商業意外保險無法取代工傷保險
（本文由勞動法鐘永棣老師原創）
【專家評析】
勞(lao)動法鐘永棣老師認為(wei)(wei)，現實中(zhong)(zhong)，由于種種原(yuan)因不少(shao)用(yong)(yong)人(ren)(ren)單位(wei)沒有為(wei)(wei)基層員工參加社會(hui)保險(xian)。為(wei)(wei)了(le)降低或者(zhe)化解風險(xian)，用(yong)(yong)人(ren)(ren)單位(wei)往(wang)往(wang)為(wei)(wei)基層員工購買商業意外保險(xian)。然而，司(si)法實踐中(zhong)(zhong)，法院往(wang)往(wang)認定商業意外保險(xian)是用(yong)(yong)人(ren)(ren)單位(wei)自愿提供給勞(lao)動者(zhe)的(de)內部福(fu)利，參加社會(hui)保險(xian)是用(yong)(yong)人(ren)(ren)單位(wei)的(de)法定義務；此(ci)內部福(fu)利并(bing)不能免(mian)除(chu)或減(jian)少(shao)用(yong)(yong)人(ren)(ren)單位(wei)的(de)法定義務和法定賠(pei)償(chang)責任。商業保險(xian)，買了(le)也是白(bai)買！
【基本案情】
陳某(mou)于2008年2月(yue)29日入職(zhi)某(mou)物(wu)業公司，擔任保(bao)(bao)安(an)一職(zhi)，雙(shuang)方有簽(qian)訂勞(lao)動合同。陳某(mou)于2012年6月(yue)20日簽(qian)署《自愿放棄參(can)保(bao)(bao)申請書》。
2012年8月9日下午，陳某(mou)騎自行車從住(zhu)處到工作(zuo)地點上(shang)班途中發生交(jiao)通事故，后被送(song)至XX人民醫院(yuan)治療(liao)。陳某(mou)于2012年9月10日出(chu)院(yuan)，共住(zhu)院(yuan)治療(liao)32天。
2012年10月(yue)(yue)28日陳某與物(wu)業(ye)公(gong)司(si)簽訂了《物(wu)業(ye)公(gong)司(si)社(she)(she)會(hui)(hui)保(bao)險補償金簽收協議》，約定(ding)：“公(gong)司(si)一次(ci)性支(zhi)付52個月(yue)(yue)，每月(yue)(yue)120元，合計人民幣6260元的(de)社(she)(she)會(hui)(hui)保(bao)險補償金。為此，本人聲明：2012年8月(yue)(yue)份以前的(de)社(she)(she)會(hui)(hui)保(bao)險關系與東莞市黃河物(wu)業(ye)管理有(you)限公(gong)司(si)沒有(you)任何關系，公(gong)司(si)已按2008年1月(yue)(yue)1日新頒布的(de)相關社(she)(she)保(bao)規(gui)定(ding)進(jin)行補償。”當(dang)天物(wu)業(ye)公(gong)司(si)支(zhi)付了該費用(yong)給陳某。
物業(ye)公司曾為陳某(mou)投保(bao)(bao)了平安(an)團體(ti)意外(wai)傷害保(bao)(bao)險(xian)(xian)(xian)，陳某(mou)領取(qu)了保(bao)(bao)險(xian)(xian)(xian)理賠款4600元。陳某(mou)于2012年(nian)12月13日(ri)以交通(tong)事(shi)故肇事(shi)車輛的車主、司機和中國(guo)人民財(cai)(cai)產(chan)保(bao)(bao)險(xian)(xian)(xian)股份(fen)有限(xian)(xian)公司東莞(guan)分公司為被告，訴至法院；2013年(nian)3月13日(ri)法院判決由中國(guo)人民財(cai)(cai)產(chan)保(bao)(bao)險(xian)(xian)(xian)股份(fen)有限(xian)(xian)公司東莞(guan)分公司賠償(chang)97054.46元給(gei)陳某(mou)。
陳某(mou)(mou)于2013年(nian)4月(yue)1日(ri)正式回(hui)到(dao)(dao)物(wu)業(ye)公(gong)司(si)處上(shang)(shang)班(ban)，因工(gong)傷事故(gu)身體未康復，不能正常上(shang)(shang)班(ban)，陳某(mou)(mou)在2013年(nian)5月(yue)1日(ri)向物(wu)業(ye)公(gong)司(si)提出書面停薪(xin)留職申請(qing)并得到(dao)(dao)物(wu)業(ye)公(gong)司(si)批準，期限是一年(nian)。陳某(mou)(mou)事故(gu)發(fa)生前十(shi)二個月(yue)平均(jun)月(yue)繳費工(gong)資為2560元。
東莞(guan)市(shi)社會(hui)保(bao)障局于2013年9月(yue)10日作出認定(ding)(ding)(ding)工傷(shang)決(jue)定(ding)(ding)(ding)書(shu)，認為陳(chen)某于2012年8月(yue)9日受到的(de)(de)事故傷(shang)害屬于工傷(shang)認定(ding)(ding)(ding)范圍，予(yu)以認定(ding)(ding)(ding)為工傷(shang)。2013年9月(yue)30日，東莞(guan)市(shi)勞動能力鑒(jian)定(ding)(ding)(ding)委員會(hui)對陳(chen)某的(de)(de)傷(shang)情進行了鑒(jian)定(ding)(ding)(ding)，鑒(jian)定(ding)(ding)(ding)結論(lun)為“傷(shang)殘(can)九級、未達護理等級、不建議安(an)裝康復器具。”陳(chen)某檢查(cha)、鑒(jian)定(ding)(ding)(ding)共花去(qu)費(fei)(fei)(fei)(fei)用(yong)436元(yuan)。陳(chen)某治療實際產生的(de)(de)醫(yi)(yi)療費(fei)(fei)(fei)(fei)為28322.1元(yuan)，其中非社保(bao)用(yong)藥費(fei)(fei)(fei)(fei)用(yong)為5432.27元(yuan)，中國人民財產保(bao)險(xian)股份有限(xian)公(gong)司(si)東莞(guan)分公(gong)司(si)承擔交(jiao)強險(xian)醫(yi)(yi)療費(fei)(fei)(fei)(fei)用(yong)10000元(yuan)。陳(chen)某住院期限(xian)伙(huo)食費(fei)(fei)(fei)(fei)為1600元(yuan)。事故相對方承擔了超出交(jiao)強險(xian)醫(yi)(yi)療費(fei)(fei)(fei)(fei)用(yong)10000元(yuan)賠償(chang)限(xian)額的(de)(de)醫(yi)(yi)療費(fei)(fei)(fei)(fei)、后(hou)續治療費(fei)(fei)(fei)(fei)和住院伙(huo)食補(bu)助費(fei)(fei)(fei)(fei)的(de)(de)60%賠償(chang)責任。
陳某于2013年10月15日(ri)(ri)申請勞動仲裁(cai)，請求(qiu)解除與物業公司的勞動關系，并要求(qiu)物業公司支付(fu)：醫(yi)藥(yao)費(fei)(fei)差(cha)額10368.84元(yuan)(yuan)(yuan)、評殘及檢查費(fei)(fei)436元(yuan)(yuan)(yuan)、一(yi)(yi)(yi)(yi)次(ci)性(xing)傷殘補助(zhu)(zhu)金(jin)23850元(yuan)(yuan)(yuan)、一(yi)(yi)(yi)(yi)次(ci)性(xing)工傷醫(yi)療補助(zhu)(zhu)金(jin)5120元(yuan)(yuan)(yuan)、一(yi)(yi)(yi)(yi)次(ci)性(xing)傷殘就業補助(zhu)(zhu)金(jin)20480元(yuan)(yuan)(yuan)、解除勞動合同經濟補償金(jin)12800元(yuan)(yuan)(yuan)、住(zhu)院(yuan)期間伙食補助(zhu)(zhu)費(fei)(fei)1600元(yuan)(yuan)(yuan)。勞動仲裁(cai)委于2013年11月28日(ri)(ri)裁(cai)決：一(yi)(yi)(yi)(yi)、確認原、陳某雙方的勞動關系解除，由物業公司在本(ben)裁(cai)決生效之日(ri)(ri)起三天內支付(fu)陳某如下(xia)款項：評殘及檢查費(fei)(fei)436元(yuan)(yuan)(yuan)、一(yi)(yi)(yi)(yi)次(ci)性(xing)傷殘補助(zhu)(zhu)金(jin)23040元(yuan)(yuan)(yuan)、一(yi)(yi)(yi)(yi)次(ci)性(xing)工傷醫(yi)療補助(zhu)(zhu)金(jin)5120元(yuan)(yuan)(yuan)、一(yi)(yi)(yi)(yi)次(ci)性(xing)傷殘就業補助(zhu)(zhu)金(jin)20480元(yuan)(yuan)(yuan)、2012年8月9日(ri)(ri)至(zhi)2012年9月10日(ri)(ri)期間住(zhu)院(yuan)期間伙食補助(zhu)(zhu)差(cha)額160元(yuan)(yuan)(yuan)。二、駁回陳某的其他(ta)申訴(su)請求(qiu)。
【法院觀點】
法(fa)院(yuan)(yuan)認為，關于物(wu)(wu)業(ye)公(gong)(gong)司(si)是否(fou)因(yin)陳(chen)(chen)(chen)某(mou)(mou)(mou)自愿放棄(qi)(qi)參(can)保(bao)(bao)(bao)(bao)而(er)無(wu)須(xu)向(xiang)陳(chen)(chen)(chen)某(mou)(mou)(mou)支(zhi)付各項費(fei)(fei)用(yong)(yong)的(de)問(wen)題。從物(wu)(wu)業(ye)公(gong)(gong)司(si)提交(jiao)(jiao)的(de)《自愿放棄(qi)(qi)參(can)保(bao)(bao)(bao)(bao)申請(qing)書(shu)》內容(rong)可見(jian)，陳(chen)(chen)(chen)某(mou)(mou)(mou)向(xiang)物(wu)(wu)業(ye)公(gong)(gong)司(si)申請(qing)放棄(qi)(qi)購買社(she)(she)(she)保(bao)(bao)(bao)(bao)，盡管陳(chen)(chen)(chen)某(mou)(mou)(mou)向(xiang)物(wu)(wu)業(ye)公(gong)(gong)司(si)提交(jiao)(jiao)了(le)放棄(qi)(qi)參(can)加(jia)(jia)社(she)(she)(she)會(hui)(hui)保(bao)(bao)(bao)(bao)險(xian)(xian)的(de)申請(qing)，但物(wu)(wu)業(ye)公(gong)(gong)司(si)根據(ju)(ju)陳(chen)(chen)(chen)某(mou)(mou)(mou)的(de)申請(qing)不(bu)為其繳(jiao)交(jiao)(jiao)社(she)(she)(she)會(hui)(hui)保(bao)(bao)(bao)(bao)險(xian)(xian)，違(wei)反了(le)《中華人(ren)(ren)民共(gong)和(he)國勞動(dong)法(fa)》第(di)七十(shi)(shi)二條(tiao)(tiao)的(de)規(gui)(gui)定(ding)，即“用(yong)(yong)人(ren)(ren)單(dan)(dan)位和(he)勞動(dong)者必須(xu)依(yi)法(fa)參(can)加(jia)(jia)社(she)(she)(she)會(hui)(hui)保(bao)(bao)(bao)(bao)險(xian)(xian)，繳(jiao)納社(she)(she)(she)會(hui)(hui)保(bao)(bao)(bao)(bao)險(xian)(xian)費(fei)(fei)。”該規(gui)(gui)定(ding)屬(shu)于強(qiang)制性(xing)(xing)規(gui)(gui)定(ding)，因(yin)而(er)《自愿放棄(qi)(qi)參(can)保(bao)(bao)(bao)(bao)申請(qing)書(shu)》是無(wu)效的(de)。根據(ju)(ju)《廣東省(sheng)工(gong)(gong)傷(shang)(shang)保(bao)(bao)(bao)(bao)險(xian)(xian)條(tiao)(tiao)例》第(di)五十(shi)(shi)七條(tiao)(tiao)的(de)規(gui)(gui)定(ding)：“用(yong)(yong)人(ren)(ren)單(dan)(dan)位依(yi)照本條(tiao)(tiao)例規(gui)(gui)定(ding)應當參(can)加(jia)(jia)工(gong)(gong)傷(shang)(shang)保(bao)(bao)(bao)(bao)險(xian)(xian)而(er)未參(can)加(jia)(jia)或者未按時繳(jiao)納工(gong)(gong)傷(shang)(shang)保(bao)(bao)(bao)(bao)險(xian)(xian)費(fei)(fei)，職(zhi)工(gong)(gong)發(fa)生工(gong)(gong)傷(shang)(shang)的(de)，由(you)該用(yong)(yong)人(ren)(ren)單(dan)(dan)位按照本條(tiao)(tiao)例規(gui)(gui)定(ding)的(de)工(gong)(gong)傷(shang)(shang)保(bao)(bao)(bao)(bao)險(xian)(xian)待(dai)遇(yu)項目和(he)標準向(xiang)職(zhi)工(gong)(gong)支(zhi)付費(fei)(fei)用(yong)(yong)。”因(yin)此，依(yi)法(fa)參(can)加(jia)(jia)社(she)(she)(she)會(hui)(hui)保(bao)(bao)(bao)(bao)險(xian)(xian)是法(fa)定(ding)義務，物(wu)(wu)業(ye)公(gong)(gong)司(si)不(bu)能以陳(chen)(chen)(chen)某(mou)(mou)(mou)自愿放棄(qi)(qi)參(can)保(bao)(bao)(bao)(bao)、社(she)(she)(she)保(bao)(bao)(bao)(bao)費(fei)(fei)已發(fa)給陳(chen)(chen)(chen)某(mou)(mou)(mou)而(er)物(wu)(wu)業(ye)公(gong)(gong)司(si)未因(yin)此獲益(yi)為由(you)拒絕支(zhi)付各項費(fei)(fei)用(yong)(yong)，而(er)應當按照上述條(tiao)(tiao)例規(gui)(gui)定(ding)的(de)工(gong)(gong)傷(shang)(shang)保(bao)(bao)(bao)(bao)險(xian)(xian)待(dai)遇(yu)項目和(he)標準向(xiang)陳(chen)(chen)(chen)某(mou)(mou)(mou)支(zhi)付費(fei)(fei)用(yong)(yong)。陳(chen)(chen)(chen)某(mou)(mou)(mou)發(fa)生前(qian)十(shi)(shi)二個月(yue)平均月(yue)繳(jiao)費(fei)(fei)工(gong)(gong)資為2560元，仲裁已確認雙方勞動(dong)關系解除，根據(ju)(ju)《廣東省(sheng)工(gong)(gong)傷(shang)(shang)保(bao)(bao)(bao)(bao)險(xian)(xian)條(tiao)(tiao)例》第(di)二十(shi)(shi)五條(tiao)(tiao)、第(di)三(san)十(shi)(shi)四條(tiao)(tiao)、第(di)四十(shi)(shi)九條(tiao)(tiao)的(de)規(gui)(gui)定(ding)，物(wu)(wu)業(ye)公(gong)(gong)司(si)應當向(xiang)陳(chen)(chen)(chen)某(mou)(mou)(mou)支(zhi)付各項費(fei)(fei)用(yong)(yong)，故物(wu)(wu)業(ye)公(gong)(gong)司(si)主張無(wu)須(xu)向(xiang)陳(chen)(chen)(chen)某(mou)(mou)(mou)支(zhi)付評(ping)殘(can)及檢查費(fei)(fei)436元、一(yi)次(ci)性(xing)(xing)傷(shang)(shang)殘(can)補助金(jin)23040元、一(yi)次(ci)性(xing)(xing)工(gong)(gong)傷(shang)(shang)醫療補助金(jin)5120元、一(yi)次(ci)性(xing)(xing)傷(shang)(shang)殘(can)就業(ye)補助金(jin)20480元、住(zhu)院(yuan)(yuan)期間(jian)伙食補助費(fei)(fei)差額160元，沒有依(yi)據(ju)(ju)，依(yi)法(fa)不(bu)予支(zhi)持。
關(guan)于(yu)物(wu)(wu)業公(gong)(gong)(gong)司(si)向(xiang)(xiang)陳(chen)某(mou)(mou)(mou)支(zhi)(zhi)付的(de)(de)社(she)會保(bao)(bao)(bao)(bao)險(xian)補償金6260元(yuan)和(he)平安保(bao)(bao)(bao)(bao)險(xian)公(gong)(gong)(gong)司(si)賠付的(de)(de)4600元(yuan)能(neng)否扣(kou)(kou)減(jian)的(de)(de)問題。物(wu)(wu)業公(gong)(gong)(gong)司(si)向(xiang)(xiang)陳(chen)某(mou)(mou)(mou)支(zhi)(zhi)付了(le)社(she)會保(bao)(bao)(bao)(bao)險(xian)補償金6260元(yuan)，該(gai)筆款項(xiang)不是(shi)用(yong)(yong)人(ren)單位(wei)向(xiang)(xiang)社(she)保(bao)(bao)(bao)(bao)機構補繳社(she)會保(bao)(bao)(bao)(bao)險(xian)費(fei)用(yong)(yong)，且物(wu)(wu)業公(gong)(gong)(gong)司(si)是(shi)在(zai)陳(chen)某(mou)(mou)(mou)發(fa)生了(le)工(gong)(gong)傷(shang)事故之后支(zhi)(zhi)付給陳(chen)某(mou)(mou)(mou)的(de)(de)，應視為(wei)物(wu)(wu)業公(gong)(gong)(gong)司(si)已(yi)提前向(xiang)(xiang)陳(chen)某(mou)(mou)(mou)支(zhi)(zhi)付了(le)部分費(fei)用(yong)(yong)，物(wu)(wu)業公(gong)(gong)(gong)司(si)主張扣(kou)(kou)減(jian)該(gai)6260元(yuan)，依(yi)(yi)法予以支(zhi)(zhi)持。物(wu)(wu)業公(gong)(gong)(gong)司(si)應支(zhi)(zhi)付的(de)(de)上述各項(xiang)費(fei)用(yong)(yong)共(gong)計49236元(yuan)，扣(kou)(kou)減(jian)6260元(yuan)，還應支(zhi)(zhi)付差額42976元(yuan)。另外，工(gong)(gong)傷(shang)保(bao)(bao)(bao)(bao)險(xian)系(xi)(xi)用(yong)(yong)人(ren)單位(wei)依(yi)(yi)法必須(xu)為(wei)勞動(dong)(dong)者購(gou)買(mai)(mai)的(de)(de)社(she)會保(bao)(bao)(bao)(bao)險(xian)，商(shang)業保(bao)(bao)(bao)(bao)險(xian)則系(xi)(xi)用(yong)(yong)人(ren)單位(wei)或勞動(dong)(dong)者自由(you)購(gou)買(mai)(mai)的(de)(de)保(bao)(bao)(bao)(bao)險(xian)，用(yong)(yong)人(ren)單位(wei)為(wei)勞動(dong)(dong)者購(gou)買(mai)(mai)商(shang)業保(bao)(bao)(bao)(bao)險(xian)性(xing)質上屬(shu)于(yu)一種福利(li)，即(ji)使物(wu)(wu)業公(gong)(gong)(gong)司(si)為(wei)陳(chen)某(mou)(mou)(mou)購(gou)買(mai)(mai)了(le)商(shang)業保(bao)(bao)(bao)(bao)險(xian)，也不能(neng)免除物(wu)(wu)業公(gong)(gong)(gong)司(si)應為(wei)陳(chen)某(mou)(mou)(mou)參(can)加(jia)社(she)會保(bao)(bao)(bao)(bao)險(xian)的(de)(de)法定(ding)義務，即(ji)使陳(chen)某(mou)(mou)(mou)從保(bao)(bao)(bao)(bao)險(xian)公(gong)(gong)(gong)司(si)處獲(huo)得了(le)賠付，物(wu)(wu)業公(gong)(gong)(gong)司(si)也應當根據(ju)相關(guan)規(gui)定(ding)向(xiang)(xiang)陳(chen)某(mou)(mou)(mou)支(zhi)(zhi)付各項(xiang)工(gong)(gong)傷(shang)待遇(yu)。因此，物(wu)(wu)業公(gong)(gong)(gong)司(si)主張扣(kou)(kou)減(jian)保(bao)(bao)(bao)(bao)險(xian)公(gong)(gong)(gong)司(si)賠付的(de)(de)4600元(yuan)，沒有依(yi)(yi)據(ju)，依(yi)(yi)法不予支(zhi)(zhi)持。
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