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Q：
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If an insured person holds both labor insurance and occupational accident insurance, and their application for occupational accident insurance benefits is denied due to the incident not being classified as an occupational accident, do they need to submit a separate application for labor insurance benefits?
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A：
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If the insurer determines that the accident is not caused by an occupational injury or sickness, the applicant can provide written consent to apply for labor insurance benefits for the same incident, in accordance with the Labor Insurance Act.
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If an insured person has already claimed occupational accident insurance pension benefits before the Labor Occupational Accident Insurance and Protection Act was implemented, and the statute of limitations for claiming has not exceeded five years after the law came into effect, can they request to recalculate the benefit amount based on the standards of the new Act?
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No, they cannot. Since the insured person has already claimed labor insurance benefits under the provisions of the Labor Insurance Act, the rules of the Labor Insurance Act will continue to apply, even after the implementation of the Labor Occupational Accident Insurance and Protection Act.
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Q：
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If an insured person experiences an occupational accident before the Labor Occupational Accident Insurance and Protection Act is implemented, can they apply for occupational accident benefits under the new Act after its implementation?
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A：
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If the insured person suffered an occupational injury, disability, or death before the implementation of the Labor Occupational Accident Insurance and Protection Act and has not yet applied for occupational accident benefits, they may choose to apply for benefits either under the Labor Insurance Act or the new Labor Occupational Accident Insurance and Protection Act, provided the statute of limitations (five years) has not expired when the new Act came into effect.
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Q：
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What are the eligibility requirements and benefit standards for claiming occupational injury accident insurance benefit?
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A：
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Eligibility Requirements:
If an insured person is injured or contracts an occupational disease due to performing their duties or is unable to work, resulting in the loss of their base salary while undergoing outpatient or inpatient treatment, they can apply for occupational accident insurance injury or sickness benefits starting from the 4th day of being unable to work.
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Benefit Standards:
The occupational injury accident insurance benefit is payable from the 4th day of being unable to work until the day before the person returns to work. For the first 60 days, the benefit is based on the insured person’s average daily insured salary over the six months prior to the month in which the accident occurred. After 60 days, the benefit is reduced to 70% of the average daily insured salary, with a maximum payment period of two years.
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Q：
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After claiming permanent disability benefits, is it still possible to claim occupational accident insurance injury or sickness benefits?
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A：
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Once an insured person has stopped treatment for their injury or illness and has received permanent disability benefits for being “permanently unable to work,” they can no longer claim injury or sickness benefits. However, if the insured person continues to be covered by the insurance and requires further treatment (inpatient or outpatient) for the same injury or illness, resulting in a inability to work and a loss of base salary, they may still apply for injury or sickness benefits.
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FAQ
