，原告超(chao)出社(she)保(bao)基金報銷(xiao)目錄范圍(wei)使用的(de)藥(yao)品(pin)確為治(zhi)療和康復必須品(pin)，在(zai)執(zhi)行工傷(shang)保(bao)險藥(yao)品(pin)目錄用藥(yao)與救治(zhi)勞動者之間，理應優先考(kao)慮救治(zhi)的(de)實際需要。由用人單位(wei)承擔(dan)社(she)保(bao)基金報銷(xiao)目錄范圍(wei)外的(de)非醫保(bao)用藥(yao)，有利于(yu)工傷(shang)職工的(de)治(zhi)療，也有利于(yu)用人單位(wei)重視(shi)生(sheng)產安全(quan)和工傷(shang)預防。
最終，法(fa)院(yuan)根據雙方當事人陳述和提供的證據，結合相關法(fa)律立法(fa)精神等綜合考慮，判決被告大(da)華(hua)公司除已支(zhi)(zhi)付的醫療(liao)費(fei)(fei)外，應再支(zhi)(zhi)付原告戴俊醫療(liao)費(fei)(fei)16萬(wan)余元，并支(zhi)(zhi)付停(ting)工(gong)留薪期間工(gong)資、護(hu)理費(fei)(fei)17萬(wan)余元。
一審判(pan)決(jue)后(hou)，被告大華(hua)公(gong)(gong)司不(bu)服(fu)判(pan)決(jue)，向衢州(zhou)市中(zhong)級人民法院(yuan)提出上訴。衢州(zhou)中(zhong)院(yuan)二(er)審判(pan)決(jue)駁回上訴，維持(chi)原判(pan)。此后(hou)，大華(hua)公(gong)(gong)司一次性(xing)履行(xing)了(le)義務。（文中(zhong)當(dang)事人系(xi)化名(ming)）
■裁判解析：
實(shi)現對(dui)受(shou)害勞動者最大限度救(jiu)濟
工傷保險作為社會保險體系的(de)一種類(lei)型，是勞動者在工傷的(de)情況(kuang)下，依法從國家和(he)社會獲得物質(zhi)幫助的(de)最(zui)主要的(de)一種途徑，是為了實(shi)現對受害(hai)人進行最(zui)大限(xian)度救濟(ji)的(de)可能，同時也是分(fen)散用(yong)人單位工傷風險壓力，不至(zhi)于(yu)因承擔過重的(de)責(ze)任而陷于(yu)破(po)產困境(jing)。
當前法(fa)律(lv)規定對超出工傷保險基金報(bao)銷(xiao)范圍(wei)的醫療費(fei)用由(you)誰(shui)承擔問題未作明(ming)確規定，故應當根據工傷保險立(li)法(fa)精神、相關(guan)法(fa)律(lv)、司法(fa)解(jie)釋以及法(fa)理進行綜合、體系考量。
第一(yi)，工(gong)(gong)傷(shang)保(bao)險的首要目(mu)的在于(yu)(yu)保(bao)障勞動者(zhe)的合法權益。《工(gong)(gong)傷(shang)保(bao)險條例(li)(li)》第一(yi)條開宗明(ming)義(yi)地表明(ming)了(le)制(zhi)定條例(li)(li)的目(mu)的，是為了(le)讓職工(gong)(gong)在遭受工(gong)(gong)傷(shang)時獲得醫療救(jiu)治和經濟補償(chang)。因此(ci)由用人單位來承擔(dan)工(gong)(gong)傷(shang)職工(gong)(gong)超(chao)出工(gong)(gong)傷(shang)保(bao)險賠付范圍(wei)的醫療費用體現了(le)其根本目(mu)的。同(tong)時，《工(gong)(gong)傷(shang)保(bao)險條例(li)(li)》并未對爭議(yi)問題作出明(ming)文規定，在行(xing)政(zheng)法規本身規定不明(ming)確的情況(kuang)下，應朝著有利于(yu)(yu)勞動者(zhe)利益的角度(du)進行(xing)理解。
第(di)二，我國現(xian)行(xing)的(de)(de)工(gong)(gong)傷(shang)保(bao)險(xian)制(zhi)度具有(you)(you)(you)民(min)(min)事(shi)(shi)(shi)(shi)(shi)(shi)(shi)侵權(quan)賠(pei)(pei)償(chang)(chang)和(he)社(she)會保(bao)險(xian)賠(pei)(pei)償(chang)(chang)雙重性質。《中華人(ren)(ren)(ren)民(min)(min)共和(he)國職業(ye)病防治(zhi)法(fa)(fa)》第(di)五十(shi)(shi)八條規(gui)定，“職業(ye)病病人(ren)(ren)(ren)除(chu)依(yi)法(fa)(fa)享有(you)(you)(you)工(gong)(gong)傷(shang)保(bao)險(xian)外，依(yi)照(zhao)有(you)(you)(you)關民(min)(min)事(shi)(shi)(shi)(shi)(shi)(shi)(shi)法(fa)(fa)律(lv)(lv)，尚有(you)(you)(you)獲得賠(pei)(pei)償(chang)(chang)的(de)(de)權(quan)利的(de)(de)，有(you)(you)(you)權(quan)向用人(ren)(ren)(ren)單位提出賠(pei)(pei)償(chang)(chang)要求(qiu)(qiu)”；《中華人(ren)(ren)(ren)民(min)(min)共和(he)國安全生(sheng)產法(fa)(fa)》第(di)五十(shi)(shi)六條規(gui)定，“生(sheng)產經營單位發生(sheng)生(sheng)產安全事(shi)(shi)(shi)(shi)(shi)(shi)(shi)故后，應當(dang)及(ji)時(shi)采(cai)取(qu)措施救治(zhi)有(you)(you)(you)關人(ren)(ren)(ren)員(yuan)。因生(sheng)產安全事(shi)(shi)(shi)(shi)(shi)(shi)(shi)故受到損害的(de)(de)從(cong)業(ye)人(ren)(ren)(ren)員(yuan)，除(chu)依(yi)法(fa)(fa)享有(you)(you)(you)工(gong)(gong)傷(shang)保(bao)險(xian)外，依(yi)照(zhao)有(you)(you)(you)關民(min)(min)事(shi)(shi)(shi)(shi)(shi)(shi)(shi)法(fa)(fa)律(lv)(lv)尚有(you)(you)(you)獲得賠(pei)(pei)償(chang)(chang)的(de)(de)權(quan)利的(de)(de)，有(you)(you)(you)權(quan)提出賠(pei)(pei)償(chang)(chang)要求(qiu)(qiu)。”因此，勞(lao)動(dong)者除(chu)了享有(you)(you)(you)工(gong)(gong)傷(shang)保(bao)險(xian)之外，還享有(you)(you)(you)向用人(ren)(ren)(ren)單位主(zhu)張(zhang)民(min)(min)事(shi)(shi)(shi)(shi)(shi)(shi)(shi)賠(pei)(pei)償(chang)(chang)的(de)(de)權(quan)利。《中華人(ren)(ren)(ren)民(min)(min)共和(he)國民(min)(min)法(fa)(fa)典》第(di)一(yi)千一(yi)百六十(shi)(shi)六條規(gui)定，行(xing)為人(ren)(ren)(ren)造成他人(ren)(ren)(ren)民(min)(min)事(shi)(shi)(shi)(shi)(shi)(shi)(shi)權(quan)益損害，不(bu)論行(xing)為人(ren)(ren)(ren)有(you)(you)(you)無過錯，法(fa)(fa)律(lv)(lv)規(gui)定應當(dang)承擔(dan)侵權(quan)責(ze)任(ren)(ren)的(de)(de)，依(yi)照(zhao)其規(gui)定。勞(lao)動(dong)者發生(sheng)傷(shang)害事(shi)(shi)(shi)(shi)(shi)(shi)(shi)故或因職業(ye)病被認(ren)定為工(gong)(gong)傷(shang)，在工(gong)(gong)傷(shang)經濟補償(chang)(chang)時(shi)應遵循無過錯責(ze)任(ren)(ren)原(yuan)則。據(ju)此，勞(lao)動(dong)者在發生(sheng)工(gong)(gong)傷(shang)事(shi)(shi)(shi)(shi)(shi)(shi)(shi)故后，可以根據(ju)無過錯責(ze)任(ren)(ren)原(yuan)則向用人(ren)(ren)(ren)單位主(zhu)張(zhang)民(min)(min)事(shi)(shi)(shi)(shi)(shi)(shi)(shi)賠(pei)(pei)償(chang)(chang)，此時(shi)如果超出社(she)保(bao)基金(jin)報銷目錄范圍的(de)(de)費用仍(reng)由勞(lao)動(dong)者自行(xing)承擔(dan)，則與現(xian)行(xing)的(de)(de)法(fa)(fa)律(lv)(lv)規(gui)定相違背。
第三(san)，民(min)事活(huo)動應當(dang)(dang)遵(zun)循公(gong)平(ping)原(yuan)則和(he)(he)公(gong)序(xu)良(liang)俗原(yuan)則。民(min)法典第六(liu)條(tiao)規定(ding)，“民(min)事主(zhu)體從事民(min)事活(huo)動，應當(dang)(dang)遵(zun)循公(gong)平(ping)原(yuan)則，合(he)(he)理確定(ding)各(ge)方的(de)權利和(he)(he)義務。”用(yong)(yong)人(ren)單(dan)(dan)位是生產經(jing)(jing)營活(huo)動的(de)受(shou)益者(zhe)(zhe)，對勞動者(zhe)(zhe)負有安全保障義務，與勞動者(zhe)(zhe)相(xiang)比，用(yong)(yong)人(ren)單(dan)(dan)位更(geng)具(ju)有經(jing)(jing)濟實力和(he)(he)風(feng)險抵抗能力，由用(yong)(yong)人(ren)單(dan)(dan)位承擔相(xiang)應費(fei)用(yong)(yong)，更(geng)符合(he)(he)公(gong)平(ping)原(yuan)則。同時，事故發生后，用(yong)(yong)人(ren)單(dan)(dan)位應以工傷(shang)救治的(de)客觀需求(qiu)為出發點，盡最大(da)努力，采(cai)取一切合(he)(he)理手段幫助勞動者(zhe)(zhe)盡早康(kang)復。因此(ci)，由用(yong)(yong)人(ren)單(dan)(dan)位承擔超出社保基金報(bao)銷目錄范圍的(de)費(fei)用(yong)(yong)也更(geng)符合(he)(he)公(gong)序(xu)良(liang)俗。
■專家點評：
精(jing)準(zhun)定位工傷保(bao)險制(zhi)度功(gong)能
西(xi)北政法大學經(jing)濟法學院教授 曹(cao) 燕
當勞動者不幸(xing)遭受工(gong)傷(shang)(shang)時，可以(yi)憑借以(yi)下三(san)種(zhong)法律(lv)制(zhi)度尋求救濟：第(di)一，勞動法上的工(gong)傷(shang)(shang)補(bu)償(chang)制(zhi)度；第(di)二，工(gong)傷(shang)(shang)保險法上的保險賠付制(zhi)度；第(di)三(san)，通(tong)過被視為工(gong)傷(shang)(shang)的民事訴(su)訟制(zhi)度，向雇(gu)主(zhu)行(xing)使損害賠償(chang)請(qing)求權(quan)。
一(yi)是(shi)用(yong)人單(dan)位負有(you)勞(lao)動法(fa)(fa)上(shang)的(de)(de)(de)工(gong)(gong)(gong)傷(shang)(shang)(shang)補償(chang)責任(ren)。工(gong)(gong)(gong)傷(shang)(shang)(shang)通(tong)常是(shi)由企業(ye)在(zai)生(sheng)產、經(jing)營過(guo)(guo)程中客觀存(cun)在(zai)、無法(fa)(fa)完全(quan)消(xiao)除的(de)(de)(de)危(wei)險或系統性風險所導致(zhi)的(de)(de)(de)，用(yong)人單(dan)位通(tong)常對此(ci)并(bing)無主觀上(shang)的(de)(de)(de)故意(yi)或過(guo)(guo)失。現代勞(lao)動法(fa)(fa)在(zai)形成(cheng)與發(fa)展中逐步(bu)認識到，勞(lao)動者是(shi)為增進(jin)雇主利(li)益(yi)而工(gong)(gong)(gong)作并(bing)受到傷(shang)(shang)(shang)害，雇主有(you)責任(ren)從盈利(li)中給(gei)予勞(lao)動者一(yi)定(ding)數額的(de)(de)(de)經(jing)濟(ji)補償(chang)，方能平衡勞(lao)資(zi)雙(shuang)方之利(li)益(yi)，促進(jin)勞(lao)資(zi)合(he)作，保(bao)障勞(lao)動關系安定(ding)。因此(ci)，我(wo)國逐步(bu)修正了(le)民法(fa)(fa)對于職業(ye)傷(shang)(shang)(shang)害補償(chang)的(de)(de)(de)過(guo)(guo)錯(cuo)責任(ren)原(yuan)則，建立(li)了(le)雇主工(gong)(gong)(gong)傷(shang)(shang)(shang)補償(chang)的(de)(de)(de)無過(guo)(guo)錯(cuo)責任(ren)原(yuan)則，即(ji)勞(lao)動法(fa)(fa)上(shang)的(de)(de)(de)工(gong)(gong)(gong)傷(shang)(shang)(shang)補償(chang)以(yi)發(fa)生(sheng)特定(ding)的(de)(de)(de)工(gong)(gong)(gong)傷(shang)(shang)(shang)事故之事實為前(qian)提，并(bing)不追究該等傷(shang)(shang)(shang)害是(shi)否由雇主過(guo)(guo)錯(cuo)所致(zhi)。
《中華人(ren)民共和國勞(lao)(lao)動(dong)法》等相關法律(lv)同(tong)樣貫徹了(le)(le)(le)上述規(gui)(gui)制理念。勞(lao)(lao)動(dong)法規(gui)(gui)定(ding)(ding)，用(yong)(yong)人(ren)單(dan)位有義務依法保(bao)障勞(lao)(lao)動(dong)者獲得勞(lao)(lao)動(dong)安(an)全衛生(sheng)保(bao)護的權利。該法還規(gui)(gui)定(ding)(ding)了(le)(le)(le)用(yong)(yong)人(ren)單(dan)位預防工(gong)傷事(shi)故，減(jian)少職(zhi)業災害的職(zhi)責(ze)。同(tong)時，《工(gong)傷保(bao)險(xian)條(tiao)(tiao)例》將(jiang)工(gong)傷界定(ding)(ding)為勞(lao)(lao)動(dong)者在工(gong)作中遭受(shou)的事(shi)故傷害或患職(zhi)業病。該條(tiao)(tiao)例第(di)十四條(tiao)(tiao)至第(di)十六條(tiao)(tiao)規(gui)(gui)定(ding)(ding)的認定(ding)(ding)工(gong)傷諸情形，均為與雇主(zhu)過錯(cuo)無(wu)直接關聯的事(shi)實。綜上可見，我(wo)國勞(lao)(lao)動(dong)法及其有關行政配套規(gui)(gui)定(ding)(ding)，貫徹了(le)(le)(le)用(yong)(yong)人(ren)單(dan)位負有工(gong)傷補(bu)償的無(wu)過錯(cuo)責(ze)任原(yuan)則之國際通例。
二是(shi)(shi)(shi)工(gong)(gong)(gong)(gong)(gong)(gong)(gong)傷(shang)(shang)(shang)保(bao)(bao)險(xian)是(shi)(shi)(shi)為了(le)(le)分(fen)散用(yong)(yong)人單(dan)(dan)位的(de)(de)(de)工(gong)(gong)(gong)(gong)(gong)(gong)(gong)傷(shang)(shang)(shang)風(feng)險(xian)，而(er)不(bu)是(shi)(shi)(shi)完全免(mian)除(chu)用(yong)(yong)人單(dan)(dan)位的(de)(de)(de)工(gong)(gong)(gong)(gong)(gong)(gong)(gong)傷(shang)(shang)(shang)補(bu)償(chang)(chang)責(ze)(ze)任。國(guo)家(jia)建(jian)立工(gong)(gong)(gong)(gong)(gong)(gong)(gong)傷(shang)(shang)(shang)保(bao)(bao)險(xian)制度，是(shi)(shi)(shi)為了(le)(le)確保(bao)(bao)勞動者在受工(gong)(gong)(gong)(gong)(gong)(gong)(gong)傷(shang)(shang)(shang)或患(huan)職(zhi)業(ye)病時獲得及時救助，而(er)讓(rang)用(yong)(yong)人單(dan)(dan)位預先(xian)加入國(guo)家(jia)運營(ying)的(de)(de)(de)工(gong)(gong)(gong)(gong)(gong)(gong)(gong)傷(shang)(shang)(shang)保(bao)(bao)險(xian)，再由(you)國(guo)家(jia)從(cong)保(bao)(bao)險(xian)基金(jin)中直接向受害的(de)(de)(de)勞動者或其遺(yi)屬支付保(bao)(bao)險(xian)金(jin)。因此，在法律規定的(de)(de)(de)支付范圍內，免(mian)除(chu)雇主的(de)(de)(de)工(gong)(gong)(gong)(gong)(gong)(gong)(gong)傷(shang)(shang)(shang)補(bu)償(chang)(chang)責(ze)(ze)任，但(dan)是(shi)(shi)(shi)，超過工(gong)(gong)(gong)(gong)(gong)(gong)(gong)傷(shang)(shang)(shang)保(bao)(bao)險(xian)范圍之外的(de)(de)(de)工(gong)(gong)(gong)(gong)(gong)(gong)(gong)傷(shang)(shang)(shang)補(bu)償(chang)(chang)責(ze)(ze)任理(li)應由(you)用(yong)(yong)人單(dan)(dan)位自己承擔。故而(er)，工(gong)(gong)(gong)(gong)(gong)(gong)(gong)傷(shang)(shang)(shang)保(bao)(bao)險(xian)實質上是(shi)(shi)(shi)對用(yong)(yong)人單(dan)(dan)位工(gong)(gong)(gong)(gong)(gong)(gong)(gong)傷(shang)(shang)(shang)補(bu)償(chang)(chang)的(de)(de)(de)責(ze)(ze)任保(bao)(bao)險(xian)。正如《工(gong)(gong)(gong)(gong)(gong)(gong)(gong)傷(shang)(shang)(shang)保(bao)(bao)險(xian)條(tiao)例(li)》第一(yi)條(tiao)所言，建(jian)立工(gong)(gong)(gong)(gong)(gong)(gong)(gong)傷(shang)(shang)(shang)保(bao)(bao)險(xian)制度是(shi)(shi)(shi)為了(le)(le)“分(fen)散用(yong)(yong)人單(dan)(dan)位的(de)(de)(de)工(gong)(gong)(gong)(gong)(gong)(gong)(gong)傷(shang)(shang)(shang)風(feng)險(xian)”，并不(bu)是(shi)(shi)(shi)免(mian)除(chu)用(yong)(yong)人單(dan)(dan)位的(de)(de)(de)工(gong)(gong)(gong)(gong)(gong)(gong)(gong)傷(shang)(shang)(shang)補(bu)償(chang)(chang)責(ze)(ze)任。
綜上(shang)，本案(an)法院判決恰當(dang)地區分了用人(ren)單位(wei)的工(gong)傷補償與工(gong)傷保險支付的責任邊界，準確地定位(wei)了工(gong)傷保險的制度功能，于法有據，說理(li)充分，有利(li)于化解此類糾紛引發的勞資矛(mao)盾。
■編后：
最高人民(min)(min)法(fa)(fa)院院長張軍強調(diao)，要(yao)牢牢把(ba)握“公正”這個(ge)根本(ben)要(yao)求，積極(ji)回應“效(xiao)率(lv)”這一(yi)人民(min)(min)期盼，圍繞(rao)抓實“公正與效(xiao)率(lv)”持(chi)續(xu)深(shen)化改(gai)革創(chuang)新；要(yao)把(ba)政治效(xiao)果(guo)(guo)(guo)、社會效(xiao)果(guo)(guo)(guo)、法(fa)(fa)律(lv)效(xiao)果(guo)(guo)(guo)統籌考慮，更加重視釋法(fa)(fa)說理(li)，實質性解決問題(ti)，讓司法(fa)(fa)裁(cai)判(pan)真正符合人民(min)(min)群(qun)眾普(pu)遍的、樸(pu)素的感受，才叫(jiao)“實現”公平正義(yi)。本(ben)案中，人民(min)(min)法(fa)(fa)院在辦案中堅持(chi)能動(dong)(dong)(dong)司法(fa)(fa)，裁(cai)判(pan)結果(guo)(guo)(guo)既實現了讓勞(lao)動(dong)(dong)(dong)者(zhe)得(de)到完(wan)全救濟，又起到了警醒用人單位提高安全保障意識的雙重效(xiao)果(guo)(guo)(guo)，對切實保障勞(lao)動(dong)(dong)(dong)者(zhe)合法(fa)(fa)權益、構建和諧勞(lao)動(dong)(dong)(dong)關系起到了積極(ji)的促(cu)進作用。
日期：2023-9-11 9:39:43 | 關閉 |
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