Regulations on Arbitration of Labor Insurance Disputes

Promulgated and enforced by Order Tai-Nei-She-Tzu No.495952 of the Ministry of the Interior on November 22, 1972
Amended, promulgated and enforced by Order Tai-Nei-She-Tzu No.24577 of the Ministry of the Interior on September 11, 1979
Amended, promulgated and enforced by Order Lao-Pao-Tzu No.23637 of the Council of Labor Affairs, Executive Yuan on October 17, 1988
Amended, promulgated and enforced by Order Tai (85) Lao-Pao(1)-Tzu No.128086 of the Council of Labor Affairs, Executive Yuan on July 30, 1996
Amended, promulgated and enforced by Order Lao-Pao(1)-Tzu No.0910061881 on December 4, 2002

Chapter 1 General Provisions

Article 1

These Regulations are enacted pursuant to Paragraph 3, Article 5 of the Labor Insurance Act.

Article 2

Any insured establishment, insured person, beneficiary, or national health insurance medical service institutes (all called "applicant" hereinafter) who disagrees a decision made by the Bureau of Labor Insurance (hereinafter referred to as "the Bureau") on the following affairs may apply for arbitration according to the provisions of these Regulations.

1. Affairs regarding the qualification of insured person and beneficiary and coverage of insurance.
2. Affairs regarding the insured salary or insured years of insured person.
3. Affairs regarding the insurance premium or late fees.
4. Affairs regarding the benefits of insurance.
5. Affairs regarding occupational injury or disease.
6. Affairs regarding the grade of disability.
7. Affairs regarding the fund of diagnosis and treatment for vocational disaster.
8. Other affairs regarding the rights and interests of insurance.

Article 3

To apply for arbitration in accordance with the provision of the above article, an applicant shall, within sixty (60) days commencing from receipt of the note of approval issued by the Bureau, fill in an application form for arbitration of labor insurance disputes (hereinafter shortened as "application form for arbitration"), and submit it together with the related certificates through the Bureau to the Labor Insurance Supervisory Commission (hereinafter referred to as "the Commission"). Where it is delayed due to a cause not attributable to the applicant, the applicant shall, within thirty (30) days commencing from the next day after elimination of the cause, explain in writing the reasons of the delay to apply for arbitration.
The date when an application for arbitration is received shall be regarded as the date of submission of the application; where an application is submitted by post, the postmark of the sending post shall apply.
Where an applicant has expressed his disagreement to the Commission or the Bureau within the time limit set forth in the first paragraph, it shall be deemed that the applicant has applied for arbitration within the statutory time limit. However, an application form shall be supplemented within thirty (30) days.
Where an applicant applies to the Commission for arbitration, the Commission shall transfer the application form to the Bureau for disposal according to the provision of Article 3-2.

Article 3-1

An application form shall include the following contents, and shall be signed or sealed by the applicant or his representative:

1. Name, date of birth, address, and ID certificate No. of the insured person and the applicant. If the applicant is an insured establishment, the name, insurance certificate No., address, and principal of the establishment shall be included.
2. The date when the applicant knows the original decision of the Bureau.
3. The matters need to be reviewed.
4. The facts and reasons for application for arbitration.
5. Evidences. In case of documental evidence, a copy or photocopy shall be enclosed.
6. Date.
   To apply for arbitration, a photocopy of the original letter of decision issued by the Bureau shall be enclosed.

Article 3-2

Upon receipt of an application form, the Bureau shall first examine whether the original decision is made legally and properly; where the application is deemed as reasonable, it may make a decision again, and shall inform the applicant and the Commission about this.

Where the Bureau doesn't cancel or modify the original decision according to the request of the applicant, it shall, as soon as possible, produce a position paper and submit it together with the necessary archives to the Commission, and send a duplicated copy of the position paper to the applicant.

Article 4

Where an applicant is a person of legal incapacity or of limited legal capacity, the application shall be made by his legal representative on behalf of him. An insured establishment may handle the procedure of application for an insured person affiliated in the establishment or his beneficiary at the request of the person or beneficiary, but may not violate the will of the insured person or his beneficiary.

Article 5

After an application for arbitration is submitted and before a letter of approval or disapproval is received, the applicant may cancel the application. However, once the application is cancelled, no application for arbitration may be raised for the same fact of dispute.

Article 6

After an application form for arbitration is received, if the Commission thinks the procedure is not complied with the relevant provisions but correction or supplement may be made, it shall notify the applicant to make correction or supplement within twenty (20) days commencing from the next day after receipt of the advice note. However, in case of due reasons, the applicant may apply for postponement before expiration of the aforementioned period.

Article 7

(Deleted)

Chapter 2 Arbitration Committee

Article 8

To arbitrate insurance disputes, the Commission sets a Labor Insurance Disputes Arbitration Committee (hereinafter referred to as "the Arbitration Committee"). Besides the director of Disputes Arbitration Division shall be one of the committeemen certainly and act as the chairman of meeting, ten (10) to twelve (12) persons shall be appointed to assume the committeemen according to the following provisions:

1. Two (2) to four (4) persons who have taught the causes of social insurance, insurance science, social welfare, and labor issues in the position of instructor or higher for not less than three (3) years.
2. Two (2) persons who have been a judge or lawyer, or worked in a position of the senior grade for not less than three (3) years.
3. Two persons who have been an instructor of law in a university for not less than three (3) years.
4. Two persons who have been an instructor in the medical college of a university or a doctor-in-charge in a public hospital for not less than two (2) years.
5. Two persons who currently hold a position of the senior grade in the regulating authority of labor insurance.

The tenure of the committeemen referred to in the above paragraph is two (2) years, and they may be continuously appointed upon expiration of the tenure. Commission of the committeeman shall be reported to the central regulating authority of labor administration for approval.

Article 9

In the Committee shall be set a convener assumed by full-time commissioner and director of the Disputes Arbitration Division on a part-time basis to take charge of calling meetings and act as the chairman of meeting.

Where the convener cannot call meetings due to some reason, the Chairperson of the Commission shall designate one of the committeemen to act as the convener.

Where the convener cannot preside over a meeting temporarily due to some reason, one shall be elected by and from the committeemen to act as the chairman of the meeting.

Article 10

A meeting of the Arbitration Committee may be opened only with the attendance of more than a half of the committeemen, and a resolution requires the consent of more than a half of the present committeemen. Where the number of consenters is equal to that of dissenters, it shall be determined by the chairman.

The resolution referred to in the above paragraph shall be made by show of hands or call the roll, and secret vote may be carried out where necessary.

Article 11

A committeeman must personally attend the meetings of the Arbitration Committee, and may not entrust a representative to attend the meeting in his name. Where a committeeman cannot personally attend a meeting, he shall submit a position paper for the chairman to make a report on behalf of him, but the chairman may not take vote in his name.

Article 12

In principle, the Arbitration Committee shall hold a meeting every half month, and may call temporary meetings where necessary.

Article 13

When the Arbitration Committee holds a meeting, the related governors of the Bureau may be invited to attend the meeting to make explanation and, where necessary, the applicant and other related personnel may be notified to make explanation in the meeting. However, the aforementioned persons shall leave the meeting place immediately after the explanation is finished.

Article 14

The Arbitration Committee may invite the related experts as listed in Article 17 to attend the meeting to provide explanation.

Chapter 3 Arbitration Procedure

Article 15

Upon receipt of a position paper submitted by the Bureau, the Commission shall immediately deliver the paper together with the application form to the Arbitration Committee for arbitration.

Decision of the arbitration referred to in the above paragraph shall be made within three (3) months commencing from the next day after receipt of the application form; where necessary, the term may be prolonged only once by up two (2) months, and notice shall be given to the applicant.

Where an application form for arbitration is supplemented under Paragraph 3 of Article 3, the term referred to in the above paragraph shall commence from the next day of supplementation; or from the next day after expiration of the time limit for supplementation if the application form is not supplemented. Where an application is corrected in accordance with the provision of Article 6, the term shall commence from the next day of correction; or from the next day after expiration of the time limit for correction.

Article 15-1

An application that meets any of the following occasions shall be rejected:

1. The application form does not conform to the legal procedure and can't be corrected, or correction is not made within the time limit after a notice for correction has been given.
2. The application for arbitration is not submitted within the time limit set forth in Paragraph 1 and Paragraph 3 of Article 3.
3. The applicant does not meet the provision of Article 2.
4. The applicant does not meet the provision of Article 4, and correction is not made within the time limit after a notice for correction has been given.
5. The original decision does not exist any longer.
6. The application is raised for a dispute case than has already been arbitrated or cancelled.
7. The application is raised for non administrative punishment or a matter other than prescribed in Article 2.

Where an application is rejected according to the provision of Subparagraph 1 or Subparagraph 2 of the above paragraph and the original decision is really illegal or improper, the Bureau or the central regulating authority of labor administration may cancel or modify it according to its authority.

Article 16

In case the decision of arbitration depends on another legal relation, and such legal relation has not been determined yet, the Commission may suspend the arbitration procedure according to its authority or at the applicant's request, and the applicant shall be informed about this.

Article 17

According to the nature of a dispute, primary opinion shall be produced by the Disputes Arbitration Division of the Commission or brought forward by an arbitration committeeman; where necessary, experts may be invited to perform examination or authentication. And then the case shall be submitted to the Arbitration Committee for arbitration.

A reasonable pay may be provided for the examination or authentication referred to in the above paragraph, and the payment standard shall be decided by the Commission.

Article 18

For an arbitration case, if the Arbitration Committee thinks it is necessary to examine the degree of injury, disease, or disability of the insured person, it may designate a special hospital or physicians to perform reexamination. Without due reasons, the insured person may not refuse to accept the aforesaid reexamination.

The expenses for the reexamination referred to in the above paragraph shall be assumed by the Bureau.

Article 18-1

The Commission shall reject the applications for arbitration submitted without due reasons.

Where an original decision made by the Bureau is deemed improper by right of the original reason, but is proper by right of other reasons, the application for arbitration shall be regarded as unreasonable.

For an application for arbitration with due reasons, the Commission shall abolish the entire or a part of the original decision made by the Bureau, and may directly change the decision or return the case to the Bureau for disposal again according to the circumstance of the case. However, the Bureau may not make a decision or disposal even more unfavorable within the scope of the opposition expressed by the applicant.

Article 19

The Commission shall produce a written decision according to the result of arbitration and submit it to the Chairperson for approval, and shall separately send the decision to the applicant, the insured establishment, and the Bureau within fifteen (15) days after it is determined.

The Bureau shall implement the result of arbitration as referred to in the above paragraph within fifteen (15) days commencing from the next day after the written decision of arbitration arrives.

The written decision of arbitration referred to in the first paragraph shall be remarked with a note that, if the applicant does not agree the result of arbitration, an appeal may be submitted through the Bureau to the central regulating authority of labor administration.

Article 19-1

A written decision of arbitration shall include the following contents:

1. Name, date of birth, address, and ID certificate No. of the applicant; if the applicant is an insured establishment, its insurance certificate No., address, and name of the principal shall be included.
2. Name, date of birth, address, ID certificate No. of the legal representative (if such representative exists)
3. Text, facts and reasons. Where it is decided the application for arbitration is rejected, it is not necessary to record the facts.
4. Department of arbitration and the principal.
5. Date

Chapter 4 Supplementary Provisions

Article 20

The formats of the letters and forms set forth in these Regulations shall be prescribed by the Commission.

Article 21

These Regulations shall become effective as of the date of promulgation.