|
Q：
|
What are the eligibility requirements for claiming occupational accident insurance disability benefits?
|
|
A：
|
If the insured person experiences an occupational accident or illness and, after receiving treatment, the condition becomes stabilized with no further improvement from continued treatment, they may be diagnosed with a permanent disability by a hospital or clinic contracted under the National Health Insurance system. If the diagnosis meets the criteria outlined in the labor occupational accident insurance disability benefit standards, the individual is eligible to claim a lump-sum disability benefit. The benefit amount will be based on the insured‘s average monthly insurance salary and the prescribed benefit standards.
|
|
Q：
|
What are the standards for occupational accident insurance disability benefits?
|
|
A：
|
-
Lump-sum benefit: the lump-sum benefit is calculated based on the insured individual’s average monthly insurance salary over the six months preceding the month when they are diagnosed with a permanent disability. The payment amount is determined according to the grade and number of days specified in the labor occupational accident insurance disability benefit standards.
-
Annual pension benefit: depending on the severity of the disability, whether total permanent disability, severe disability, or partial disability, the insured individual will receive a disability pension calculated at 70%, 50%, or 20% of their average monthly insurance salary. If the individual has a spouse or children who qualify for additional dependent support, the disability pension amount will increase by 10% for each dependent up to a maximum of 20%.
|
|
Q：
|
Is the eligibility for claiming occupational accident insurance disability pension same as labor insurance, requiring more than 70% reduction in work capacity to receive the pension?
|
|
A：
|
The eligibility criteria for the occupational accident insurance disability pension differ from those of the labor insurance disability pension. The conditions are categorized into three levels based on the severity of the disability, with the following claim standards:
-
Total permanent disability: the individual must meet the criteria for the 1st or 2nd grade of disability as specified in the labor insurance disability benefit standards, particularly for conditions that indicate a lifetime inability to work.
-
Severe disability: the individual must meet one of the following conditions:
- Qualify for the 3rd grade of disability under the labor insurance disability benefit standards, specifically for conditions indicating a lifetime inability to work.
- If the overall disability falls within the 1st to 9th grade of the disability standards, and after individualized professional assessment, the person is deemed to have more than a 70% reduction in work capacity and is unable to return to the workforce.
-
Partial disability: the overall disability must fall within the 1st to 9th grade of the disability standards, and an individualized professional assessment must determine that the person’s work capacity is reduced by more than 50%.
|
|
Q：
|
If an insured person receives a disability card after suffering an occupational accident, can they claim occupational accident insurance disability benefits?
|
|
A：
|
The issuance of a disability card follows different regulations from the criteria for claiming occupational accident insurance disability benefits. However, if the insured individual experiences an occupational accident or illness, and after treatment, the condition is stabilized but cannot be further improved even with additional treatment, they may be diagnosed with permanent disability by a hospital or clinic contracted with the National Health Insurance. If this diagnosis meets the standards set for occupational accident insurance disability benefits, the insured individual may apply for the lump-sum disability benefit.
|
|
Q：
|
If an insured person already has a partial disability and then suffers another occupational accident, can they claim disability benefits again? How is an increased level of disability determined?
|
|
A：
|
If an insured person already has a partial disability and then suffers an occupational accident that either worsens the disability in the same area or causes disability in a different area, a comprehensive assessment will be conducted. If the following conditions are met, it will be recognized as an increased level of disability, allowing the insured person to apply for benefits:
-
Lump-sum disability benefit: if comprehensive assessment results in a higher disability rating for the overall condition.
-
Disability pension: if comprehensive assessment results in a higher disability rating for the overall condition, or if the new disability affects additional areas beyond the original partial disability.
|
FAQ
