Article Content

  Chapter 2 Occupational Accident Insurance

   Section 4 Insurance Benefits

     Subparagraph 1 General Terms

Article 38
The insured unit shall apply for insurance benefits for the insured, the beneficiary, or the person who pays the funeral expenses and shall not thereby charge any fees.
Article 39
Under any of the following circumstances, the insured, the beneficiary, or the person who pays funeral expenses may apply to the insurer for insurance benefits in their capacity:
1. The insured unit is closed, dissolved, revoked, canceled, or becomes bankrupt, etc., and fails to file the application for the insured, beneficiary, or person paying funeral expenses.
2. For workers who meet the provisions of Article 6 of the Act, and their employers have not applied for the insurance by the provisions of Article 12.
3. Apply by the provisions of Paragraph 2 of Article 27 of the Act.
Article 40
The average monthly insured salary specified in Paragraph 2, Article 28 of the Act shall be calculated by dividing by six the total monthly insured salary of the insured for the last six months from the month in which the insured accident occurs; those who have been insured for less than six months shall be calculated based on the average monthly insured salary during the actual insured period.
When the insured has more than two monthly insured salaries in the same particular month, the highest one shall prevail, which shall then be averaged with the monthly insured salaries of the other months.
Article 41
The average monthly insured salary of all insureds in the most recent year as specified in Paragraph 4 of Article 28 of the Act shall be based on the average monthly insured salary of the most recent statistical annual report of the insurance announced by the insurer at the time of the occurrence of the insured accident. However, for the period before the first announcement of such insurance statistical annual report, the average monthly insured salary announced in the latest labor insurance statistical annual report shall prevail.
Article 42
When the insured specified in Paragraph 2 of Article 29 of the Act has any death event insured, the beneficiary or the person who pays the funeral expenses shall also meet the requirements of Articles 49 or 50 of the Act. Only either the stipulated death benefits or other social insurance benefits specified in the following Subparagraphs can be claimed:
1. The death benefit specified in Articles 62, 63, or 63-1 of the Labor Insurance Act.
2. The funeral and interment allowance specified in Article 40 of the Farmer Health Insurance Act.
3. The funeral and interment allowance specified in Article 19 of Guidelines for the Trial Implementation of Farmer Occupational Accident Insurance
4. The lump-sum death benefit or survivor's pension is specified in Article 27 of the Public Servant and Teacher Insurance Act.
5. The death benefit is specified in Article 13 of the Act of Insurance for Military Personnel.
6. The funeral and interment benefit under Article 39 and survivor's pension under Article 40 of the National Pension Act.
Article 43
If the insured, the beneficiary, or the person who pays funeral expenses applies for insurance benefits after the insurer examines that the insured accident is not caused by occupational injury or disease, the applicant may agree in writing to apply to the same accident by the Labor Insurance Act.
Article 44
Insurance benefits distributed in cash under the Act shall, after being approved by the insurer, be directly remitted to the personal account at the financial institution designated by the insured, beneficiary, or person paying funeral expenses, and the insured unit shall be notified. However, in the event of the application of insurance benefits as specified in Subparagraph 1 or 3 of Article 39, the insurer may not notify the insured unit.
If the financial institution account mentioned in the preceding Paragraph is located overseas, the handling fee shall be borne by the insured, the beneficiary, or the person who pays the funeral expenses.
Article 45
The interest to be accrued on the overdue part specified in Paragraph 1 of Article 35 of the Act shall be paid by the insurer's official budget.
Article 46
If the insured, the beneficiary, or the person who pays the funeral expenses, applies to the insurer for insurance benefits by mail, the date of the original postmark of the post office shall prevail.
Article 47
To apply for various insurance benefits by the provisions of the Act, the attached documents and materials shall be verified by the following units if such documents and materials are prepared outside the premise of government agencies (institutions) of the Republic of China:
1. Prepared overseas: To be verified by ROC embassies abroad; those prepared at foreign embassies and consulates in Taiwan or authorized institutions shall be re-verified by the Ministry of Foreign Affairs.
2. Prepared in Mainland China: To be verified by the agency established or designated by the Executive Yuan or the non-governmental organization entrusted by it.
3. Prepared in Hong Kong or Macau: To be verified by the agency established or designated by the Executive Yuan or a non-governmental organization entrusted by it in Hong Kong or Macau.
If the documents and materials in the preceding Paragraph are in foreign languages, the Chinese translation certified by the units listed in the preceding Paragraphs or the notary public in China shall be attached. However, if the documents and materials are in English, they may be exempted from being attached unless the insurer considers it necessary.