CHAPTER 4 INSURANCE BENEFITS
Section 5 Permanent Disability Benefits
In case an insured person suffers from ordinary injury or sickness and the person's condition is stable after medical treatment but no improvement could be expected for further treatment, and if the person is diagnosed to be permanently disabled by the insurer's own hospital or qualified hospital and the disability comply with the disability benefit standard regulation, the insured person could claim disability benefit according to his/her average month insurance salary and stipulated benefit payment standard.
If the insured person has the situation as described in previous paragraph or the insured person is physically or mentally disabled as stipulated in People with Disabilities Rights Protection Act, and is examined as no capability to work permanently, the insured person could claim for disability pension benefit. The disability benefit standard is calculated based on the insured's insurance coverage years. 1.55% of the insured's average monthly insurance salary is granted for every single insurance coverage year; if the total amount is less than four thousand NT dollars, four thousand NT dollars will be granted to the insured person.
For the insured person as stipulated in previous two paragraphs and has insurance coverage year in National Pension, the pension benefit could be assessed separately according to different insurance regulations and issued by the insurer jointly and the fund needed is supplied by individual insurance.
If a person has insurance coverage year before the enforcement of the amendments of this Act on July 17, 2008 and his/her condition complies with the regulations in second paragraph, other than claiming for pension according the regulations in previous two paragraphs, the insured person could also choose to claim for a lump sum disability benefit, however, if such claim has been made and the benefit paid by the insurer, it could not be changed.
In case an insured person suffers from occupational injury or disease and the person's condition is stable after medical treatment but no improvement could be expected for further treatment, and if the person is diagnosed to be permanently disabled by the insurer's own hospital or qualified hospital and the disability is qualified to claim a lump sum disability benefit standard regulation, the insured person could claim disability compensation according to his/her average month insurance salary and stipulated benefit payment standard with 50% extra benefit.
If the insured person in previous paragraph is examined as no capability to work permanently and has claimed for disability pension benefit, other than granting the pension according to the regulation in article 53, an extra twenty month occupational injury or disease disability compensation based on the insured's average monthly insurance salary should also be issued.
The central competent authority shall define the type, status and severity of the disabilities described in the two preceding articles, the corresponding benefit amounts, the level of medical institutions to issue the diagnoses, and the reviewing criteria.
The central competent authority shall establish the standards of individual work capacity evaluation to be conducted by specialists to serve as the basis for disability pension payment.
The mechanism for individual work capacity evaluation by specialists described in the preceding paragraph shall take effect five years after promulgation of the amendment made to the Act on Jul. 17, 2008.
For those who claim for disability pension benefit and have family dependants who comply with the following criteria, an extra 25% family dependant allowance on the amount calculated using the regulation in article 53 should be issued for every dependant with the maximum of 50% extra:
1.The spouse should be more than 55 years of age and the conjugal relationship has existed for more than one year. However, the above regulation does not apply if any following condition exists:
（1）incapable of earning a livelihood.
（2）raising children as stipulated on subparagraph 3.
2.The spouse should be more than 45 years of age and the conjugal relationship has existed for more than one year and the spouse's monthly work income does not exceed the amount defined in the first level of Table of Grades of Insurance Salary.
3.The dependent children should comply with at least one of following criteria. As for adopted children, the adoption relation should have been existed for more than six months:
（2）incapable of earning a livelihood;
（3）under the age of 25 and still goes to school with monthly work salary does not exceed the amount defined in the first level of Table of Grades of Insurance Salary.
The definitions of the incapable of earning a livelihood as stipulated in the previous paragraph will be stipulated by the competent central authority.
The extra family dependant allowance will be terminated if the dependent stipulated in paragraph one has the following condition:
（2）less than 55 years of age and the children he/she supports does not conform with the regulation in the third subparagraph of first paragraph in this Article.（（3）doesn't conform with the claiming regulation defined in the second subparagraph of first paragraph in this Article.
2.The dependent children don't conform to the claiming regulation defined in the third subparagraph of first paragraph in this Article.
3.Currently serving sentences in a prison, or, being detained or imprisoned because of criminal cases.
The imprisonment described in the third subparagraph of previous paragraph means personal freedom was deprived of or limited to due to the execution of sentences of detention, custody, observatory rehabilitation, compulsory rehabilitation, rehabilitative measures or correctional measures in specific locations. But people under the execution of protective correction, wanted but not yet arrested, medication after being bailed out, or currently under parole are not included.
In case an insured person was originally partially-disabled and a new injury or sickness not only has aggravated his/her disability on the same part or caused disability to another part of his/her body, the insurer should grant disability benefit according to disability benefit payment standard and the degree of disability aggravated . However, the total could not exceed the first degree of the benefit standard.
If the insured person in previous paragraph conform with criteria for granting the disability pension and has claimed disability pension, insurer should issue 80% of the disability pension amount to the insured every month until 50% of the amount of a lump sum disability benefit calculated based on the original partial disability is completely deducted.
For the insured person in previous two paragraphs who are partially disabled while the insurance is still effective but has not claimed disability benefit, the insurer should issue disability benefit according to the disability benefit standards and the degree of disability after the disability is aggravated. However, the total should not exceed the first degree of the benefit standard.
If, in reviewing a claim for permanent disability benefits, the insurer deems it is necessary to conduct a re-examination, another hospital or doctor may be appointed for the re-examination and the fee for the re-examination is the obligation of insurance fund.
After the insured person claimed and got disability pension, the insurer should review the degree of disability at least every five years. However, this rule doesn't apply if the insurer think there is no need to review the disability.
If the insurer reviews the degree of disability on those who have claimed disability pension according to the former paragraph and finds the disability has been reduced and does not conform to the criteria for claiming disability pension, the insurer should stop issuing disability pension benefit and grant a lump sum disability benefit.
In case an insured person is evaluated to be incapable of earning a livelihood and has claimed disability benefits, the insurer may withdraw insurance coverage immediately.