當前位置：法律圖書館>>法治動態>>法規釋義>>《最高人民法(fa)院(yuan)關于(yu)審理工傷保險行政(zheng)案件若干(gan)問題的規定》的理解與(yu)適用
《最高人民法院關于審理工傷保險行政案件若干問題的規定》的理解與適用
//cciia.org.cn 2014-8-21 8:38:30 來源：人民(min)法(fa)院報(bao)
馬永欣 李濤 楊科雄
最高人(ren)民(min)法院于近日發布的《最高人(ren)民(min)法院關于審理(li)工傷(shang)保(bao)(bao)險(xian)行(xing)(xing)政(zheng)案件若干問題的規(gui)(gui)定(ding)》（以下簡稱《規(gui)(gui)定(ding)》）將于2014年(nian)9月1日起施行(xing)(xing)。正確(que)理(li)解(jie)和(he)適用這一司法解(jie)釋相關規(gui)(gui)定(ding)的精(jing)神，對于依法正確(que)審理(li)工傷(shang)保(bao)(bao)險(xian)行(xing)(xing)政(zheng)案件具有(you)重要意義。
一(yi)、司法(fa)解釋的(de)起草背(bei)景
2010年10月(yue)，全國人大常委會(hui)審(shen)議通過了(le)(le)《中(zhong)華人民共和國社會(hui)保(bao)險(xian)法(fa)》，對(dui)(dui)工(gong)(gong)(gong)(gong)(gong)傷(shang)(shang)保(bao)險(xian)制度作了(le)(le)一(yi)些(xie)新(xin)(xin)的(de)規(gui)定(ding)。隨后(hou)，國務院(yuan)對(dui)(dui)《工(gong)(gong)(gong)(gong)(gong)傷(shang)(shang)保(bao)險(xian)條(tiao)(tiao)例》進行了(le)(le)修訂，并(bing)于2011年1月(yue)1日起實施。隨著新(xin)(xin)修訂《工(gong)(gong)(gong)(gong)(gong)傷(shang)(shang)保(bao)險(xian)條(tiao)(tiao)例》的(de)實施，工(gong)(gong)(gong)(gong)(gong)傷(shang)(shang)保(bao)險(xian)參保(bao)范圍進一(yi)步(bu)擴大，參保(bao)人數(shu)也不(bu)斷增(zeng)加，工(gong)(gong)(gong)(gong)(gong)傷(shang)(shang)保(bao)險(xian)行政(zheng)案(an)(an)(an)件(jian)(jian)數(shu)量有進一(yi)步(bu)上升的(de)趨勢。據統(tong)計(ji)，近幾(ji)年案(an)(an)(an)件(jian)(jian)數(shu)排(pai)在(zai)各類行政(zheng)案(an)(an)(an)件(jian)(jian)前4位。工(gong)(gong)(gong)(gong)(gong)傷(shang)(shang)保(bao)險(xian)行政(zheng)案(an)(an)(an)件(jian)(jian)涉(she)及(ji)民生(sheng)，關系到(dao)職(zhi)工(gong)(gong)(gong)(gong)(gong)的(de)切身利益(yi)， 直接(jie)影響社會(hui)穩定(ding)。相(xiang)關行政(zheng)案(an)(an)(an)件(jian)(jian)審(shen)判過程中(zhong)新(xin)(xin)情(qing)況新(xin)(xin)問題(ti)不(bu)斷出(chu)(chu)現(xian)，解決糾紛的(de)難(nan)度日益(yi)增(zeng)大，已經成(cheng)為當前法(fa)院(yuan)審(shen)理(li)案(an)(an)(an)件(jian)(jian)和化解矛(mao)盾的(de)重點難(nan)點。為了(le)(le)妥善處理(li)工(gong)(gong)(gong)(gong)(gong)傷(shang)(shang)保(bao)險(xian)行政(zheng)糾紛，依法(fa)審(shen)理(li)工(gong)(gong)(gong)(gong)(gong)傷(shang)(shang)保(bao)險(xian)行政(zheng)案(an)(an)(an)件(jian)(jian)，統(tong)一(yi)司法(fa)尺(chi)度，最高人民法(fa)院(yuan)按照“依法(fa)保(bao)障工(gong)(gong)(gong)(gong)(gong)傷(shang)(shang)職(zhi)工(gong)(gong)(gong)(gong)(gong)權益(yi)、大力促進社會(hui)公平正(zheng)義”要求，經反復(fu)調研并(bing)征求各方意見，制定(ding)出(chu)(chu)臺了(le)(le)本《規(gui)定(ding)》。
二、關于影響工傷(shang)認定的(de)特殊情形的(de)認定問題
《工(gong)(gong)傷(shang)(shang)保(bao)(bao)險(xian)條(tiao)例》第(di)(di)(di)(di)十四(si)條(tiao)、第(di)(di)(di)(di)十五條(tiao)規定(ding)了認(ren)定(ding)工(gong)(gong)傷(shang)(shang)或(huo)者視同(tong)(tong)工(gong)(gong)傷(shang)(shang)的(de)具體條(tiao)件(jian)，同(tong)(tong)時(shi)該條(tiao)例第(di)(di)(di)(di)十四(si)條(tiao)的(de)部分(fen)內容(rong)和(he)第(di)(di)(di)(di)十六(liu)條(tiao)也(ye)明確出(chu)現“本人主要(yao)責任的(de)交通事故(gu)”、“醉(zui)酒(jiu)或(huo)者吸毒”和(he)“自(zi)殘或(huo)者自(zi)殺”等(deng)特(te)殊情形時(shi)，職工(gong)(gong)雖(sui)然(ran)符(fu)合工(gong)(gong)傷(shang)(shang)或(huo)者視同(tong)(tong)工(gong)(gong)傷(shang)(shang)的(de)條(tiao)件(jian)，但(dan)也(ye)不能(neng)認(ren)定(ding)為工(gong)(gong)傷(shang)(shang)或(huo)者視同(tong)(tong)工(gong)(gong)傷(shang)(shang)。《規定(ding)》第(di)(di)(di)(di)一條(tiao)的(de)主要(yao)目的(de)在于(yu)明確《工(gong)(gong)傷(shang)(shang)保(bao)(bao)險(xian)條(tiao)例》第(di)(di)(di)(di)十四(si)條(tiao)、第(di)(di)(di)(di)十六(liu)條(tiao)關于(yu)不認(ren)定(ding)工(gong)(gong)傷(shang)(shang)或(huo)者不視同(tong)(tong)工(gong)(gong)傷(shang)(shang)的(de)特(te)殊情形的(de)認(ren)定(ding)問題(ti)。本條(tiao)主要(yao)明確以下(xia)幾(ji)點內容(rong)：
1.因(yin)特殊(shu)(shu)情(qing)形(xing)(xing)(xing)(xing)不(bu)(bu)(bu)(bu)認(ren)(ren)(ren)(ren)定(ding)(ding)(ding)(ding)(ding)工(gong)傷(shang)或(huo)者不(bu)(bu)(bu)(bu)視同工(gong)傷(shang)的(de)，必須提(ti)供特殊(shu)(shu)情(qing)形(xing)(xing)(xing)(xing)存在(zai)的(de)證據。有(you)(you)些工(gong)傷(shang)認(ren)(ren)(ren)(ren)定(ding)(ding)(ding)(ding)(ding)案件中，因(yin)沒(mei)(mei)有(you)(you)有(you)(you)權機關出具(ju)的(de)“非本人主(zhu)要(yao)責任的(de)交通事(shi)故”、“醉酒”、“自殺”等特殊(shu)(shu)情(qing)形(xing)(xing)(xing)(xing)的(de)認(ren)(ren)(ren)(ren)定(ding)(ding)(ding)(ding)(ding)意見，社(she)會(hui)保(bao)險行(xing)政部(bu)門往(wang)往(wang)以(yi)無相關認(ren)(ren)(ren)(ren)定(ding)(ding)(ding)(ding)(ding)意見，無法(fa)判斷(duan)是否(fou)屬(shu)于(yu)特定(ding)(ding)(ding)(ding)(ding)情(qing)形(xing)(xing)(xing)(xing)為(wei)由，長時(shi)間中止(zhi)工(gong)傷(shang)認(ren)(ren)(ren)(ren)定(ding)(ding)(ding)(ding)(ding)程序或(huo)者不(bu)(bu)(bu)(bu)認(ren)(ren)(ren)(ren)定(ding)(ding)(ding)(ding)(ding)為(wei)工(gong)傷(shang)。我們認(ren)(ren)(ren)(ren)為(wei)，因(yin)存在(zai)特殊(shu)(shu)情(qing)形(xing)(xing)(xing)(xing)而(er)排除(chu)工(gong)傷(shang)認(ren)(ren)(ren)(ren)定(ding)(ding)(ding)(ding)(ding)，社(she)會(hui)保(bao)險部(bu)門的(de)不(bu)(bu)(bu)(bu)予認(ren)(ren)(ren)(ren)定(ding)(ding)(ding)(ding)(ding)工(gong)傷(shang)決定(ding)(ding)(ding)(ding)(ding)必須以(yi)能夠證明存在(zai)特殊(shu)(shu)情(qing)形(xing)(xing)(xing)(xing)的(de)證據為(wei)依據，如果(guo)沒(mei)(mei)有(you)(you)相關證據，而(er)職(zhi)工(gong)受(shou)傷(shang)害符(fu)合認(ren)(ren)(ren)(ren)定(ding)(ding)(ding)(ding)(ding)為(wei)工(gong)傷(shang)的(de)其他條(tiao)件，則應當認(ren)(ren)(ren)(ren)定(ding)(ding)(ding)(ding)(ding)為(wei)工(gong)傷(shang)，不(bu)(bu)(bu)(bu)能以(yi)沒(mei)(mei)有(you)(you)有(you)(you)權機構的(de)法(fa)律(lv)文書(shu)為(wei)由拖(tuo)延認(ren)(ren)(ren)(ren)定(ding)(ding)(ding)(ding)(ding)或(huo)不(bu)(bu)(bu)(bu)予認(ren)(ren)(ren)(ren)定(ding)(ding)(ding)(ding)(ding)。
2.特殊情(qing)形是(shi)否(fou)存(cun)在，原則(ze)上應(ying)當以有(you)權機(ji)構(gou)(gou)(gou)的(de)事(shi)故責任認(ren)定書、結論性意(yi)見和人民法(fa)院的(de)生(sheng)效裁判(pan)等法(fa)律(lv)文書為判(pan)斷(duan)依據(ju)。特殊情(qing)形是(shi)否(fou)存(cun)在，涉及到特定部門或者(zhe)(zhe)特殊機(ji)構(gou)(gou)(gou)的(de)專(zhuan)業(ye)(ye)分析和權威(wei)判(pan)斷(duan)，如交通(tong)事(shi)故責任、自殺、醉酒等，專(zhuan)業(ye)(ye)的(de)權威(wei)機(ji)構(gou)(gou)(gou)判(pan)斷(duan)或者(zhe)(zhe)經訴訟程序對證(zheng)(zheng)據(ju)嚴格(ge)審核后認(ren)定的(de)事(shi)實，屬于公認(ren)的(de)證(zheng)(zheng)明(ming)力較高的(de)證(zheng)(zheng)據(ju)材料。當然，也不排除上述(shu)法(fa)律(lv)文書出現錯誤的(de)可能，本條(tiao)同時也規(gui)定了出現相反證(zheng)(zheng)據(ju)的(de)處理方式(shi)。
3.沒有有權(quan)機構(gou)或人(ren)民(min)法(fa)(fa)(fa)院的法(fa)(fa)(fa)律(lv)文(wen)書(shu)時，社會(hui)保險行政部(bu)(bu)門可(ke)以結(jie)合(he)相(xiang)關證據作出事實認(ren)(ren)定(ding)，但(dan)是(shi)，涉及到“故意(yi)犯罪”事實的認(ren)(ren)定(ding)，必(bi)須以刑(xing)事偵查(cha)機關、檢察機關和(he)審判機關的生效法(fa)(fa)(fa)律(lv)文(wen)書(shu)和(he)結(jie)論性意(yi)見(jian)為依據，社會(hui)保險行政部(bu)(bu)門無權(quan)認(ren)(ren)定(ding)。主要考慮到，雖然特殊情(qing)形(xing)的認(ren)(ren)定(ding)具(ju)有較(jiao)強的專(zhuan)業(ye)技術特點，但(dan)在(zai)當事人(ren)無法(fa)(fa)(fa)獲得相(xiang)關法(fa)(fa)(fa)律(lv)文(wen)書(shu)或者法(fa)(fa)(fa)律(lv)文(wen)書(shu)內容(rong)不明確時，社會(hui)保險行政部(bu)(bu)門基于履行工傷認(ren)(ren)定(ding)的法(fa)(fa)(fa)定(ding)職責的需要，根據《工傷保險條例》第十九條的規(gui)定(ding)，行使調(diao)查(cha)核(he)(he)實權(quan)對是(shi)否存(cun)在(zai)特殊情(qing)形(xing)的作出的明確認(ren)(ren)定(ding)，人(ren)民(min)法(fa)(fa)(fa)院應當依法(fa)(fa)(fa)予以審核(he)(he)。
三、關于工傷認定中出(chu)現是否(fou)存在勞動關系的爭議應(ying)當(dang)如何(he)處理(li)的問題(ti)
人(ren)(ren)(ren)(ren)民法院(yuan)在受(shou)理工傷認定(ding)行(xing)政案件(jian)后發現(xian)職工或者(zhe)(zhe)用(yong)人(ren)(ren)(ren)(ren)單位對(dui)(dui)是否(fou)存(cun)(cun)在勞(lao)(lao)動關(guan)(guan)(guan)系發生(sheng)爭議(yi)，在處理方式上(shang)應當區分情(qing)(qing)況分別對(dui)(dui)待。第(di)一種情(qing)(qing)況是，職工和(he)用(yong)人(ren)(ren)(ren)(ren)單位對(dui)(dui)是否(fou)存(cun)(cun)在勞(lao)(lao)動關(guan)(guan)(guan)系發生(sheng)爭議(yi)，提(ti)起(qi)行(xing)政訴訟(song)前已經申(shen)請勞(lao)(lao)動仲裁或者(zhe)(zhe)提(ti)起(qi)民事訴訟(song)的，人(ren)(ren)(ren)(ren)民法院(yuan)應當中止正在審(shen)理的工傷認定(ding)行(xing)政案件(jian)；第(di)二種情(qing)(qing)況是職工和(he)用(yong)人(ren)(ren)(ren)(ren)單位對(dui)(dui)是否(fou)存(cun)(cun)在勞(lao)(lao)動關(guan)(guan)(guan)系發生(sheng)爭議(yi)，沒有申(shen)請勞(lao)(lao)動仲裁或者(zhe)(zhe)提(ti)起(qi)民事訴訟(song)的，人(ren)(ren)(ren)(ren)民法院(yuan)可以在審(shen)理工傷認定(ding)行(xing)政案件(jian)時一并對(dui)(dui)是否(fou)存(cun)(cun)在勞(lao)(lao)動關(guan)(guan)(guan)系進行(xing)審(shen)查。
主要(yao)(yao)考(kao)慮到(dao)，勞(lao)(lao)(lao)(lao)動(dong)(dong)行(xing)(xing)政(zheng)部(bu)(bu)門在(zai)(zai)(zai)工(gong)(gong)傷(shang)(shang)(shang)認(ren)(ren)(ren)定程序中(zhong)(zhong)(zhong)，具有(you)(you)認(ren)(ren)(ren)定受(shou)(shou)到(dao)傷(shang)(shang)(shang)害的(de)(de)(de)職(zhi)(zhi)(zhi)工(gong)(gong)與企(qi)業之(zhi)間是(shi)否(fou)(fou)存在(zai)(zai)(zai)勞(lao)(lao)(lao)(lao)動(dong)(dong)關(guan)系(xi)的(de)(de)(de)職(zhi)(zhi)(zhi)權(quan)(quan)。社(she)會(hui)(hui)(hui)保(bao)險(xian)行(xing)(xing)政(zheng)部(bu)(bu)門在(zai)(zai)(zai)工(gong)(gong)傷(shang)(shang)(shang)認(ren)(ren)(ren)定程序中(zhong)(zhong)(zhong)已經(jing)對是(shi)否(fou)(fou)存在(zai)(zai)(zai)勞(lao)(lao)(lao)(lao)動(dong)(dong)關(guan)系(xi)作出了判斷，進入到(dao)行(xing)(xing)政(zheng)訴(su)(su)(su)訟(song)(song)程序后，人(ren)(ren)民(min)法(fa)(fa)(fa)院(yuan)可以對社(she)會(hui)(hui)(hui)保(bao)險(xian)部(bu)(bu)門就是(shi)否(fou)(fou)存在(zai)(zai)(zai)勞(lao)(lao)(lao)(lao)動(dong)(dong)關(guan)系(xi)的(de)(de)(de)認(ren)(ren)(ren)定進行(xing)(xing)審(shen)查，職(zhi)(zhi)(zhi)工(gong)(gong)或(huo)(huo)(huo)(huo)者(zhe)用(yong)人(ren)(ren)單(dan)位(wei)無需就是(shi)否(fou)(fou)存在(zai)(zai)(zai)勞(lao)(lao)(lao)(lao)動(dong)(dong)關(guan)系(xi)另行(xing)(xing)申(shen)請(qing)(qing)勞(lao)(lao)(lao)(lao)動(dong)(dong)仲(zhong)(zhong)裁(cai)(cai)(cai)或(huo)(huo)(huo)(huo)者(zhe)提(ti)起(qi)民(min)事(shi)訴(su)(su)(su)訟(song)(song)。另外，效率(lv)和(he)便(bian)民(min)問題也(ye)是(shi)處理(li)方式(shi)選擇上的(de)(de)(de)重要(yao)(yao)考(kao)量因(yin)(yin)素(su)。《社(she)會(hui)(hui)(hui)保(bao)險(xian)法(fa)(fa)(fa)》第(di)三十六條第(di)二款(kuan)規(gui)定，認(ren)(ren)(ren)定程序應當盡可能簡便(bian)。如果社(she)會(hui)(hui)(hui)保(bao)險(xian)行(xing)(xing)政(zheng)部(bu)(bu)門已對是(shi)否(fou)(fou)存在(zai)(zai)(zai)勞(lao)(lao)(lao)(lao)動(dong)(dong)關(guan)系(xi)作出了判斷，在(zai)(zai)(zai)行(xing)(xing)政(zheng)訴(su)(su)(su)訟(song)(song)中(zhong)(zhong)(zhong)再要(yao)(yao)求原告或(huo)(huo)(huo)(huo)者(zhe)第(di)三人(ren)(ren)另行(xing)(xing)申(shen)請(qing)(qing)勞(lao)(lao)(lao)(lao)動(dong)(dong)仲(zhong)(zhong)裁(cai)(cai)(cai)或(huo)(huo)(huo)(huo)者(zhe)提(ti)起(qi)民(min)事(shi)訴(su)(su)(su)訟(song)(song)，中(zhong)(zhong)(zhong)止(zhi)行(xing)(xing)政(zheng)訴(su)(su)(su)訟(song)(song)，必(bi)然會(hui)(hui)(hui)因(yin)(yin)繁(fan)多的(de)(de)(de)程序導致效率(lv)低(di)下，往(wang)往(wang)耽(dan)誤(wu)了受(shou)(shou)傷(shang)(shang)(shang)職(zhi)(zhi)(zhi)工(gong)(gong)及(ji)時的(de)(de)(de)治療和(he)康復，也(ye)導致在(zai)(zai)(zai)實踐中(zhong)(zhong)(zhong)很多勞(lao)(lao)(lao)(lao)動(dong)(dong)者(zhe)因(yin)(yin)程序繁(fan)雜而放棄(qi)申(shen)請(qing)(qing)工(gong)(gong)傷(shang)(shang)(shang)認(ren)(ren)(ren)定或(huo)(huo)(huo)(huo)者(zhe)匆忙和(he)用(yong)人(ren)(ren)單(dan)位(wei)達成不(bu)(bu)平等的(de)(de)(de)協議，造成更多的(de)(de)(de)社(she)會(hui)(hui)(hui)矛盾，不(bu)(bu)利于職(zhi)(zhi)(zhi)工(gong)(gong)權(quan)(quan)益(yi)(yi)保(bao)護。一并進行(xing)(xing)審(shen)查，有(you)(you)利于防止(zhi)用(yong)人(ren)(ren)單(dan)位(wei)因(yin)(yin)工(gong)(gong)傷(shang)(shang)(shang)認(ren)(ren)(ren)定對己不(bu)(bu)利時，故意就是(shi)否(fou)(fou)存在(zai)(zai)(zai)勞(lao)(lao)(lao)(lao)動(dong)(dong)關(guan)系(xi)申(shen)請(qing)(qing)勞(lao)(lao)(lao)(lao)動(dong)(dong)仲(zhong)(zhong)裁(cai)(cai)(cai)或(huo)(huo)(huo)(huo)者(zhe)提(ti)起(qi)民(min)事(shi)訴(su)(su)(su)訟(song)(song)，借此拖延行(xing)(xing)政(zheng)案件的(de)(de)(de)審(shen)理(li)，損害工(gong)(gong)傷(shang)(shang)(shang)職(zhi)(zhi)(zhi)工(gong)(gong)合法(fa)(fa)(fa)權(quan)(quan)益(yi)(yi)。同(tong)時，鑒(jian)于《勞(lao)(lao)(lao)(lao)動(dong)(dong)法(fa)(fa)(fa)》、《勞(lao)(lao)(lao)(lao)動(dong)(dong)爭議調解仲(zhong)(zhong)裁(cai)(cai)(cai)法(fa)(fa)(fa)》和(he)《民(min)事(shi)訴(su)(su)(su)訟(song)(song)法(fa)(fa)(fa)》有(you)(you)關(guan)“申(shen)請(qing)(qing)勞(lao)(lao)(lao)(lao)動(dong)(dong)仲(zhong)(zhong)裁(cai)(cai)(cai)或(huo)(huo)(huo)(huo)者(zhe)提(ti)起(qi)民(min)事(shi)訴(su)(su)(su)訟(song)(song)”的(de)(de)(de)規(gui)定，人(ren)(ren)民(min)法(fa)(fa)(fa)院(yuan)發現原告或(huo)(huo)(huo)(huo)者(zhe)第(di)三人(ren)(ren)在(zai)(zai)(zai)提(ti)起(qi)行(xing)(xing)政(zheng)訴(su)(su)(su)訟(song)(song)前已經(jing)就是(shi)否(fou)(fou)存在(zai)(zai)(zai)勞(lao)(lao)(lao)(lao)動(dong)(dong)關(guan)系(xi)申(shen)請(qing)(qing)勞(lao)(lao)(lao)(lao)動(dong)(dong)仲(zhong)(zhong)裁(cai)(cai)(cai)或(huo)(huo)(huo)(huo)者(zhe)提(ti)起(qi)民(min)事(shi)訴(su)(su)(su)訟(song)(song)的(de)(de)(de)，應當依法(fa)(fa)(fa)中(zhong)(zhong)(zhong)止(zhi)工(gong)(gong)傷(shang)(shang)(shang)認(ren)(ren)(ren)定行(xing)(xing)政(zheng)案件的(de)(de)(de)審(shen)理(li)。
四、關(guan)于特殊情(qing)況下(xia)如何確定(ding)用人單位的(de)問題
一般情(qing)況下，職工(gong)只(zhi)有(you)(you)一個(ge)工(gong)作(zuo)(zuo)單(dan)(dan)(dan)位，承(cheng)擔工(gong)傷(shang)(shang)保險(xian)責(ze)任(ren)的(de)(de)用人單(dan)(dan)(dan)位是(shi)工(gong)傷(shang)(shang)發生時(shi)職工(gong)的(de)(de)工(gong)作(zuo)(zuo)單(dan)(dan)(dan)位，但(dan)在(zai)特殊(shu)情(qing)況下，工(gong)傷(shang)(shang)發生時(shi)與(yu)職工(gong)存在(zai)工(gong)作(zuo)(zuo)關系的(de)(de)單(dan)(dan)(dan)位有(you)(you)兩個(ge)以(yi)上，如何確(que)(que)定(ding)(ding)承(cheng)擔工(gong)傷(shang)(shang)保險(xian)責(ze)任(ren)的(de)(de)用人單(dan)(dan)(dan)位，《規(gui)定(ding)(ding)》第三條(tiao)概括了下列(lie)情(qing)況下確(que)(que)定(ding)(ding)承(cheng)擔工(gong)傷(shang)(shang)保險(xian)責(ze)任(ren)的(de)(de)用人單(dan)(dan)(dan)位的(de)(de)規(gui)則(ze)。
1.職工(gong)(gong)與兩個(ge)以(yi)(yi)上單位(wei)(wei)存在勞(lao)動(dong)關(guan)系，應當以(yi)(yi)發生工(gong)(gong)傷(shang)(shang)事故時，職工(gong)(gong)實際為(wei)(wei)之工(gong)(gong)作的(de)(de)單位(wei)(wei)為(wei)(wei)承擔工(gong)(gong)傷(shang)(shang)保險責任的(de)(de)用人單位(wei)(wei)。此(ci)種情況下，難以(yi)(yi)區分多個(ge)勞(lao)動(dong)關(guan)系的(de)(de)主(zhu)次，工(gong)(gong)傷(shang)(shang)認定應當以(yi)(yi)誰受益(yi)、誰負責的(de)(de)原(yuan)則(ze)界定責任主(zhu)體。
2.指(zhi)(zhi)派(pai)(pai)(pai)、派(pai)(pai)(pai)遣(qian)關系(xi)(xi)(xi)情況下承擔工(gong)(gong)(gong)傷保(bao)險責任的(de)(de)用(yong)(yong)人(ren)(ren)單(dan)位的(de)(de)確定(ding)(ding)，主要考(kao)(kao)慮(lv)了(le)(le)職工(gong)(gong)(gong)與(yu)(yu)指(zhi)(zhi)派(pai)(pai)(pai)、派(pai)(pai)(pai)遣(qian)單(dan)位以(yi)及實際工(gong)(gong)(gong)作(zuo)單(dan)位形成(cheng)的(de)(de)雙重(zhong)工(gong)(gong)(gong)作(zuo)關系(xi)(xi)(xi)，與(yu)(yu)第一項(xiang)規(gui)定(ding)(ding)中(zhong)的(de)(de)多(duo)個(ge)勞動(dong)關系(xi)(xi)(xi)存(cun)在區(qu)別(bie)。職工(gong)(gong)(gong)與(yu)(yu)多(duo)個(ge)用(yong)(yong)人(ren)(ren)單(dan)位形成(cheng)的(de)(de)多(duo)個(ge)勞動(dong)關系(xi)(xi)(xi)之(zhi)間互相獨(du)(du)立，無法(fa)區(qu)分主次(ci)，而(er)在指(zhi)(zhi)派(pai)(pai)(pai)、派(pai)(pai)(pai)遣(qian)關系(xi)(xi)(xi)中(zhong)，兩個(ge)用(yong)(yong)人(ren)(ren)關系(xi)(xi)(xi)存(cun)在主次(ci)區(qu)別(bie)，職工(gong)(gong)(gong)與(yu)(yu)指(zhi)(zhi)派(pai)(pai)(pai)和派(pai)(pai)(pai)遣(qian)單(dan)位之(zhi)間的(de)(de)用(yong)(yong)人(ren)(ren)關系(xi)(xi)(xi)是主要的(de)(de)、獨(du)(du)立的(de)(de)用(yong)(yong)人(ren)(ren)關系(xi)(xi)(xi)，而(er)與(yu)(yu)被指(zhi)(zhi)派(pai)(pai)(pai)或(huo)被派(pai)(pai)(pai)遣(qian)到的(de)(de)實際工(gong)(gong)(gong)作(zuo)單(dan)位之(zhi)間的(de)(de)用(yong)(yong)人(ren)(ren)關系(xi)(xi)(xi)是因(yin)指(zhi)(zhi)派(pai)(pai)(pai)和派(pai)(pai)(pai)遣(qian)而(er)形成(cheng)的(de)(de)次(ci)要的(de)(de)、附屬的(de)(de)用(yong)(yong)人(ren)(ren)關系(xi)(xi)(xi)，不能獨(du)(du)立存(cun)在。另外，勞務派(pai)(pai)(pai)遣(qian)關系(xi)(xi)(xi)中(zhong)用(yong)(yong)人(ren)(ren)單(dan)位的(de)(de)確定(ding)(ding)，除考(kao)(kao)慮(lv)以(yi)上(shang)因(yin)素(su)外，還考(kao)(kao)慮(lv)了(le)(le)《勞動(dong)合同(tong)法(fa)》第五(wu)十八條(tiao)規(gui)定(ding)(ding)，勞務派(pai)(pai)(pai)遣(qian)單(dan)位是本法(fa)所稱用(yong)(yong)人(ren)(ren)單(dan)位，應當履(lv)行用(yong)(yong)人(ren)(ren)單(dan)位對勞動(dong)者的(de)(de)義務。
3.存在轉包(bao)關(guan)(guan)系(xi)的(de)(de)情況(kuang)下，發生工(gong)(gong)(gong)傷事故時用人(ren)單位的(de)(de)確定(ding)，以有利于保護職工(gong)(gong)(gong)為原(yuan)則。本規(gui)定(ding)是對原(yuan)勞動(dong)和社會(hui)(hui)保障部2005年5月25日勞社部發［2005］12號《關(guan)(guan)于確立勞動(dong)關(guan)(guan)系(xi)有關(guan)(guan)事項的(de)(de)通知》第四條(tiao)(tiao)關(guan)(guan)于“建筑施工(gong)(gong)(gong)、礦山企業等用人(ren)單位將工(gong)(gong)(gong)程(cheng)（業務）或(huo)(huo)經營權發包(bao)給不具備(bei)用工(gong)(gong)(gong)主(zhu)體(ti)資(zi)格的(de)(de)組(zu)織或(huo)(huo)自(zi)然人(ren)，對該組(zu)織或(huo)(huo)自(zi)然人(ren)招用的(de)(de)勞動(dong)者，由具備(bei)用工(gong)(gong)(gong)主(zhu)體(ti)資(zi)格的(de)(de)發包(bao)方承(cheng)擔用工(gong)(gong)(gong)主(zhu)體(ti)責任(ren)”規(gui)定(ding)的(de)(de)發展(zhan)，也吸收(shou)采納了(le)《人(ren)力資(zi)源(yuan)和社會(hui)(hui)保障部關(guan)(guan)于執行〈工(gong)(gong)(gong)傷保險條(tiao)(tiao)例(li)〉若干(gan)問題的(de)(de)意見》（人(ren)社部發〔2013〕34號）第七條(tiao)(tiao)的(de)(de)精神。
4.掛(gua)(gua)靠(kao)關系(xi)中(zhong)用(yong)(yong)人(ren)(ren)(ren)單(dan)(dan)位(wei)的(de)(de)(de)確定(ding)，最高人(ren)(ren)(ren)民法院行(xing)政庭(ting)［2006］行(xing)他字(zi)第17號批復《關于車輛(liang)掛(gua)(gua)靠(kao)其(qi)他單(dan)(dan)位(wei)經營(ying)(ying)車輛(liang)實際所有(you)(you)人(ren)(ren)(ren)聘(pin)用(yong)(yong)的(de)(de)(de)司機工(gong)(gong)作(zuo)中(zhong)傷亡能否(fou)認(ren)(ren)(ren)定(ding)為(wei)(wei)工(gong)(gong)傷問題的(de)(de)(de)請示(shi)》已(yi)經予以(yi)明(ming)確。關于掛(gua)(gua)靠(kao)經營(ying)(ying)過程中(zhong)，聘(pin)用(yong)(yong)的(de)(de)(de)人(ren)(ren)(ren)員(yuan)與掛(gua)(gua)靠(kao)單(dan)(dan)位(wei)之(zhi)間是(shi)否(fou)存(cun)在勞(lao)動關系(xi)的(de)(de)(de)問題，存(cun)在不(bu)同(tong)認(ren)(ren)(ren)識。我們認(ren)(ren)(ren)為(wei)(wei)，本(ben)條(tiao)(tiao)規定(ding)主要是(shi)從有(you)(you)利于職工(gong)(gong)的(de)(de)(de)角度(du)出發，其(qi)原理與轉包(bao)關系(xi)中(zhong)無用(yong)(yong)工(gong)(gong)主體資格組織(zhi)或個人(ren)(ren)(ren)聘(pin)用(yong)(yong)的(de)(de)(de)人(ren)(ren)(ren)從事發包(bao)工(gong)(gong)程遭受工(gong)(gong)傷情況下的(de)(de)(de)用(yong)(yong)人(ren)(ren)(ren)單(dan)(dan)位(wei)確認(ren)(ren)(ren)相同(tong)，不(bu)以(yi)是(shi)否(fou)存(cun)在真實勞(lao)動關系(xi)為(wei)(wei)前(qian)提，這是(shi)對工(gong)(gong)傷保險條(tiao)(tiao)例將勞(lao)動關系(xi)作(zuo)為(wei)(wei)工(gong)(gong)傷認(ren)(ren)(ren)定(ding)前(qian)提的(de)(de)(de)一般規定(ding)之(zhi)外的(de)(de)(de)特殊情形處(chu)理。需要注意的(de)(de)(de)有(you)(you)兩點，一是(shi)掛(gua)(gua)靠(kao)人(ren)(ren)(ren)是(shi)自然人(ren)(ren)(ren)，單(dan)(dan)位(wei)掛(gua)(gua)靠(kao)不(bu)能適(shi)用(yong)(yong)本(ben)條(tiao)(tiao)；二是(shi)僅(jin)適(shi)用(yong)(yong)于掛(gua)(gua)靠(kao)人(ren)(ren)(ren)聘(pin)用(yong)(yong)的(de)(de)(de)人(ren)(ren)(ren)員(yuan)，不(bu)包(bao)括掛(gua)(gua)靠(kao)人(ren)(ren)(ren)。
由(you)于轉包(bao)關系(xi)(xi)和(he)(he)掛靠(kao)關系(xi)(xi)中職工(gong)(gong)(gong)和(he)(he)承(cheng)(cheng)擔(dan)工(gong)(gong)(gong)傷(shang)保(bao)險(xian)(xian)責(ze)任(ren)(ren)的(de)(de)(de)(de)用人(ren)(ren)單位(wei)之間(jian)并(bing)不存(cun)在(zai)真實(shi)(shi)(shi)的(de)(de)(de)(de)勞動關系(xi)(xi)，對職工(gong)(gong)(gong)造成傷(shang)害(hai)的(de)(de)(de)(de)實(shi)(shi)(shi)際(ji)(ji)侵權(quan)人(ren)(ren)仍然(ran)是不具有用工(gong)(gong)(gong)主(zhu)體(ti)資(zi)格的(de)(de)(de)(de)組織、自然(ran)人(ren)(ren)。確定用工(gong)(gong)(gong)單位(wei)和(he)(he)被掛靠(kao)單位(wei)作(zuo)為承(cheng)(cheng)擔(dan)工(gong)(gong)(gong)傷(shang)保(bao)險(xian)(xian)責(ze)任(ren)(ren)的(de)(de)(de)(de)用人(ren)(ren)單位(wei)，雖然(ran)有利于保(bao)護職工(gong)(gong)(gong)的(de)(de)(de)(de)合法(fa)權(quan)益，但在(zai)責(ze)任(ren)(ren)的(de)(de)(de)(de)承(cheng)(cheng)擔(dan)上，由(you)工(gong)(gong)(gong)傷(shang)保(bao)險(xian)(xian)基金支付(fu)工(gong)(gong)(gong)傷(shang)保(bao)險(xian)(xian)待遇(yu)，會出現免除(chu)實(shi)(shi)(shi)際(ji)(ji)侵權(quan)人(ren)(ren)賠償(chang)責(ze)任(ren)(ren)的(de)(de)(de)(de)不公(gong)平現象。為解決(jue)這一問題，司(si)法(fa)解釋(shi)明確了承(cheng)(cheng)擔(dan)工(gong)(gong)(gong)傷(shang)保(bao)險(xian)(xian)責(ze)任(ren)(ren)的(de)(de)(de)(de)用人(ren)(ren)單位(wei)和(he)(he)社會保(bao)險(xian)(xian)經辦(ban)機構在(zai)實(shi)(shi)(shi)際(ji)(ji)承(cheng)(cheng)擔(dan)工(gong)(gong)(gong)傷(shang)保(bao)險(xian)(xian)責(ze)任(ren)(ren)后，可(ke)以根據實(shi)(shi)(shi)際(ji)(ji)支出的(de)(de)(de)(de)工(gong)(gong)(gong)傷(shang)保(bao)險(xian)(xian)待遇(yu)，向實(shi)(shi)(shi)際(ji)(ji)侵權(quan)人(ren)(ren)行(xing)使追(zhui)償(chang)權(quan)。
五、關于工(gong)作原(yuan)因、工(gong)作時間和工(gong)作場所在工(gong)傷(shang)認定(ding)中(zhong)所起作用的問(wen)題
法(fa)律法(fa)規對 “工(gong)作原因(yin)”、“工(gong)作場所”和“工(gong)作時(shi)間”（以(yi)(yi)下(xia)簡稱為“三工(gong)”）規定的比(bi)較(jiao)(jiao)原則(ze)，具有(you)較(jiao)(jiao)大的解釋空間和較(jiao)(jiao)高(gao)的適應性，能夠滿足(zu)不斷發(fa)展的實踐需求(qiu)；但是由于比(bi)較(jiao)(jiao)原則(ze)容易產生分歧，容易導致標準不統一的問題。《規定》第四條明確(que)以(yi)(yi)下(xia)情況(kuang)可以(yi)(yi)認定為工(gong)傷：
1.職(zhi)工(gong)(gong)(gong)(gong)在工(gong)(gong)(gong)(gong)作(zuo)(zuo)時間和工(gong)(gong)(gong)(gong)作(zuo)(zuo)場(chang)所(suo)內受到傷(shang)害，用(yong)人單位或者社會(hui)保(bao)險行政部門沒有證據證明是(shi)(shi)非工(gong)(gong)(gong)(gong)作(zuo)(zuo)原因(yin)(yin)導(dao)致的(de)。工(gong)(gong)(gong)(gong)傷(shang)認定(ding)(ding)(ding)的(de)“三工(gong)(gong)(gong)(gong)”要素中(zhong)，工(gong)(gong)(gong)(gong)作(zuo)(zuo)原因(yin)(yin)是(shi)(shi)核心(xin)要件(jian)，是(shi)(shi)認定(ding)(ding)(ding)工(gong)(gong)(gong)(gong)傷(shang)的(de)充分條(tiao)件(jian)。即使(shi)不(bu)在工(gong)(gong)(gong)(gong)作(zuo)(zuo)時間、工(gong)(gong)(gong)(gong)作(zuo)(zuo)場(chang)所(suo)，但只要是(shi)(shi)工(gong)(gong)(gong)(gong)作(zuo)(zuo)原因(yin)(yin)，同樣應(ying)當認定(ding)(ding)(ding)為工(gong)(gong)(gong)(gong)傷(shang)。工(gong)(gong)(gong)(gong)作(zuo)(zuo)場(chang)所(suo)和工(gong)(gong)(gong)(gong)作(zuo)(zuo)時間在工(gong)(gong)(gong)(gong)傷(shang)認定(ding)(ding)(ding)中(zhong)一(yi)(yi)方(fang)面是(shi)(shi)補強工(gong)(gong)(gong)(gong)作(zuo)(zuo)原因(yin)(yin)，另一(yi)(yi)方(fang)面是(shi)(shi)在工(gong)(gong)(gong)(gong)作(zuo)(zuo)原因(yin)(yin)無法查(cha)明時，用(yong)以推定(ding)(ding)(ding)是(shi)(shi)否屬于工(gong)(gong)(gong)(gong)作(zuo)(zuo)原因(yin)(yin)。因(yin)(yin)此(ci)，在工(gong)(gong)(gong)(gong)作(zuo)(zuo)場(chang)所(suo)和工(gong)(gong)(gong)(gong)作(zuo)(zuo)時間內，沒有證據證明是(shi)(shi)非工(gong)(gong)(gong)(gong)作(zuo)(zuo)原因(yin)(yin)導(dao)致職(zhi)工(gong)(gong)(gong)(gong)傷(shang)亡的(de)亦應(ying)認定(ding)(ding)(ding)為工(gong)(gong)(gong)(gong)傷(shang)。
2.職工(gong)參加(jia)(jia)用人單(dan)位(wei)(wei)組(zu)織(zhi)或(huo)者(zhe)受(shou)(shou)用人單(dan)位(wei)(wei)指(zhi)派參加(jia)(jia)其(qi)他(ta)單(dan)位(wei)(wei)組(zu)織(zhi)的(de)(de)活(huo)(huo)動受(shou)(shou)到傷害的(de)(de)。關(guan)于職工(gong)在參加(jia)(jia)本(ben)單(dan)位(wei)(wei)或(huo)者(zhe)受(shou)(shou)用人單(dan)位(wei)(wei)指(zhi)派參加(jia)(jia)其(qi)他(ta)單(dan)位(wei)(wei)組(zu)織(zhi)的(de)(de)集(ji)體活(huo)(huo)動受(shou)(shou)到傷害是否認(ren)(ren)定工(gong)傷的(de)(de)問題，爭(zheng)議較(jiao)大。我們認(ren)(ren)為，如果屬于用人單(dan)位(wei)(wei)強制要求(qiu)或(huo)者(zhe)鼓勵(li)參加(jia)(jia)的(de)(de)集(ji)體活(huo)(huo)動，這些活(huo)(huo)動可以被認(ren)(ren)為是工(gong)作(zuo)的(de)(de)一個組(zu)成部分，應該屬于工(gong)作(zuo)原因，由此受(shou)(shou)到的(de)(de)傷害應當認(ren)(ren)定為工(gong)傷。
3.在(zai)工(gong)(gong)(gong)作時間(jian)(jian)內(nei)，職(zhi)工(gong)(gong)(gong)來往于(yu)多個與其工(gong)(gong)(gong)作職(zhi)責(ze)相關的(de)(de)(de)(de)工(gong)(gong)(gong)作場(chang)(chang)(chang)所之間(jian)(jian)的(de)(de)(de)(de)合理區域因(yin)(yin)工(gong)(gong)(gong)受(shou)(shou)到傷(shang)(shang)害(hai)的(de)(de)(de)(de)。對(dui)工(gong)(gong)(gong)作場(chang)(chang)(chang)所的(de)(de)(de)(de)認(ren)定(ding)，既不(bu)宜(yi)過(guo)于(yu)寬泛(fan)也(ye)不(bu)宜(yi)過(guo)于(yu)狹窄。實踐中將(jiang)完成工(gong)(gong)(gong)作所應當(dang)(dang)經過(guo)或(huo)可能經過(guo)的(de)(de)(de)(de)區域確定(ding)為工(gong)(gong)(gong)作場(chang)(chang)(chang)所比(bi)較合理。這里(li)所說的(de)(de)(de)(de)“為履行(xing)工(gong)(gong)(gong)作職(zhi)責(ze)應當(dang)(dang)經過(guo)或(huo)可能經過(guo)的(de)(de)(de)(de)場(chang)(chang)(chang)所”是(shi)對(dui)工(gong)(gong)(gong)作場(chang)(chang)(chang)所的(de)(de)(de)(de)合理延(yan)伸，因(yin)(yin)其與工(gong)(gong)(gong)作職(zhi)責(ze)有直(zhi)接關聯，應當(dang)(dang)認(ren)定(ding)為工(gong)(gong)(gong)作場(chang)(chang)(chang)所。因(yin)(yin)此，職(zhi)工(gong)(gong)(gong)來往于(yu)多個與其工(gong)(gong)(gong)作職(zhi)責(ze)相關的(de)(de)(de)(de)工(gong)(gong)(gong)作場(chang)(chang)(chang)所之間(jian)(jian)的(de)(de)(de)(de)合理區域因(yin)(yin)工(gong)(gong)(gong)受(shou)(shou)到傷(shang)(shang)害(hai)的(de)(de)(de)(de)，應當(dang)(dang)認(ren)定(ding)為工(gong)(gong)(gong)傷(shang)(shang)。
4.其他與(yu)履行工(gong)(gong)作職責相關，在(zai)工(gong)(gong)作時間和(he)涉及的(de)合理區(qu)域內受到(dao)傷(shang)害(hai)的(de)。此項(xiang)既為兜底條(tiao)(tiao)款，也(ye)是對(dui)《工(gong)(gong)傷(shang)保險(xian)條(tiao)(tiao)例》第十四條(tiao)(tiao)第（一）項(xiang)“職工(gong)(gong)在(zai)工(gong)(gong)作時間和(he)工(gong)(gong)作場(chang)所內，因工(gong)(gong)作原因受到(dao)事故傷(shang)害(hai)的(de)，應當認(ren)定(ding)為工(gong)(gong)傷(shang)”規(gui)定(ding)作出(chu)的(de)進(jin)一步(bu)解(jie)釋。
六(liu)、關于(yu)“因工外出期間”的規定
關(guan)于“因(yin)(yin)(yin)工(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)外(wai)(wai)(wai)(wai)(wai)(wai)(wai)出(chu)期(qi)間(jian)(jian)”的認定。“因(yin)(yin)(yin)工(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)外(wai)(wai)(wai)(wai)(wai)(wai)(wai)出(chu)期(qi)間(jian)(jian)”屬于“工(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)作(zuo)(zuo)(zuo)(zuo)(zuo)(zuo)時(shi)(shi)間(jian)(jian)”的一種特殊情(qing)形。《工(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)傷(shang)(shang)保(bao)險條(tiao)例(li)》第(di)(di)(di)十(shi)四條(tiao)第(di)(di)(di)（五）項(xiang)規(gui)定，職(zhi)(zhi)工(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)因(yin)(yin)(yin)工(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)外(wai)(wai)(wai)(wai)(wai)(wai)(wai)出(chu)期(qi)間(jian)(jian)，由于工(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)作(zuo)(zuo)(zuo)(zuo)(zuo)(zuo)原因(yin)(yin)(yin)受到(dao)傷(shang)(shang)害(hai)或(huo)者(zhe)發(fa)(fa)生(sheng)事(shi)故下落不明的，應(ying)當認定為(wei)工(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)傷(shang)(shang)。這里的“因(yin)(yin)(yin)工(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)外(wai)(wai)(wai)(wai)(wai)(wai)(wai)出(chu)期(qi)間(jian)(jian)”和(he)通(tong)常意(yi)義(yi)的“工(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)作(zuo)(zuo)(zuo)(zuo)(zuo)(zuo)時(shi)(shi)間(jian)(jian)”是不同的。通(tong)常意(yi)義(yi)的“工(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)作(zuo)(zuo)(zuo)(zuo)(zuo)(zuo)時(shi)(shi)間(jian)(jian)”是指(zhi)《工(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)傷(shang)(shang)保(bao)險條(tiao)例(li)》第(di)(di)(di)十(shi)四條(tiao)第(di)(di)(di)（一）、（二(er)）、（三(san)(san)）項(xiang)、第(di)(di)(di)十(shi)五條(tiao)第(di)(di)(di)（一）項(xiang)規(gui)定的“工(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)作(zuo)(zuo)(zuo)(zuo)(zuo)(zuo)時(shi)(shi)間(jian)(jian)”，多數發(fa)(fa)生(sheng)在(zai)工(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)作(zuo)(zuo)(zuo)(zuo)(zuo)(zuo)場(chang)所或(huo)工(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)作(zuo)(zuo)(zuo)(zuo)(zuo)(zuo)崗(gang)位(wei)內，而“因(yin)(yin)(yin)工(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)外(wai)(wai)(wai)(wai)(wai)(wai)(wai)出(chu)期(qi)間(jian)(jian)”則發(fa)(fa)生(sheng)在(zai)工(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)作(zuo)(zuo)(zuo)(zuo)(zuo)(zuo)場(chang)所和(he)工(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)作(zuo)(zuo)(zuo)(zuo)(zuo)(zuo)崗(gang)位(wei)之(zhi)外(wai)(wai)(wai)(wai)(wai)(wai)(wai)，是用人單(dan)(dan)位(wei)為(wei)了(le)工(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)作(zuo)(zuo)(zuo)(zuo)(zuo)(zuo)指(zhi)派職(zhi)(zhi)工(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)或(huo)者(zhe)職(zhi)(zhi)工(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)因(yin)(yin)(yin)工(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)作(zuo)(zuo)(zuo)(zuo)(zuo)(zuo)需要，在(zai)工(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)作(zuo)(zuo)(zuo)(zuo)(zuo)(zuo)場(chang)所或(huo)工(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)作(zuo)(zuo)(zuo)(zuo)(zuo)(zuo)崗(gang)位(wei)以外(wai)(wai)(wai)(wai)(wai)(wai)(wai)從事(shi)與(yu)工(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)作(zuo)(zuo)(zuo)(zuo)(zuo)(zuo)有關(guan)的活(huo)(huo)動(dong)期(qi)間(jian)(jian)。因(yin)(yin)(yin)此，“因(yin)(yin)(yin)工(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)外(wai)(wai)(wai)(wai)(wai)(wai)(wai)出(chu)期(qi)間(jian)(jian)”可以從職(zhi)(zhi)工(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)外(wai)(wai)(wai)(wai)(wai)(wai)(wai)出(chu)是否因(yin)(yin)(yin)工(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)作(zuo)(zuo)(zuo)(zuo)(zuo)(zuo)或(huo)者(zhe)為(wei)用人單(dan)(dan)位(wei)的正當利(li)益等(deng)方面綜(zong)合考慮。為(wei)了(le)更(geng)好地明確“因(yin)(yin)(yin)工(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)外(wai)(wai)(wai)(wai)(wai)(wai)(wai)出(chu)期(qi)間(jian)(jian)”的有關(guan)情(qing)形，本條(tiao)第(di)(di)(di)一款列(lie)舉(ju)了(le)三(san)(san)種情(qing)形：（一）職(zhi)(zhi)工(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)受用人單(dan)(dan)位(wei)指(zhi)派或(huo)者(zhe)因(yin)(yin)(yin)工(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)作(zuo)(zuo)(zuo)(zuo)(zuo)(zuo)需要在(zai)工(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)作(zuo)(zuo)(zuo)(zuo)(zuo)(zuo)場(chang)所以外(wai)(wai)(wai)(wai)(wai)(wai)(wai)從事(shi)與(yu)工(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)作(zuo)(zuo)(zuo)(zuo)(zuo)(zuo)職(zhi)(zhi)責有關(guan)的活(huo)(huo)動(dong)期(qi)間(jian)(jian)。（二(er)）職(zhi)(zhi)工(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)受用人單(dan)(dan)位(wei)指(zhi)派外(wai)(wai)(wai)(wai)(wai)(wai)(wai)出(chu)學習或(huo)者(zhe)開會的活(huo)(huo)動(dong)期(qi)間(jian)(jian)。（三(san)(san)）職(zhi)(zhi)工(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)因(yin)(yin)(yin)工(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)作(zuo)(zuo)(zuo)(zuo)(zuo)(zuo)需要的其他外(wai)(wai)(wai)(wai)(wai)(wai)(wai)出(chu)期(qi)間(jian)(jian)。此為(wei)兜底條(tiao)款。
關于(yu)職(zhi)工(gong)(gong)因(yin)工(gong)(gong)外(wai)(wai)出(chu)(chu)期(qi)間(jian)的(de)(de)(de)(de)工(gong)(gong)傷(shang)(shang)(shang)認定。《工(gong)(gong)傷(shang)(shang)(shang)保(bao)險(xian)條(tiao)(tiao)例》第(di)(di)十(shi)四(si)條(tiao)(tiao)第(di)(di)（五(wu)）項規(gui)定：“職(zhi)工(gong)(gong)因(yin)工(gong)(gong)外(wai)(wai)出(chu)(chu)期(qi)間(jian)，由(you)于(yu)工(gong)(gong)作(zuo)(zuo)(zuo)(zuo)(zuo)原因(yin)受(shou)到傷(shang)(shang)(shang)害(hai)(hai)(hai)(hai)(hai)或者(zhe)發生(sheng)事故下落不明的(de)(de)(de)(de)，應當認定為(wei)(wei)工(gong)(gong)傷(shang)(shang)(shang)”。如何理(li)解這(zhe)里所(suo)規(gui)定的(de)(de)(de)(de)“工(gong)(gong)作(zuo)(zuo)(zuo)(zuo)(zuo)原因(yin)”，存在(zai)較大(da)爭(zheng)議(yi)。我們認為(wei)(wei)，“因(yin)工(gong)(gong)外(wai)(wai)出(chu)(chu)期(qi)間(jian)”較之一般工(gong)(gong)作(zuo)(zuo)(zuo)(zuo)(zuo)時(shi)間(jian)存在(zai)許多(duo)不可預測的(de)(de)(de)(de)風險(xian)，這(zhe)些風險(xian)由(you)職(zhi)工(gong)(gong)承(cheng)擔(dan)不甚(shen)公(gong)平；2010年《工(gong)(gong)傷(shang)(shang)(shang)保(bao)險(xian)條(tiao)(tiao)例》第(di)(di)十(shi)四(si)條(tiao)(tiao)第(di)(di)（五(wu)）項規(gui)定的(de)(de)(de)(de)“由(you)于(yu)工(gong)(gong)作(zuo)(zuo)(zuo)(zuo)(zuo)原因(yin)受(shou)到傷(shang)(shang)(shang)害(hai)(hai)(hai)(hai)(hai)”是指由(you)于(yu)工(gong)(gong)作(zuo)(zuo)(zuo)(zuo)(zuo)原因(yin)直(zhi)接(jie)或間(jian)接(jie)造成(cheng)(cheng)的(de)(de)(de)(de)包括(kuo)事故傷(shang)(shang)(shang)害(hai)(hai)(hai)(hai)(hai)、暴力(li)傷(shang)(shang)(shang)害(hai)(hai)(hai)(hai)(hai)和其他(ta)形(xing)式的(de)(de)(de)(de)傷(shang)(shang)(shang)害(hai)(hai)(hai)(hai)(hai)。既包括(kuo)與(yu)工(gong)(gong)作(zuo)(zuo)(zuo)(zuo)(zuo)直(zhi)接(jie)有關而形(xing)成(cheng)(cheng)的(de)(de)(de)(de)傷(shang)(shang)(shang)害(hai)(hai)(hai)(hai)(hai)，也包括(kuo)開(kai)展工(gong)(gong)作(zuo)(zuo)(zuo)(zuo)(zuo)過程中(zhong)所(suo)發生(sheng)的(de)(de)(de)(de)傷(shang)(shang)(shang)害(hai)(hai)(hai)(hai)(hai)，如外(wai)(wai)出(chu)(chu)途中(zhong)產生(sheng)的(de)(de)(de)(de)傷(shang)(shang)(shang)害(hai)(hai)(hai)(hai)(hai)，因(yin)住宿、餐飲等場所(suo)存在(zai)的(de)(de)(de)(de)不安全(quan)因(yin)素產生(sheng)的(de)(de)(de)(de)傷(shang)(shang)(shang)害(hai)(hai)(hai)(hai)(hai)等。因(yin)此(ci)，這(zhe)里的(de)(de)(de)(de)“工(gong)(gong)作(zuo)(zuo)(zuo)(zuo)(zuo)原因(yin)”是一個(ge)范圍很廣(guang)的(de)(de)(de)(de)概念(nian)。只要不屬于(yu)職(zhi)工(gong)(gong)從(cong)事與(yu)工(gong)(gong)作(zuo)(zuo)(zuo)(zuo)(zuo)或者(zhe)受(shou)用(yong)人單位指派外(wai)(wai)出(chu)(chu)學習、開(kai)會無關的(de)(de)(de)(de)個(ge)人活動受(shou)到傷(shang)(shang)(shang)害(hai)(hai)(hai)(hai)(hai)的(de)(de)(de)(de)，原則(ze)上應當認定為(wei)(wei)《工(gong)(gong)傷(shang)(shang)(shang)保(bao)險(xian)條(tiao)(tiao)例》第(di)(di)十(shi)四(si)條(tiao)(tiao)第(di)(di)（五(wu)）項規(gui)定的(de)(de)(de)(de)“由(you)于(yu)工(gong)(gong)作(zuo)(zuo)(zuo)(zuo)(zuo)原因(yin)受(shou)到傷(shang)(shang)(shang)害(hai)(hai)(hai)(hai)(hai)”。
七(qi)、關于(yu)上(shang)下班途(tu)中的規定
人民法(fa)院對“上下班途(tu)中”的(de)認定(ding)至少應當考慮以下三個要(yao)素(su)：一是(shi)目(mu)的(de)要(yao)素(su)。即以上下班為目(mu)的(de)；二(er)是(shi)時(shi)間要(yao)素(su)。即上下班時(shi)間是(shi)否合理；三是(shi)空間要(yao)素(su)。即往返于工作地和居住地的(de)路(lu)線是(shi)否合理。
為了更好指(zhi)導下級法院，《規定(ding)》第七條列(lie)舉了 “上下班途中”的具(ju)體情形：
1.以上(shang)下(xia)班(ban)為目的(de)(de)(de)，在合理(li)時間內(nei)往(wang)(wang)返(fan)于(yu)工(gong)作地(di)(di)和(he)住(zhu)(zhu)所(suo)地(di)(di)、經常(chang)居(ju)(ju)住(zhu)(zhu)地(di)(di)、單(dan)位提供的(de)(de)(de)居(ju)(ju)住(zhu)(zhu)地(di)(di)或者(zhe)(zhe)配(pei)偶(ou)父母子女(nv)居(ju)(ju)住(zhu)(zhu)地(di)(di)的(de)(de)(de)合理(li)路線的(de)(de)(de)途(tu)(tu)中(zhong)。實踐中(zhong)，工(gong)作地(di)(di)的(de)(de)(de)認(ren)定較(jiao)為簡單(dan)，而職工(gong)的(de)(de)(de)居(ju)(ju)住(zhu)(zhu)地(di)(di)，認(ren)定起來往(wang)(wang)往(wang)(wang)非常(chang)復(fu)雜。我們認(ren)為，鑒于(yu)“上(shang)下(xia)班(ban)途(tu)(tu)中(zhong)”的(de)(de)(de)情況(kuang)復(fu)雜，對“居(ju)(ju)住(zhu)(zhu)地(di)(di)”應當(dang)作廣義的(de)(de)(de)理(li)解(jie)。所(suo)謂的(de)(de)(de)“居(ju)(ju)住(zhu)(zhu)地(di)(di)”除住(zhu)(zhu)所(suo)地(di)(di)和(he)經常(chang)居(ju)(ju)住(zhu)(zhu)地(di)(di)外(wai)，還應當(dang)包括以下(xia)居(ju)(ju)住(zhu)(zhu)地(di)(di)：單(dan)位宿舍或者(zhe)(zhe)配(pei)偶(ou)、父母以及子女(nv)居(ju)(ju)住(zhu)(zhu)地(di)(di)等等。凡是職工(gong)以上(shang)下(xia)班(ban)為目的(de)(de)(de)，在合理(li)時間內(nei)往(wang)(wang)返(fan)于(yu)工(gong)作地(di)(di)和(he)上(shang)述住(zhu)(zhu)所(suo)地(di)(di)或者(zhe)(zhe)居(ju)(ju)住(zhu)(zhu)地(di)(di)的(de)(de)(de)合理(li)路線的(de)(de)(de)途(tu)(tu)中(zhong)，原則上(shang)應當(dang)認(ren)定為“上(shang)下(xia)班(ban)途(tu)(tu)中(zhong)”。
2.在(zai)(zai)(zai)(zai)上(shang)下(xia)(xia)(xia)班(ban)(ban)(ban)途中(zhong)(zhong)從(cong)事(shi)屬于(yu)(yu)日常工作生(sheng)活所必須的(de)活動(dong)，且(qie)在(zai)(zai)(zai)(zai)合(he)(he)理時間內(nei)(nei)未改變以上(shang)下(xia)(xia)(xia)班(ban)(ban)(ban)為目(mu)的(de)的(de)合(he)(he)理路線(xian)的(de)途中(zhong)(zhong)。在(zai)(zai)(zai)(zai)實(shi)(shi)踐(jian)中(zhong)(zhong)，爭議較大的(de)是(shi)職工在(zai)(zai)(zai)(zai)上(shang)下(xia)(xia)(xia)班(ban)(ban)(ban)途中(zhong)(zhong)繞(rao)道(dao)(dao)(dao)(dao)是(shi)否(fou)屬于(yu)(yu)“上(shang)下(xia)(xia)(xia)班(ban)(ban)(ban)途中(zhong)(zhong)”。我(wo)們(men)認為，是(shi)否(fou)屬于(yu)(yu)“上(shang)下(xia)(xia)(xia)班(ban)(ban)(ban)途中(zhong)(zhong)”應當(dang)視(shi)繞(rao)道(dao)(dao)(dao)(dao)的(de)原(yuan)(yuan)(yuan)因(yin)而(er)定。對于(yu)(yu)繞(rao)道(dao)(dao)(dao)(dao)的(de)原(yuan)(yuan)(yuan)因(yin)，實(shi)(shi)踐(jian)中(zhong)(zhong)有因(yin)客(ke)(ke)觀(guan)原(yuan)(yuan)(yuan)因(yin)（突發(fa)事(shi)件、交通堵塞、天氣惡劣等(deng)(deng)）而(er)繞(rao)道(dao)(dao)(dao)(dao)，也(ye)有因(yin)私事(shi)而(er)繞(rao)道(dao)(dao)(dao)(dao)等(deng)(deng)多種情形。因(yin)客(ke)(ke)觀(guan)原(yuan)(yuan)(yuan)因(yin)繞(rao)道(dao)(dao)(dao)(dao)的(de)，原(yuan)(yuan)(yuan)則上(shang)要認定為“上(shang)下(xia)(xia)(xia)班(ban)(ban)(ban)途中(zhong)(zhong)”。而(er)因(yin)私事(shi)而(er)繞(rao)道(dao)(dao)(dao)(dao)的(de)，不能一刀切(qie)，如(ru)職工在(zai)(zai)(zai)(zai)上(shang)下(xia)(xia)(xia)班(ban)(ban)(ban)途中(zhong)(zhong)從(cong)事(shi)屬于(yu)(yu)日常工作生(sheng)活所必須的(de)活動(dong)，且(qie)在(zai)(zai)(zai)(zai)合(he)(he)理時間內(nei)(nei)未改變以上(shang)下(xia)(xia)(xia)班(ban)(ban)(ban)為目(mu)的(de)的(de)合(he)(he)理路線(xian)的(de)途中(zhong)(zhong)，應當(dang)視(shi)為“上(shang)下(xia)(xia)(xia)班(ban)(ban)(ban)途中(zhong)(zhong)”，其他(ta)原(yuan)(yuan)(yuan)則上(shang)不宜(yi)認定為“上(shang)下(xia)(xia)(xia)班(ban)(ban)(ban)途中(zhong)(zhong)”。前者如(ru)接送孩子上(shang)學、去菜(cai)市(shi)場買菜(cai)等(deng)(deng)繞(rao)道(dao)(dao)(dao)(dao)，后者為下(xia)(xia)(xia)班(ban)(ban)(ban)后朋友聚會(hui)等(deng)(deng)等(deng)(deng)。
3.以上下班為(wei)(wei)目的，在合理(li)時(shi)間內其(qi)他合理(li)路線的途(tu)中。此項為(wei)(wei)兜底條款。
八(ba)、關于工傷(shang)認定申請法定期限的規定
根(gen)據2010年《工(gong)(gong)(gong)傷(shang)保(bao)險(xian)條(tiao)例》的(de)規定(ding)，用人單位工(gong)(gong)(gong)傷(shang)認(ren)(ren)(ren)定(ding)申(shen)(shen)(shen)(shen)請(qing)(qing)(qing)法(fa)(fa)定(ding)期限遇有特殊情況(kuang)，經報社(she)會保(bao)險(xian)行政(zheng)部門同(tong)意(yi)，申(shen)(shen)(shen)(shen)請(qing)(qing)(qing)時限可(ke)以適當(dang)延(yan)(yan)長(chang)(chang)。但對工(gong)(gong)(gong)傷(shang)職(zhi)工(gong)(gong)(gong)或者(zhe)其(qi)近(jin)親屬的(de)1年工(gong)(gong)(gong)傷(shang)認(ren)(ren)(ren)定(ding)申(shen)(shen)(shen)(shen)請(qing)(qing)(qing)法(fa)(fa)定(ding)期限是否可(ke)以適當(dang)延(yan)(yan)長(chang)(chang)則沒有明確規定(ding)。對此，有兩(liang)種(zhong)不(bu)(bu)同(tong)意(yi)見(jian)(jian)：一(yi)(yi)種(zhong)意(yi)見(jian)(jian)認(ren)(ren)(ren)為(wei)，《工(gong)(gong)(gong)傷(shang)保(bao)險(xian)條(tiao)例》第十七(qi)條(tiao)第二款規定(ding)的(de)是除斥期間，不(bu)(bu)能(neng)延(yan)(yan)長(chang)(chang)；另一(yi)(yi)種(zhong)意(yi)見(jian)(jian)認(ren)(ren)(ren)為(wei)，不(bu)(bu)屬于除斥期間，可(ke)以適當(dang)延(yan)(yan)長(chang)(chang)。我們認(ren)(ren)(ren)為(wei)，國務(wu)院法(fa)(fa)制辦（國法(fa)(fa)秘函［2005］39號）《對〈關于對〈工(gong)(gong)(gong)傷(shang)保(bao)險(xian)條(tiao)例〉第十七(qi)條(tiao)、第六十四條(tiao)關于工(gong)(gong)(gong)傷(shang)認(ren)(ren)(ren)定(ding)申(shen)(shen)(shen)(shen)請(qing)(qing)(qing)時限問題的(de)請(qing)(qing)(qing)示〉的(de)復(fu)函》明確“申(shen)(shen)(shen)(shen)請(qing)(qing)(qing)工(gong)(gong)(gong)傷(shang)認(ren)(ren)(ren)定(ding)時限應扣除因不(bu)(bu)可(ke)抗力耽誤(wu)的(de)時間”，由此可(ke)見(jian)(jian)，該條(tiao)規定(ding)的(de)不(bu)(bu)是除斥期間，申(shen)(shen)(shen)(shen)請(qing)(qing)(qing)時限依(yi)法(fa)(fa)可(ke)以延(yan)(yan)長(chang)(chang)，但應當(dang)有正(zheng)(zheng)當(dang)理由。《規定(ding)》第七(qi)條(tiao)將(jiang)延(yan)(yan)長(chang)(chang)的(de)正(zheng)(zheng)當(dang)理由明確為(wei)“不(bu)(bu)屬于職(zhi)工(gong)(gong)(gong)或者(zhe)其(qi)近(jin)親屬自身原(yuan)因”。主(zhu)要包括不(bu)(bu)可(ke)抗力和社(she)會保(bao)險(xian)行政(zheng)部門、用人單位等(deng)不(bu)(bu)當(dang)致(zhi)使受傷(shang)職(zhi)工(gong)(gong)(gong)或者(zhe)其(qi)近(jin)親屬耽誤(wu)工(gong)(gong)(gong)傷(shang)認(ren)(ren)(ren)定(ding)申(shen)(shen)(shen)(shen)請(qing)(qing)(qing)等(deng)情形。
九(jiu)、關于第三人侵權情況(kuang)下，工傷(shang)(shang)認定(ding)和工傷(shang)(shang)保險(xian)待遇(yu)支付的問題
關于職(zhi)工(gong)(gong)(gong)(gong)因第(di)(di)三(san)(san)(san)人侵(qin)(qin)(qin)(qin)(qin)權(quan)受(shou)到傷(shang)(shang)(shang)害，如(ru)何處理(li)第(di)(di)三(san)(san)(san)人侵(qin)(qin)(qin)(qin)(qin)權(quan)賠(pei)(pei)償(chang)(chang)(chang)責任(ren)和(he)工(gong)(gong)(gong)(gong)傷(shang)(shang)(shang)保(bao)(bao)(bao)(bao)險(xian)(xian)(xian)待遇(yu)(yu)(yu)支(zhi)付的(de)(de)關系(xi)，爭議(yi)較大。因第(di)(di)三(san)(san)(san)人侵(qin)(qin)(qin)(qin)(qin)權(quan)導致(zhi)職(zhi)工(gong)(gong)(gong)(gong)工(gong)(gong)(gong)(gong)傷(shang)(shang)(shang)的(de)(de)，根據(ju)侵(qin)(qin)(qin)(qin)(qin)權(quan)責任(ren)法(fa)和(he)社會保(bao)(bao)(bao)(bao)險(xian)(xian)(xian)法(fa)的(de)(de)規定(ding)，職(zhi)工(gong)(gong)(gong)(gong)既可以(yi)向(xiang)侵(qin)(qin)(qin)(qin)(qin)權(quan)的(de)(de)第(di)(di)三(san)(san)(san)人要(yao)(yao)求民(min)(min)事(shi)侵(qin)(qin)(qin)(qin)(qin)權(quan)賠(pei)(pei)償(chang)(chang)(chang)，也(ye)可以(yi)向(xiang)工(gong)(gong)(gong)(gong)傷(shang)(shang)(shang)保(bao)(bao)(bao)(bao)險(xian)(xian)(xian)基(ji)金(jin)要(yao)(yao)求享(xiang)(xiang)受(shou)工(gong)(gong)(gong)(gong)傷(shang)(shang)(shang)保(bao)(bao)(bao)(bao)險(xian)(xian)(xian)待遇(yu)(yu)(yu)，從而出現民(min)(min)事(shi)侵(qin)(qin)(qin)(qin)(qin)權(quan)責任(ren)和(he)工(gong)(gong)(gong)(gong)傷(shang)(shang)(shang)保(bao)(bao)(bao)(bao)險(xian)(xian)(xian)責任(ren)如(ru)何處理(li)的(de)(de)問題。對于這兩種法(fa)律關系(xi)如(ru)何處理(li)存在不(bu)同(tong)(tong)意見(jian)。第(di)(di)一種意見(jian)主(zhu)張(zhang)單賠(pei)(pei)，認為(wei)受(shou)傷(shang)(shang)(shang)害的(de)(de)職(zhi)工(gong)(gong)(gong)(gong)只能(neng)在民(min)(min)事(shi)侵(qin)(qin)(qin)(qin)(qin)權(quan)賠(pei)(pei)償(chang)(chang)(chang)和(he)工(gong)(gong)(gong)(gong)傷(shang)(shang)(shang)保(bao)(bao)(bao)(bao)險(xian)(xian)(xian)待遇(yu)(yu)(yu)中選(xuan)擇(ze)一項(xiang)，如(ru)果享(xiang)(xiang)受(shou)了工(gong)(gong)(gong)(gong)傷(shang)(shang)(shang)保(bao)(bao)(bao)(bao)險(xian)(xian)(xian)待遇(yu)(yu)(yu)，工(gong)(gong)(gong)(gong)傷(shang)(shang)(shang)保(bao)(bao)(bao)(bao)險(xian)(xian)(xian)基(ji)金(jin)就取得了對第(di)(di)三(san)(san)(san)人的(de)(de)代位追(zhui)償(chang)(chang)(chang)權(quan)；如(ru)果工(gong)(gong)(gong)(gong)傷(shang)(shang)(shang)職(zhi)工(gong)(gong)(gong)(gong)追(zhui)究第(di)(di)三(san)(san)(san)人民(min)(min)事(shi)賠(pei)(pei)償(chang)(chang)(chang)責任(ren)的(de)(de)，不(bu)能(neng)再享(xiang)(xiang)受(shou)工(gong)(gong)(gong)(gong)傷(shang)(shang)(shang)保(bao)(bao)(bao)(bao)險(xian)(xian)(xian)待遇(yu)(yu)(yu)。第(di)(di)二(er)種意見(jian)主(zhu)張(zhang)補差，應(ying)當實行(xing)工(gong)(gong)(gong)(gong)傷(shang)(shang)(shang)保(bao)(bao)(bao)(bao)險(xian)(xian)(xian)與(yu)第(di)(di)三(san)(san)(san)人侵(qin)(qin)(qin)(qin)(qin)權(quan)賠(pei)(pei)償(chang)(chang)(chang)相(xiang)結合，由(you)(you)工(gong)(gong)(gong)(gong)傷(shang)(shang)(shang)保(bao)(bao)(bao)(bao)險(xian)(xian)(xian)基(ji)金(jin)先行(xing)支(zhi)付，民(min)(min)事(shi)侵(qin)(qin)(qin)(qin)(qin)權(quan)賠(pei)(pei)償(chang)(chang)(chang)超出工(gong)(gong)(gong)(gong)傷(shang)(shang)(shang)保(bao)(bao)(bao)(bao)險(xian)(xian)(xian)待遇(yu)(yu)(yu)的(de)(de)部分，歸工(gong)(gong)(gong)(gong)傷(shang)(shang)(shang)職(zhi)工(gong)(gong)(gong)(gong)所(suo)有。第(di)(di)三(san)(san)(san)種意見(jian)主(zhu)張(zhang)雙賠(pei)(pei)，根據(ju)《社會保(bao)(bao)(bao)(bao)險(xian)(xian)(xian)法(fa)》第(di)(di)四十(shi)二(er)條規定(ding)，除工(gong)(gong)(gong)(gong)傷(shang)(shang)(shang)醫(yi)療費用外，工(gong)(gong)(gong)(gong)傷(shang)(shang)(shang)職(zhi)工(gong)(gong)(gong)(gong)可以(yi)同(tong)(tong)時享(xiang)(xiang)受(shou)工(gong)(gong)(gong)(gong)傷(shang)(shang)(shang)保(bao)(bao)(bao)(bao)險(xian)(xian)(xian)待遇(yu)(yu)(yu)和(he)獲得民(min)(min)事(shi)侵(qin)(qin)(qin)(qin)(qin)權(quan)賠(pei)(pei)償(chang)(chang)(chang)。也(ye)就是一般所(suo)說的(de)(de)“雙賠(pei)(pei)”或者“一補一賠(pei)(pei)”。主(zhu)要(yao)(yao)理(li)由(you)(you)如(ru)下：
1.理論上，工傷(shang)(shang)(shang)職(zhi)工可(ke)以(yi)同時主張工傷(shang)(shang)(shang)保(bao)(bao)險(xian)(xian)待(dai)遇(yu)(yu)和請求民(min)事侵(qin)權(quan)賠償(chang)(chang)。一(yi)是(shi)(shi)工傷(shang)(shang)(shang)保(bao)(bao)險(xian)(xian)與民(min)事侵(qin)權(quan)賠償(chang)(chang)性質不同。工傷(shang)(shang)(shang)保(bao)(bao)險(xian)(xian)待(dai)遇(yu)(yu)屬于(yu)公法(fa)(fa)領(ling)域(yu)的(de)(de)補償(chang)(chang)，人(ren)身損(sun)害賠償(chang)(chang)則(ze)屬于(yu)私(si)法(fa)(fa)領(ling)域(yu)的(de)(de)賠償(chang)(chang)，二者(zhe)不能(neng)混用(yong)，也不能(neng)相互替代。二是(shi)(shi)工傷(shang)(shang)(shang)保(bao)(bao)險(xian)(xian)金是(shi)(shi)用(yong)人(ren)單(dan)位而不是(shi)(shi)侵(qin)權(quan)的(de)(de)第(di)三人(ren)繳納(na)的(de)(de)，那么(me)用(yong)人(ren)單(dan)位以(yi)外(wai)的(de)(de)第(di)三人(ren)承擔(dan)民(min)事責任不能(neng)免除接受用(yong)人(ren)單(dan)位工傷(shang)(shang)(shang)保(bao)(bao)險(xian)(xian)金的(de)(de)工傷(shang)(shang)(shang)保(bao)(bao)險(xian)(xian)基金支付受傷(shang)(shang)(shang)職(zhi)工工傷(shang)(shang)(shang)保(bao)(bao)險(xian)(xian)待(dai)遇(yu)(yu)的(de)(de)法(fa)(fa)定義務(wu)，否則(ze)工傷(shang)(shang)(shang)保(bao)(bao)險(xian)(xian)基金便擁有了(le)“享受權(quan)利而不承擔(dan)義務(wu)”的(de)(de)特(te)權(quan)。
2.法律規(gui)定(ding)上，除工(gong)(gong)(gong)(gong)傷醫(yi)療費用(yong)外，法律不禁止(zhi)工(gong)(gong)(gong)(gong)傷職(zhi)工(gong)(gong)(gong)(gong)享受(shou)工(gong)(gong)(gong)(gong)傷保險(xian)待遇后再獲得民(min)事(shi)(shi)賠(pei)償(chang)(chang)(chang)。《社會保險(xian)法》、《工(gong)(gong)(gong)(gong)傷保險(xian)條例(li)》明確規(gui)定(ding)了構(gou)成工(gong)(gong)(gong)(gong)傷應享受(shou)相關(guan)待遇，沒有規(gui)定(ding)第三人(ren)(ren)侵(qin)權工(gong)(gong)(gong)(gong)傷應當(dang)扣減第三人(ren)(ren)賠(pei)償(chang)(chang)(chang)部(bu)分，也(ye)沒有規(gui)定(ding)工(gong)(gong)(gong)(gong)傷基金(jin)或(huo)用(yong)人(ren)(ren)單位追償(chang)(chang)(chang)權（除工(gong)(gong)(gong)(gong)傷醫(yi)療費用(yong)）。現行法律和(he)行政法規(gui)沒有明確規(gui)定(ding)受(shou)傷職(zhi)工(gong)(gong)(gong)(gong)只能(neng)得到(dao)一份賠(pei)償(chang)(chang)(chang)或(huo)者補償(chang)(chang)(chang)，司法解釋限制受(shou)傷職(zhi)工(gong)(gong)(gong)(gong)只能(neng)得到(dao)一份賠(pei)償(chang)(chang)(chang)，甚(shen)至只能(neng)先請求民(min)事(shi)(shi)侵(qin)權賠(pei)償(chang)(chang)(chang)的(de)做法缺乏法律依據。
; 3.在程(cheng)序上，設計民(min)事(shi)侵權賠償(chang)與(yu)工(gong)傷保險待遇雙(shuang)向就高補差的程(cheng)序過(guo)于復雜，缺乏操作性，難以切實保障職(zhi)工(gong)權益。極易導致(zhi)工(gong)傷職(zhi)工(gong)一(yi)(yi)方面因侵權賠償(chang)不能(neng)及時(shi)到位，而另一(yi)(yi)方面又因民(min)事(shi)先行而不能(neng)享受工(gong)傷保險待遇的兩難境(jing)地。
4.現實情況中(zhong)，由工(gong)傷(shang)職工(gong)向侵權(quan)第三人(ren)(ren)主張(zhang)民(min)(min)事賠(pei)償責任存在相當(dang)多(duo)的(de)(de)(de)問題。一是(shi)(shi)(shi)在實踐中(zhong)，侵權(quan)人(ren)(ren)具有完全賠(pei)償能力(li)的(de)(de)(de)并不多(duo)。即使法院(yuan)判決侵權(quan)人(ren)(ren)支(zhi)付賠(pei)償金(jin)，也難以執行到位(wei)。從實際情況來(lai)看，侵權(quan)人(ren)(ren)的(de)(de)(de)賠(pei)償往往不足以彌補受害人(ren)(ren)的(de)(de)(de)實際損失。二是(shi)(shi)(shi)工(gong)傷(shang)職工(gong)打(da)民(min)(min)事官(guan)司(si)要花費很大的(de)(de)(de)人(ren)(ren)力(li)和(he)金(jin)錢成本。如果把打(da)官(guan)司(si)的(de)(de)(de)成本除去，受到工(gong)傷(shang)的(de)(de)(de)職工(gong)即使打(da)贏官(guan)司(si)，扣除成本后所獲得的(de)(de)(de)利益是(shi)(shi)(shi)有限的(de)(de)(de)。三是(shi)(shi)(shi)民(min)(min)事訴訟實行的(de)(de)(de)是(shi)(shi)(shi)“誰主張(zhang)誰舉證(zheng)”，工(gong)傷(shang)職工(gong)存在舉證(zheng)不能而(er)無法獲得民(min)(min)事賠(pei)償的(de)(de)(de)巨大風險。
上(shang)述(shu)三(san)(san)種(zhong)觀點(dian)均有一(yi)定(ding)的(de)(de)(de)(de)合(he)理(li)性，上(shang)述(shu)三(san)(san)種(zhong)模式在其他國家也都有所體現。《社會保(bao)(bao)(bao)(bao)險(xian)(xian)(xian)法(fa)(fa)(fa)》制(zhi)定(ding)時，這個問題(ti)也存在較(jiao)大分歧。《社會保(bao)(bao)(bao)(bao)險(xian)(xian)(xian)法(fa)(fa)(fa)》第(di)(di)四(si)十二(er)條規定(ding)“由(you)于第(di)(di)三(san)(san)人(ren)的(de)(de)(de)(de)原因(yin)(yin)(yin)造成工(gong)傷(shang)(shang)(shang)(shang)，第(di)(di)三(san)(san)人(ren)不(bu)(bu)(bu)支(zhi)(zhi)(zhi)付(fu)(fu)工(gong)傷(shang)(shang)(shang)(shang)醫(yi)療費用或者(zhe)(zhe)無法(fa)(fa)(fa)確(que)定(ding)第(di)(di)三(san)(san)人(ren)的(de)(de)(de)(de)，由(you)工(gong)傷(shang)(shang)(shang)(shang)保(bao)(bao)(bao)(bao)險(xian)(xian)(xian)基金先行(xing)支(zhi)(zhi)(zhi)付(fu)(fu)。工(gong)傷(shang)(shang)(shang)(shang)保(bao)(bao)(bao)(bao)險(xian)(xian)(xian)基金先行(xing)支(zhi)(zhi)(zhi)付(fu)(fu)后，有權(quan)向第(di)(di)三(san)(san)人(ren)追償(chang)”。鑒于這一(yi)問題(ti)爭議(yi)較(jiao)大且屬(shu)(shu)(shu)于立(li)法(fa)(fa)(fa)權(quan)限，本著不(bu)(bu)(bu)突破司法(fa)(fa)(fa)權(quan)，不(bu)(bu)(bu)逾越基本法(fa)(fa)(fa)理(li)的(de)(de)(de)(de)原則，最大限度(du)保(bao)(bao)(bao)(bao)護職(zhi)(zhi)工(gong)合(he)法(fa)(fa)(fa)權(quan)益出發，《規定(ding)》第(di)(di)八(ba)條明確(que)：一(yi)是職(zhi)(zhi)工(gong)因(yin)(yin)(yin)第(di)(di)三(san)(san)人(ren)的(de)(de)(de)(de)原因(yin)(yin)(yin)受(shou)到(dao)傷(shang)(shang)(shang)(shang)害，社會保(bao)(bao)(bao)(bao)險(xian)(xian)(xian)行(xing)政(zheng)部門以(yi)職(zhi)(zhi)工(gong)或者(zhe)(zhe)其近(jin)(jin)親屬(shu)(shu)(shu)已經對第(di)(di)三(san)(san)人(ren)提(ti)起(qi)民(min)事訴(su)(su)(su)訟或者(zhe)(zhe)獲得(de)民(min)事賠(pei)償(chang)為(wei)由(you)，作(zuo)出不(bu)(bu)(bu)予(yu)(yu)(yu)受(shou)理(li)工(gong)傷(shang)(shang)(shang)(shang)認(ren)定(ding)申請或者(zhe)(zhe)不(bu)(bu)(bu)予(yu)(yu)(yu)認(ren)定(ding)工(gong)傷(shang)(shang)(shang)(shang)決定(ding)的(de)(de)(de)(de)，人(ren)民(min)法(fa)(fa)(fa)院(yuan)不(bu)(bu)(bu)予(yu)(yu)(yu)支(zhi)(zhi)(zhi)持(chi)。二(er)是職(zhi)(zhi)工(gong)因(yin)(yin)(yin)第(di)(di)三(san)(san)人(ren)的(de)(de)(de)(de)原因(yin)(yin)(yin)受(shou)到(dao)傷(shang)(shang)(shang)(shang)害，社會保(bao)(bao)(bao)(bao)險(xian)(xian)(xian)行(xing)政(zheng)部門已經作(zuo)出工(gong)傷(shang)(shang)(shang)(shang)認(ren)定(ding)，職(zhi)(zhi)工(gong)或者(zhe)(zhe)其近(jin)(jin)親屬(shu)(shu)(shu)未對第(di)(di)三(san)(san)人(ren)提(ti)起(qi)民(min)事訴(su)(su)(su)訟或者(zhe)(zhe)尚(shang)未獲得(de)民(min)事賠(pei)償(chang)，起(qi)訴(su)(su)(su)要求社會保(bao)(bao)(bao)(bao)險(xian)(xian)(xian)經辦機構(gou)(gou)支(zhi)(zhi)(zhi)付(fu)(fu)工(gong)傷(shang)(shang)(shang)(shang)保(bao)(bao)(bao)(bao)險(xian)(xian)(xian)待(dai)遇的(de)(de)(de)(de)，人(ren)民(min)法(fa)(fa)(fa)院(yuan)應(ying)予(yu)(yu)(yu)支(zhi)(zhi)(zhi)持(chi)。三(san)(san)是職(zhi)(zhi)工(gong)因(yin)(yin)(yin)第(di)(di)三(san)(san)人(ren)的(de)(de)(de)(de)原因(yin)(yin)(yin)導致(zhi)工(gong)傷(shang)(shang)(shang)(shang)，社會保(bao)(bao)(bao)(bao)險(xian)(xian)(xian)經辦機構(gou)(gou)以(yi)職(zhi)(zhi)工(gong)或者(zhe)(zhe)其近(jin)(jin)親屬(shu)(shu)(shu)已經對第(di)(di)三(san)(san)人(ren)提(ti)起(qi)民(min)事訴(su)(su)(su)訟為(wei)由(you)，拒絕支(zhi)(zhi)(zhi)付(fu)(fu)工(gong)傷(shang)(shang)(shang)(shang)保(bao)(bao)(bao)(bao)險(xian)(xian)(xian)待(dai)遇的(de)(de)(de)(de)，人(ren)民(min)法(fa)(fa)(fa)院(yuan)不(bu)(bu)(bu)予(yu)(yu)(yu)支(zhi)(zhi)(zhi)持(chi)，但(dan)第(di)(di)三(san)(san)人(ren)已經支(zhi)(zhi)(zhi)付(fu)(fu)的(de)(de)(de)(de)醫(yi)療費用除(chu)外。上(shang)述(shu)規定(ding)，充分保(bao)(bao)(bao)(bao)障了工(gong)傷(shang)(shang)(shang)(shang)職(zhi)(zhi)工(gong)取得(de)工(gong)傷(shang)(shang)(shang)(shang)保(bao)(bao)(bao)(bao)險(xian)(xian)(xian)待(dai)遇的(de)(de)(de)(de)權(quan)利。
十、關于因申請(qing)人(ren)或者用人(ren)單位提(ti)交虛假材料導(dao)致(zhi)工(gong)傷(shang)認定錯誤的(de)問題
根據《最高人民法院關于執行〈中華人民共和國行政訴訟法〉若干問題的解釋》第五十條規定，行政機關可以依法改變具體行政行為，改變后原告不撤訴的，人民法院經審查認為原具體行政行為違法，應當作出確認違法的判決；認為原具體行政行為合法，應當判決駁回原告的訴訟請求。但在工傷認定行政案件中，因工傷認定申請人隱瞞有關情況或提供虛假材料導致工傷認定錯誤的，社會保險行政部門依法改正且在作出原工傷認定決定時無過錯，是否應當依據《最高人民法院關于執行〈中華人民共和國行政訴訟法〉若干問題的解釋》第五十條規定作出確認其違法的判決，在實踐中爭議較大。一種意見認為，依據《最高人民法院關于執行〈中華人民共和國行政訴訟法〉若干問題的解釋》第五十條規定，應當作出確認原工傷認定決定違法的判決；另一種意見認為，此種情形社會保險行政部門畢竟在作出原工傷認定決定時無過錯且依法予以改正，判決駁回原告的訴訟請求為妥。我們認為，造成工傷認定錯誤的原因，既有社會保險行政部門主觀方面的原因，也有工傷認定申請人隱瞞有關情況或提供虛假材料以及其他客觀方面的原因，不同原因處理的方式應當不同，否則對社會保險行政部門是不公平的，也不利于其積極改正錯誤。社會保險行政部門進行工傷認定時有賴于各方當事人提供的證據材料，如果社會保險行政部門已經盡到法定調查核實的義務，主觀上不存在導致錯誤認定的過錯，則可以駁回原告的訴訟請求，不判決工傷認定違法。
日期：2014-8-21 8:38:30 | 關閉 | 分享到：
