Permanent Disability Benefits
- Qualification
- Lump-sum permanent disability benefits:
(1)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 benefits under labor occupational accident insurance. He/she may seek an lump sum payment of permanent disability benefits based on his/her average monthly insured salary and the prescribed benefit standards.
(2)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.
- When the level of Permanent disability of the insured person meets Full Permanent disability, Serious Permanent disability, or Partial Permanent disability, Permanent disability pension may be claimed.
(1)Full Permanent disability: Satisfy the requirements referred to in the First Level or Second Level of the Attachment of Article 3 of the Labor Insurance Disability Benefit Payment Standards which cover the incapability of work for the rest of their lives.
(2)Serious Permanent disability, which shall satisfy any of the following conditions:
- Satisfy the requirements referred to in the Third Level of the Attachment of Article 3 of the Labor Insurance Disability Benefit Payment Standards which cover the incapability of work for the rest of their lives.
- With the overall disability satisfies the First Level to Ninth Level of the Attachment of Article 3 of the Labor Insurance Disability Benefit Payment Standards, and assessed subject to an individual professional evaluation that they have lost more than 70% work capacity and therefore cannot return to the workplace.
(3)Partial Permanent disability: With the overall disability satisfies the First Level to Ninth Level of the Attachment of Article 3 of the Labor Insurance Disability Benefit Payment Standards, and assessed subject to an individual professional evaluation that they have lost more than 50% work capacity.
- Disability Benefit Payment Schedule
- Occupational accident insurance permanent disability benefits shall be reviewed and handled in accordance with the disability items and levels specified in the Standards for Disability Benefits of Labor Occupational Accident Insurance and the Attachment of the Labor Insurance Disability Benefit Payment Standards.
- Disability item:
According to Labor Insurance Disability Benefit Payment Schedule and its attachment, the disability types are divided depending on the part of a body which are: mental, neuropathic, eyes, ears, nose, mouth, viscera in chest and abdomen, trunk, head, face, neck, skin, upper limbs, and lower limbs, a total of 12 types, 221 disability items and 15 disability levels.
- The calculation of Average monthly Insurance Salary and average daily Insurance Salary:
It is calculated by averaging the actual monthly Insurance Salary six months before the month when the insurance accident occurred to the insured person (which is the date the insured person is diagnosed as permanently disabled); the average daily Insurance Salary is calculated by dividing the average monthly Insurance Salary by 30. - Amount of benefit:
- It is calculated using the actual average monthly insured salary for the 6 months prior to the insurance accident happened to the insured person (meaning the date the insured person is diagnosed as permanently disable), and issued according to the payment days defined in labor occupational accident insurance disability benefit standard. The highest disability level is the first level with the highest lump-sum permanent disability benefits of 1,800 days and the lowest level is the fifteenth level with the lowest lump-sum permanent disability benefits of 45 days.
- When the level of Permanent disability of the insured person meets Full Permanent disability, Serious Permanent disability, or Partial Permanent disability, Permanent disability pension may be claimed. The benefit standard are as follows:
- Full Permanent disability: Issuance based on 70% of average monthly insured salary.
- Serious Permanent disability: Issuance based on 50% of the average monthly insured salary.
- Partial Permanent disability: Issuance based on 20% of the average monthly insured salary.
- Dependent Allowances:
Additional Dependent Allowances: 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%.
- Spouse:
Those who meet one of the following conditions:
(1)Spouse aged 55 or above and the marriage relationship with the insured person lasts more than one year. However, if the spouse has no capability of earning a livelihood or raising children as stipulated in the below shall not be limited by this regulation.
(2)Spouse aged 45 or above, the marriage relationship with the insured person lasts more than one year, and the monthly income of the spouse does not exceed the first grade in Table of Grades of Insurance Salary.
- Children:
Those who meet one of the following conditions (For Adopted children, the adoption relationship shall last for more than 6 months):
(1)Under age or minor children.
(2)No capability of earning a livelihood.
(3)Under the age of 25 and still go to school with monthly income not exceeding the first grade in Table of Grades of Insurance Salary.
- Suspension of dependent allowances: When the dependents do not qualified for the allowance any more, the dependent allowance shall be suspended.
- Spouse:
(1)Divorced.
(2)Do not meet the qualification indicated above for claiming dependent allowance by spouse.
- Children
Do not meet the qualification indicated above for claiming dependent allowance by children.
- Spouse and Children
(1)Serving sentences in a prison, or, being detained or kept in custody because of criminal offenses.
(2)Disappearance.
- Disability Benefits Application Procedures
- Labor Occupational Accident Insurance Permanent Disability Benefits Application Form and Payment Receipt
- Labor/Labor Occupational Accident Insurance Permanent Disability Statement (the insured person shall contact hospitals or clinics for diagnosing and issuing such report, the report shall be sent directly by those hospitals or clinics to Bureau of Labor Insurance within five days after it is issued, the insured persons shall send “Certificate of Proof for sending Labor/Labor Occupational Accident Insurance Permanent Disability Statement directly to Bureau of Labor Insurance”).
- For those who have eyes, ear, mastication, deglutition and speaking disability, viscera in chest and abdomen disability (functional disability), rachis deformity and moving disability, upper and lower limbs functions or skin disability, their disability diagnosis report shall be issued by national health insurance special contracted hospital, which is rated as excellence or better in Hospital Accreditation, or as qualified in Hospital Accreditation(for medical center and regional hospital), or as qualified in Hospital Accreditation and Teaching Hospital Accreditation by the Ministry of Health and Welfare. However, insured persons who live in Penghu county, Kinmen county and Lienchiang county are not limited by these regulations.
- For those who are mentally disabled, the report shall be issued by Psychiatrists; for those who have neuropathic disability, the diagnosis report shall be issued by medical specialists from neurology, neurological surgery or rehabilitation department; for those who have bladder disability, the diagnosis report shall be issued by Urologist.
- Other disability type, the disability diagnosis report shall be issued by National Health Insurance special contracted hospitals or clinics.
- For those who are disabled outside the effective area of this Act, the diagnosis report shall be issued by the original diagnosis hospitals or clinics.
- Labor/Labor Occupational Accident Insurance Disability Pension Extra Dependent Allowances Application Form and Payment Receipt (it is limited to those who have applied pension payment and are spouse or dependent children who meet the criteria for claiming additional dependent support allowance).
- For those who have gone through medicinal examinations, the medicinal examination report and related pictures shall be enclosed.
- In cases where the insured persons are disabled by diseases or injured caused by accidents which happened during the insured person's commute from home to work or from work to home or during business trip and apply for occupational disability benefits, the insured person shall fill in a “Labor Occupational Accident Insurance Insured Person Report of Injury Resulting from Accident on the Way to or from Work or during Business Trip”
- Points for Attention
- An insured person filing for the disability benefits needs to present whose filing within a five-year period from the date the hospital diagnosed the individualized with permanent disability.
- If the insured persons are still in treatment for the disability and the symptoms are not stable, it is advised not to apply for disability benefit under such condition.
- Of an insured being reviewed with a disabled status conforming to the “permanent inability to work” payout item who collects the disability payout, or an insured upon undergoing the individualized professional assessment as loss of lifetime working capability who claims the “disability pension payout”(when the disability level meet the criteria of” Full Permanent disability “or” Serious Permanent disability”), the individualized shall be cancelled of whose insurance by the Labor Insurance Bureau, effective from the date the individualized has been diagnosed with permanent disability.
- If the insured person or beneficiary seeks the permanent disability pension benefit or survivor pension benefit of the Labor Occupational Accident Insurance or other social insurance pension at the same time based on different insured incidents, the amount of the total pension benefits in excess of the average monthly insured salary adopted by the pension benefits under the Insurance, the permanent disability pension benefit or survivor pension benefit of the Insurance shall make such reduction by "Regulations for Adjustment on Combined Collection of Pension Benefits of Labor Occupational Accident Insurance".
- The insured person shall select the scheme stringently, as it can no longer be changed once the Bureau of Labor Insurance approves and releases the payout.
- In case an insured person was originally partially-disabled and a new injury or sickness has aggravated his/her disability on the same part or caused disability to another part of his/her body as referred to in Article 46 of the Labor Occupational Accident Insurance and Protection Act, the insurer shall grant disability benefit according to the degree of disability aggravated. However, the disability level shall satisfy any of the following conditions upon consolidated assessment:
- A lump sum payment of permanent disability benefits: The overall disability level as authorized shall be higher than the originally partially-disabled level.
- Permanent disability pension: The overall disability level as authorized shall be higher than the originally partially-disabled level, or more than those for the originally partially-disabled level, and satisfy the disability level set forth in Paragraph 1 of Article 3.
- The insured’s body is already partially disabled: After claiming the lump-sum permanent disability benefits for labor occupational accident insurance or labor insurance, and the degree of disability of the same part is aggravated due to occupational injury or disease or the disability occurs in different parts. If you choose to claim lump-sum permanent disability benefits, it will be distributed according to the difference in the number of days before and after the disability level is aggravated; if you choose to claim permanent disability pension, 80% of the pension will be distributed monthly until half of the originally received payment has been deducted.
- The insured is already partially disabled before applying for the labor occupational accident insurance or during the period of suspension of the insurance: After applying for the insurance and the degree disability of the same part of the body is aggravated due to occupational injury or disease or the disability occurs in different parts. If you choose to claim lump-sum permanent disability benefits, it will be distributed according to the difference in the number of days before and after the disability level is aggravated; if you choose to claim permanent disability pension, 80% of the pension will be distributed monthly until half of the lump-sum permanent disability benefits amount calculated according to the disability benefits distribution standard of accident insurance has been deducted.
- If the insured persons who have applied for disability pension benefit and later found themselves not qualified for the benefits, they shall submit related documents and inform the Bureau of Labor Insurance within 30 days after they found out the fact and the pension payments shall be terminated in the next month after the fact was realized.