How to Determine Death Within the 48‑Hour Rule for an On‑the‑Job Sudden Illness

Wu suffered a sudden illness while at work and was admitted to hospital at 11:42 a.m. on April 29, 2021. In the early hours of May 1, Wu experienced cardiac arrest. Heartbeat was temporarily restored after resuscitation, yet spontaneous breathing could not be regained. At 11:20 a.m. on the same day, Wu suffered a second cardiac arrest. The hospital continued resuscitation measures including cardiopulmonary resuscitation and electric defibrillation, and clinical death was declared at 12:08 p.m. The time from admission to the declaration of death exceeded 48 hours. The human‑resources and social‑security authority accordingly made a decision not to recognize a work‑related injury. After multiple rounds of litigation and a protest lodged by the Supreme People’s Procuratorate, the Supreme People’s Court ultimately held that, based on the complete medical course records, Wu had sustained no heartbeat or respiration from 11:20 a.m. on May 1 onwards, with irreversible death having occurred. The fact that the hospital fulfilled its duty to save lives by postponing the formal declaration of clinical death should not automatically preclude a deemed work‑related‑injury finding. Ultimately, Wu’s case was affirmed to fall under the circumstance of “death from failure to respond to rescue efforts within 48 hours”. ((2025) Supreme People’s Court Administrative Retrial No. 516)

Under Item 1 of Paragraph 1 of Article 15 of the “Regulations on Work‑Related Injury Insurance”, an employee who “dies of a sudden illness at work hours and at the work post, or dies despite rescue efforts within 48 hours” shall be deemed to have suffered a work‑related injury. This “48‑hour” threshold raises two questions: when does the 48‑hour clock start, and what standard governs the time‑of‑death determination.

First, the 48‑hour period does not commence when the employee collapses, feels unwell, or calls an ambulance. Instead, it starts from the time of the initial medical diagnosis made by a medical institution. This is explicitly stipulated in Article 3 of the “Opinions on Several Issues Concerning the Implementation of the Regulations on Work‑Related Injury Insurance”. In practice, key documents such as emergency‑room medical records, admission notes and pre‑hospital emergency care reports should be reviewed, rather than simply counting backwards from other events to calculate the 48‑hour period.

Second, the time of death shall in principle be that recorded on the death certificate, though the death certificate is not absolutely conclusive under all circumstances. Article 15 of the “Civil Code” provides: “The time of death of a natural person is the time recorded in the death certificate; in the absence of a death certificate, it shall be the time recorded in household‑registration or other valid identity registers. Where other evidence is sufficient to overturn the aforesaid recorded times, the time proven by such evidence shall prevail.” This is the core takeaway from the aforementioned Supreme People’s Court case. The judgment did not establish a new rule that deaths occurring after 48 hours automatically qualify as work‑related injuries. Rather, it conducted a substantive review of when the actual fatal state set in under specific evidentiary conditions.

However, such exception does not constitute a general rule. For example, in the case (2024) Hu7101XingChu No. 427, family members contended that the employee had suffered brain death within 48 hours, but a deemed work‑related‑injury finding was ultimately denied. By contrast, in the case (2017) LuXingShen No. 127, the Shandong High People’s Court upheld using the time of brain death as the time of death.

A persistent vegetative state is clearly distinguished from brain death and does not equate to death. Item 5.1.1 in the “Announcement of the Supreme People’s Court, Supreme People’s Procuratorate and Ministry of Public Security on Issuing the Grading of Disability Caused by Human‑Body Injuries” classifies “persistent vegetative state” as Grade‑I disability (the most severe disability grade). Therefore, even if an employee enters a vegetative state within 48 hours of falling ill, so long as the person remains alive, the condition cannot be treated as “death despite rescue efforts within 48 hours”.

Where an employee suffers a severe sudden illness at work, prompt hospital admission is a must to do action. For incidents falling near the 48‑hour threshold, a 48‑hour countdown should not be rigidly applied. Instead, a 48‑hour countdown time point shall be determined with a complete chain of evidence covering medical admission, diagnosis, resuscitation and the formal declaration of death.