勞工職業災害保險職業傷病審查準則

These Regulations are drawn upon by Paragraph 3 of Article 27 of the Labor Occupational Accident Insurance and Protection Act (hereinafter referred to as the Act).

The examination of occupational injuries and diseases suffered by the insured person (hereinafter referred to as the “occupational injuries and diseases”) shall be governed by the Regulations. Any matters not covered herein shall be governed by the other related laws and regulations.

1The injuries suffered by the insured person due to performance of his/her job duty shall be defined as occupational injuries.

2The injuries caused by animals or plants to the insured person due to the performance of his/her job duty shall be defined as occupational injuries.

1The injuries caused to the insured person by accidents occurring while he/she is on and off duty, at the proper time, on the way of round trips from his/her regular address or residence to the workplace, or on the way between workplaces if he/she is performing two or more job duties concurrently injuries shall be defined as occupational injuries.

2If the insured person referred to in the preceding paragraph is a student, or a student of any night school or vocational education cooperation program, the injuries caused to the insured person by accidents occurring while they are on and off duty on the way to school and workplace shall be defined as occupational injuries.

1The injuries caused by the following accidents to the insured before and after work shall be defined as occupational injuries:

21. Accidents resulting from the preparation before work and clearance after work.

32. Accidents in any of the following circumstances, insofar as the employer’s direction and supervision or labor service management is required:

4(1) On the way of the round trip from workplace to dining room or meeting place;

5(2) On the way of the round trip from workplace to office, to accept and return office appliances, receive wages, and perform other related routine duties.

1The injuries caused to the insured person by the accidents resulting from defects in the facilities, equipment, or management in the workplace under any of the following circumstances shall be defined as occupational injuries:

21. Before work or on waiting for work.

32. During interruption of work or break hours.

43. When using the facilities or equipment in the workplace after work, subject to the employer’s prior approval.

The injuries caused to the insured person by the accidents occurring when the insured person goes to the toilet or drinks water for physiological needs during the working hours shall be defined as occupational injuries.

The injuries suffered by the insured person due to performance of the different job duty which the insured person is asked to perform preliminarily in an emergent case, insofar as the different job duty is expected by the employer to be performed by any of its employees, shall be defined as occupational injuries.

1The injuries caused to the insured person by the accidents occurring while he/she works out of the workplace for business trips for any other official reasons and during the official activities and on the reasonable paths, since he/she leaves his/her regular address or residence or workplace until he/she returns to the same after performing the job duty, shall be defined as occupational injuries.

2The injuries caused to the insured person by the accidents occurring on the reasonable path to the workplace directly if the employer assigns him/her to perform duty preliminarily beyond the working hours shall be defined as occupational injuries.

1The injuries caused to the insured person by the accidents occurring while he/she is attending the activities designated by the employer, including continuing education & training, skills certification, skills competition, celebration ceremonies, physical activities or other activities, and on the reasonable paths, since he/she leaves his/her regular address or residence or workplace until he/she returns to the same at the end of the activities, shall be defined as occupational injuries.

2The injuries caused to the insured person referred to in Article 7 and the subparagraph 3, Paragraph 1 of Article 9 herein by the accidents occurring while he/she is designated by his/her group to attend the activities referred to in the preceding paragraph and on the reasonable path since he/she leaves his/her regular address or residence or workplace until he/she returns to the same at the end of the activities, shall be defined as occupational injuries.

The injuries caused to the insured person by the accidents resulting from another person’s act while he/she is performing job duty shall be defined as occupational injuries.

The injuries caused to the insured person by the accidents resulting from natural disasters while he/she is performing job duty shall not be defined as occupational injuries, unless the accidents resulting from the natural disasters indirectly render higher risk, or higher risk would derive if the insured person’s job duty is damaged by natural disasters.

The injuries caused to the insured person by the accidents resulting from defects in the subsidiary facilities or equipment provided by the employer for labor service management, while he/she is using the facilities or equipment, shall be defined as occupational injuries.

The injuries caused to the insured person by the accidents resulting from defects in the facilities or equipment managed or provided by the employer, while he/she is attending the recreational activities or other activities organized by the employer, shall be defined as occupational injuries.

1The injuries caused to the insured person again by the accidents occurring in the following circumstances, while he/she is still suffering certain occupational injuries, shall be defined as occupational injuries:

21. On the way from the workplace to the medical institution/hospital directly upon the employer’s approval or after work and back to the regular address or residence after medical treatment.

32. On the way from the regular address or residence to the medical institution/hospital for treatment, during the occupational injuries and disease treatment period.

The injuries caused to the insured person by the accidents occurring on the way there and back for having meals out of the workplace during the break hour on working days, or during overtime work or on-duty insofar as the employer doesn’t require him/her to have meals at the workplace compulsorily, shall be defined as occupational injuries.

1The injuries caused to the insured person as referred to in Article 4, Article 9, Article 10, Article 15, and Article 16 shall not be defined as occupational injuries, in any of the following circumstances:

21. Personal activities are not required by daily life.

32. Lack of the driver’s license for the driving car model.

43. Drive when the driver’s license is withheld, suspended, or canceled.

54. Break rules by running a red light when passing through any intersection controlled with light signals.

65. Cross railroad crossing forcibly.

76. Drive under the influence of alcohol concentrations beyond the standard, narcotics, psychedelic drugs, anesthetic medicine, and other similar controlled drugs.

87. Access the shoulder of any freeway, highway, or roadway with a control station against rules.

98. Race, compete or meander the car on the road, or drive the car in any other dangerous manner.

1The disease suffered by the insured person due to performance of job duty shall be defined as the occupational disease if any of the following circumstances are met:

21. The diseases referred to in the List of Types of Occupational Disease under Labor Occupational Accident Insurance, as shown in Attachment.

32. Occupational diseases or work-related diseases as identified by the Committee of Identification of Occupational Diseases of the Ministry of Labor.

The disease suffered by the insured person, of which the lesion or exacerbation has the cause-and-effect relationship with work, shall be defined as an occupational disease.

The mental disease suffered by the insured person, which has a cause-and-effect relationship with the performance of job duties, shall be defined as an occupational disease.

1To identify the occupational injuries and diseases defined in Article 27 herein, the insurer shall judge the following matters during the review procedure:

21. Occupational injuries: Time, place, and process of the accident, the connection between the accident and performance of job duty, cause-and-effect relationship between the injuries and accident, and other related matters.

32. Occupational disease: Exposure to the occupational hazard before suffering the disease, evidence for the disease, cause-and-effect relationship between the disease and occupational exposure, and other related matters.

1The insured person, beneficiary, person who pays funeral expenses, or insurance applicant shall state any opinions or provide any evidence, concerning the circumstances referred to in the preceding article, when claiming insurance benefits.

2Where said person or unit fails to state opinions or provide evidence referred to in the preceding paragraph, the insurer may notify the person or unit to supplement the opinion or evidence within a specific time limit. Where the person or unit fails to do so within the specified time limit and it is impossible to identify the occupational injuries and disease simply based on the related facts and evidence, the insurer will pay no insurance benefits.

3Where the opinion or evidence stated or provided by the insured person, beneficiary, or person who pays the funeral expenses is inconsistent with that stated or provided by the insurance applicant, the insurer shall ask the insurance applicant to present counter-proof. Where the insurance applicant fails to do so, the insurer shall conduct the review simply based on the insured person’s opinion or evidence and other related evidence.

1Whenever the insurer deems it necessary when reviewing the occupational injuries and diseases, the insurer may investigate in the following manners:

21. On-site survey.

32. Request access to the insured person’s medical record with a national health insurance medical care institution.

43. Ask the insured person’s attending physician or the insurer’s specialist by contract for a medical opinion.

54. Ask the specialist from the Occupational Medicine Department of the medical institution recognized in Paragraph 1 of Article 73 of the Act for professional opinions on the evaluation of occupational diseases.

65. Request access to any necessary information with any agency, group, juristic or individual.

The insured person referred to in Article 8 of the Act may apply the Regulations mutatis mutandis.

1The Regulations shall be enforced as of May 1, 2022.

2The amendments of The Regulations shall be enforced as of the publication date.