Chapter IV Insurance Benefit Payments
Section 5 Disability Benefits
Anyone who applies for the payment of disability benefits in accordance to Article 53 or 54 of the Act shall prepare the following documents:
1.Application forms for disability benefit payments and Receipts of benefits payment.
2.Medical certificate of disability.
3.Enclose check-out report and related pictures and photos where medical examination is made.
To audit disability benefit payments, the insurer may designate authorized national health insurance hospital or clinic or physicians according to Article 56 of the Statute to perform re-examination, and may notify the hospital or clinic producing the medical certificate of disability to provide necessary records of examination or patient data of diagnosis and treatment.
The date an insured person applies for disability benefits in accordance with Article 53 or 54 of the Act and is diagnosed by a contracted hospital or clinic paid by National Health Insurance, as with permanent disability shall be the day the benefits become payable as set forth in Article 30 of the Act. If injury or accident occurred to the insured person during the effective period of insurance, the insured in compliance with the treatment period prescribed in the attachment of Article 3 of Labor Insurance Benefit Payment Criteria after insurance effect is terminated, diagnosed permanent disability with the degree equivalent to that in expiration of a year of insurance effect, and having fixed symptoms shall apply for disability benefit payment according to Paragraph 1 of Article 20 of the Enforcement Rules.
If the date of the diagnosis for permanent disability prescribed in the preceding paragraph is unclear or in dispute, the insurer may check the relevant medical records or documents to confirm the date.
In the event that the insured persons request the diagnosis report for disability, the hospitals or clinics under special contracts with the National Health Insurance Program shall issue and mail the documents within five days.
According to the regulations in Paragraph 3 of Article 53 of the Act , the National Pension disability benefit of the National Pension Insurance Program and the disability pension of Labor insurance are separately calculated, if the total number of the disability benefits are more than four thousand N.T. dollars, the total amount would be issued; if the total number of the disability benefits are less than four thousand N.T. dollars, then four thousand N.T dollars would be issued.
The marriage relationship lasts more than one year defined in Subparagraph 1 and 2 of Paragraph 1 of Article 54-2 means the period of one year before application date without interruption.
Students currently attending schools referred in Subparagraph 3 of Paragraph 1 of Article 54-2 of the Act means students who have formally registered and study in public schools, private schools which have been formally approved and registered by competent educational authorities of its accreditation or foreign schools that meet Ministry of Education recognition requirements.
For those who apply for dependent allowance according to Article 54-2 of the Act , the following documents shall be prepared:
1.Application form for Dependent Allowance of Disability pension and Receipts of Allowance payment.
2.The insured person's whole family household registration certificate; If the dependent and the insured person are not under the same household registration, their household registration certificates should both be presented and indicates the following matters:
(1) If the dependent is a spouse, the marriage date shall be recorded on the household registration certificates.
(2) If the dependents are adopted sons or daughters, the adoption and registration date shall be recorded on the household registration certificates.
3.If the dependents are attending schools, the copy of Tuition Receipt or In-school certificate shall be enclosed, and those certificates and related proof shall be re-submitted to the insurer for checking every year before the end of September. If the information complies with the criteria after checking, the Allowance would continue to be issued until the end of August of the next year.
4.For dependents who are unable to make their own living, a physical and mental disability manual or related proof or any proof of the dependents having been declared by a Court of law to be unable to manage their own assets shall be enclosed.
The term “on the same part” referred to in Paragraph 1 of Article 55 of the Act means the same portions of the disability type.
When issuing 80% of the amount of disability pension according to Paragraph 2 of Article 55 to the Act , if the amount is less than four thousand N.T. dollars, then, four thousand N.T. dollars will be issued; Article 70 shall be resorted for those who have National Pension coverage records.
For insured person who is discharged directly by the insurer according to Article 57 of the Act, the discharging date shall be set on the dates on which the hospitals or clinics under special contracts with the national insurance declare the insured person actually disabled permanently.