Occupational Accident Medical Benefits

The Bureau of Labor Insurance provides occupational accident medical benefits to worker who has occupational injury or disease during the period of insurance coverage in need of outpatient and hospitalization. Worker having the status of occupational accident of labor insurance enjoy more privileges!

【Qualification】

1. An insured person who is involved in occupational accident commencing from the date of effect of his/her insurance and prior to the termination of labor insurance and conforming to the regulations stipulated in the "Regulations of the Examination of Injuries and Diseases Resulting from the Performance of Duties by the Insured Persons of the Labor Insurance Program" and requires outpatient or hospitalization.
2. An insured person who is involved in occupational accident and disease during the period of insurance coverage who needs outpatient or hospitalization within 1 year of termination of his/her labor insurance.
3. An insured person who is involved in occupational accident and disease during the period of insurance coverage, who needs outpatient or hospitalization in accordance with "Regulation Governing Laid Off Insured Person Continued Joining the Labor Insurance and Insurance Benefits" and "Regulation Governing Occupational Accident Labor Withdrawing from Labor Insurance During Medical Treatment Period But Continued Joining the Labor Insurance".

【Claim Standard】

1. It was stipulated by the national health insurance that the insured person shall pay for a portion of the medical expenses, but it is not required in the occupational accident medical treatment of labor insurance. Expenses are paid by the Bureau of Labor Insurance.
2. Ordinary meal expenses and ordinary medical food expenses are not payable in the national health insurance, but the labor insurance pays half of the expenses in the occupational accident treatment within 30 days.

【Documents Required】

1. An insured person who is applying for outpatient or hospitalization should submit the following identification documents to the national health insurance service institutions:
   1. "Clinic Note of Occupational Injury or Disease of Labor Insurance" or "Application for Hospitalization of Occupational Injury or Disease of Labor Insurance".
   2. National Health Insurance Card and National Identification Card or other identification document.
2. The following documents should be submitted for refund of medical expenses:
   1. Application form for refund of self-advanced medical expense.
   2. Clinic note of occupational injury or disease of labor insurance or application for hospitalization.
   3. Original medical expense receipt and detailed list of expenses. In case the original medical expense receipt and detailed list of expenses were lost or use in other purpose, photocopies of the said bills should be submitted and duly affixed with the official seal of the issuing medical institution stating that these are true and correct copies of the original. 〈Should also state the reason for not able to submit the originals.〉
   4. Medical certificate or certification documents, Chinese translation should be submitted if these certificates are in foreign language.
   5. An insured person who was involved in an occupational injury or disease outside the territory stipulated in the Labor Insurance Act should submit a photocopy of his/her exit and entry certification documents of that time or a certification issued by the company he/she works.
   6. Sea crew of deep-sea fishing boat should submit identification document and a certification document of his/her departure and arrival of that voyage.
   7. An insured person who applies for refund of medical expenses for accident incurred on the way to or leaving from work or on official business should fill up the "Certificate of Injury Due to Accident Incurred on the Way to or Leaving from Work or on Official Business" together with the photocopy of the front and reverse side of the driver license of driver.

【Note】

1. There are upper and lower part on the outpatient treatment form. The insured person may use the outpatient treatment form at a maximum of 6 times for the same occupational injury or disease at the same national health insurance service institution. If the insured person must go to another national health insurance service institution for treatment of the same occupational injury or disease, the insured unit should issue another outpatient treatment form.  There are upper and lower part on the hospitalization application form. One hospitalization application form shall be used only once.
2. The insured person shouldn’t use the outpatient treatment form for treatment and hospitalization application form for hospitalization after withdraws from labor insurance. But if the insured person has occupational injury or disease during the period of validity of the labor insurance, and needs outpatient treatment and hospitalization for within one year after an insurance policy has been terminated, the insured person still can use the outpatient treatment form and hospitalization application form.
3. If the premium and penalty have not been paid by the insured unit and when Bureau of Labor Insurance, Ministry of Labor had temporarily suspended the benefits, outpatient treatment form or hospitalization application form of occupational injury or disease shall not be issued to the insured person commencing from the date of temporarily suspension of benefits, except when the portion of the premium payable by the insured person was already deducted or paid to the insured unit.
4. Where the insured person suffers occupational injury or disease, but the insured unit fails to issue an outpatient treatment form or hospitalization application form of occupational injury or disease in accordance with Labor Insurance Act, the insured person can directly apply for the form from  Bureau of Labor Insurance ,Ministry of Labor, the bureau will issue the forms after the situation is verified through investigation.
5. In case an application for outpatient treatment or hospitalization filled by an insured unit is deemed not to have conformed with the provisions governing insurance benefits, medical care benefits, or hospitalization care benefits, or in case of misrepresentations in the application forms, or in case the application forms are given to non-insured persons for use, the insured unit shall be responsible for paying all the medical expenses incurred.
6. For applications for the reimbursement of medical expenses, the BLI shall complete the review process within ten working days after receiving the application, if the relevant application formalities have been properly completed.

【Form Downloading】

1. Labor Insurance Occupational Accident Self-Advanced Expense Reimbursement Application Form and Payment Receipt
   “Public Service>Table Download>Labor Insurance>Insurance Benefits>Labor Insurance Occupational Accident Self-Advanced Expense Reimbursement Application Form and Payment Receipt”
2. Labor Insurance Insured Person Proof of Injury Resulting from an Accident  on the Way to or from Work or during Business Trip
   “Public Service>Table Download>Labor Insurance>Insurance Benefits>Labor Insurance Insured Person Proof of Injury Resulting from an Accident on the Way to or from Work or during Business Trip”