Thông tư 07/2010/TT-BYT

CIRCULAR

INSTRUCTIONS ON ASSESSMENT OF WORK CAPABILITY OF EMPLOYEES HAVING COMPULSORY SOCIAL INSURANCE

Pursuant to Law on Social Insurance No. 71/2006/QH11 dated June 29, 2006

Pursuant to Decree 152/2006/NĐ-CP dated December 22, 2006 of the Government giving guidance on the Law on Social insurance on compulsory social insurance

Pursuant to Decree No. 68/2007/NĐ-CP of the Government giving guidance on implementation of some articles of Law on Social Insurance on compulsory social insurance on servicemen, police officers and ciphers whose salaries are the same as the salaries of servicemen and police officers

Pursuant to Decree No. 188/2007/NĐ-CP of the Government regulating the functions, tasks, powers and organizational structure of the Ministry of Health

After obtaining the consensus of Ministry of Labor - Invalids and Social Affairs; Ministry of Justice; General Confederation of Labor of Vietnam; Social Insurance of Vietnam, Ministry of Health gives guidance on the assessment of work capability of employees having compulsory social insurance as follows:

Chapter 1

GENERAL PROVISIONS

Article 1. Scope

This Circular gives guidance on the assessment of work capability of employees having compulsory social insurance, including application compilation, medical assessment procedures for employees having occupational accidents, occupational diseases or taking early retirement and for relatives of employees losing work capacity.

Article 2. Regulated subjects:

1. The employees having compulsory social insurance are those:

a) Who have compulsory social insurance as prescribed in Article 2 Decree No. 152/2006/NĐ-CP of the Government.

b) Who have compulsory social insurance as prescribed in Clauses 1, 2, 3, Article 2 Decree No. 68/2007/NĐ-CP of the Government.

2. The employees retaining the duration of compulsory social insurance’s participation or receiving lump sum or monthly pensions due to occupational accidents or occupational diseases.

All of the subjects prescribed in Clauses 1 and 2 in this Article are hereinafter collectively referred to as the employees.

3. Relatives of the employees:

Including relatives of the employees prescribed in Clauses 1 and 2 in Article 2; relatives of the employees having paid compulsory social insurance for over 15 years, relatives of the person being receiving monthly pensions due to retirement and loss of working capacity and having died, relatives of the person being receiving monthly pensions due to occupational accidents or occupational diseases having their work capacity reduced by 61% or more and having died, relatives of the person dying from occupational accidents and occupational diseases prescribed in Clause 1, Article 64 and Clause 3, Article 139 of Law on Social Insurance

4. The employers:

a) Who are prescribed in Article 3 Circular No. 152/2006/NĐ-CP of the Government.

b) Who are prescribed in Clause 4, Article 2 Circular No. 68/2007/NĐ-CP of the Government.

Article 3: Implementing agencies:

1. Social Insurance Agencies:

a) Social Insurance of Vietnam

b) Social Insurance of provinces and centrally run cities (hereinafter referred to as provinces).

c) Social insurance- Ministry of Defense, Social insurance- Ministry of Public Security and Social insurance- Government Cipher Committee

Every Social Insurance Agency prescribed in points b and c this Clause is hereinafter referred to as provincial Social Insurance Agency

2. Medical Assessment Councils:

a) Central Medical Assessment Council;

b) Medical Assessment Sub-council 1 and Medical Assessment  Sub-council 2, Medical Assessment Councils- Ministry of Defense  including:  Medical Assessment Council- Ministry of Defense, Medical Assessment Council for Occupational diseases- Ministry of defense, Medical Assessment Council for Psychiatry- Ministry of Defense

Every Central Medical Assessment Council prescribed in point a and point b in this Clause is hereinafter referred to Central Central Medical Assessment Council.

c) Medical Assessment Council of provinces,  Medical Assessment Council- Ministry of Public Security, Ministry of Public Security- Ministry of Transportation and Medical Assessment Council Military Regions, Corps, Arms and Areas belonging to Ministry of Defense (hereinafter referred to as Provincial Medical Assessment Councils)

Article 4. Explanation of Terms:

In this Circular, the following terms shall be construed as follows:

1. The first assessment is the assessment of the work capability of the employees suffering from the first occupational accident or occupational disease without having been given any assessment; the employees having social insurance or retaining the duration of social insurance’s participation and the employees’ relatives receiving monthly death benefits.

2. Re-assessment (relapse) is the assessment of the work capability for the second time onwards of the employees suffering from the first occupational accident or occupational disease which has been assessed.

3. Overall assessment is the overall assessment of the work capability when the employees: suffer from occupational diseases and meet with traffic accidents at the same time, have met with traffic accident for many times, have suffered from many occupational diseases.

4. Appeal assessment (re-decision) is the re- assessment of the work capability of the objects regulated in Clauses 1, 2, 3, Article 2 in this Circular in case the assessed employees, individuals, agencies, organizations appeal against the Medical Assessment Council’s decisions.

Chapter 2:

ASSESSMENT APPLICATION

Article 5: The first assessment application

1. The application for the first assessment of injuries due to occupational accidents consists of:

a) A letter of recommendation of the employer using form prescribed in Appendix 1 attached to this Circular.

b) An investment record of the occupational accident using applicable form. In case the employee meets with a traffic accident which is defined as an occupational accident, a photocopy of the traffic accident record is required.

c) A photocopy of the injury record issued by the medical facility (where the employee is given first aid or treated) under regulations of Ministry of Health.

d) A photocopy of hospital discharge permit. In case the employee is not an inpatient, papers of treatment for injuries due to occupational accidents are required.

Upon assessment the employee must present the original papers prescribed in points b, c, and d Clause 1 in this Article in order to be compared by the Medical Assessment Council.

2. The application for the first assessment of injuries due to occupational diseases consists of

a) A letter of recommendation of the employer

b) Papers of the employee suffering from occupational diseases under applicable regulations.

3. Application for assessment used for receiving early retirement benefits consists of:

a) A letter of recommendation of the employer. In case the employee is retaining the duration of Social Insurance’s participation, (s)he shall be issued a letter of recommendation by the provincial Social Insurance Agency using form prescribed in Appendix 1 attached to this Circular.

A written request for assessment using form prescribed in Appendix 2 attached to this Circular.

c) A brief application of the employee using form in Appendix 3 attached to this Circular.

4. Application for assessment used for receiving death benefits consists of:

a) A written request for assessment;

b) A letter of recommendation issued by the provincial Social Insurance Agency.

Article 6: An application for re-assessment in case of replasing injuries and occupational accidents

1. The application for re-assessment of occupational accidents incurring consists of:

a) A written request for assessment;

b) A letter of recommendation issued by the provincial Social Insurance;

b) Papers of treatment for replasing injuries: A photocopy of Hospital discharge permit. In case the employee is not an inpatient, photocopies of outpatient treatment papers of injuries due to occupational accidents are required

d) Previous Medical Assessment records.

Upon assessment, the employee must present the original papers prescribed in point c, point d Clause 1 in this Article in order to be compared by the Medical Assessment Council.

2. The application for assessment of relapsing occupational diseases consists of:

a) A written request for assessment;

b) A letter of recommendation issued by the Provincial Social Insurance Agency.

c) The patient’s application under the regulations.

d) Papers of treatment for relapsing diseases: A photocopy of the hospital discharge permit. In case the employee is not an inpatient, photocopies of outpatient treatment papers of injuries due to occupational diseases are required.

e) Photocopies of previous Medical Assessment records.

Upon assessment, the employee must present the original papers prescribed in point d, point e Clause 2 in this Article in order to be compared by the Medical Assessment Council.

Article 7. An application for overall assessment consists of:

1. A written request for assessment;

2. A letter of recommendation issued by the provincial Social Insurance agency.

3. The original copies of previous Medical Assessment records (for any assessed employee)

4. The applications for the first overall assessment of occupational accidents are similar to those prescribed in Clause 1, Article 5 in this Circular.

5. The applications for the first overall assessment of occupational diseases are similar to those prescribed in Clause 1, Article 5 in this Circular.

Article 8. An application for appeal consists of:

1. A written appeal against the client’s result or a written appeal of any individual, agencie, employer or other organization.

2. An application for assessment sent by the employer or the provincial Social Insurance agency to the Medical Assessment Council.

3. A photocopy of the application for assessment given by the appealed Medical Assessment Council.

4. A photocopy of the Medical Assessment record made by the appealed Medical Assessment Council.

Upon assessment, the employee must present the original papers prescribed in Clauses 3 and 4 in this Article in order to be compared by the Medical Assessment Council.

Article 9. Responsibilities for application completion

1. The employers or the provincial Social Insurance agencies or the provincial Medical Assessment Councils shall request the employees or the employees’ relatives (if they are assessed to receive the death benefits) to submit relevant papers, compile and complete the applications under the regulations prescribed in Articles 5, 6, 7, 8 in this Circular and transfer that assessment applications to the provincial or central Medical Assessment Councils.

2. At least 15 working days from the receipt of the valid assessment applications, the employers or the provincial Social Insurance agencies shall transfer the clients’ assessment applications to the provincial or central Medical Assessment Councils.

In case of any invalid assessment, the employer or the provincial Social Insurance agency shall send a written reply to the client.

Chapter 3.

PROCEDURES FOR MEDICAL ASSESSMENT

Article 10. Receipt of Medical Assessment Application:

1. In case of any invalid application, in 15 working days from the Receipt of the Medical Assessment Application, the provincial or central Medical Assessment Council shall send a written reply to the client.

2. In case of any valid application, in 30 working days from Receipt of the Medical Assessment Application the provincial or central Medical Assessment Council shall carry out an assessment of the employee

Article 11. Expiration of Medical Assessment recommendations

1. In case any assessment is used for receiving retirement benefits, the succeeding assessment shall only be carried out after at least 06 (six) months from the previous assessment.

2. In case of any re-assessment of occupational accidents, occupational diseases, the expiration is at least 2 years (full 24 months) after the Medical Assessment Council gives the latest result of loss of work capacity due to occupational accidents and occupational diseases.

3. In case any employee is eligible for overall assessment, the employee’s agency must write “overall assessment” in the letter of recommendation sent to Medical Assessment Council.

4. In case of any appeal assessment, its expiration is prescribed in applicable regulations of the law on appeal.

Article 12: Medical Assessment fees:

Medical Assessment fees are paid under the regulations of the law.

Article 13. Procedures for Medical Assessment

1. The first assessment

1. The employers and the employees shall compile and complete the assessment applications and send them to the provincial or central Medical Assessment Councils. In case the employees retain the duration of Social Insurance’s participation or the employees’ relatives assessed to receiving monthly death benefits, the provincial Social Insurance agencies shall compile and complete the assessment applications and send them to the Medical Assessment Council

2. The re-assessment (relapse), the overall assessment

a)  After the employees have been completely treated for the replasing occupational diseases or occupational accidents, the employers and the employees shall complete the assessment applications and send them to the provincial Social Insurance agencies for consideration;

b) The provincial Social Insurance agencies shall examine and complete the applications and recommend the employees to the provincial or central Medical Assessment Councils for assessment.

- The first assessment of the employees or the employees’ relatives (who are assessed to receive death benefits); the relapse assessments, the overall assessments of the employees of a province, city or centrally-attached Ministries located in any province or city shall be undertaken by such provincial or central Medical Assessment Councils.

- The first assessment of the employees or the employees’ relatives (who are assessed to receive death benefits); the relapse assessment, the overall assessment of the employees of the units under the management of Ministry of Public Security, Ministry of Defense, Ministry of Transportation shall be undertaken by the Medical Assessment Councils of those Ministries.

3. The appeal assessment:

a) Any employee, agency, employer or organization appealing against the Medical Assessment Council’s decision shall send a written appeal to that Medical Assessment Council.

b) Within 15 working days from the receipt of a written appeal, the Medical Assessment Council shall deal with the appeal. If the client is not satisfied with the Medical Assessment Council’s resolution, within at least 15 working days, the appealed Medical Assessment Council shall complete the assessment application and send it to a superior Medical Assessment Council

c) Appeal assessment

- The appeals against the assessment result given by the provincial Medical Assessment Councils shall be dealt with by the central Medical Assessment sub-council 1 or the central Medical Assessment sub-council 2 or the Medical Assessment Council- Ministry of Defense.

- The appeals against the assessment result given by the central Medical Assessment sub-council 1 or the central Medical Assessment sub-council 2 or Medical Assessment Council- Ministry of Defense shall be dealt with by the central Medical Assessment Councils.

d) In case any client still files an appeal after given an appeal assessment in the central Medical Assessment Council, the relevant Medical Assessment Institute and Social Insurance agency shall explain to him or her. If the client is not satisfied with the result of the appeal assessment of the central Medical Assessment Council, Minister of Health shall establish a Medical Assessment Council for the last re-decision.

e) ) In case any client still files an appeal after given the last re-decision, the competent authorities shall consider the appeal under regulations of law on appeal.

4. The organizations or individuals compiling assessment applications must examine and compare the ID cards or other valid personal papers of the persons given assessments with the papers in the applications when compiling assessment applications.

Article 14. Assessment of loss of work capacity

1. Cases in which the assessments of loss of work capacity shall be carried out include:

The clients having occupational accidents or diseases who are assessed to receive retirement benefits or death benefits as prescribed in the Regulations on standards of injuries and loss of work capacity due to diseases.   

b) The clients having occupational diseases as prescribed in the Regulations on standards of loss of work capacity due to occupational diseases

Methods for assessment of loss of work capacity are regulated by the Ministry of Health.

IMPLEMENTATION CLAUSES

Article 15. Effect

1. This Circular takes effect from May 19, 2010.

2. The Circular No. 18/2000/TT-BYT dated October 17, 2000 of the Ministry of Health giving guidance on the application and procedures for medical assessment of the employee having social insurance shall expire after the effective date of this Circular.

Article 16. Transitional Clauses

The application of every employee receiving monthly compensation for loss of work capacity under Decree No. 60/NĐ-CP dated March 01, 1990 of Minister Council (currently as the Government) who is given assessment of work capability as if assessment for determination of retirement benefits (Clause 3 Article 5 of this Circular) consists of : a written request (using form in Appendix 2 attached to this Circular), a Letter of Recommendation of the provincial Social Insurance agency (using form in Appendix 1 attached to this Circular), the first Medical Assessment record, valid treatment papers.

The Medical Assessment Council, based on the first Medical Assessment record and other valid papers of treatment, shall assess these objects and evaluate their work capability as prescribed in Article 14 in this Circular.

Article 17. Implementation Responsibilities

1. Medical Services Administration – Ministry of Health, Medical Assessment Institute shall instruct the Department of Health of provinces, Health agencies of Ministries, the Medical Assessment Council of all levels to implement under the regulations of this Circular;

2. The Social Insurance of Vietnam shall instruct the Social Insurance of provinces, the Social Insurance of Ministries to implement under the regulations of this Circular.

Any difficulty or obstacle that arises during the implementation of this Circular should be reported to the Ministry of Health (Medical Services Administration, Medical Assessment Institute) for consideration./.