Individualized Professional Assessment Points for Labor Insurance Disability Pension Payments Consigned by the Bureau of Labor Insurance
Individualized Professional Assessment Points for Labor Insurance Disability Pension Payments Consigned by the Bureau of Labor Insurance
Office Letter Lao-Bao-3-Tze No. 1020140362 dated May 27th, 2013 issued
by the Council of Labor Affairs, Executive Yuan for future reference
Order Bao-Ji-Can-Tze No. 10260317801 dated June 13th, 2013
announced by the Bureau of Labor Insurance
Article 1
The Bureau of Labor Insurance (hereinafter called “the Bureau”) hereby establishes these points to carry out the regulations prescribed in Article 4-1 of the Standards of Labor Insurance Disability Benefits.
Article 2
Insured persons who apply for a labor insurance disability pension payment shall receive an individualized professional assessment (hereinafter referred to as an “Assessment”) of the overall degree of disability in ompliance with levels 1 to 6 in professional hospitals consigned by the Bureau (hereinafter referred to as “Consigned Hospitals”), unless otherwise evaluated according to this Act as incapable of work for the rest of their lives, which refers to the insured individual having the disability conditions described in the attached table under “loss of the ability to work for the rest of their lives”.
Article 3
The Bureau shall submit the following documents when performing an assessment in Consigned Hospitals:
（1）Application form of labor insurance disability benefit and payment
receipt
（2）Medical certificate for labor insurance disability
（3）Medical record, pathological examination report or the relevant assessment documents
（4）Transaction data and job position of the insured person based on the starting date of the effectiveness of the labor insurance
Article 4
When considering an assessment, the Consigned Hospital shall notify the Bureau to provide essential documents and data or notify the Bureau to request the insured person to resubmit data or to recheck within a stipulated time frame.
Article 5
Consigned Hospitals, pursuant to the form stipulated by the Bureau, shall deliver the assessment report along with original documents to the Bureau after completing the assessment. The assessment date, hospital and doctor’s seal shall be included in the preceding assessment report, which will also have the following contents:
（1）Basic information of the insured individual
（2）Medical history
（3）Occupational history (including job position)
（4）Science/inspection report
（5）Major diagnosis
（6）AMA (Permanent obstacle assessment guidelines of the American Medical Association) obstacle classification
（7）Loss percentage adjustment of work capacity
Article 6
The Bureau shall adjust the following payment standards of the assessment fee if necessary in the following situations:
（1）An assessment fee of NT$5,000 per case for an assessment report completed by a Consigned Hospital according to the preceding points
（2）The failure of an assessment caused by an uncooperative insured individual as required or not attributable to a Consigned Hospital, along with a written assessment situation and causes of the incomplete assessment shall have an NT$2,500 assessment fee per case.
（3）If the Bureau delivers the case to the original Consigned Hospital for a recheck because the insured has been requested to resubmit the relevant data to meet the Consigned Hospital’s requirement, or the applicant raises an objection after the assessment, the assessment fee is NT$2,500. However, an assessment in a different Consigned Hospital shall be excluded.
Article 7
The Consigned Hospital shall apply for an assessment fee with the assessment fee application form and receipt on a monthly basis subject to complete assessment reports and assessment cases.
Article 8
Consigned Hospitals shall sign a contract with the Bureau for individualized professional assessment consigned by the Bureau.
Article 9
These points shall be reported to the relevant competent authority for future reference; the same applies to amendments.