Chapter IV Insurance Benefit Payments
Section One General Rules
The insured units shall process the application of insurance benefit payment procedures for their affiliated insured persons, their beneficiaries or the persons who actually paid for the funeral expenses and shall not receive any form of monetary compensation.
If due to suspension of operations, dissolution, revocation of registration, declared bankruptcy or any other matter, an insured unit fails to submit an application for insurance benefits on behalf of any insured person, any beneficiary, or any person who paid the funeral expenses, then the insured person, the beneficiary and the person who paid the funeral expenses may claim these benefits by themselves.
When a claim to insurance benefits is made pursuant to Article 20, Subparagraph 1 or Subparagraph 2, Paragraph 1, Article 31, and Article 62 of the Labor Insurance Act, it may be made by the insured person, the beneficiary, or the person who paid the funeral expenses themselves.
The “concurrently employed by more than two insurance coverage units” referred to in Paragraph 2 of Article 19 of the Act shall mean the insured person who joins insurance coverage in more than two insured units according to Subparagraph 1 to 5 of Paragraph 1 of Article 6 and Subparagraph 1 and 2 of Paragraph 1 of Article 8.
The average monthly insurance salary referred to in Paragraph 3 of Article 19 of the Act is calculated using the following methods:
1.Pension benefit and a lump sum old-age benefit: It is calculated by dividing the sum of the sixty highest average monthly insurance salaries during insurance coverage years by sixty.
2.If the insured person choose to have the one time old-age benefits according to Paragraph 2 of Article 58 of the Act: It is calculated by dividing the insured persons' total monthly insurance salary in the most current three years prior to the retirement by thirty-six.
3.Other cash payment: It is calculated by dividing the insured persons' total monthly insurance salaries in the most current six months prior to the insurance incident occurs; for those who have joined insurance coverage less than six months, their average monthly insurance salaries shall be calculated by their actual coverage years.
In the event that the insured persons have more than two insurance salaries in the same month, except for calculating the insurance wages following the rules in Paragraph 2 of Article 19 of the Act, the highest wages shall be used as a standard and calculated on average along with the monthly insurance salaries of the other months.
The less than one actual coverage year referred to in Paragraph 4 of Article 19 of the Act is calculated proportionately according to actual insurance coverage months, rounded off to the second decimal place.
When applying for the missing allowance in accordance with Paragraph 5 of Article 19 of the Act , the following documents must be prepared:
1.Application forms for missing allowance and R eceipts of benefits payments.
2.Certificates of whole household registration: if the beneficiary is not in the same household registration with the insured person, the certificates of household registration of the beneficiary should also be submitted.
3.Accident report or other proof to the related missing incident.
Paragraph 1 of Article 63 and Paragraph 1 and 2 of Article 65 of the Act will be resorted as the regulations for beneficiary and the order for claiming the missing allowance.
If the beneficiary of the missing allowance is under aged, the Application form and receipts of benefits payments should be signed or sealed by the beneficiary's legal representative.
If the beneficiary of the missing allowance is the insured persons' grandchildren, brothers or sisters, the related documents for proving the beneficiaries are raised by the insured person should be submitted when claiming the allowance.
In the event that survivor benefits are paid to the beneficiary or the person who paid for the funeral expenses according to Paragraph 6 of Article 19 of the Act but the insured persons are in fact alive. When the Death Announcement Registration is revoked and the insured persons return the paid survivor benefits and rejoin labor insurance, their prior insurance coverage records shall be restored and recognized.
In case insurance benefits are payable in cash in accordance with the Act, upon calculation by the insurer, they shall be transferred directly to the personal account designated by the insured persons, their beneficiaries or the person pays for the funeral expenses. The insured units they are affiliated with shall be notified about the payment. The notification is not required, however, if the insurance claim is made personally by the insured person as prescribed in Article 43.
If the account designated is located overseas, the surcharge for remittance shall be paid by the insured persons who claim for the benefit, their beneficiaries or the individuals who pay the funeral expenses.
After reviewing the applications for cash payments filed by the insured persons, their beneficiaries or the person pays for funeral expenses and all procedures are deemed complete, the insurer shall make the payments within ten days after receiving the application forms. However, for pension payment, the insurer shall make the payments by the end of the next month of the application date for the latest.
Interest that should be added in overdue premium prescribed in Article 29-1 herein shall be based on the fixed interest rate on January 1st every year for a one-year postal saving time deposit, calculated in NT dollars per day, and NT dollars below 0.1 shall be rounded.
If the insured persons, their beneficiaries or the person pays for funeral expenses submit their applications for payment to the insurer by post mail, the postmark of the sending post office shall apply.
The intended crime as referred to in Article 26 of the Act shall be applied to the final judgment of a judicial department or military juridical department.
All categories of insurance benefit payment application forms, receipts, diagnostic documents and certificates used by the insured persons, insured units, hospitals, clinics or licensed doctors or midwives shall be filled out according to related written instructions.
With the exception of those stipulated in Articles 68 and 69, the medical diagnosis or birth certificates used in applying for all kinds of insurance benefit payments shall be valid only after they are prepared and issued by the hospitals, clinics or licensed doctors.
Birth certificates prepared and issued by licensed midwives shall also be valid.
When applying for all kind of insurance benefits according to the Act, the official documents enclosed not issued by our governmental organizations agencies (institutions) shall be verified by the following organizations:
1.If the documents are made in foreign countries, they should be certified or authenticated by the R.O.C. embassy, consulate, representative office, office in the foreign country; if the documents are made in R.O.C. by foreign embassies or their authorized organizations, they should be re-inspected by the Ministry of Foreign Affairs of the R.O.C.
2.Documents produced in the Mainland China area shall be authenticated by the institution set up or designated, or by the private organization entrusted by the Executive Yuan.
3.For documents issued in Hong Kong or Macau, they shall be authenticated by the institution set up or designated, or by the private organization entrusted by the Executive Yuan in Hong Kong or Macau .
If the original documents are in foreign language, the Chinese translations of the documents must be enclosed and Chinese translations shall be produced by the authorized organizations listed above or notarized by domestic notary public. Unless it is considered necessary by the insurer, the Chinese translation is not required if the document is made in English.
If the original documents are in foreign language, the Chinese translations of the documents must be enclosed and Chinese translations shall be produced by the authorized organizations listed above or notarized by domestic notary public.