History

Theses Regulations are drawn up in accordance with Article 5 Paragraph 3 of the Labor Insurance Act.

An insured unit, insured person, beneficiary, person paying for the funeral, or National Health Insurance medical service institution (hereinafter all referred to as the applicant) having disputes with the Bureau of Labor Insurance (hereinafter referred to as BLI) over the recognition of the following particulars may apply for reviewing and evaluation according to these Regulations:
1.Qualifications of the insured or the beneficiary, and insurance particulars.
2.An insured person's insured salary or length of insurance enrollment.
3.Insurance premiums or overdue fines.
4.Payment of insurance benefits.
5.Occupational injuries and Diseases.
6.Levels of disability.
7.Medical expenses for occupational accidents.
8.The rights and interests of the insured.

As the applicants apply for examination and review pursuant to Article 2 of these Regulations, should fill in and submit the Application Form for the Settlement of Labor Insurance Disputes (hereinafter referred to as Application Form for the Settlement) within 60 days, after received the appraised and decided notification from BLI the next day, and check and attach related certificates to the BLI. Then the BLI will apply the Examination and Review to Labor Insurance Supervisory Commission (hereinafter referred to as the Supervisory Commission). Once the event will procrastinate the period but cannot refer the duty to the applicant's own, the applicants should explain the procrastinated reasons in written form and apply for examination and review within 30 days when the event is wiped out next day.
The application of Application Form for the Settlement is according to the date of receiving Application Form for the Settlement. If the Application Form for the Settlement was by postal delivery, then the date of receiving is by the postmark of original post office.
The applicants who have ever express to Supervisory Commission or BLI about that they unwillingly accept the judgment as final within the period described in the first paragraph, then the application can be regarded as submitted in statutory period. But the Application Form for the Settlement should be resubmitted within 30 days.
For those applicants who apply for examination and review to Supervisory Commission, the Supervisory Commission shall transfer the Application Form for the Settlement to BLI in accordance with Article 3-2.

The Application Form for the Settlement shall be recorded clearly the following items with signature or seal by the applicants or representatives:
1. The Insured Persons' and the applicants' name, birthrates (Year, Month, Day), resident address, serial number of identification document. If it was applied by the Insured Unit, shall be recorded clearly name, serial number of Insurance Certificate, address and name of the person in charge.
2. The original appraised and decided date (Year, Month, Day) of the received or informed by BLI.
3. The request particulars of the application for examination or review.
4. The facts and reasons of the application for examination or review.
5. Evidences, for those are papers, shall add copy or photocopy.
6. Year, Month, Day.
Application for examination or review shall attach the photocopy of original appraised decided letter from BLI.

After the BLI received the applications form for settlement, shall review the original appraised and decided in advance for its legitimacy and properness. If the application for examination or review is reasonable, the BLI can appraise and decide anew, and inform the applicant and copy to the Supervisory Commission.
BLI did not follow the request by the applicant to withdraw or change the original appraised and decided, shall submit written opinions with necessary archives to the Supervisory Commission and copy the written opinions to the applicant.

In the event that the applicant is an incapacitated person or an individual with limited capacity or declared under guardianship, the applicant’s legal representative or guardian shall process the application on behalf of the applicant. An insured unit may process the application at the request of the insured, the beneficiary or the person paying for the funeral but shall never act against the intention of the insured, the beneficiary or the person paying for the funeral expenses.

The applicants can withdraw the application after application for examination or review and prior to Examination Report was sent in. Once withdraw the application, the applicants cannot apply to examine or review for the same disputes.

After the Supervisory Commission received the application form for the Settlement, once the Supervisory Commission judges the procedures did not match the regulations but the state of affairs can be resubmitted and corrected, the Supervisory Commission shall inform the applicants to resubmit and correct within 20 days after received the notification next day. If the applicants with proper reasons, they can apply to postpone during the period and before the expiration.

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In order to examine and review insurance disputes, the Labor Insurance Supervisory Commission has created the Labor Insurance Dispute Evaluation Committee (hereinafter referred to as LIDEC). The chief of the Dispute Evaluation Section shall be a member automatically as well as the chair of the committee. In addition, ten to twelve people with the following qualifications shall be recruited to fill the other seats.
1.Two to four people with at least three years of experience as an assistant professor in social insurance, insurance, social welfare or labor studies
2.Two people with at least three years of experience as a judge, lawyer or legal official with the ranking of selected appointment.
3.Two people with at least three years of experience as an assistant professor in jurisprudence.
4.Two people with at least three years of experience as an assistance professor in a medical school or an attending physician in a public hospital.
5.Two people currently working in the competent authority of labor insurance with the ranking of selected appointment.
The term of service for the committee members described in the proceeding paragraph shall be 2 years and extendable at the end of each term. Recruitment of committee members shall be reported to the central competent authority of labor affairs for approval.

The Committee of E&R arranges one Chairperson, who holds concurrent post of full-time member of the committee of Supervisory Commission and concurrent the section head of Section of Examination and Review of Disputes, Chairperson is responsible for convoking meeting and as the chairman of the meeting.
When the Chairperson for the reason cannot convoke the meeting, the chairman of the Supervisory Commission will designated one of the members of the Committee of E&R to act as the Chairperson.
When the Chairperson for the reason cannot stand for the meeting provisionally, the members of the Committee of E&R will mutually elect one member as the meeting chairman.

It has to have over 1/2 members of the Committee of E&R attending the meeting while the meeting is held. To execute the resolution matter must be agreed by over 1/2 attendant member. The chairman will make when the votes for approving and disapproving are the same, then the decision.
The voting method of preceding paragraph is raising hand or calling, it can be voted in unnamed when in the need.

The Committee of E&R, the members of the Committee of E&R have to attend personally and cannot appoint representative in the meeting. In case the member cannot attend personally, he (she) can submit written opinion and the chairman will report it for him (her), but the chairman cannot vote for him (her).

The meeting of Committee of E&R will be held once half a month in principle, it can be called for meeting provisionally when it is need.

when the meeting of the Committee of E&R is held, it can invite the related persons in charge of BLI to attend as nonvoting delegates for explanations. While it is necessary, it can inform the applicant and others related to be present and explain. Once finish the explanation, the applicant and others related should leave the meeting.

when the meeting of the Committee of E&R is held, it can invite experts who are defined in Article 17 to attend as nonvoting delegates to explain.

As Supervisory Commission received written opinion from BLI, shall hand over written opinion with the Application Form for the Settlement to the Committee of E&R for examination and review.
The decision of the preceding examination and review should be made within 3 months while received the Application Form for the Settlement the next day. It can be lengthened when necessary but cannot over 2 months, and has to inform the applicant.
The period of preceding paragraph will be calculated from the next day when one resubmits Application Form for the Settlement following by the proviso in Article 3 paragraph 3. The one who did not resubmits Application Form for the Settlement; the period will be calculated from the next day of expiration of resubmitted duration. The one who follows stipulation of Article 6 for informed to resubmit and correct, then the period will be calculated from the next day of resubmission and correction; for the one who did not resubmit and correct, the period will be calculated from the next day of expiration of resubmission and correction.

Disputes with following situations shall not be accepted for examination and approval:
1. The Application Form for the Settlement does not appropriate with the legal procedures not to be able to resubmit and correct; or informed to resubmit and correct but did not make up behind time.
2. The applicants apply for examination and review is behind the time which subscribed in Article 3 paragraph 1 and the proviso of Article 3.
3. The applicants do not conform to the stipulation of Article 2.
4. The applicants do not conform to Article 4, and had informed the duration to resubmit and correct but did not do on the appointed date.
5. The original appraised and decided had not existed.
6. To reapply for examination and review for the case which had have examination and review or had withdrawn.
7. To reapply for examination and review for non-administrative disciplinary action or items described in Article 2.
For those do not accept for examination and review according to preceding stipulations of subparagraph 1 or subparagraph 2, its original appraised and decided were indeed illegal or inappropriate, the BLI or Central Labor Administration Competent Authority can withdraw or change it standing on their authority of office.

For the decisions of examination and review must according to the standard that other law concerns with or without existence, while the law concerns are not certain yet, the process of examination and review can be stopped temporarily and inform the applicant in accordance with the authority of office or applicants' application.

Examination and review affairs will be put down preliminary comments or review suggestions on by Section of Examination and Review of Disputes of Supervisory Commission and members of E&R separately according to the characters of affairs; the affairs can ask experts to review, authenticate if it is necessary, then submit to Committee of E&R for examination and review.
It can be rendered to each according to review or authentication described in preceding paragraph, the standard of expenses shall be provided by Supervisory Commission.

Committee of E&R will judge examination and review affairs, for the affair with the necessity of re-examination for insured person's injury and sickness or degree of disability, they can ask for re-examination by assigned special hospital or physician. Insured person can not refuse re-examination without proper reason.
The charge of re-examination described in preceding paragraph will be paid by BLI.

For the applications of examination and review without reason, Supervisory Commission shall turn down the application according to examination and approval.
The original examination and approval of BLI relies on reason by although to be is improper, but takes other reason warrants, should apply for the consideration as unreasonably by. The application consideration has the reason; the Supervisory Commission shall rescind whole or part of original examination and approval of BLI and regard plot of the event to change the examination and approval directly or send back to BLI for another disciplinary action. But to the applicant indicated refuses to accept in the scope, can not have much detrimental examination and approval or disciplinary action.

Supervisory Commission ought to complete the Examination Report according to the results of examination and review, and submit to the Chairman of Supervisory Commission for appraising and decision. And Supervisory Commission will send it to the applicant, Insured Units and BLI separately in 15 days after examination and review.
The BLI has to carry out the result of examination and review of preceding paragraph within 15 days while the Examination Report is sent in BLI the next day.
The Examination Report of first paragraph should be annotated if one refused to accept the result of examination and review, one can transcribe and submit Administrative Appeal Form to Central Labor Administration Competent Authority via BLI to appeal within 30 days when one received the Examination Report the next day.

Examination Report shall be recorded clearly the following items:
1. The applicants' name, birthdate (Year, Month, Day), resident address, serial number of the identification document. If the applicants were Insured Units, then the Insurance Units' serial number of Insurance Certificate, address and name of the person in charge were needed..
2. With legal representatives, the name, birthdate (Year, Month, Day), resident address, serial number of the identification document.
3. The main body of a court verdict, facts and reasons. For those are not accepted and made decision, should not be recorded.
4. Examination Authority and its commander.
5. Year, Month, Day.

Forms, lists and charts of related documents provided for in the Regulations should be designed and determined by the Supervisory Commission.

These regulations take effect on the day of promulgation.
These Regulations were amended on Dec. 31, 2008. In addition to Paragraph 1 of Article 4 that shall become effective on Nov. 23, 2009, the remaining provisions are effective as of Jan. 1, 2009.