Circular No. 07/2010/TT-BYT guides the assessment of the degree of reduction in work capacity for employees participating in mandatory social insurance.

CIRCULAR

Guidelines for assessing the degree of reduction in work capacity of employees participating in mandatory social insurance

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Based on the Social Insurance Law No. 71/2006/QH11 dated June 29, 2006;

Based on Decree No. 152/2006/NĐ-CP dated December 22, 2006 of the Government guiding certain provisions of the Social Insurance Law regarding mandatory social insurance;

Based on Decree No. 68/2007/NĐ-CP dated April 19, 2007 of the Government detailing and guiding the implementation of certain provisions of the Social Insurance Law concerning mandatory social insurance for military personnel, public security officers, and civil servants with equivalent benefits to military personnel and public security officers;

Pursuant to Decree No. 188/2007/NĐ-CP dated December 27, 2007 of the Government on the functions, tasks, powers, and organizational structure of the Ministry of Health;

After receiving the unified opinions of the Ministry of Labor - Invalids and Social Affairs; the Ministry of Justice; the Vietnam General Confederation of Labor; the Vietnam Social Security,

The Ministry of Health guides the assessment of the degree of reduction in work capacity of employees participating in mandatory social insurance as follows:

PART I

GENERAL PROVISIONS

Article 1. Scope of Regulation

This Circular guides the assessment of the degree of reduction in work capacity of individuals participating in mandatory social insurance, including the establishment of files, procedures for medical examination and assessment for individuals participating in mandatory social insurance who have suffered workplace accidents, occupational diseases, early retirement as prescribed, and relatives of individuals participating in mandatory social insurance who have reduced work capacity.

Article 2. Applicability

1. Employees participating in mandatory social insurance

a) Employees participating in mandatory social insurance as stipulated in Article 2 of Decree No. 152/2006/NĐ-CP of the Government.

b) Employees participating in mandatory social insurance as provided for in Clause 1, Clause 2 and Clause 3, Article 2 of Decree No. 68/2007/NĐ-CP of the Government.

2. Employees currently suspending their time of mandatory social insurance contributions, individuals receiving one-time or monthly occupational accident and occupational disease benefits.

All subjects specified in Clause 1 and Clause 2 of this Article shall hereinafter be collectively referred to as employees.

3. Relatives of employees participating in mandatory social insurance

Including relatives of employees as stipulated in Clause 1 and Clause 2, Article 2; relatives of employees who have contributed to mandatory social insurance for at least fifteen years but have not yet received one-time social insurance benefits and have died; individuals currently receiving monthly pension or disability allowance and have died; individuals currently receiving monthly occupational accident and occupational disease benefits with a reduction in work capacity of 61% or more and have died; employees who died due to occupational accidents or occupational diseases as stipulated in Clause 1, Article 64 and Clause 3, Article 139 of the Social Insurance Law.

4. Employers participating in mandatory social insurance

a) Employers participating in mandatory social insurance as stipulated in Article 3 of Decree No. 152/2006/NĐ-CP of the Government.

b) Employers participating in mandatory social insurance as stipulated in Clause 4, Article 2 of Decree No. 68/2007/NĐ-CP of the Government.

Article 3. Implementing agencies

1. Social Insurance Agency:

a) Vietnam Social Security;

b) Social Insurance agencies of provinces and centrally governed cities;

c) Social Insurance - Ministry of National Defense, Social Insurance - Ministry of Public Security, Social Insurance - State Administration under the Government.

Social Insurance Agencies as stipulated in point b and c of this Clause (hereinafter referred to as provincial-level Social Insurance Agencies).

2. Medical Examination and Assessment Council:

a) Central Medical Examination and Assessment Council;

b) Branch Central Medical Examination and Assessment Council I and Branch Central Medical Examination and Assessment Council II; Medical Examination and Assessment Councils - Ministry of National Defense including: Medical Examination and Assessment Council - Ministry of National Defense; Occupational Disease Medical Examination and Assessment Council - Ministry of National Defense; Mental Health Medical Examination and Assessment Council - Ministry of National Defense.

Medical Examination and Assessment Councils as stipulated in point a and b of this Clause (hereinafter referred to as central-level Medical Examination and Assessment Councils).

c) Medical Examination and Assessment Councils of provinces and centrally governed cities; Medical Examination and Assessment Council - Ministry of Public Security, Medical Examination and Assessment Council - Ministry of Transport, and Medical Examination and Assessment Councils of Military Regions, Corps, Services, and Areas under the Ministry of National Defense (hereinafter referred to as provincial-level Medical Examination and Assessment Councils).

Article 4. Definitions

In this Circular, the following terms are understood as follows:

1. Initial Medical Examination and Assessment is the assessment of the degree of reduction in work capacity for employees suffering from their first workplace accident, first occupational disease without having undergone any previous medical examination and assessment; employees currently participating in social insurance or suspending their time of social insurance contributions and relatives of employees participating in mandatory social insurance receiving monthly survivor benefits.

2. Re-examination (recurrence) is the assessment of the degree of reduction in work capacity from the second time for employees who have been injured or ill due to workplace accidents or occupational diseases that have already been assessed and subsequently recur after stable treatment.

3. Comprehensive Medical Examination and Assessment is the comprehensive assessment of the degree of reduction in work capacity when employees fall into one of the following situations: suffering both a workplace accident and an occupational disease; suffering multiple workplace accidents; suffering multiple occupational diseases.

4. Medical Examination and Assessment upon Complaint (reconsideration) is the reassessment of the degree of reduction in work capacity for the subjects specified in Clause 1, Clause 2, Clause 3, Article 2 of this Circular when the individual being assessed has a complaint, or when there is a complaint or accusation from an individual, agency, or organization against the decision of the Medical Examination and Assessment Council.

Chapter II

EXAMINATION FILE

Article 5. Initial Medical Examination File

1. Initial Medical Examination for Work-related Injury Disability

a) An introduction letter from the employer according to the form prescribed in Appendix No. 1 issued together with this Circular;

b) The Work-related Accident Investigation Report according to the current model. In cases where traffic accidents are determined to be work-related accidents, a copy of the Traffic Accident Report must also be provided;

c) A certificate of injury issued by a healthcare facility (where the worker was treated) according to the regulations of the Ministry of Health (copy);

d) A discharge certificate according to the regulations of the Ministry of Health (copy). In cases where the worker did not undergo inpatient treatment, documents related to outpatient examination and treatment for work-related injuries must be provided;

When attending the initial medical examination, the worker must present the original copies of the documents specified in points b, c, and d of Clause 1 of this Article for the Medical Examination Board to verify;

2. Initial Medical Examination for Occupational Disease

a) An introduction letter from the employer;

b) The occupational disease patient's file according to the current regulations;

3. Initial Medical Examination for Early Retirement Benefits

a) An introduction letter from the employer. In cases where the worker is preserving their social insurance contribution period, the provincial social insurance agency issues an introduction letter according to the form prescribed in Appendix No. 1 issued together with this Circular;

b) A request for medical examination according to the form prescribed in Appendix No. 2 issued together with this Circular;

c) A summary of the worker's file according to the form prescribed in Appendix No. 3 issued together with this Circular;

4. Initial Medical Examination for Death Benefits

a) A request for medical examination;

b) An introduction letter from the provincial social insurance agency;

Article 6. Re-examination File for Recurrent Work-related Injury or Occupational Disease

1. Re-examination for Recurrent Work-related Injury

a) A request for medical examination;

b) An introduction letter from the provincial social insurance agency;

c) Documents related to recurrent injury treatment: A discharge certificate according to the regulations of the Ministry of Health (copy). In cases where the worker did not undergo inpatient treatment, documents related to outpatient examination and treatment for recurrent work-related injuries must be provided (copy);

d) Medical Examination Reports from previous examinations;

When attending the re-examination, the worker must present the original copies of the documents specified in points c and d of Clause 1 of this Article for the Medical Examination Board to verify;

2. Re-examination for Recurrent Occupational Disease

a) A request for medical examination;

b) An introduction letter from the provincial social insurance agency;

c) The occupational disease patient's file according to the regulations;

d) Documents related to recurrent occupational disease treatment: A discharge certificate according to the regulations of the Ministry of Health (copy). In cases where the worker did not undergo inpatient treatment, documents related to outpatient examination and treatment for recurrent occupational diseases must be provided (copy);

đ) Previous Medical Examination Reports (copy);

When attending the re-examination, the worker must present the original copies of the documents specified in points d and đ of Clause 2 of this Article for the Medical Examination Board to verify;

Article 7. Comprehensive Medical Examination File

1. A request for medical examination;

2. An introduction letter from the provincial social insurance agency;

3. Original copies of Medical Examination Reports from previous examinations (for cases that have undergone previous medical examinations);

4. For comprehensive medical examinations due to initial work-related injuries, the file should comply with the provisions of Clause 1, Article 5 of this Circular;

5. For comprehensive medical examinations due to initial occupational diseases, the file should comply with the provisions of Clause 2, Article 5 of this Circular.

Article 8. Documents for medical examination appeal

1. The complaint letter from the party regarding the results of the medical examination; or the complaint or accusation letter from an individual or agency; or the written communication from the employer or other organizations;

2. The medical examination file sent by the employer or the provincial Social Insurance Agency to the Medical Examination Board;

3. The medical examination file of the Medical Examination Board being appealed (copy);

4. The Medical Examination Record of the Medical Examination Board being appealed (copy);

When attending the medical examination, the employee must present the original copies of the documents specified in Clause 3 and Clause 4 of this Article for the Medical Examination Board to compare.

Article 9. Responsibility for Completing the File

1. The employer or the provincial Social Insurance Agency or the provincial or central Medical Examination Board has the responsibility to request the employee or the employee's family member (in cases of examination for implementing the pension system) to submit relevant documents, establish and complete the file in accordance with the provisions of Articles 5, 6, 7, and 8 of this Circular, and transfer the employee’s or the employee's family member’s medical examination file to the provincial or central Medical Examination Board.

2. After receiving a valid medical examination file, within the latest fifteen working days, the employer or the provincial Social Insurance Agency has the responsibility to transfer the medical examination file to the provincial or central Medical Examination Board.

If the medical examination file is not valid, the employer or the provincial Social Insurance Agency has the responsibility to respond in writing to the employee or the employee's family member.

Chapter III

PROCEDURE FOR MEDICAL EXAMINATION AND APPRAISAL

Article 10. Receiving the Medical Examination File

1. If the medical examination file is not valid, within fifteen working days, the provincial or central Medical Examination Board has the responsibility to respond in writing to the individual, agency, or organization requesting the examination.

2. If the medical examination file is valid, within thirty days, the provincial or central Medical Examination Board has the responsibility to conduct the medical examination for the employee.

Article 11. Time Limit for Referring Employees for Medical Examination

1. For cases of examination to implement the retirement system, the minimum interval between two examinations is six months.

2. For cases of re-examination of work-related accidents or occupational diseases, the time limit for referring for examination is at least two years (twenty-four months) from the date the employee was concluded by the Medical Examination Board on the degree of reduction in labor capacity due to work-related accidents or occupational diseases in the immediately preceding examination.

3. For cases that meet the conditions for comprehensive examination, the referral letter sent to the Medical Examination Board must clearly state the requirement: "comprehensive medical examination" from the beginning.

4. For cases of examination appeal, the time limit for resolving appeals shall be in accordance with the current laws on appeals.

Article 12. Fees for Medical Examination

The medical examination fees shall be implemented in accordance with the law.

Article 13. Medical Examination Process

1. Initial examination and assessment

The employer and the employee have the responsibility to establish and complete the medical examination file and transfer it to the provincial or central Medical Examination Board. In cases where the employee is preserving social insurance contribution time or the employee's family member is suffering from reduced labor capacity and seeking monthly pension benefits, the provincial Social Insurance Agency has the responsibility to establish and complete the medical examination file and transfer it to the Medical Examination Board.

2. Re-examination (recurrence), Comprehensive Examination

a) After the employee has been stabilized in treatment for recurrent occupational disease or work-related accident, the employer and the employee themselves have the responsibility to complete the medical examination file and send it to the provincial Social Insurance Agency for consideration and resolution.

b) The provincial Social Insurance Agency will check, complete the file, and refer the employee for medical examination at the provincial or central Medical Examination Board.

- For initial examinations for employees or their family members (for cases of examination to implement the pension system); recurrence examinations; comprehensive examinations for employees of provinces, cities, or units under central ministries located in those provinces or cities will be handled by the provincial or central Medical Examination Board located in those provinces or cities.

- Cases of initial examinations for employees or their family members (for cases of examination to implement the pension system); recurrence examinations; comprehensive examinations for employees under the management of the Ministry of Public Security, the Ministry of National Defense, or the Ministry of Transport will be handled by the Medical Examination Boards under the Ministry of Public Security, the Ministry of National Defense, or the Ministry of Transport.

3. Examination Appeal

a) An individual employee; or an agency; or the employer; or another organization disagrees with the conclusion of the Medical Examination Board, then they should submit a complaint letter or written communication to the Medical Examination Board that issued the decision.

b) Within fifteen working days from the date of receipt of the complaint letter or written communication, the Medical Examination Board has the responsibility to resolve the appeal. If the individual, agency, or organization does not agree with the resolution of the Medical Examination Board, within the latest fifteen working days, the Medical Examination Board being appealed must complete the medical examination file according to regulations and send it to the higher-level Medical Examination Board.

c) Conducting an examination appeal

- Appeals against the results of the provincial Medical Examination Board are handled by the Central Medical Examination Board I, Central Medical Examination Board II, or the Medical Examination Board of the Ministry of National Defense.

- Appeals against the results of the Central Medical Examination Board I, Central Medical Examination Board II, or the Medical Examination Board of the Ministry of National Defense are resolved by the Central Medical Examination Board.

d) If the person who has appealed at the central Medical Examination Board still has objections, the Institute of Medical Examination and related Social Insurance agencies will carefully study to explain to the employee. If the employee does not agree with the resolution of the appeal by the central Medical Examination Board, the Minister of Health will establish a Medical Examination Board to make the final review.

đ) After the final decision on the complaint is made, if the party still lodges a complaint, competent authorities shall handle the complaint in accordance with the provisions of the law on complaints and denunciations.

4. During the process of establishing the file for medical examination and appraisal, the agency or individual responsible for establishing the appraisal file must verify and compare the identification card or other lawful personal documents of the person undergoing the examination with the documents in the appraisal file.

Article 14. Assessment of the degree of reduction in work capacity

1. The assessment of the degree of reduction in work capacity shall be applied to the following cases:

a) Persons who have suffered a workplace accident, illness, and are entitled to retirement benefits and survivor benefits, shall be assessed according to the Table of standards for disability and loss of working capacity due to illness.

b) Persons suffering from occupational diseases shall be assessed according to the Table of standards for loss of working capacity due to occupational diseases.

2. The method for determining the degree of reduction in work capacity for these subjects shall be carried out in accordance with the regulations of the Ministry of Health.

Chapter IV

IMPLEMENTING PROVISIONS

Article 15. Effective Date

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

2. Circular No. 18/2000/TT-BYT dated October 17, 2000 of the Ministry of Health guiding the files and procedures for medical examination and appraisal for workers participating in social insurance shall cease to be effective from the date this Circular takes effect.

Article 16. Transitional Provisions

Persons receiving monthly disability allowance under Decree No. 60/ND-CP dated March 1, 1990 of the Council of Ministers (now the Government) shall be appraised for the degree of reduction in work capacity as in the cases of medical examination and appraisal for retirement benefits (Clause 3, Article 5 of this Circular) if they have, the file includes: Application form (according to Form 2 attached to this Circular); Introduction letter from the provincial Social Insurance Office (according to Form 1 attached to this Circular); First Medical Appraisal Record; Valid treatment documents.

The Medical Examination and Appraisal Board bases on the First Medical Appraisal Record and valid treatment documents to examine and appraise these subjects.

The assessment of the degree of reduction in work capacity for these subjects shall be conducted in accordance with the provisions of Article 14 of this Circular.

Article 17. Responsibility for Implementation

1. The Department of Medical Examination and Treatment - Ministry of Health, the Institute of Medical Examination and Appraisal shall be responsible for directing and guiding the Provincial Health Departments, health departments of ministries, and medical examination and appraisal boards at all levels to implement in accordance with the provisions of this Circular.

2. The Vietnam Social Security shall be responsible for disseminating, guiding, and directing the provincial social insurances, social insurances of ministries to implement in accordance with the provisions of this Circular.

In the course of implementation, if there are difficulties or obstacles, units and localities need to promptly reflect them to the Ministry of Health (Department of Medical Examination and Treatment, Institute of Medical Examination and Appraisal) for guidance, consideration, and resolution./.