Does your employer owe you when you're sick or injured? Labor insurance and occupational injury claims, fully explained

When illness or accident strikes, most people think first of their commercial medical insurance — forgetting the labor insurance deducted from every paycheck. Many workers complain: 'I got hurt — why won't the company pay? Why can't I claim labor insurance?'

In truth, most failed claims are not the Bureau of Labor Insurance being difficult, but workers and HR half-understanding the rules distinguishing ordinary sickness benefits from occupational injury benefits. Since the Occupational Accident Insurance Act took effect on 1 May 2022, labor insurance and occupational injury insurance are formally separate. To reclaim your wage compensation, learn the rules. Here are the four core rights and the common landmines.

1. Labor insurance vs. occupational injury: hospitalization is the key

Both benefits compensate wages lost when injury or illness stops you working — but their thresholds and caps differ fundamentally.

• Ordinary sickness benefit (labor insurance): a car accident on a holiday outing is an ordinary event. The hard rule: you must be hospitalized. Outpatient recuperation alone is not compensated. The insured-salary cap is currently NT$45,800.
• Occupational injury benefit: injuries during commuting or work count as occupational. No hospitalization requirement — outpatient treatment and home recuperation both qualify — and the insured-salary cap is NT$72,800, better protecting higher earners.

The fatal blind spot: occupational claims have one absolute condition — inability to work. Many injured workers soften and 'just answer a few calls' or work from home at the boss's request. The moment there is evidence of work, the Bureau deems you recovered and cancels the benefit. Kindness costs you the claim.

2. Full pay means no benefit? The leave-type checkbox is the biggest landmine

The most absurd and most common rejection reason: the form was ticked wrong.

Hospitalized for an appendectomy, most workers take annual leave first to protect attendance bonuses and avoid pay cuts. The contradiction: sickness benefit presupposes a wage shortfall — full pay on annual leave means no benefit.

The fix: the application form has an 'original wages received' field with five specific leave types listed after it (annual leave, shift compensatory leave, overtime compensatory leave and others). These leaves are rights you earned with past work — tick them precisely, and even on full pay that month, the Bureau will still grant the sickness allowance.

3. Cancer and serious illness: disability benefits and post-withdrawal rights

For cancer or catastrophic illness, sickness benefit alone is not enough — look to labor insurance disability benefits: 15 grades and 221 items, with the advantage of ignoring pre-existing conditions.

• No six-month wait for many determinations: mastectomy for breast cancer can be claimed right after surgery; dialysis can be filed the day after a physician confirms long-term need (grade 7, 440 days of benefit). Oral cancer leaving only liquid diet possible reaches grade 4 (740 days) — an enormous financial pillar.
• The hidden lifeline within one year of withdrawal: many seriously ill workers resign (withdrawing from coverage) to recuperate, assuming ties to the Bureau end there. A serious misconception: if disability or death causally related to the prior illness occurs within one year of withdrawal, the worker or family can still claim with a physician's certificate.

4. Employer compensation and hidden allowances: legal baselines both sides must know

• Ordinary sick leave: under the Regulations of Leave-Taking, for up to 30 days a year the employer must pay half wages; labor insurance sickness benefit covers the rest.
• Occupational injury leave: under Article 59 of the Labor Standards Act, the employer bears absolute compensation liability — full original wages. If past under-reporting of salaries reduced the insurance payout, the employer must personally make up the difference. If refused, go straight to the city or county labor bureau for mediation.
• Hidden occupational allowance: since May 2022, hospitalization for occupational injury carries a care allowance — NT$1,200 extra per day when a physician certifies care is needed (except in ICU). And while sickness benefits have a three-day waiting period, repeated hospitalizations for the same cause deduct those three days only once — count your days carefully.

Illness and injury are torment enough — don't let ignorance of the rules bleed your wallet too. Correct leave classification and diagnosis certificates that state the key points: that is the most practical first line of defense.