海南省三亚市中级人民法院
p t ; ” > 民 事 判 决 书
（2017）琼02民终1479号
上诉人（原审被告）：张帅，男，1980年5月1日出生，汉族，住辽宁省灯塔市。
委托诉讼代理人：胡建，海南惠海律师事务所律师。
被上诉人（原审原告）：三亚椰林滩大酒店有限责任公司，住所地海南省三亚市海坡经济开发区椰林滩大酒店。
法定代表人：夏桂兰，该公司董事长。
委托诉讼代理人：麦耒，海南琼亚律师事务所律师。
上诉人张帅因与被上诉人三亚椰林滩大酒店有限责任公司（以下简称椰林滩大酒店）劳动争议一案，不服三亚市城郊人民法院（2017）琼0271民初5353号民事判决，向本院提起上诉。本院于2017年10月11日立案后，依法组成合议庭进行了审理。本案现已审理终结。
张帅上诉请求：1.撤销三亚市城郊人民法院（2017）琼0271民初5353号民事判决，改判驳回椰林滩大酒店的全部诉讼请求；2.本案一、二审诉讼费全部由椰林滩大酒店承担。事实和理由：张帅认为一审判决认定事实错误，适用法律错误，请求二审法院在查明案件事实的基础上依法改判。一、一审判决遗漏对工伤医疗费的认定。椰林滩大酒店诉讼请求第一项即要求驳回张帅要求其支付工伤医疗费的仲裁请求。但一审判决在认定事实时从未对这一事实进行任何阐述，查明事实时也未对医疗费的问题进行阐述。属于遗漏案件事实。二、关于双方劳动关系是否解除并终止的问题。椰林滩大酒店认为双方劳动关系已经终止。张帅受伤之后，椰林滩大酒店停发了其工资且张帅在劳动仲裁庭审中正式通知解除与椰林滩大酒店的劳动合同关系。根据《中华人民共和国劳动合同法》规定，劳动者只要提前30日告知用工单位，即可解除劳动关系。该法并未强制要求劳动者必须以书面方式提出解除劳动关系。至起诉之日前，已满30日，双方劳动关系已经解除。事发之后椰林滩大酒店停发了张帅的工资，以事实行为拒绝履行合同义务，双方默认了劳动关系终止的事实。三、关于人社部门是否决定不予支付工伤保险待遇的问题。劳动仲裁阶段，三亚市劳动人事争议仲裁委员会向人社部门询问了本案工伤保险待遇支付的相关情况。人社部门表示，由于椰林滩大酒店存在逾期缴费情况，拒不向张帅支付相关保险待遇。综上，一审判决认定事实错误，适用法律错误，依法应予纠正。
椰林滩大酒店辩称，社保局工作人员的答复并非社保局的决定。依照法律规定，一次性工伤医疗补助金是由社保局支付。双方对于一次性伤残补助金应由谁来支付有争议，支付的主体依照法律规定应是工伤保险基金。关于就业补助金，如果双方解除合同应由椰林滩大酒店支付。
椰林滩大酒店向一审法院起诉请求：1.驳回张帅要求椰林滩大酒店支付工伤医疗费358690.89元（2016年2月15日至2017年2月12日）的仲裁请求；2.驳回张帅要求椰林滩大酒店支付住院伙食补助费7300元（2016年2月15日至4月29日）的仲裁请求；3.驳回张帅要求椰林滩大酒店支付一次性工伤医疗补助金68138元的仲裁请求；4.驳回张帅要求椰林滩大酒店支付一次性伤残补助金36296元的仲裁请求；5.驳回张帅要求椰林滩大酒店支付一次性伤残就业补助金55840元的仲裁请求；6.驳回张帅要求椰林滩大酒店支付停工留薪期工资33504元的仲裁请求。
一审法院认定事实，2015年11月24日，张帅入职椰林滩大酒店，任前厅部司机，双方签订了书面劳动合同。椰林滩大酒店为张帅缴纳工伤保险等社会保险费至2017年7月。其中2016年2月的社会保险费为2月23日补缴，同时缴纳了相应的滞纳金。2016年2月16日凌晨4时左右，张帅将客人从酒店送到三亚大茅村后，在224国道中廖小学附近，被案外人符某醉酒驾驶摩托车撞倒受伤，送往中国人民解放军第四二五医院救治。2016年4月29日张帅出院，住院治疗共73天，住院费用总计345511.35元。2017年1月4日至1月7日，张帅第二次在四二五医院住院治疗，住院费为8508.27元。张帅住院期间，椰林滩大酒店并未派人或聘人对其进行护理。椰林滩大酒店已向张帅支付医疗费共167800元，含职工捐款的27800元。张帅工伤后，椰林滩大酒店不再向张帅发放工资。2016年3月21日，三亚市人力资源和社会保障局作出三人社工认字〔2016〕第154号《工伤认定决定书》，认定张帅所受伤害为工伤，即失血性休克、重型颅脑损伤、双侧额叶脑挫裂伤、蛛网膜下腔出血、上下颌骨多发骨折、颅底骨折、视神经损伤、脑脊液漏、双眼挫伤、右肺挫伤、左上眼睑软组织挫裂伤、骨盆骨折、左胫腓骨粉碎性骨折、鼻骨开放性骨折和左小腿外侧皮肤坏死。2016年12月27日，三亚市劳动能力鉴定委员会作出三劳鉴字〔2016〕109号《劳动能力鉴定结论书》，将张帅所受的上述伤害鉴定为伤残七级，无生活自理障碍。之后，张帅以椰林滩大酒店为被申请人，向三亚市劳动人事争议仲裁委员会申请劳动仲裁，请求：1.椰林滩大酒店支付工伤医疗费358690.89元（2016年2月15日至2017年2月12日）；2.椰林滩大酒店支付住院伙食补助费7300元（2016年2月15日至4月29日）；3.椰林滩大酒店支付护理费11843元（2016年2月15日至4月29日）；4.椰林滩大酒店支付一次性医疗补助金68138元；5.椰林滩大酒店支付一次性伤残补助金36296元；6.椰林滩大酒店支付一次性伤残就业补助金55840元；7.椰林滩大酒店支付停工留薪期工资33504元。三亚市劳动人事争议仲裁委员会于2017年6月19日作出三劳人仲裁字〔2017〕第194号仲裁裁决书，裁决：椰林滩大酒店于裁决书生效之日起10日内，一次性向张帅支付工伤医疗费185759.94元、住院期间伙食补助费7300元、护理费11843元、一次性工伤医疗补助金68138元、一次性伤残就业补助金55840元、一次性伤残补助金36296元和停工留薪期工资23918.13元。椰林滩大酒店对上述仲裁裁决不服，向一审法院起诉。对于上述双方没有争议的事实，一审法院予以确认。
对双方有争议的事实。关于月工资，根据张帅在庭审中的陈述，其转正后月基本工资及各项补助、全勤奖共2700元至2800元，椰林滩大酒店予以认可，结合张帅提交的《工伤保险缴费工资清单》，一审法院认定张帅的月平均工资为2792元[（2529.6元+2596元+3251元）÷3个月]。关于双方劳动关系，张帅在庭审中称其在劳动仲裁阶段口头提出与椰林滩大酒店解除劳动关系，但其并未提交书面离职申请，双方亦未办理离职手续，椰林滩大酒店在其受伤后仍为其缴纳社会保险费。因此，一审法院认定双方劳动关系并未解除。
一审法院认为，关于工伤医疗费、住院伙食补助费和一次性伤残补助金的问题。根据椰林滩大酒店提交《社会保险费缴纳申报表》可以认定，张帅入职以来，椰林滩大酒店一直按月为其缴纳社会保险费，其2016年2月的社会保险费虽逾期申报，但椰林滩大酒店在2月23日进行了补缴并缴纳了相应的滞纳金，此种情形属于逾期申报缴纳社会保险费，不属于《工伤保险条例》第六十二条第二款规定的”应当参加工伤保险而未参加工伤保险”的情形。根据已查明的事实，三亚市社保局并未对张帅的工伤保险待遇报销申请作出不予报销的决定。因此，张帅要求椰林滩大酒店向其支付工伤待遇各项款项的请求，没有法律依据，一审法院不予支持。依据《工伤保险条例》第三十条第一款和《中华人民共和国社会保险法》第三十八条第（一）项、第（二）项和第（六）项的规定，张帅的工伤医疗费、住院伙食补助费和一次性伤残补助金，应由工伤保险基金支付。关于住院期间护理费，第194号仲裁裁决书已裁决椰林滩大酒店向张帅支付两次住院期间护理费共计11843元，双方对该项裁决均未提起诉讼，视为对该项裁决的认可。因此，一审法院确认椰林滩大酒店应当向张帅支付两次住院期间护理费共11843元。关于一次性医疗补助金和一次性伤残就业补助金，依据《工伤保险条例》第三十七条第（二）项的规定，”劳动、聘用合同期满终止，或者职工本人提出解除劳动、聘用合同的，由工伤保险基金支付一次性工伤医疗补助金，由用人单位支付一次性伤残就业补助金”。根据已查明的事实，张帅受伤至今并未与椰林滩大酒店办理离职手续，椰林滩大酒店仍为其按月缴纳社会保险费，双方劳动关系并未解除。因此，张帅请求支付一次性医疗补助金和一次性伤残就业补助金，没有事实和法律依据，一审法院不予支持。关于停工留薪期工资。依据《工伤保险条例》第三十三条第一款的规定，”职工因工作遭受事故伤害或者患职业病需要暂停工作接受工伤医疗的，在停工留薪期内，原工资福利待遇不变，由所在单位按月支付”。椰林滩大酒店应当向张帅支付停工留薪期工资。张帅两次住院治疗76天，参照《关于印发北京市工伤职工停工留薪期管理办法的通知》中”蛛网膜下腔出血、颅底骨折、视神经损伤的停工留薪期为6个月”的规定，酌情给予张帅256天的停工留薪期较为合理。因此，椰林滩大酒店应当向张帅支付停工留薪期工资23825元（2792元÷30天×256天）。综上所述，依照《中华人民共和国社会保险法》第三十八条第（一）项、第（二）项和第（六）项，《工伤保险条例》第三十条第一款、第三十三条第一款和第三十七条，及《最高人民法院关于适用〈中华人民共和国民事诉讼法〉的解释》第九十条规定，判决：一、椰林滩大酒店不向张帅支付工伤医疗费185759.94元、住院伙食补助费7300元、一次性伤残补助金36296元、一次性工伤医疗补助金68138元和一次性伤残就业补助金55840元；二、椰林滩大酒店于判决发生法律效力之日起七日内一次性向张帅支付住院期间护理费11843元和停工留薪期工资23825元。如果未按判决指定的期间履行给付金钱义务，应当依照《中华人民共和国民事诉讼法》第二百五十三条规定，加倍支付迟延履行期间的债务利息。一审案件受理费10元（椰林滩大酒店已预交），由椰林滩大酒店负担。
本院二审期间，当事人没有提交新证据。
一审法院认定事实属实，本院予以确认。
另查明，张帅与椰林滩大酒店签订的《劳动合同书》自2015年11月24日至2017年11月23日，应认定双方于2017年11月23日终止劳动关系。双方对一审法院认定的各项费用的金额没有异议，本院予以确认。关于住院期间护理费，第194号仲裁裁决书已裁决椰林滩大酒店向张帅支付两次住院期间护理费共计11843元，双方对该项裁决均未提起诉讼，本院予以确认。关于停工留薪期工资，一审法院认定椰林滩大酒店应向张帅支付停工留薪期工资23825元，椰林滩大酒店未提起上诉，本院予以确认。
本院认为，本案的争议焦点为：一、一审判决是否遗漏对工伤医疗费的认定；二、椰林滩大酒店是否应向张帅支付工伤医疗费、住院伙食补助费、一次性伤残补助金、一次性工伤医疗补助金、一次性伤残就业补助金。
一、一审判决是否遗漏对工伤医疗费的认定。
张帅上诉称一审判决遗漏对工伤医疗费的认定，因一审判决已认定张帅的工伤医疗费由工伤保险基金支付，并判决椰林滩大酒店不向张帅支付工伤医疗费185759.94元，故张帅该项上诉请求与查明事实不符，本院不予支持。
二、椰林滩大酒店是否应向张帅支付工伤医疗费、住院伙食补助费、一次性伤残补助金、一次性工伤医疗补助金、一次性伤残就业补助金。
根据《工伤保险条例》第三十条第一款和《中华人民共和国社会保险法》第三十八条第（一）项、第（二）项和第（六）项的规定，张帅的工伤医疗费、住院伙食补助费和一次性伤残补助金，应由工伤保险基金支付。张帅诉求椰林滩大酒店支付工伤医疗费、住院伙食补助费和一次性伤残补助金，没有事实和法律依据，一审法院不予支持正确，本院予以确认。根据《工伤保险条例》第三十七条第（二）项”劳动、聘用合同期满终止，或者职工本人提出解除劳动、聘用合同的，由工伤保险基金支付一次性工伤医疗补助金，由用人单位支付一次性伤残就业补助金”的规定，张帅与椰林滩酒店间的劳动关系已于2017年11月23日终止，张帅诉求椰林滩大酒店支付一次性伤残就业补助金55840元，有事实和法律依据，本院予以支持。一审法院对张帅所主张的一次性伤残就业补助金判决不当，本院予以纠正。张帅诉求椰林滩大酒店支付一次性工伤医疗补助金，没有法律依据，本院不予支持。故椰林滩大酒店应向张帅支付一次性伤残就业补助金55840元和停工留薪期工资23825元。三亚市社保局并未对张帅的工伤保险待遇报销申请作出不予报销的决定。因此，张帅要求椰林滩大酒店向其支付工伤医疗费185759.94元、住院伙食补助费7300元、一次性伤残补助金36296元和一次性工伤医疗补助金68138元，没有法律依据，一审法院不予支持正确，本院予以确认。
综上所述，张帅的上诉请求部分成立。依照《工伤保险条例》第三十七条、《中华人民共和国民事诉讼法》第一百七十条第一款第二项规定，判决如下：
一、维持三亚市城郊人民法院（2017）琼0271民初5353号民事判决第二项；
二、变更三亚市城郊人民法院（2017）琼0271民初5353号民事判决第一项为三亚椰林滩大酒店有限责任公司不向张帅支付工伤医疗费185759.94元、住院伙食补助费7300元、一次性伤残补助金36296元、一次性工伤医疗补助金68138元；
三、三亚椰林滩大酒店有限责任公司于本判决发生法律效力之日起十日内向张帅支付一次性伤残就业补助金55840元。
如果未按判决指定的期间履行给付金钱义务，应当依照《中华人民共和国民事诉讼法》第二百五十三条规定，加倍支付迟延履行期间的债务利息。
一审案件受理费10元（三亚椰林滩大酒店有限责任公司已预交），由三亚椰林滩大酒店有限责任公司负担。二审案件受理费10元（张帅已预交），由三亚椰林滩大酒店有限责任公司负担。
本判决为终审判决。
审判长梁泽
审判员黄学文
审判员李柔翰
二○一七年十二月十四日
法官助理纪诗媛
书记员徐涛
附相关法律条文：
《工伤保险条例》
第三十七条职工因工致残被鉴定为七级至十级伤残的，享受以下待遇：
（一）从工伤保险基金按伤残等级支付一次性伤残补助金，标准为：七级伤残为13个月的本人工资，八级伤残为11个月的本人工资，九级伤残为9个月的本人工资，十级伤残为7个月的本人工资；
（二）劳动、聘用合同期满终止，或者职工本人提出解除劳动、聘用合同的，由工伤保险基金支付一次性工伤医疗补助金，由用人单位支付一次性伤残就业补助金。一次性工伤医疗补助金和一次性伤残就业补助金的具体标准由省、自治区、直辖市人民政府规定。
《中华人民共和国民事诉讼法》
第一百七十条第二审人民法院对上诉案件，经过审理，按照下列情形，分别处理：
(一)原判决、裁定认定事实清楚，适用法律正确的，以判决、裁定方式驳回上诉，维持原判决、裁定;
(二)原判决、裁定认定事实错误或者适用法律错误的，以判决、裁定方式依法改判、撤销或者变更;
(三)原判决认定基本事实不清的，裁定撤销原判决，发回原审人民法院重审，或者查清事实后改判;
(四)原判决遗漏当事人或者违法缺席判决等严重违反法定程序的，裁定撤销原判决，发回原审人民法院重审。
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