【作者】 徐杰；

【导师】 余飞跃；

【作者基本信息】 华东师范大学 ， 社会保障， 2022， 硕士

【摘要】 在整个社会保险制度体系中,工伤保险制度是一个重要的组成部分,能够为遭遇工伤的劳动者及其家庭提供必要的补偿,在降低用人单位风险、维护正常的生产秩序、促进社会安全稳定方面发挥着积极作用。工伤认定是由劳动行政部门按照法律规定对劳动者遭遇的事故伤害或所患的职业病进行是否工伤或视同工伤的行政确认,其客观依据是法定的工伤认定范围。这一环节所作出的结论决定了遭受工伤的劳动者是否能获得相应的补偿,它是工伤保险最核心的环节,因此工伤认定标准是工伤认定制度的重要内容。现实中工伤事故发生的情形多种多样,工伤认定标准暴露出很多问题,由此引发了许多工伤认定纠纷,导致同案不同判,职工合法权益得不到保障,企业雇主责任风险也得不到有效分散。对此,学界从政策和法律的视角对我国工伤认定存在的问题进行了条文的法律分析,提出改善的政策建议。但现有研究忽略了工伤认定标准问题形成的原因,到底是什么原因导致目前这些标准存在的问题,即为本文需要研究的问题。本文首先通过文献梳理、归纳工伤认定标准本身存在的问题;其次,分析标准问题所带来的工伤认定实践困境,对广东深圳判决文书进行检索、筛选、整理与分析,揭示标准问题所导致的工伤保险制度目标,即雇主责任风险分散和劳工权益保障都难以实现的结果;再次,使用连续逼近法质性研究标准存在问题的原因,最终归因于制度设计的政策移植和路径依赖两个方面,于是运用政策移植理论和路径依赖理论去深入解释问题存在的原因;最后,基于原因解释,提出工伤认定标准改善的路径和政策建议。具体包括以下内容:首先,通过梳理学界对工伤认定标准的研究,归纳出我国工伤保险制度中工伤认定标准存在的问题:一般性列举周延性欠缺问题、核心概念内涵模糊问题、因果关系判定不明晰问题、认定规则冲突问题、视同工伤背后的价值伦理冲突问题以及职业病诊断与鉴定问题。其次,对广东省深圳市中级法院2019年全年与工伤认定有关的判决文书进行检索与筛选,得到有效判决文书180份,其中与认定标准直接相关的有134份。对这134份判决书的基本信息、具体事由、判决依据、争议点、判决结果等进行整理与分析,揭示由于工伤认定标准问题而导致的工伤争议多、耗时长、同案不同判、视同工伤加重基金负担以及成本规避导致劳动者权利得不到救济,进而使得工伤保险制度目标难以实现。第三,使用连续逼近的研究方法,先对在一线使用工伤认定标准的企业人力资源部门的负责人进行面对面访谈,不同行业的受访者都认为我国工伤认定标准问题存在主要是由于政策层面的制度设计问题;再进一步找到当前的政策制定者,即政府职能部门的负责人,受访者谈到他认为我国工伤认定标准问题存在主要是有历史遗留问题,现行制度依赖于原有的制度体系;再进一步找到早期的政策制定者,受访者提到我国工伤认定标准在最初建立时参考借鉴了国外改革经验,其中主要学习了德国的工伤认定标准。通过这一连续的、逐渐逼近的归因过程,最终将我国工伤认定标准问题的存在归因于历史路径依赖以及学习国外政策导致水土不服。第四,根据上述质性研究方法得出的研究结论,用政策移植理论与路径依赖理论对我国工伤认定标准存在的问题进行理论解释。一方面,对我国工伤认定标准的政策移植现象进行分析,用历史证据证明我国工伤认定标准确实存在政策移植,本质即通过学习与模仿,建立起一个可以与国际接轨的普适性制度框架。政策的转轨背景主要有工伤保险化的趋同效应、《劳动保险条例》面临适用困境,但由于水土不服造成工伤保险基金的不可持续性以及不当得利现象,因此对政策移植的内容进行了适应性调整,包括通勤事故标准中“过失责任”的调整、职业病目录采用列举式的调整以及不得认定工伤标准的调整。另一方面,对我国工伤认定标准政策移植中的路径依赖现象进行分析,揭示我国工伤认定制度中视同工伤标准存在着对原有路径的依赖。由于转轨时期经济体制的渐进性改革、工伤中“公”的观念、旧制度的既得利益以及缺乏其他保障配套,旧有的工伤认定标准并未彻底去除,而是在一定程度上得到了传承。但这种路径依赖带来了突发疾病条款的伦理问题、见义勇为权益得不到保障、军人反而不被聘用的问题,应当进行政策创新。最后,基于上述研究提出以下政策建议:一是基于无过失责任原则和定额补偿完善认定标准,立法明确工伤认定原则、设计工伤认定一般条款、通勤事故认定采用无过失原则、职业病目录中增设开放性条款。二是进行视同工伤功能剥离的配套制度建设,与工作无关的突发疾病工伤保障回归医疗保障、为公共利益损害建立国家补偿制度、为退役伤残军人建立二次伤残基金,从而尽可能让视同工伤条款具有普适性。更多还原

【Abstract】 In the whole social insurance system,the employment injury insurance system is an important part,can provide necessary compensation for the workers and their families who suffer from employment injury,and plays a positive role in reducing the risk of employing units,maintaining normal production order and promoting social security and stability.Employment injury identification is the procedure that labor administrative branch affirms lawfully if the accident that laborer encounters or the occupational disease that suffers belongs to employment injury or inspect employment injury,its objective basis is legal employment injury identification range.The conclusion made by this link determines whether the workers suffering from employment injury can obtain corresponding compensation,it is the most core link of employment injury insurance.So employment injury identification standard is an important content of employment injury identification system.In reality,industrial injury accidents occur in a variety of situations,and employment injury identification standards exposed a lot of problems,resulting in many employment injury identification disputes,therefore there are different judgments in the same case.The legitimate rights and interests of workers can not be protected,and enterprise employer liability risk can not be effectively dispersed.In this regard,from the perspective of policy and law,scholars have made legal analysis on the existing problems of employment injury identification in China,and put forward some policy suggestions for improvement.However,existing studies have ignored the reasons for the formation of employment injury identification standards.What causes the existing problems of these standards is the problem that needs to be studied in this paper.Firstly,this paper summarizes the existing problems of employment injury identification standard through literature review.Secondly,this paper analyzes the practical problems of employment injury identification caused by problems of standards.Search,screen,sort out and analyze the judgment documents of Shenzhen,Guangdong province,to reveal that the objectives of the employment injury insurance system,the dispersion of employer liability risk and the protection of labor rights and interests,are difficult to achieve caused by problems of standards.Thirdly,the continuous approximation method is used to conduct qualitative research on the causes of the standard problems,which are ultimately attributed to two aspects of institutional design: policy transplantation and path dependence.Therefore,the policy transplantation theory and path dependence theory are used to explain the causes of the problems.Finally,based on the explanation of the reasons,the path and policy suggestions for the improvement of employment injury identification standards are put forward.Specific contents include the following:Firstly,by combing academic research on employment injury criteria,induce the problems of employment injury identification standards that exist in employment injury insurance system in China: general list exhaustiveness lack problem,fuzzy connotation of core concept problem,unclear causality judgement problem,decision rules conflict problem,value ethic conflict behind regards as employment injury problem and diagnosis and appraisal of occupational diseases problem.Secondly,this paper searches and screened the judgment documents related to the identification of work-related injuries in Shenzhen Intermediate Court of Guangdong Province in 2019,and obtained 180 valid judgment documents,among which 134 were directly related to the identification standards.Sort and analyze these 134 judgment documents,including the basic information,the specific reason,judgment basis,and controversial,the verdict,etc.,reveal problems caused by the identification of industrial injury standards,including large number of industrial injury disputes,time-consuming,different judgments in the same case,increased fund burden because of regarding employment injury and workers’ rights can not be relieved resulting by cost avoidance,then make it difficult to achieve the goal of employment injury insurance system.Thirdly,the continuous approach method is used to conduct a face-to-face interview with the person in charge of the human resources department of the enterprise who uses the employment injury identification standard at the front line.The interviewees from different industries all believe that the problem of the employment injury identification standard in China is mainly due to the system design problem at the policy level.Further find the current policy maker,that is,the head of the government functional departments,the interviewee said that he believed that the existence of employment injury identification standards in China is mainly a historical legacy,the current system depends on the original system.Further find the early policy makers,respondents mentioned that China’s employment injury identification standards in the initial establishment of reference to foreign reform experience,which mainly learned from Germany’s employment injury identification standards.Through this continuous and gradually approaching attribution process,the existence of problems of employment injury identification standards in China is finally attributed to historical path dependence and learning foreign policies resulting in acclimation.Fourthly,according to the conclusions of the qualitative research methods,this paper explains the existing problems of employment injury identification standards in China theoretically with the policy transplantation theory and path dependence theory.On the one hand,analyze the phenomenon of policy transplantation of employment injury identification standards in China,and historical evidence is used to prove that there is indeed a policy transplantation of employment injury identification standards in China.The essence is to establish a universal institutional framework that can be in line with international standards through learning and imitation.The background of policy transition mainly includes convergence effect of employment injury insurance and difficulties in application of Labor Insurance Regulations.But the acclimatization caused the unsustainability of employment injury insurance fund and the phenomenon of unjust enrichment,so the content of policy transplantation has been adapted,including the adjustment of "fault liability" in commuter accident standard,the adjustment of closed occupational disease catalogue and the adjustment of the standards that cannot identify employment injury.On the other hand,analyze the path dependence phenomenon in the transplantation of employment injury identification standard policy in China,revealing that the regard as employment injury identification standards of the employment injury identification system in China has the dependence on the original path.Due to the gradual reform of the economic system in the transition period,the concept of "public" in the employment injury,the vested interests of the old system and the lack of other guarantee,the old employment injury identification standard has not been completely removed,but to a certain extent has been inherited.However,this kind of path dependence brings about the ethical problems of sudden disease clause,the rights and interests of good samaritans can not be guaranteed,and the soldiers are not employed.Therefore,policy innovation should be carried out.Finally,based on the above research,the following policy suggestions are put forward: first,based on the principle of no-fault liability and fixed compensation to improve the identification standard,legislation to clarify the principle of employment injury identification,design the general provisions of employment injury identification,adopt the no-fault principle in the identification of commuting accidents,add open clauses in the list of occupational diseases.The second is to strip the function of being regarded as work-related injury,and improve the construction of supporting systems.Unrelated to the work of sudden disease industrial injury security return to medical security,establish a national compensation system for the public interest damage,and establish a second disability fund for retired disabled soldiers,So as far as possible to make the provisions of regarding as employment injury universal.更多还原