Enforcement Rules of Protection for workers Incurring Occupational Accidents Act Article 5
When applying for disability subsidy of occupational accident in accordance with Paragraph 1 of Article 6 of the Act, the following forms and documents shall be prepared:1. Application form of worker incurring Occupational accident for disability subsidy and receipt of subsidy.2. A written diagnosis of disability of labor insurance.3. Relevant supporting documents for occupational accident.4. Examination report and image pictures if examined with medical image.5. Name of business establishment, name and address of the responsible person and other relevant information.6. A written statement that receiving no occupational accident disability compensation paid by the employer in accordance with the provisions of Labor Standards Act.The written diagnosis of disability of labor insurance prescribed in Subparagraph 2 of the previous paragraph shall be issued by a contracted hospital or clinic of National Health Insurance. A person whose disability is caused outside the enforcement area of Labor Insurance Act may obtain a written diagnosis from the initially diagnostic hospital or clinic.
中文原文 職業災害勞工保護法施行細則第5條
依本法第六條第一項規定申請職業災害失能補助，應備下列書件：
一、職業災害勞工失能補助申請書及補助收據。
二、勞工保險失能診斷書。
三、職業災害相關證明文件。
四、經醫學影像檢查者，檢查報告及影像圖片。
五、事業單位之名稱、負責人姓名及地址等相關資料。
六、未領取雇主依勞動基準法規定給付職業災害失能補償之聲明書。
前項第二款勞工保險失能診斷書，由應診之全民健康保險特約醫院或診所出具。
在勞工保險條例施行區域外致失能者，得由原應診之醫院或診所出具。
一、職業災害勞工失能補助申請書及補助收據。
二、勞工保險失能診斷書。
三、職業災害相關證明文件。
四、經醫學影像檢查者，檢查報告及影像圖片。
五、事業單位之名稱、負責人姓名及地址等相關資料。
六、未領取雇主依勞動基準法規定給付職業災害失能補償之聲明書。
前項第二款勞工保險失能診斷書，由應診之全民健康保險特約醫院或診所出具。
在勞工保險條例施行區域外致失能者，得由原應診之醫院或診所出具。