Labor insurance is a social welfare program established by the State to implement and enforce the fundamental national policies to protect workers as provided in Article 153-I of the Constitution and to provide a social insurance system as described in Article 155 thereof and Article 10-VIII of the Amendments to the Constitution. Labor insurance, which is a type of social insurance, is intended to ensure the stability of workers’ lives and to promote social security. As such, labor insurance has a clear social policy purpose. A worker’s right to participate in the labor insurance program pursuant to law shall be protected by the Constitution. According to the Labor Insurance Act, the insurance premium contributed by a worker is calculated based on a certain percentage of the insured worker*s monthly insurance salary (See Articles 13 and 14 of the Labor Insurance Act). As such, the payment of insurance premium is not exactly in proportion to the risks of the insurance contingencies. Instead, the function of social and mutual aid is maintained under the principle of the ability to pay. Furthermore, unlike commercial insurance where an individual may decide of his or her own volition whether to participate in the insurance program or not, the labor insurance is a type of mandatory insurance except for those who participate in the insurance voluntarily, which means that whoever meets certain conditions shall participate in the insurance program (See Articles 6, 8, 71 and 72 of said Act). Therefore, the Labor Insurance Bureau is not required to assess the likelihood of the risks involved for any particular worker when an insured unit applies for the insurance coverage for its workers in accordance with the provisions of the Labor Insurance Act, let alone to reject the application for said insurance on the ground that there exist significant risks. Besides, the employees of an insured unit have no choice but to participate in the labor insurance program since they should, by law, participate in the insurance program without exception, paying insurance premiums and sharing the risks of the insurance contingencies that may occur to themselves and other insured workers. Moreover, since labor insurance is, in essence, a form of social insurance, the legislature may, of course, decide upon the scope of its coverage after considering such factors as the purposes of the labor insurance policies, proper implementation of the social security system, protection of workers’ rights and interests, distribution of overall social resources, financial burden of the State, and so forth. A worker’s rights arising from participation in the labor insurance program under public law shall also be protected by the Constitution. Since the suspension and termination of the effectiveness of the insurance, types of insurance contingencies, and distribution of insurance benefits closely concern the rights and obligations of a worker or of his or her beneficiaries which arise in connection with the insurance, such matters should be regulated either by law or by orders clearly and definitely authorized by law. Additionally, the legislative purposes and means thereof will not be constitutional unless they are consistent with the provisions of Article 23 of the Constitution.
Article 19-I of the Labor Insurance Act as amended on February 28, 1995 provides, “Upon the occurrence of an insurance contingency covered by the insurance after the beginning and before the end of the effective period of the insurance, an insured person or his beneficiary may claim insurance benefit payments pursuant to the provisions of this Act.” The foregoing provision does not impose any restriction on the time when the cause of the insurance contingency occurs. In respect of ordinary injury insurance, Article 2 and Chapter IV of the Labor Insurance Act provide for seven kinds of benefits, namely those for maternity, injury and sickness, medical care, disability, unemployment, old age and death, covering a variety of specific insurance contingencies. According to Articles 62 to 64 of said Act, the insurance contingencies for death benefits, unless specifically excluded by law (See Articles 23 and 26 of said Act), shall refer to the death of an insured person or his or her parent, spouse or child, irrespective of the time when the cause of the death occurs. After all, death benefits are meant to prevent the economic hardships that may burden the family or dependents of a worker who died during his or her service by sustaining their livelihood through insurance benefits, thereby conforming to the constitutional intent to protect workers. However, in case an insured person already lost his or her ability to work due to serious injury or sickness prior to participating in an insurance program but participated in such insurance anyway, the insured person should be disqualified (See Article 24 of said Act). In an even worse scenario, in case an insured person receives insurance benefits through fraudulent or other improper acts, he or she should be subject to administrative fine, as well as civil and/or criminal liabilities (See Article 70 of said Act).
The Directive Ref. No. T77LB2-6530 issued by the Council of Labor Affairs on April 14, 1988 read, “Where an insured person or his or her beneficiary claims insurance benefit payments pursuant to Article 19 of said Act (Labor Insurance Act), the insurance contingency covered by the insurance should occur after the beginning and before the end of the effective period of the insurance. Thus, no insurance benefit payments should be made for any disability or death of a worker resulting from a contingency that had occurred before the worker enrolled in the insurance program.” In respect of the death of a worker resulting from any injury or sickness occurring prior to his or her participating in the insurance program, the foregoing directive has imposed an additional condition that no insurance benefit payments should be made unless the cause of the insurance contingency occurred during the effective period of the insurance. The Directive Ref. No. T79LB3-4451 issued by the same Council on March 10, 1990 read, “In case an insured person is confirmed to have contracted any serious physical or mental disease or apparent external symptoms, or to have been positively diagnosed as suffering from such diseases as lupus erythematosus, cancer or uremia prior to his or her participating in the insurance program, neither cash benefit nor medicalcare benefit should be claimed for that particular contingency.” Since the cash benefit mentioned above covers death benefits, the foregoing directive is considered to have imposed an additional condition on the claim for death benefits by stipulating “no prior disease of the specified kinds before participating in the insurance program.” To the extent that the aforesaid directives apply to death benefits, they have imposed additional restrictions on the right of a beneficiary to claim insurance benefit payments, which are not provided for by the Labor Insurance Act, because they state that a beneficiary of an insured person who articipated in the labor insurance program pursuant to law and died of cancer or any other specified disease or injury or sickness during the effective period of the insurance may not claim death benefits unless the respective injury or sickness occurred during the effective period of the insurance. As such, they are inconsistent with the principle of legal reservation as embodied by Article 23 of the Constitution and shall no longer apply to the extent of such inconsistency. As for the correlation between the suffering from any particular diseases and the effective period of insurance, as well as the exclusion of such diseases from labor insurance benefits based on rationales of insurance law and considerations of other social security systems, it should be an issue subject to legislative discretion.
The Directive Ref. No. T82LB315865 issued by the Council of Labor Affairs on March 16, 1993 stated, “In case an insured person is confirmed to have been positively diagnosed as suffering from lupus erythematosus or cancer prior to his or her participation in the insurance program, and he or she had a relapse through a period of remission after enrolling in the insurance program, the contingency should be regarded as having occurred after the effective period of the insurance and thus insurance benefit may be claimed in accordance with the provisions of the Labor Insurance Act.” The aforesaid directive has made an interpretation in favor of a worker who suffered from lupus erythematosus or cancer prior to his or her participation in the insurance program and had a relapse through a period of remission after joining the insurance program, which does not relate to the issue of whether death benefits may be claimed in respect of a worker who, during the effective period of the insurance, died of any specified disease from which he or she already suffered prior to his or her participation in the insurance program. Thus, it should be noted that it is beyond the scope of this Interpretation.
*Translated by Vincent C. Kuan.