Regulations of Application for Occupational Accident Insurance Disability Benefits for Insured Person Diagnosed With Occupational Disease Withdrawn from Labor Insurance
2016-03-16
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Article 1
These regulations are enacted in accordance with Paragraph 2 of Article 20-1 of the Labor Insurance Act (hereafter referred to as this Act).
Article 2
According to the regulation of Article 20-1 of the Act, in addition to the certificates prescribed in Paragraph 1 of Article 68 of the Enforcement Rules of the Labor Insurance Act, applicants for occupational accident insurance disability benefits shall submit the following documents:
1. Descriptions of the nature, content and duration of work, as well as of the work environment or toxic substance the applicant was exposed to before leaving the job.
2. Certificate of occupational disease diagnosis.
3. Proof of tests on the environment in which the insured has worked – where such proof is unavailable due to the original business operation has closed down, the applicant shall submit the record of medical treatment for the disease for at least one year and physical checkup results. If necessary, the applicant is required to provide related pathology and biopsy reports.
Certificate of occupational disease diagnosis referred to in the preceding Subparagraph 2 issued with a diplomate in the hospital shall be meet at least one of the following required：
1. Be a hospital rated as of the level of excellence or better by hospitals accreditation conducted by the competent central health authority.
2. Be a medical center or regional hospital rated as qualified by hospitals accreditation conducted by the competent central health authority.
3. Be a hospital rated as qualified by hospitals accreditation and teaching hospitals Accreditation conducted by the competent central health authority.
4. Be a National Health Insurance contracted hospital or clinic of a diplomate with occupational medicine passed the specialist examination of the competent central health authority.
The insured person who is in Penghu County,Kinmen County,Lienchiang County or other offshore islands, certificate of occupational disease diagnosis referred to in the second subparagraph of first paragraph in this Article may be issued from the origin National Health Insurance contracted hospital or clinic and is not restricted by the preceding paragraph.
The insured person diagnosed occupational disease outside of the enforcement areas of this Act, certificate of occupational disease diagnosis referred to in the second subparagraph of first paragraph in this Article may be issued from the origin hospital or clinic and is not restricted by the preceding paragraph.
Marble, coal and metal mine workers with pneumoconiosis shall not be required to submit the proof of tests on the work environment prescribed in the third subparagraph of first paragraph in this Article if they are unable to produce such proof.
1. Descriptions of the nature, content and duration of work, as well as of the work environment or toxic substance the applicant was exposed to before leaving the job.
2. Certificate of occupational disease diagnosis.
3. Proof of tests on the environment in which the insured has worked – where such proof is unavailable due to the original business operation has closed down, the applicant shall submit the record of medical treatment for the disease for at least one year and physical checkup results. If necessary, the applicant is required to provide related pathology and biopsy reports.
Certificate of occupational disease diagnosis referred to in the preceding Subparagraph 2 issued with a diplomate in the hospital shall be meet at least one of the following required：
1. Be a hospital rated as of the level of excellence or better by hospitals accreditation conducted by the competent central health authority.
2. Be a medical center or regional hospital rated as qualified by hospitals accreditation conducted by the competent central health authority.
3. Be a hospital rated as qualified by hospitals accreditation and teaching hospitals Accreditation conducted by the competent central health authority.
4. Be a National Health Insurance contracted hospital or clinic of a diplomate with occupational medicine passed the specialist examination of the competent central health authority.
The insured person who is in Penghu County,Kinmen County,Lienchiang County or other offshore islands, certificate of occupational disease diagnosis referred to in the second subparagraph of first paragraph in this Article may be issued from the origin National Health Insurance contracted hospital or clinic and is not restricted by the preceding paragraph.
The insured person diagnosed occupational disease outside of the enforcement areas of this Act, certificate of occupational disease diagnosis referred to in the second subparagraph of first paragraph in this Article may be issued from the origin hospital or clinic and is not restricted by the preceding paragraph.
Marble, coal and metal mine workers with pneumoconiosis shall not be required to submit the proof of tests on the work environment prescribed in the third subparagraph of first paragraph in this Article if they are unable to produce such proof.
Article 3
A worker diagnosed as having an occupational disease after withdrawal from labor insurance may still apply for disability benefits according to related regulations in this Act. Those who opt to receive the disability benefits in a lump sum may apply once only.
Article 4
When an insure person applies to receive the general disability benefits for an occupational disease in a lump sum as prescribed in the preceding article, the total days of benefits already remitted against previous applications shall be deducted.
When an insured person applies for the occupational disability pension, besides payment for the pension according to the regulation of Article 53 of this Act, half of the amount already remitted shall be deducted from the 20-month lump sum given as occupational disability compensation. In the event that the said lump sum is smaller than the amount deductible, 20% of the monthly disability pension shall be deducted until half of the already remitted amount is recovered. (Payment = Disability pension + “20-month lump sum given as occupational disability compensation – half of general disability benefits already remitted”)
When an insured person applying for the occupational disability pension has already received the general disability pension for an occupational disease as prescribed in the preceding article, in addition to continued payment of the pension, there shall also be a 20-month lump sum given as occupational disease compensation. (Payment = Disability pension + 20-month lump sum given as occupational disease compensation)
When an insured person applies for the occupational disability pension, besides payment for the pension according to the regulation of Article 53 of this Act, half of the amount already remitted shall be deducted from the 20-month lump sum given as occupational disability compensation. In the event that the said lump sum is smaller than the amount deductible, 20% of the monthly disability pension shall be deducted until half of the already remitted amount is recovered. (Payment = Disability pension + “20-month lump sum given as occupational disability compensation – half of general disability benefits already remitted”)
When an insured person applying for the occupational disability pension has already received the general disability pension for an occupational disease as prescribed in the preceding article, in addition to continued payment of the pension, there shall also be a 20-month lump sum given as occupational disease compensation. (Payment = Disability pension + 20-month lump sum given as occupational disease compensation)
Article 5
The average insured monthly salary of an applicant for disability benefits is calculated as follows:
1. The average monthly salary insured for the disability pension shall be calculated according to Subparagraph 1 of Paragraph 3 of Article 19 of this Act.
2. The average insured monthly salary of workers applying to receive disability benefits in a lump sum shall be the average of the monthly salary insured in the six months immediately before the worker withdrew from labor insurance. For benefits to be paid on a daily basis, the payment shall be the average insured monthly salary divided by 30 days.
The average insured monthly salary prescribed in the preceding paragraph shall be adjusted with consumer price fluctuation taken into consideration according to the Consumer Price Indexes for the Taiwan Area from the Directorate-General of the Budget, Accounting and Statistics institutions in the central government based on different annual and monthly periods.
In the event that the adjusted average insured monthly salary falls below the Grade 1 salary in the Table of Grades of Insurance Salary or the average insured monthly salary before adjustment, payment of benefits shall be made according to the Grade 1 salary in the Table of Grades of Insurance Salary or the average insured monthly salary before adjustment. In the event that the adjusted average insured monthly salary exceeds the highest grade in the Table of Grades of Insurance Salary, according to the highest grade of salary in the Table of Grades of Insurance Salary.
1. The average monthly salary insured for the disability pension shall be calculated according to Subparagraph 1 of Paragraph 3 of Article 19 of this Act.
2. The average insured monthly salary of workers applying to receive disability benefits in a lump sum shall be the average of the monthly salary insured in the six months immediately before the worker withdrew from labor insurance. For benefits to be paid on a daily basis, the payment shall be the average insured monthly salary divided by 30 days.
The average insured monthly salary prescribed in the preceding paragraph shall be adjusted with consumer price fluctuation taken into consideration according to the Consumer Price Indexes for the Taiwan Area from the Directorate-General of the Budget, Accounting and Statistics institutions in the central government based on different annual and monthly periods.
In the event that the adjusted average insured monthly salary falls below the Grade 1 salary in the Table of Grades of Insurance Salary or the average insured monthly salary before adjustment, payment of benefits shall be made according to the Grade 1 salary in the Table of Grades of Insurance Salary or the average insured monthly salary before adjustment. In the event that the adjusted average insured monthly salary exceeds the highest grade in the Table of Grades of Insurance Salary, according to the highest grade of salary in the Table of Grades of Insurance Salary.
Article 6
These regulations take effect on January 1, 2009.
Articles amended since the date of promulgation.
Articles amended since the date of promulgation.