The types of benefits of the Insurance are as follows:
1.Medical care benefit.
2.Injury or sickness benefit.
3.Permanent disability benefits.
4.Survivor benefit.
5.Disappearance benefit.

When an insured person suffers occupational injury or occupational disease (hereinafter referred to as “occupational injury or disease”) and incurs an insured medical, injury or sickness, permanent disability, death or disappearance incident after the insurance coverage starts and before it ends, the insured person, the beneficiary of the funeral cost payer may seek insurance benefit in accordance with the Act.
When an insured person suffers occupational injury or disease during the existence of the insurance coverage, he/she may seek medical care benefit, Injury or sickness benefit, permanent disability benefit or survivor benefit for the same injury or sickness and the disease caused by the Injury or sickness within one year from the day following the end of coverage.
The central competent authority shall prescribe the guidelines for the types of occupational injury, types of occupational disease, standards of review and determination, categorized investigation review procedure and other relevant matters of the occupational injury or disease under the first paragraph.

For insurance benefits issued in cash, the amount shall be calculated based on the average monthly insured salary of the insured person and the payment standards.
The average monthly insured salary under the previous paragraph shall be based on the average of the actual monthly insured salary during the 6 months before the month during which the insured person suffers the insured incident. If the period is less than 6 months, it shall be calculated based on the average monthly insured salary during the actual period of the insurance.
Insurance benefit paid on a daily basis shall be based on the average monthly insured salary under the previous paragraph, divided by 30.
When the insured unit of a worker under Article 6 fails to complete insurance participation or withdrawal procedure in accordance with Article 12 and if an insured incident occurs, the monthly insured salary during the period for which the procedure was not completed shall be determined by the insurer based on the insured salary category chart level that corresponds to the total amount of monthly salary, provided that it shall not be higher than the level corresponding to the average monthly insured salary of all insured persons during the most recent year published by the insurer at the time of occurrence of the incident.
If the insured unit or the insured person does not provide information showing relevant salary to the insurer for review and approval in relation to the monthly insured salary during the period for which the procedure was not completed under the previous paragraph, the calculation shall be based on the first level of the insured salary category chart.

Insurance benefits of the same type shall not be collected more than once for the same incident.
For the same insured incident occurred to an insured person, if the insured person, the beneficiary or the funeral cost payer meets the conditions for the Insurance, labor insurance, farmer health insurance, farmer occupational accident insurance, civil servant/educator insurance, military personnel insurance or national pension insurance (hereinafter referred to as “Other Social Insurance”), only one claim may be made.

If a person is covered by the Insurance while the qualifications for participation defined by the Act are not satisfied, the insurer shall cancel the qualification of such insured person. If the person has received insurance benefits, the insurer shall issue a written administrative decision to order reimbursement before a deadline.
If excess or wrongful collection of insurance benefits without meeting the conditions for collection defined under the Act, the insurer shall issue a written administrative decision to order the reimbursement of the excess or wrongfully collected insurance benefit before a deadline.
The provisions about reimbursement of benefit under the previous two paragraphs apply mutatis mutandis to beneficiaries, claimants and legal successors.

The insurer shall not issue insurance benefits if supporting documents required are not submitted without justification or in case of failure to accept repeat examination by the hospital or physician designated by the insurer in accordance with Article 47.

When the insurer or the central competent authority needs information required for the processing activities of the Insurance or for the review of insurance dispute, it may ask the insured person, beneficiary, insured unit, medical service institution, physician or other relevant authority (institution), organization, corporation or individual to provide such information. The party receiving such request shall not evade, interfere, refuse or provide false justification, report or statement.
The information referred to under the previous paragraph is as follows:
1.Information related to the records of work attendance, medical history, prescriptions, records of examinations, x-ray diagnosis report and use of medical services of the insured person.
2.Information related to the work of the insured person and occupational exposure to health hazard.
3.Accounts, books, lists and documents of the insured unit related to the handling of Insurance.
4.Other documents and electronic files related to the handling of the Insurance or insurance dispute matters.
If the authority (institution) referred to in the first paragraph has computerized the information under the previous paragraph, the insurer may seek a link to acquire such information and such authority (institution) shall not refuse.
The insurer and the central competent authority shall exercise the due care of good administrators in relation to the information acquired in accordance with the previous three paragraphs. The retention, processing and use of relevant information shall be in accordance with the provisions of the Personal Data Protection Act.

No right to collect any insurance benefit by the insured person, beneficiary or funeral cost payer shall be assigned, set off, seized or provided as security.
When the insured person or beneficiary seeks cash payment according to the Act, supporting documents issued by the insurer may be used to open an account with a financial institution to depositing the cash paid.
The deposit in the account under the previous paragraph shall not be subject to setoff, seizure, security or enforcement.

If the insurer cancels or revokes any insurance benefit already collected and such benefit should be returned and is not returned, the insurer may make a deduction from the insurance benefit collected by the same person or the beneficiary.
The central competent authority shall prescribe the regulations about the types, manner, amount of insurance benefit deduction under the previous paragraph and other relevant matters.
Any insurance benefit that should be returned and not yet returned under the first paragraph shall be repaid before normal claims and shall not be subjet to the following:
1.Provisions about waiver of indebtedness in relation to company reorganization under the Company Act.
2.Provisions about waiver of indebtedness in relation to liquidation under the Consumer Debt Cleanup Act.
3.Provisions about waiver of indebtedness in relation to bankruptcy under the Bankruptcy Act.

Insurance benefit issued in cash in accordance with the Act shall be paid within 15 days from the insurer’s approval. Pension payments shall be made before the end of the following month. In case of delayed payment imputable to the insurer, interest shall accrue on the delayed portion.
Interest under the previous paragraph shall be based on the one-year term deposit fixed interest rate offered by the post office on 1 January of each year and shall accrue on a daily basis in NT Dollars, rounded to 1/10 of a dollar.

When an insured unit fails to complete insurance participation or withdrawal procedure for any worker meeting the requirements under Article 6 in accordance with Article 12 and if the worker suffers Occupational injury or disease and seeks insurance benefit, after the insurer issues the insurance benefit, to the extent of such insurance benefit, the insurer shall confirm the amount due from the insured unit and issue a written administrative decision to order payment before a deadline.
If the insured unit has made payment in accordance with the previous paragraph, the insurance benefit collected by its worker may be used to set off against occupational accident compensation due in accordance with Article 59 of the Labor Standards Act.
The scope of the amount payable under the previous paragraph, the calculation manner, payment manner, payment deadline and other compliance matters shall be prescribed by the central competent authority.

The claim to receive insurance benefit shall cease to exist if it is not exercised within 5 years from the date on which the claim can be made.

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.

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.

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.

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.

If the insured person suffers occupational injury or disease, cannot perform for, cannot receive original salary as a result and is under treatment, he/she may claim Injury or sickness benefit starting from the 4th day of inability to perform work.
The injury or sickness benefit under the previous paragraph shall be issued based on the average monthly insured salary of the insured person in the previous 2 months. Starting from the 3rd month, 70% of the average monthly insured salary of the insured person shall be paid. Payment shall be made every half a year. The maximum payment period is 2 years.

When an insured person suffers occupational injury or disease, if the symptoms are fixed following treatment, further treatment will not improve the result of treatment. The person is diagnosed with permanent disability by a contracted hospital or clinic of national health insurance, meeting the conditions for permanent disability benefit under the Insurance. He/she may seek an lump sum payment of permanent disability benefit based on his/her average monthly insured salary and the prescribed benefit standards.
When the level of Permanent disability of the insured person under the previous paragraph meets one of the following conditions following evaluation, Permanent disability pension may be claimed.
1.Full Permanent disability: Issuance based on 70% of average monthly insured salary.
2.Serious Permanent disability: Issuance based on 50% of the average monthly insured salary.
3.Partial Permanent disability: Issuance based on 20% of the average monthly insured salary.
If the insured person has accrued seniority under labor insurance before the implementation of the labor insurance pension system on 1 January 2009 and meets the conditions for permanent disability pension payment following evaluation, in addition to the permanent disability pension already collected, the insured person may still choose to collect a permanent disability lump sum benefit, which shall not be changed after approved payment by the insurer.
During the period when the insured person collects permanent disability pension, he/she shall not collect Injury or sickness benefit for the same Injury or sickness.
The types, status, and level of permanent disability under the first and second paragraphs, the amount of benefit, the level of medical institution for the issuance of diagnosis, the review and approval standards, the evaluation standards for the level of permanent disability and the standards for other compliance matters shall be prescribed by the central competent authority.

When permanent disability pension is collected, any family member who meets one of the following conditions shall also be issued a family allowance equivalent to 10% of the amount calculated under the second paragraph of the previous paragraph per person. Such additional issuance shall not exceed a maximum of 20%.
1.The spouse is aged 55 or more and the marriage has continued for one year or longer, except if there are any of the following events:
(1)No capacity to earn a living.
(2)Child in care under subparagraph 3.
2.The spouse is aged 45 or more, the marriage has continued for one year or longer and the monthly work income does not exceed level 1 of the Insured Salary Category Chart.
3.The child must meet one of the following conditions. In case of a foster child, the foster relationship must have continued for 6 months or longer.
(1)Minor.
(2)No capacity to earn a living.
(3)Aged 25 or less, schooled, with monthly work income below level 1 of the Insured Salary Category Chart.
The issuance of additional family allowance shall end if the family member under any subparagraph of the previous paragraph has any of the following events:
1.Divorced spouse or inconsistency with the conditions for collection under subparagraphs 1 and 2 of the previous paragraph.
2.Child inconsistent with the conditions for collection under subparagraph 3 of the previous paragraph.
3.Serving prison sentence, under seizure or detention.
4.Disappearance.
“Detention” referred to under subparagraph 3 of the previous paragraph means a declaration of detention, custody, observation for rehabilitation, forceful rehabilitation or security sanction, enforced in a specific location where the physical freedom is deprived or restricted. It does not include protective measures, release from detention for medical care or probation.

After the insured person collects the permanent disability pension, the insurer shall review the level of permanent disability at least every 5 years, except if the insurer deems that there is no need for such review.
When the insurer reviews the collection of permanent disability pension in accordance with the previous paragraph, if it deems that the level of permanent disability has reduced but the conditions for collecting permanent disability pension are still satisfied, permanent disability pension shall be issued based on the reduced level of permanent disability. If the level of permanent disability has been reduced to below the conditions for issuance of permanent disability pension, the issuance of Permanent disability pension shall end and a permanent disability lump sum benefit shall be issued.
The review under the first paragraph shall be performed by the insurer together with functional rehabilitation measures.

If the insured person’s body previously suffered from a part of permanent disability and if the occupational injury or disease further aggravates the level of permanent disability of the same body part or causes permanent disability in a different body part, the insurer shall issue permanent disability benefit based on the aggravated level of permanent disability calculated in accordance with the permanent disability benefit standards. However, the total amount of permanent disability lump sum benefit shall not exceed the level 1 payment standard.
If the insured person under the previous paragraph meets the conditions for permanent disability pension and seeks collection of ermanent disability pension, the insurer shall pay 80% of the amount of permanent disability pension on a monthly basis until half of the amount of lump sum ermanent disability benefit calculated based on the previous level of permanent disability and in accordance with the permanent disability benefit standards is fully deducted.
When the insured person under the previous two paragraphs suffers occupational injury or disease during the insurance period and did not collect permanent disability benefit for the previous partial permanent disability, the insurer shall issue permanent disability benefit in accordance with Article 43 based on the aggravated level of permanent disability. However, the total amount of permanent disability lump sum benefit shall not exceed the level 1 payment standard.
If an insured person who collects permanent disability pension suffers an aggravated level of permanent disability in the same body part or permanent disability in a different body part due to the same occupational injury or disease or further suffering of occupational injury or disease, the insurer shall issue permanent disability pension in accordance with the second paragraph of Article 43 based on the level of ermanent disability following evaluation. However, if the level of permanent disability still meets the conditions for the previous pension collected, the previous pension shall continue to be issued.
The central competent authority shall prescribe the manner of benefit issuance under the previous four paragraphs and the standards for other compliance matters.

In the review of permanent disability benefit, if the insurer deems it necessary for the insured person to have a repeat examination, it may designate a hospital or physician to perform such repeat examination.

When an insured person is evaluated to be without working capability for life and collects Permanent disability benefit under the Insurance or labor insurance, the insurer shall withdraw the insured person from the Insurance.

When an insured person suffers occupational injury or disease leading to death during the period of insurance, the funeral cost payer may seek to collect a funeral grant.
If the insured person under the previous paragraph has a surviving spouse, child, parent, grandparent, grandchild under his/her care or sibling under his/her care, survivors’ pension may be collected in the sequence listed under Article 52 if the following conditions are satisfied:
1.Spouse meeting the conditions under subparagraph 1 or 2, the first paragraph of Article 44.
2.Child meeting the conditions under subparagraph 3, fist paragraph of Article 44.
3.Parent or grandparent aged 55 or more, with monthly work income not exceeding level 1 of the Insured Salary Category Chart.
4.Grandchild meeting the conditions under sections (1) to (3), subparagraph 3, first paragraph of Article 44.
5.Sibling meeting one of the following conditions:
(1)Any event under section (1) or (2), subparagraph 3, first paragraph of Article 44.
(2)Aged 55 or more, with monthly work income not exceeding level 1 of the Insured Salary Category Chart.
If none of the surviving family in the same order of sequence under the previous paragraph meets the conditions for survivors’ pension at the time of the decease of the insured person, a survivors’ lump sum benefit may be collected. After approval and payment by the insurer, no further survivors’ pension shall be collected.
After the insurer approves and pays the survivors’ lump sum benefit in accordance with the previous paragraph, if there is still any other surviving family under the same order of sequence whose name was not listed, no further survivors’ pension shall be collected. The surviving family member who has collected the benefit shall be responsible for the sharing of the benefit received.
If the insured person has accrued insurance seniority before the implementation of the labor insurance pension system on 1 January 2009, in addition to collecting the survivors’ pension in accordance with the second paragraph, surviving family members may also choose to collect survivors’ allowance, without the restriction of the conditions under the second paragraph. Once approved and paid by the insurer, the choice shall not be changed.

When the person seeking permanent disability pension in accordance with subparagraph 1 or 2, second paragraph of Article 43 is deceased at the time of collection, the surviving family may seek collection of survivors’ pension if he/she meets the conditions under the second paragraph of the previous article.
If the insured person has accrued insurance seniority before the implementation of the labor insurance pension system on 1 January 2009, in addition to collecting the pension in accordance with the previous paragraph, surviving family members may also choose to collect the amount of difference between the permanent disability lump sum benefit and the total amount of pension already collected, without the restriction of the conditions under the second paragraph of the previous article. Once approved and paid by the insurer, the choice shall not be changed.
Articles 52 and 53 apply mutatis mutandis to the sequence of collection and manner of payment of the amount of difference under the previous paragraph.

The standards for funeral grant, survivors’ pension, survivors’ lump sum benefit and survivors’ allowance under the previous two articles are as follows:
1.Funeral grant: Lump sum issuance equivalent to 5 months of the average monthly insured salary of the insured person. However, if the insured person does not have surviving family, 10 months of average monthly insured salary shall be issued.
2.Survivors’ pension:
(1)Survivors’ pension sought in accordance with the second paragraph of Article 49 shall be issued based on 50% of the average monthly insured salary of the insured person.
(2)Survivors’ pension sought in accordance with the first paragraph of the previous article shall be issued at half the amount calculated in accordance with the Permanent disability pension standards.
3.Survivors’ lump sum benefit and survivors’ allowance: Issued at 40 months of average monthly insured salary of the insured person.
When there are two or more surviving family members in the same order of sequence entitled to survivors’ pension, an additional 10% of the amount calculated in accordance with subparagraph 2 of the previous paragraph shall be issued for each one additional person, up to a maximum of additional 20%.

The order of sequence for the collection of survivors’ pension, survivors’ lump sum benefit and survivors’ allowance is as follows:
1.Spouse and child.
2.Parent.
3.Grandparent.
4.Grandchild under care.
5.Sibling under care.
When there are family members entitled to survivors’ pension, survivors’ lump sum benefit or survivors’ allowance under an order of sequence, surviving family of the following sequence shall not seek any collection.
If none of the surviving family under the first order of sequence in the first paragraph meets the conditions for collection, or if there is any of the following events and none of the surviving family under the same order of sequence meets the conditions for collection, surviving family under the second order of sequence may seek collection of survivors’ pension:
1.Death.
2.Presentation of waiver declaration.
3.Failure to seek collection within one year from the date on which the conditions for collection are satisfied.
Issuance of survivors’ pension under the previous paragraph shall end when the surviving family under the first order of sequence seeks collection or further meets the conditions for collection and the surviving family shall make the collection under the first order of sequence. However, pension already issued to surviving family under the second order of sequence shall not be re-issued.

The funeral grant, survivors’ pension, survivors’ lump sum benefit and survivors’ allowance under the Insurance shall be collected by no more than one person.If two or more persons meet the conditions for collection, the collection shall be made jointly. If no one seeks collection or if another person seeks collection before the insurer’s determination, the insurer shall give notice to each applicant to agree for one of the persons to collect the benefit on their behalf. If an agreement cannot be reached, the average amount of the total benefit shall be issued to each applicant.
If there are two or more surviving family members under the same order of sequence and if one of them seeks to collect the survivors’ pension, the survivors’ pension shall be issued. However, if an agreement is made for the collection of survivors’ allowance or the amount of difference between Permanent disability benefit and the total amount of pension already collected in accordance with the fifth paragraph of Article 49 of the second paragraph of Article 50, such agreement shall prevail.
After the insurer issues the surviving family benefit in accordance with the previous two paragraphs, if there is any other surviving family under the same order of sequence whose name was not listed, the surviving family who has collected the benefit shall be responsible for sharing the benefit.

When survivors’ pension is collected, the issuance of the pension shall end if there are any of the following events:
1.Spouse remarries or does not meet the conditions for collection under subparagraph 1, second paragraph of Article 49.
2.Child, parent, grandparent, grandchild or sibling does not meet the conditions for collection under subparagraphs 2 to 5, the second paragraph of Article 49.
3.Any event under subparagraph 3 or 4, second paragraph of Article 44.

If the insured person suffers an accident in the course of duty, leading to his/her disappearance, the disappearance benefit shall be issued from the date of disappearance.
The disappearance benefit under the previous paragraph shall be paid at the end of each 3-month period based on 70% of the average monthly insured salary of the insured person until the day preceding the return, the day preceding the one-year anniversary of the disappearance or the day preceding the death confirmed by a death declaration judgment.
When the insured person under the first paragraph has disappeared for one year or has been confirmed deceased by death declaration judgment, the surviving family may seek Survivor benefit in accordance with Article 49.

If the insured person or the beneficiary meets the conditions for pension collection, an application form shall be completed and relevant documents enclosed to file an application with the insurer.
If the insurer reviews and approves the conditions for collection by the insured person or beneficiary under the previous paragraph, the pension shall be issued on a monthly basis from the month of application until the month during which the issuance should end.
If the beneficiary of survivors’ pension fails to file an application in the month when the conditions for collection are satisfied, the insurer shall make retrospective payment for the benefit that may be collected during 5 years preceding the date of application, except the portion that is already collected by other beneficiaries.

When an insured person or beneficiary seeks pension, the insurer may make verification and may withhold benefit issuance during the verification period. If the verification shows that the conditions for the benefit are satisfied, benefits due during the verification period shall be issued and issuance shall continue in accordance with the regulations.
If the person collecting pension does not meet the conditions for the benefit or is deceased, such person or the successor shall submit relevant documents and information and give notice to the insurer within 30 days from the date of occurrence of the event. The insurer shall cease pension issuance from the month following the date of occurrence of the event.
If the person collecting pension is deceased and the pension due has not been remitted into his/her account, the successor may submit justification documents showing the date of decease of the applicant and the successor to collect the pension. If there are two or more successors, a power of attorney and an affidavit may be issued jointly for one of the persons to collect the benefit.
If the person collecting pension or his/her successor fails to give notice to the insurer in accordance with the second paragraph, resulting in the excess collection of pension, the insurer shall give written notice to the person who has collected excess pension and the excess may be deducted from the pension issued. If no more payment is due or if the amount due is insufficient for the reduction, the insurer shall give written notice to seek reimbursement within 30 days.

If the insured person or beneficiary seeks the benefit of the Insurance or other social insurance pension at the same time based on different insured incidents, the amount of the pension under the Insurance shall be reduced in consideration of the number, amount, type of pension that the insured person or beneficiary may collect and other elements of livelihood protections.
The reduction ratio of pension under the Insurance in the previous paragraph shall be limited to 50%.
The central competent authority shall prescribe the regulations about the situation, ratio and manner of the reduction of pension under the Insurance and other compliance matters under the first paragraph.