Article Content

  Chapter 2 Occupational Accident Insurance

   Section 4 Insurance Benefit

     Subparagraph 2 Medical care benefit

Article 38
Medical care benefits are divided into clinical treatment and hospitalized treatment.
The insurer may outsource the medical care benefit under the previous paragraph to an insurer of national health insurance.
Any insured person who suffers occupational injury or disease shall seek treatment from a contracted hospital or clinic of national health insurance. The medical cost incurred shall be paid by the insurer to the insurer of national health insurance. The insured person shall not collect cash.
In addition to the application mutatis mutandis of the National Health Insurance Act and relevant regulations, the scope of treatment under the previous paragraph, the items of medical expenses and the payment standards shall be proposed by the insurer, discussed with the insurer of national health insurance and submitted to the central competent authority for approval and publication.
Article 39
When an insured person suffers occupational injury or disease, the insured unit shall complete an occupational injury or disease Clinic Visit Form or Hospitalization Application Form (hereinafter referred to as the “Medical Form”) to seek treatment. If the insured unit fails to complete the forms as required or if the insured person acquires its own insurance in accordance with Article 10, the insured person may seek payment from the insurer, which shall be issued following verification.
If the insured person fails to complete the Medical Form under the previous paragraph and the physician issues a diagnosis of occupational disease, the physician may issue an Occupational Disease Clinical Visit Form.
The regulations about the physician's qualifications under the previous paragraph, the collection of Clinical Visit Form, the use thereof and other compliance matters shall be proposed by the insurer and submitted to the central competent authority for approval and publication.
Article 40
Any insured person who has any of the following events may seek reimbursement of medical expense from the insurer:
1.Completion of Medical Form after treatment is acquired from a contracted hospital or clinic of national health insurance for occupational injury or disease.
2.Treatment acquired from an organization other than a contracted hospital or clinic of national health insurance due to emergency Injury or sickness following occupational injury or disease within the Republic of China.
3.Treatment acquired from local hospital or clinic for occupational injury or disease outside the Republic of China.
The National Health Insurance Act and related regulations apply mutatis mutandis to the application for reimbursement of medical expenses under the previous paragraph, the supporting documents required, the deadline for approved reimbursement, the standards for approved reimbursement, the procedure and scope of emergency Injury or sickness.
Article 41
When the Medical Form completed by the insured unit is inconsistent with the requirements of the insurance benefit, is false or is used by a person other than the insured person, all medical expenses shall be paid by the insured unit except those that should be borne by the insurer of national health insurance in accordance with national health insurance-related legislations.
When the medical care provided by a contracted hospital or clinic of national health insurance to an insured person is outside the scope of benefit under the Insurance, such medical expenses shall be undertaken by the hospital, the clinic or the insured person.
In the event of the first paragraph, the insurer shall issue a written administrative decision ordering the insured unit to reimburse the same amount of medical expenses that the insurer has paid to the insurer of national health insurance before a deadline.