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Regulations for Implementing Labor Occupational Accident Insurance Occupational Disease Appraisal(2022.03.31) Chinese

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Promulgated on March 31,2022
Article 1 These Regulations are established in accordance with Paragraph 4 of Article 75
of the Labor Occupational Accident Insurance and Protection Act (hereinafter
referred to as the Act).
Article 2 The scope of occupational disease appraisal accepted by these Regulations is
as follows:
1.When the insurer deemed required to review and approve an occupational
disease benefit case.
2.The insurer applies for appraisal in accordance with Paragraph 2 of Article
75 of the Act.
When it is deemed necessary, as specified in the first paragraph of the
preceding article, it is one of the following circumstances:
1.When there is difficulty in reviewing occupational disease benefit cases.
2.After the approved cases of occupational disease benefits are revoked
through administrative relief procedures such as dispute deliberation,
petition or administrative litigation, the insurer shall conduct another
review.
Article 3 When applying to the central competent authority for occupational disease
appraisal in accordance with Paragraph 1 of Article 75 of this Act, the
insurer shall provide the following documents:
1.Application for payment of labor occupational accident insurance.
2.The insured's medical certificate of injury and illness, disability
diagnosis, medical diagnosis certificate, death certificate, or a public
prosecutor's autopsy certificate.
3.Medical records of the insured.
4.The medical opinion of the specialist in occupational medicine was appointed
by the insurer.
When applying to the central competent authority for occupational disease
appraisal in accordance with Paragraph 2 of Article 75 of this Act, besides
the above documents, the insurer shall provide the following documents:
1.The insured's application for dispute review.
2.Approval documents for occupational disease benefit cases.
3.A diagnosis certificate of the insured suffering from an occupational
disease diagnosed by a specialist in the occupational medicine department of
an approved medical institution in Paragraph 1 of Article 73 of this Act.
Article 4 Where an insurer applies for occupational disease appraisal under any of the
following circumstances, the central competent authority may not accept it:
1.If the documents required in the preceding article have not been prepared,
they will be notified to make corrections within a time limit, but they will
not be corrected within the time limit.
2.Does not comply with the provisions of Paragraph 2 of Article 75 of this
Act.
3.The cause of the same occupational disease shall be re-approved as an
occupational disease by the insurer.
In a case where an occupational disease appraisal has been made by the central
competent authority, the insurer shall not apply for the appraisal for the
same occupational disease. However, this requirement is exempt if any one of
the following conditions applies:
1.The committee members who should be recused in accordance with these
regulations participate in the appraisal.
2.The facts on which the appraisal is based are subsequently changed in favor
of the insured.
3.The occurrence of new facts or the discovery of new evidence, subject to the
insured being subject to a more favorable appraisal result upon
consideration.
The new evidence specified in Subparagraph 3 of the preceding paragraph shall
be evidence that exists or is established before the occupational disease
appraisal result is made but has not been considered for investigation, and
that the occupational disease appraisal result does not exist or is
established until after the occupational disease appraisal result is made.
Article 5 In order to handle occupational disease appraisal, the central competent
authority shall establish a list of occupational disease appraisal experts
(hereinafter referred to as the “Expert List”), which may be recommended by
labor organizations, employer organizations, occupational safety and health,
occupational medicine, and related medical organizations.
The experts referred to in the preceding paragraph shall have majors in
occupational medicine, occupational safety and health, or labor law, and have
more than five years of teaching or practical experience.
Article 6 In order to identify occupational diseases, the central competent authority
shall form occupational disease appraisal committees (hereinafter referred to
as appraisal committees) according to the following types of diseases in
appraisal cases, and conduct occupational disease appraisal:
1.Group 1: Diseases caused by chemical hazards, physical hazards and
biological hazards, respiratory diseases, skin diseases and occupational
cancers.
2.Group 2: is a musculoskeletal disease.
3.Group 3: cerebrovascular and heart disease and mental disease.
If the application for occupational disease appraisal involves multiple
diseases and cannot be grouped according to the preceding paragraphs, the case
may be jointly identified by the group appraisal committee of the relevant
diseases.
Article 7 The nine members of the group appraisal committee as specified in the preceding
article shall be appointed by the central competent authority as the convener
of the group appraisal committee, and the following persons shall be selected
from the expert roster of Article 5 according to the types of diseases in each
group:
1.There are five physicians specializing in occupational medicine.
2.One relevant medical specialist.
3.One occupational safety and health expert.
4.One legal expert.
The term of office of the members referred to in the preceding paragraph is
two years, and the term of office may be renewed. If there is a vacancy during
the term of office, a replacement (assignment) may be employed, and the term
of office will expire on the date of the original term.
For the members of Paragraph 1, the ratio of any gender shall not be less than
one-third.
Article 8 When the central competent authority accepts an application for occupational
disease appraisal, it shall submit the relevant materials to the appraisal
committee members for written appraisal according to the type of disease. The
appraisal operation period shall be based on the principle of 14 days, and the
decision shall be made on the basis of two-thirds or more of the members who
have the same opinion.
When the appraisal result cannot be made according to the preceding paragraph,
the convener shall convene the appraisal committee members to hold a meeting
for appraisal. More than two-thirds of the members should be present,
including at least three specialists in the occupational medicine department.
The decision shall be made with the opinion of more than half of the members
present.
The opinions of the appraisal committee members in the preceding two
paragraphs shall be prepared by filling in the Occupational Disease Appraisal
Opinion Forms in Attachment 1 and Attachment 2 with reasons and selection
methods.
The decision method of the joint appraisal in Paragraph 2 of Article 6 shall
apply mutatis mutandis to the provisions of the preceding three paragraphs;
the convener of the joint appraisal shall be elected by each other.
Article 9 In cases where the appraisal result cannot be obtained in accordance with
Paragraph 2 or Paragraph 4 of the preceding article, the central competent
authority may designate a convener of a group appraisal meeting and convene
all 27 members to jointly hold a meeting for appraisal.
The meeting referred to in the preceding paragraph shall be attended by more
than half of all members, and more than half of the members who are
specialists in occupational medicine shall be present. The decision shall be
made with the opinion of more than half of the members present.
The opinions of the appraisal committee members in the preceding two
paragraphs shall be prepared by filling in the Occupational Disease Appraisal
Opinion Forms in Attachment 1 and Attachment 2 with reasons and selection
methods.
Article 10 The occupational disease appraisal results of the appraisal committee are
classified as follows:
1.Diseases listed in the “List of Types of Occupational Disease under Labor
Occupational Accident Insurance”: divided into occupational diseases or non-
occupational diseases.
2.Cerebrovascular and heart disease and mental disease: divided into work-
related diseases or non-work-related diseases.
Diseases other than those mentioned in the preceding paragraph may be
identified as occupational diseases or work-related diseases if there is
scientific evidence to prove that the worker suffers from the disease and its
work exposure is related.
The occupational diseases specified in the preceding two paragraphs are those
whose causal relationship or contribution degree is greater than 50%.
The work-related diseases specified in Paragraph 1, Subparagraph 2 and
Paragraph 2 are diseases with multiple pathogenic factors, work is only one
factor, and the disease is caused by the joint action of other risk factors.
Article 11 In order to handle occupational disease appraisal, the central competent
authority may dispatch personnel or request labor inspection agencies to
dispatch personnel, together with the personnel of an occupational accident
prevention and rehabilitation center as a juridical person (hereinafter
referred to as the “Occupational Accident Prevention and Rehabilitation
Center”) as specified in Article 70 of this Act, to the insured collect
relevant evidence at workplaces or places related to occupational disease
exposure.
The Occupational Accident Prevention and Rehabilitation Center shall conduct
an occupational medical assessment based on the evidence in the preceding
paragraph, and prepare an Oc-cupational Medical Evidence Investigation
Report.
Article 12 In order to identify occupational diseases, the central competent authority
may invite experts, scholars, representatives of organizations,
organizations, or relevant personnel to provide information, or express
opinions during the meeting.
Article 13 The withdrawal of members of the appraisal committee, the investigators of
Article 11 or related personnel, and the prohibition of contact outside the
procedure shall be handled in accordance with the provisions of Articles 32,
33 and 47 of the Administrative Procedure Act.
The personnel referred to in the preceding paragraph shall keep confidential
the content of the deliberation case and relevant appraisal matters.
Article 14 For an application for appraisal in accordance with Paragraph 2 of Article 75
of this Act, before the appraisal result is made, the insured may, at any
time, in writing, request the insurer to submit an application for withdrawal
of appraisal to the central competent authority.
After the insurer withdraws the application for occupational disease
appraisal in accordance with the provisions of the preced-ing paragraph, the
insured shall not request the insurer to apply for appraisal to the central
competent authority for the same oc-cupational disease.
Article 15 The central competent authority shall regularly analyze the results of
occupational disease appraisal, remove identifiable personal data of relevant
personnel and business secrets of business units, and publish them on the
website.
Article 16 These Regulations shall enter into force and take effect on May 1, 2022.